Name of the Procedure:

Nasal/sinus endoscopy, surgical, with orbital decompression; medial and inferior wall.

Summary

In this procedure, a surgeon uses an endoscope to access and treat sinus issues and perform orbital decompression by removing parts of the medial and inferior walls of the orbit. The endoscope is a thin, flexible tube equipped with a camera and light.

Purpose

This procedure addresses conditions like severe sinusitis or thyroid eye disease that cause pressure and pain in the sinuses and eyes. The goal is to relieve this pressure, improve breathing, and enhance vision.

Indications

• Persistent or severe sinusitis resistant to medical treatment
• Thyroid eye disease with proptosis (eye bulging) causing vision problems or eye pain
• Chronic nasal congestion impacting quality of life

• Recurrent sinus infections

  Preparation

• Patients may need to fast for several hours before the procedure.
• Certain medications, especially blood thinners, may need to be adjusted or stopped.

• A pre-operative assessment, including blood tests and imaging studies like CT scans, may be required.

  Procedure Description

  1. The patient is given general anesthesia for comfort.
  2. A small endoscope is inserted into the nasal passage.
  3. The surgeon uses specialized instruments to remove or reposition parts of the medial and inferior orbital walls.
  4. Any obstructions or damaged tissue within the sinuses are also addressed.
  5. The area is carefully inspected to ensure proper decompression before concluding the procedure.

Duration

The procedure typically lasts about 1-2 hours.

Setting

This procedure is performed in a hospital or a surgical center.

Personnel

• An ENT (Ear, Nose, and Throat) surgeon or an ophthalmic surgeon
• Surgical nurses
• An anesthesiologist

Risks and Complications

• Infection
• Bleeding
• Double vision or vision changes
• Orbital hematoma (a collection of blood within the orbit)
• Cerebrospinal fluid leak
• Persistent swelling or pain

Benefits

• Relief from chronic sinusitis symptoms
• Reduced pressure and pain around the eyes
• Improved nasal airflow
• Enhanced or preservation of vision affected by nerve compression

Recovery

• Patients can usually go home the same day or the next.
• Follow-specific post-operative care instructions which may include nasal irrigation and avoiding strenuous activities.
• Recovery time is typically between 1-2 weeks, with follow-up appointments to monitor healing.

Alternatives

• Medical management with medications (antibiotics, steroids, saline irrigation)
• Traditional sinus surgery without endoscopy
• Less invasive office-based interventions for mild cases

Patient Experience

During the procedure, the patient is under general anesthesia and should not feel any pain. Afterward, they might experience some nasal congestion, mild pain, or swelling around the eyes. Pain management strategies and comfort measures will be provided to ensure a smooth recovery.