An ethmoidectomy is a surgical procedure involving the precise removal of bone and tissue within the ethmoid sinuses. This surgery is most frequently performed as a component of Functional Endoscopic Sinus Surgery (FESS), the standard approach for treating severe, recurring sinus issues. The objective is to enlarge the natural drainage pathways of the ethmoid sinuses, clearing blockages and restoring healthy airflow and mucus clearance, thereby improving the function of the entire sinonasal system.
The Ethmoid Sinuses and Reasons for Surgery
The ethmoid sinuses are unique among the paranasal sinuses because they are not a single cavity but a collection of multiple small, interconnected air-filled spaces called ethmoid air cells. These cells are situated deep within the face, positioned between the eyes and just behind the bridge of the nose. The ethmoid bone forms a significant part of the medial wall of the orbit and the roof of the nasal cavity.
These sinuses play a central role in the body’s respiratory system by producing mucus that helps humidify inhaled air and trap airborne particles and pathogens. Because they are strategically located where other sinuses drain—including the frontal and maxillary sinuses—a blockage in the ethmoid cells can obstruct the entire sinonasal drainage system.
The main indication for an ethmoidectomy is chronic rhinosinusitis (CRS) that persists despite optimal medical management, such as nasal steroids and antibiotics. Patients with CRS refractory to treatment often experience chronic nasal obstruction, persistent discharge, facial pressure, and a reduced sense of smell. Other conditions requiring this procedure include extensive nasal polyps, which are non-cancerous growths that block sinus openings. Ethmoidectomy may also be performed to treat complications from acute infections, manage fungal sinusitis, or gain access to the skull base for other procedures.
How the Procedure is Perform
The ethmoidectomy is performed using an endoscopic approach, meaning the surgeon works entirely through the nostrils without external incisions. The procedure typically takes between one and three hours, depending on the extent of the disease and whether other sinus procedures are performed concurrently. Patients are placed under general anesthesia to ensure they remain completely still during this demanding surgery.
The surgeon inserts a slender, rigid tube called an endoscope into the nose; this instrument has a light and camera, providing a magnified view of the sinus anatomy on a monitor. Specialized micro-instruments, such as powered microdebriders, are then introduced alongside the endoscope to remove diseased tissue and bony septations within the ethmoid air cells. The goal is to create a single, larger cavity from the original honeycomb structure, allowing for proper drainage and the direct application of topical medications post-surgery.
The procedure may be an anterior ethmoidectomy, addressing the front cells, or a total ethmoidectomy, removing both anterior and posterior air cells. Dissection is carefully carried out along the lamina papyracea (the thin bony plate separating the sinus from the orbit) and the skull base (the bony barrier separating the sinus from the brain). Image-guided surgery, which uses a real-time tracking system referenced to a pre-operative CT scan, is often employed to enhance precision and minimize the risk of injury to adjacent structures.
What to Expect During Recovery
Immediately following the procedure, patients are monitored in a recovery area and can often be discharged home the same day, though an overnight stay may be necessary. Patients should expect symptoms similar to a severe head cold, including nasal congestion, mild facial pressure, and a blood-tinged discharge that may require a nasal drip pad for a few days.
Post-operative care focuses on keeping the surgical site clean and moist to promote healing. Nasal saline rinses, usually starting the day after surgery, must be performed multiple times daily to clear blood, mucus, and crusting. Patients are advised to rest with their head elevated to reduce swelling and bleeding, and they should avoid blowing their nose forcefully for at least a week.
Most individuals can return to work or school within a few days to one week, depending on job demands. Strenuous activities, heavy lifting (over 10 pounds), and bending over should be avoided for ten days to two weeks to prevent increasing sinus pressure and triggering bleeding. Follow-up appointments with the surgeon are necessary for several months to ensure the sinus pathways remain open and are healing correctly.
Potential Complications
While an ethmoidectomy is generally safe, the close proximity of the ethmoid sinuses to the brain and the eyes means that complications, though rare, can be serious. The ethmoid roof, or skull base, is extremely thin, and an inadvertent breach can result in a cerebrospinal fluid (CSF) leak. A CSF leak, which is the leakage of fluid surrounding the brain and spinal cord into the nose, significantly increases the risk of meningitis.
Injury to the lamina papyracea, the thin bone wall separating the sinus from the eye socket, is another potential risk. Damage here can lead to an orbital hematoma (bleeding into the eye socket) that can put pressure on the optic nerve and cause temporary or permanent vision changes. Damage to the muscles controlling eye movement is also possible, which could result in double vision. Other common risks include post-operative bleeding, infection, and a temporary reduction in the sense of smell.