ENT GROUP CAPE TOWN
DR RYAN KARRO | ROLIEN BOTHA | KYLIE DURBACH
What are sinuses and what is sinusitis?
Sinuses are hollow cavities in the skull and facial skeleton. There are four groups of sinuses:
They communicate via narrow passages called ostia with the nasal cavity. They naturally produce mucus, which is wafted by means of cilia (microscopic hairs) through these ostia and into the nasal cavity. In certain conditions, (e.g. allergies, common colds, structural abnormalities) these ostia may become blocked and then mucous dams up within the affected sinus. Since it remains there, static, it eventually becomes infected, producing “sinusitis”. If this does not resolve properly, this sepsis destroys the mucous-transporting ciliary pathways, producing further mucous stasis and hence further sepsis. Thus a “vicious cycle” is set up and the condition, now known as “chronic sinusitis” becomes permanent.
FESS is highly successful at improving the symptoms of nasal blockage, runny nose and sometimes facial pain. FESS is not aimed to improve the sense of smell; however there may be some improvement.
It may not offer a permanent complete cure because the mucous drainage mechanism has already been badly damaged by the infection. Artificially created pathways never work as well as natural ones, but are better than none at all.
Polyps often come back after surgery over time, however medication prescribed may help to prevent or reduce the rate of recurrence. At 5 years there is an 80% chance of being free of polyps.
Even after successful surgery, the patient will be more prone to bouts of sinus trouble than the average person, but usually this will still be better than if they had never had their sinus operation. Most often, even if sinusitis recurs in somebody who has had FESS, it can be brought under control medically (rather than surgically) using various antibiotics, sprays/drops, decongestants or anti-inflammatory steroids. Therefore, most patients who undergo FESS although not completely cured, are a lot better.
The nose is partitioned in the middle by the nasal septum, dividing it into two nostrils. The nasal septum is made of cartilage and bone.
Few adults have a straight nasal septum, but only if the deviation is significant and interferes with normal breathing will surgery be considered. Septoplasty is performed under general anaesthesia. A small cut is made inside one of the nostrils and from this cut the lining of the septum is lifted off. The septum is then refashioned by manipulation and/or partial excision of the cartilage. The lining of the septum is then sutured (“stitched”) into place with absorbable sutures. The procedure is performed internally, through the nostrils, without the need for external scars. Nasal packs are sometimes inserted into nostrils to prevent the build up of blood between the cartilage of the septum and the lining. There are no black eyes after the surgery and the outward shape of the nose is generally unaltered. Septoplasty takes about 30-60 minutes, depending on how badly bent the septum is. Septoplasty is not a cosmetic procedure (does not alter the shape of a nose). However, it can be performed along with rhinoplasty, which is a cosmetic procedure aimed to improve the shape of a “crooked” nose. The combined surgery is called septorhinoplasty.