Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus
CPT4 code
Name of the Procedure:
Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus.
Summary
This procedure is a type of sinus surgery where doctors use an endoscope to view and operate within the nasal passages. It involves removing part or all of the ethmoid sinuses and opening the sphenoid sinus to remove tissue.
Purpose
This surgery addresses chronic sinusitis and other related sinus problems that haven't responded to medical treatment. The goal is to improve sinus drainage and alleviate symptoms such as congestion, pain, and infection.
Indications
- Chronic sinusitis
- Sinus polyps
- Fungal sinusitis
- Sinus infections that don't respond to medication
- Anatomical blockages affecting sinus drainage
Preparation
- Fasting for at least 6 hours before the procedure
- Stopping certain medications like blood thinners
- Preoperative imaging tests like CT scans to assess the sinuses
- Informing the doctor about any allergies or medical conditions
Procedure Description
- Anesthesia, usually general, is administered.
- An endoscope is inserted into the nasal cavity.
- Specialized instruments are used to remove inflamed tissue and bone from the ethmoid sinuses.
- The sphenoid sinus is opened (sphenoidotomy).
- Any obstructing tissue in the sphenoid sinus is removed.
- The area is cleaned, and any excessive bleeding is controlled.
Duration
The procedure typically takes 1 to 2 hours.
Setting
The procedure is performed in a hospital or outpatient surgical center.
Personnel
- Otolaryngologist (ENT surgeon)
- Anesthesiologist
- Surgical nurse
- Scrub technician
Risks and Complications
- Bleeding
- Infection
- Damage to surrounding structures (e.g., eye socket or brain)
- Scar tissue formation
- Persistent symptoms or need for additional surgery
Benefits
- Relief from chronic sinusitis symptoms
- Improved breathing and sinus drainage
- Reduced frequency of sinus infections
- Enhanced quality of life
Recovery
- Rest for a few days post-surgery
- Avoid blowing the nose and heavy lifting for at least a week
- Use saline sprays to keep nasal passages moist
- Follow-up appointments to monitor healing
- Full recovery typically takes a few weeks
Alternatives
- Medical management with nasal sprays, antibiotics, and steroids
- Balloon sinuplasty, a less invasive option
- Nasal irrigation and lifestyle modifications
Patient Experience
During the procedure:
- The patient will be asleep under general anesthesia.
After the procedure:
- Expect some nasal congestion and mild discomfort
- Pain can usually be managed with prescribed medication
- Instructions on sleeping with the head elevated to reduce swelling