Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed
CPT4 code
Name of the Procedure:
Total Ethmoidectomy with Frontal Sinus Exploration
Common name(s): Ethmoidectomy with Frontal Sinus Surgery, Sinus Endoscopy with Ethmoidectomy
Technical/medical term: Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed.
Summary
This surgical procedure involves using an endoscope to look inside the nasal and sinus passages. During the operation, the surgeon removes part or all of the ethmoid sinuses and may explore and remove tissue from the frontal sinuses to improve drainage and alleviate symptoms.
Purpose
This procedure addresses chronic sinusitis, nasal polyps, and other sinus-related issues that haven't responded to medical treatment. The goal is to reduce sinus infections, improve breathing, and enhance overall sinus function.
Indications
- Chronic sinusitis unresponsive to medications
- Recurrent acute sinusitis
- Nasal polyps
- Sinus infections causing complications
- Nasal obstruction causing breathing difficulties
Preparation
- Fasting for 6-8 hours before the procedure
- Medication adjustments per physician's advice (e.g., blood thinners)
- Preoperative diagnostic tests: CT scan or MRI of the sinuses, nasal endoscopy, blood tests
Procedure Description
- Anesthesia is administered, typically general anesthesia.
- The surgeon inserts an endoscope into the nasal passages to visualize the sinus structures.
- Using specialized surgical tools, the surgeon removes diseased tissue from the ethmoid sinuses.
- The frontal sinuses are explored, and any obstructions or pathological tissues are removed to restore drainage.
- The endoscope helps guide all steps, ensuring precision and minimizing damage to surrounding tissues.
Duration
The procedure typically takes between 1 to 3 hours, depending on complexity.
Setting
The procedure is usually performed in a hospital or an outpatient surgical center.
Personnel
- Otolaryngologist (ENT surgeon)
- Anesthesiologist
- Surgical nurses
- Possibly an assistant surgeon or surgical technician
Risks and Complications
- Bleeding
- Infection
- Cerebrospinal fluid leak
- Injury to the eye or brain
- Scarring inside the nose
- Persistent sinus issues
- Reaction to anesthesia
Benefits
- Relief from chronic sinus infections
- Improved nasal airflow and breathing
- Reduction in sinus-related symptoms like headaches and facial pain
- Enhanced quality of life Benefits might be noticed within weeks as inflammation subsides and healing progresses.
Recovery
- Rest and avoid strenuous activities for a few days post-surgery
- Pain management with prescribed medications
- Saline nasal rinses and possibly nasal corticosteroids
- Follow-up appointments for post-operative assessments
- Full recovery typically occurs within 4-6 weeks
Alternatives
- Medical therapy (antibiotics, nasal corticosteroids)
- Balloon sinuplasty
- Endoscopic sinus surgery without ethmoidectomy
Pros of alternatives: less invasive, less recovery time
Cons of alternatives: may be less effective for severe cases
Patient Experience
During the procedure, patients will be under general anesthesia and will not feel any pain. Post-operatively, they might experience nasal congestion, mild pain, and some bleeding. Pain management includes medications, and comfort measures involve keeping the head elevated and using ice packs. Recovery experiences vary but generally include improving symptoms within a few weeks.