Name of the Procedure:

Ethmoidectomy; intranasal, total
Common name: Total Intranasal Ethmoidectomy

Summary

In layman's terms, a total intranasal ethmoidectomy is a surgical procedure performed through the nose to remove diseased tissue from the ethmoid sinuses, which are air-filled spaces located between the nose and the eyes. This helps to improve nasal airflow and alleviate sinus-related symptoms.

Purpose

The procedure addresses chronic sinusitis or recurrent sinus infections that do not respond to medications. The goal is to remove infected or inflamed tissue from the ethmoid sinuses to improve breathing, reduce sinus infections, and relieve symptoms such as nasal congestion, facial pain, and headaches.

Indications

• Chronic sinusitis
• Recurrent sinus infections
• Nasal polyps
• Obstructed nasal passages
• Sinus headaches and facial pain
• Lack of response to medical treatments like antibiotics, nasal sprays, or decongestants

Preparation

• Patients may be instructed to fast for 6-8 hours before the procedure.
• Adjustments to certain medications may be needed; for example, blood thinners might need to be paused.
• Pre-procedure diagnostic tests may include a CT scan of the sinuses and a thorough nasal examination.

Procedure Description

1. The procedure is typically performed under general anesthesia.
2. The surgeon inserts an endoscope (a thin tube with a camera) through the nostrils to visualize the ethmoid sinuses.
3. Using specialized instruments, the surgeon removes the bony partitions and infected or inflamed sinus tissue.
4. The nasal cavities are rinsed, and any remaining debris is removed to ensure clear sinuses.
5. The procedure is completed without external incisions since entry is entirely through the nostrils.

Instruments used may include an endoscope, powered sinus instruments, and suction devices.

Duration

The procedure typically takes about 1-2 hours to perform.

Setting

The procedure is usually carried out in a hospital or a specialized outpatient surgical center.

Personnel

• Otorhinolaryngologist (ENT surgeon)
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

Common risks include nasal bleeding, infection, or swelling. Rare risks may involve damage to the eye or surrounding tissues, cerebrospinal fluid leak, or a loss of sense of smell. Management of complications may involve medications, additional treatments, or supportive care.

Benefits

The procedure is expected to significantly improve nasal airflow, reduce the frequency and severity of sinus infections, and alleviate symptoms like nasal congestion and headaches. Benefits are often realized within a few weeks after surgery.

Recovery

• Post-procedure care includes nasal irrigation and the use of saline sprays to keep nasal passages clean.
• Patients may need to avoid strenuous activities and blowing their nose for a few weeks.
• Follow-up appointments are necessary to monitor healing and address any concerns.
• Full recovery typically takes 2-4 weeks.

Alternatives

• Medical treatments: antibiotics, nasal corticosteroid sprays, decongestants
• Lifestyle changes: humidifiers, nasal irrigation with saline solutions
• Balloon sinuplasty: a less invasive procedure to open blocked sinuses

Compared to a total ethmoidectomy, these alternatives might be less effective in severe cases but are associated with fewer risks.

Patient Experience

During the procedure, the patient will be under general anesthesia and won't feel anything. Post-procedure, there may be some nasal discomfort, mild pain, or congestion, but these can be managed with prescribed pain medications and care routines. Patients can expect initial discomfort to subside within a few days and should follow all postoperative care instructions to facilitate smooth recovery.