Sinus surgery, or FESS (functional endoscopic sinus surgery) is a procedure where the sinus cavities are examined and opened to provide improved drainage. There are four paired sinus cavities (maxillary, ethmoid, sphenoid and frontal). Surgery is only performed on the affected sinus cavities, and is usually performed through the nostrils.
This procedure is typically performed an operating room under general anesthesia. Sometimes this procedure is performed in conjunction with other procedures to improve nasal breathing (ie: inferior turbinate reduction, nasal endoscopy, nasal cautery or septoplasty)
Typically, children benefit from sinus surgery in cases where chronic and/or recurrent infections in the sinus cavities are problematic. Children will have typically been treated with antibiotics, nasal steroid sprays, topical nasal saline irrigations and allergy therapy, as indicated, prior to being recommended for sinus surgery.
Typically, radiographic imaging including a CT scan of the sinuses is taken prior to surgery, and this acts as the “roadmap” for surgery, helping the pediatric ENT surgeon determine the problematic area. Small bridges of thin bone or mucus membrane may be blocking the natural drainage pathways of the sinus cavities, leading to blockage and subsequent infection. The goal of sinus surgery is to establish natural, normal drainage patterns, and to allow access to the sinus cavities for topical medications and saline irrigation.
The child’s procedure takes place in an operating room. The procedure usually takes about 1-2 hours, but can take much longer depending on the severity and any other additional combined procedures planned. The surgeon provides an idea of how much time is expected, but this may change during the procedure.
Before and after surgery: a pediatric nurse prepares the child for surgery, assists the pediatric ENT surgeon during surgery, and cares for the child after the procedure.
Anesthesiology: The child is placed under general anesthesia by a pediatric anesthesiologist. At Nationwide Children’s, subspecialty-trained pediatric anesthesiologists regularly provide pediatric anesthesiology services for patients undergoing surgical procedures. It is important that the parent meet with the anesthesiologist prior to the procedure.
Surgery: A pediatric ENT surgeon may use specialized telescopes to systematically evaluate the nasal airway in conjunction with specialized nasal instruments. If additional procedures are needed, additional special instruments may be used to perform these procedures.
After Surgery: The surgeon may feel it is safe for the child to go home after the procedure, or may recommend that he/she be observed at the hospital for a period of time afterward. The surgeon discusses the postoperative plan with the parent after the procedure. Follow up plans are discussed as well.
The child may be more sleepy than usual. Some additional nasal obstruction is normal after surgery. There are sometimes small plastic splints placed in the nose after surgery, to help with healing. These are usually left in place for 1-7 days. Some minor nosebleeds or nasal drainage is normal after the surgery. Antibiotics are typically prescribed while the splints are in place.
A slightly increased temperature after anesthesia is normal. The child should be encouraged to drink plenty of liquids after the procedure. The surgeon will discuss when he/she should return to a normal diet.
Tylenol or ibuprofen is typically appropriate for pain control. Sometimes stronger narcotic pain medications may be prescribed for additional pain control
If the child develops any concerning symptoms after surgery, including pauses in breathing, color change of the skin (particularly if the lips, face, or hands are turning blue), appearing lethargic or tired, severe bleeding or any other sudden change from his/ her normal behavior, please seek immediate medical attention.
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