31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed

Name of the Procedure:

Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus.

• Common names: Frontal Sinus Surgery, FESS (Functional Endoscopic Sinus Surgery).

Summary

This procedure involves using an endoscope (a thin, flexible tube with a light and camera) to explore and treat issues within the frontal sinuses. During the procedure, any problematic tissue in the frontal sinus can be removed.

Purpose

The procedure aims to address chronic sinusitis or inflammation that has not responded to other treatments, such as medications. It helps to improve sinus drainage, relieve symptoms, and prevent future infections.

Indications

• Chronic sinusitis leading to persistent symptoms like congestion, headaches, or facial pain.
• Frequent sinus infections.
• Nasal polyps obstructing the frontal sinus.
• Failure to respond to medical treatments like antibiotics or decongestants.

Preparation

• Patients are typically advised to fast for several hours before the procedure.
• Medication adjustments may be required, especially for blood thinners.
• Pre-procedure diagnostic tests such as CT scans of the sinuses are often performed to assess the extent of the condition.

Procedure Description

1. Anesthesia: The procedure is typically done under general anesthesia.
2. Endoscope Insertion: The surgeon inserts the endoscope through the nostril to visualize the sinus cavities.
3. Exploration and Cleaning: The surgeon explores the frontal sinus, identifying any problematic tissue.
4. Tissue Removal: Utilizing specialized surgical instruments, the surgeon removes any tissue (e.g., polyps or inflamed lining) obstructing the sinus.
5. Completion: The endoscope is removed, and the sinus passages are left open for better drainage.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity of the case.

Setting

It is usually performed in a hospital operating room or an outpatient surgical center.

Personnel

• ENT Surgeon
• Anesthesiologist
• Surgical Nurse
• Surgical Technician

Risks and Complications

• Common risks: Bleeding, infection, swelling, and bruising.
• Rare complications: Damage to the surrounding structures (e.g., eye or brain), cerebrospinal fluid leakage, persistent symptoms, or anesthesia-related complications.

Benefits

• Improved sinus drainage and relief from chronic sinusitis symptoms.
• Reduction in the frequency and severity of sinus infections.
• Improved quality of life with better breathing and reduced facial pain.

Recovery

• Patients usually go home the same day but need someone to drive them.
• Post-procedure instructions include nasal irrigations, avoiding strenuous activities, and following medications prescribed for pain or infection.
• Full recovery varies but typically ranges from a few days to a couple of weeks.
• Follow-up appointments ensure the sinuses heal properly.

Alternatives

• Medical management with antibiotics, nasal corticosteroids, or saline rinses.
• Balloon sinuplasty: A less invasive procedure to enlarge the sinus openings using a balloon catheter.
• Pros and cons of alternatives: Medication is non-invasive but may not be effective for severe cases; balloon sinuplasty is less invasive but may not be suitable for extensive tissue removal.

Patient Experience

• Patients may experience mild to moderate discomfort or nasal congestion post-surgery.
• Pain management includes prescribed pain relievers.
• Patients can expect improved breathing and reduced sinus symptoms once fully recovered.