Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior)
CPT4 code
Name of the Procedure:
Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior)
Summary
A total ethmoidectomy involves the surgical removal of the ethmoid sinuses, located between the nose and the eyes, using an endoscope—a thin, flexible tube equipped with a camera and light. This procedure is conducted through the nasal passages, avoiding external incisions.
Purpose
The procedure addresses chronic sinusitis, nasal polyps, or other nasal obstructions that do not respond to medication. The goal is to improve sinus drainage, relieve symptoms like nasal blockage, and prevent recurrent infections.
Indications
- Chronic sinusitis unresponsive to medical therapy
- Recurrent nasal polyps
- Obstructed nasal passages causing breathing difficulties
- Sinus drainage issues leading to infections
- Chronic headaches or facial pain related to sinus issues
Preparation
- Fast from midnight prior to the procedure (no food or drink)
- Follow specific medication adjustments as directed by the physician (e.g., stopping blood thinners)
- Undergo a CT scan or MRI to assess the sinus anatomy and plan the surgery
Procedure Description
- The patient is given general anesthesia to ensure they are asleep and comfortable.
- The surgeon inserts the endoscope into the nasal cavity.
- Guided by the camera, surgical instruments are used to remove the anterior and posterior ethmoid sinuses.
- Any obstructions are cleared to enhance sinus drainage.
- Hemostasis is achieved to manage bleeding.
- Nasal packing may be placed to reduce bleeding and support structures.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
It is usually performed in a hospital or outpatient surgical center.
Personnel
- An ENT (Ear, Nose, and Throat) surgeon
- An anesthesiologist
- Surgical nurses
- Possibly a surgical technician
Risks and Complications
- Bleeding
- Infection
- Damage to surrounding structures (e.g., eye, brain)
- Recurrence of sinusitis or polyps
- Anesthesia-related complications
- Postoperative nasal congestion or drainage
Benefits
- Relief from chronic sinusitis symptoms
- Improved nasal breathing
- Reduction in the frequency of sinus infections
- Enhanced quality of life due to alleviated symptoms
Recovery
- Patients may go home the same day or stay overnight for observation.
- Nasal splints or packing usually remain for a few days.
- Avoid strenuous activities for at least a week.
- Follow-up appointments to monitor healing.
- Pain and swelling managed with prescribed medications.
Alternatives
- Medical management with antibiotics, steroids, or nasal sprays
- Balloon sinuplasty (a less invasive procedure)
- Functional endoscopic sinus surgery (FESS)
- Each alternative has varying degrees of invasiveness, effectiveness, and suitability based on the patient’s condition.
Patient Experience
During the procedure, the patient will be under general anesthesia and not feel anything. Postoperatively, some discomfort, nasal congestion, and mild pain are typical. Pain management includes medications, and saline nasal sprays may be recommended to cleanse the nasal passages. Most patients resume normal activities within a week but should follow care instructions closely to ensure proper healing.