Sinusitis, nasal polyps, deviated nasal septum and other nasal diseases belong to the common rhinology diseases, according to statistics in North America about more than 30 million people suffer from this disease, although there is no exact epidemiological data in China, but the clinical rhinosinusitis (rhinosinusitis, RS) patients are very common, patients not only have local symptoms of the nose, the systemic impact is also very big, induced aggravation of asthma Patients not only have localized nasal symptoms, but also have significant systemic effects, inducing exacerbation of asthma, hypertension, pulmonary hypertension, and other problems that seriously affect the quality of life of patients. Once sinusitis is diagnosed, medication is routinely chosen, but surgery is considered for patients who do not respond to medication. With the introduction of nasal endoscopy by Messerklinger in the 1960s, this procedure has gradually become the main procedure of otorhinolaryngologists, and hundreds of thousands of nasal endoscopic procedures are performed internationally every year. The quality of life of patients is also greatly improved. Patients who need to undergo functional endoscopic surgery (FESS) need to have some knowledge in order to prepare for a better recovery.
Normal sinus structure and function.
The nose has three parts, the external nose, the nasal cavity and the sinuses. The external nose is located in the middle of the face, behind the nasal cavity, while the sinuses are located around the nasal cavity and the eye, including four: maxillary sinus, septal sinus, frontal sinus and butterfly sinus.
The maxillary sinus is located below the eye, next to the nose, and is the one sinus most prone to sinusitis.
The septal sinus is located between the eyes and contains a honeycomb-like airspace structure, which is also susceptible to lesions.
The frontal sinus is located in the forehead above the eye, and the pterygoid sinus is located deep in the nose, behind the septal sinus and in the center of the skull base.
The sinuses are connected to the nasal cavity through sinus openings. If the sinus openings are blocked due to infection, polyps, masses, allergies, anatomical variations, etc., sinusitis can result, and if the inflammation does not respond to conservative treatment, surgery may be required.
What kind of patients need surgery.
Patients with sinusitis and nasal polyps can undergo a period of standardized conservative treatment, and there are many of these treatments; they mainly include: antibiotic therapy: such as clarithromycin; hormone therapy: nasal spray hormones such as: rhinocort, coleus, etc., which have minimal side effects and are more effective; mucus-thinning drugs: such as ginoton, evias, mucosolvan, etc.; nasal rinses: nasal rinses using deep sea water or saline.
Pre-surgical preparation.
Patients usually need to go through a period of standardized conservative treatment with no effect, and the patient’s symptoms are obvious. The patient needs to have the right to know, but if the patient is very worried, he or she needs to go to a qualified hospital to find an experienced surgeon to perform the surgery, and good communication is needed before the surgery. The possibilities of complications of FESS surgery are: bleeding, infection, recurrence (especially in patients with allergies, aspirin intolerance, allergic fungal sinusitis, asthma, chronic diseases such as diabetes, people who smoke, recurrence of reoperation); the need for a long-term medication after surgery, or even the possibility of reoperation; adhesions in the operative cavity; numbness of the teeth; septal hematoma after septal surgery , abscesses, perforations, collapsed nasal bridge; and the most serious eye complications and brain complications.
This is not to scare the patient or the doctor to shirk his responsibility, but to tell the patient truthfully about the possible accidents of the surgery, although the probability of these accidents, especially the serious complications, is not very high.
Pre-operative preparation: Pre-operative CT check (preferably outpatient), allergen check, nasal resistance and nasal acoustic reflex and general blood, electrocardiogram, chest X-ray and even pulmonary function, echocardiography and other routine checks, generally these take about two days, if the patient is seriously ill, pre-operative drugs are also needed to create a good condition for surgery, which will take a little longer.
Choice of anesthesia.
Surgery can choose between local anesthesia and general anesthesia, but because local anesthesia is more painful for patients, now in relatively large hospitals no longer use local anesthesia to operate on patients, and most patients who have experienced general anesthesia feel like sleeping after surgery is over, not uncomfortable at all, lamenting the magic of anesthesia technology. And now the side effects of anesthesia drugs are not too big, many children are also selected for surgery, the child’s later intellectual development is not affected.
Surgical procedure.
Simply put, the main thing is to remove irreversible lesions such as: polyps, pus, mycotic masses, etc., and to open the blocked sinus openings so that the sinuses can communicate with the outside world through the sinus openings. Because of the many anatomical variations in the sinuses, there are different variations of air spaces in the sinuses, and the sinuses are surrounded by the orbits next to the eyes and the head above, as well as large blood vessels such as the internal carotid artery and the important nerves of the optic nerve, which are very important structures. Therefore, the surgeon must be highly trained and have many years of clinical experience in order to complete a “beautiful” endoscopic surgery.
The length of the procedure varies from patient to patient, from more than half an hour to a few hours, and generally takes about one to two hours.
Post-operative considerations.
The patient will be pushed to the ward and transferred to the bed. The nurse will give him oxygen, ECG monitoring, and head elevation in semi-recumbent position for a period of time, usually 3 hours, during which the patient will have some discomfort, after all, it is not too small a surgery. At the same time, fluids will be given, mainly anti-inflammatory drugs.
Patients and their families will be concerned about several issues in the postoperative period.
Bleeding: There will be a small amount of blood oozing from the patient’s nasal cavity, as long as it is not flowing like blood, don’t be too nervous, it is a normal phenomenon, this bleeding will last for some time, there will still be some by the time of discharge or even postoperative review, but it will gradually decrease.
Discomfort: Although we now use the method of no or micro-filling during surgery, patients will have some discomfort such as head swelling and stuffiness after surgery, but most patients can tolerate it without painkillers, and pain pumps are not needed, and the symptoms will be gradually reduced.
Nasal blockage: Because there will be edema, bleeding, exudation and partial filling in the nasal cavity, patients will generally have nasal blockage for a period of time after surgery, patients do not need to be too anxious, this symptom will gradually improve, and most of them can partially ventilate when they are discharged.
Nasal clearance: Generally, before discharge, the bedside doctor will arrange a nasal clearance to remove the accumulated blood and exudate from the nasal cavity and to suck out the absorbable hemostatic material in the nasal cavity, which is generally a small and gentle operation.
Discharge time; if there are no special circumstances and the postoperative recovery is smooth, you can be discharged after three days, but the specific discharge time depends on the patient’s condition and recovery.
Follow-up examinations
Even if the surgery is perfect, if the patient does not pay attention to the follow-up and does not go to the outpatient clinic for review, the surgery may fail and all the efforts of the doctor will be lost.
Generally, patients need to go to the outpatient clinic for a week after the surgery for follow-up. The surgeon will clean up the nasal secretions, remove the accumulated blood and some residual filling materials, prescribe some recovery-friendly medications to the patient, and schedule the next follow-up appointment.
Recovery time.
The recovery time of general patients will vary from person to person, but if it goes well three months to six months the basic condition is stable, while patients with refractory rhinosinusitis (with allergic rhinitis, asthma, aspirin intolerance, allergic rhinitis fungal sinusitis, and patients with osteosclerosis, recurrent multiple surgeries) need long-term follow-up.