Endoscopic Sinus Surgery


Today, endoscopic Sinus Surgery (ESC) is one of the most applied surgeries that is performed mainly in the treatment of chronic sinus inflammations, sinus tumors, injuries of the procephalic base, eyeball injuries related to trauma, and pressure on the eye nerve.

At the same time, it is preferred to be used in the drainage surgeries of the lacrimal sac surgeries (Dacryocystorhinostomy) and in the surgical treatment of some pituitary gland adenomas (Endoscopic hypophysectomy) in gradually increasing ratios.

In USA, about 200.000 ESC operations are being performed per year directed to chronic sinusitis that is seen with a prevalence of 14% in the community.

Due to narrow, complex anatomy of the regions in which sinuses around the nose are located, and due to the important neighboring organs like the brain, eyes, eye nerves, lacrimal sac, carotid arteries make training, experience and the highest technical skill with a small error of margin essential in Endoscopic sinus operations.

In chronic sinus diseases, with ESC mainly the below specified operations are performed;

  • Removal of inflamed tissues/polyps
  • Drainage canals that connect the sinuses to the nose
  • The correction of anatomical problems like concha bullosa, more than one drainage holes (accessory ostium), abnormal mucosa contact regions.

During ESC, in cases in which advanced technological devices are especially used like navigation, balloon, shaver, general anesthesia is preferred for the comfort of the patient and the surgeon. The duration of the surgery varies according to the prevalence extent of the pathology and to the presence of additional interventions like the correction of intranasal deviation, aesthetic nose surgery, concha reducing, anatomical variations. While the intervention to a single sinus lasts for approximately 15 minutes, the pathology involving all sinuses may exceed two hours.

If a necessity does not occur related to additional interventions like reducing of the concha, intranasal compresses are not placed after the surgery, and the patients may breathe comfortably from the nose. Special compresses and various materials that are placed after the operation at the site of the surgery that is found under the middle concha to prevent the bleeding and tissue adhesions that may occur during recovery do not effect breathing from the nose negatively.

After the surgery, complaint of serious pain does not occur, simple pain killers are generally enough.

Though the patients are recommended to stay at the hospital at the day of the surgery, they may be discharged on the same day according to the content of the operation.

After the surgery, antibiotic administration is recommended to be applied at least for 10 days, this period may be prolonged or additional medications may be added when it is necessary. Sprays containing sterile saline that clean the nose mechanically and moisten the nose should be used till the end of rind formation. In patients with allergy and polyp, cortisone containing sprays and medications that decrease the risk of polyp formation from the beginning of the second week. In patients suspected to have allergic fungi sinusitis, are recommended to receive oral treatment for fungi as well.

After the surgery, dressings are applied for 3-4 times. During the first dressing that is applied at the end of the first week and that lasts for half an hour, the rinds that have formed in the nose and the drainage canals are cleaned, if materials that prevent adhesion were placed in the sinuses, they are removed and infection is checked. The performance of the first dressing as necessary is very important in respect to the success of the operation. Patients have to come back for controls with intervals of 7-10 days till the completion of recovery according to the magnitude of the operation.

In some special conditions, the level of difficulty in ESC increases and the increase in failure or complication also increases. These special conditions are;

  • Excessive bleeding in tissues during the surgery
  • Presence of excessive inflammation
  • Surgeries of tumors that are especially rich in vascularization
  • Hypertension
  • Coagulation disorders (Bleeding diasthesis) / Usage of aspirin
  • Surgical trauma
  • The change in the anatomy due to previous operation / trauma
  • Formation of hard scar tissue due to previous operations
  • Widespread polyps
  • Paranasal tumors in / out of he sinuses
  • Anatomical changes (variations)
  • Operations directed to posterior ethmoid, sphenoid, frontal sinuses.

    During or after ESC, some minor and major complications are present. The most important ones among these are:
  • Active bleeding
  • Intraorbital (intraocular) bleeding
  • Rupturing of carotis
  • Trauma of the Orbit
  • Endophtalmitis
  • Movement disorder in the eye
  • Nasolacrimal canal (lacrimal sac) trauma
  • Leakage of cerebrospinal fluid
  • Intracranial complications
    • Abscess
    • Meningitis
    • Pneumocephaly
    • Pituitary gland damage.

Computer Aided Sinus Surgery (Surgical Navigation)

It is the technology that enable the following of the locations of the surgical equipment that are being used in paranasal sinus surgery within the sinus anatomy on the images of sinus tomography that have been acquired before the surgery with the help of a special device and a software in real time, in three dimensions and with a margin of error less than 1 mm (Figure. 1). It provides safer application of endoscopic sinus surgery, safer access to all diseased locations and increases the success rate of the surgery to a significant extent and is also useful in special cases with high risk of complication in the elimination of this risk. (see: Surgical Navigation)


The Cost of Surgery
In endoscopic sinus surgery, many variables are present that determine your cost of surgery, among these are:

  • The scope of the operation to be performed: single sided, double sided surgery
  • Special sinuses to be intervened: Frontal sinus, sphenoid sinus
  • Surgery method: Standard surgery, surgery with balloon synoplasty method, combination surgery
  • Advanced technology to be used: Surgical navigation (computer aided surgery), Microdebrider (shaver)
  • Special materials to be used: Seprafilm, Seprajel etc.
  • Other surgeries that have to be/ that are wanted to be performed simultaneously: Reducing of concha, deviation surgery, nose aesthetics etc.
  • Additional materials and technologies to be used in the additional surgery: Radiofrequency, nasal splints etc.
  • The hospital in which the surgery will be applied.

Endoscopic sinus surgery is a surgery that is performed by using small and precise surgical tools without a direct vision in an anatomical region having critical neighborhoods while the images obtained with endoscopic systems are watched on the monitor. Surgical knowledge, and experience, and also the quality and competence of the present surgical equipment and endoscopic systems and the availability of special materials and advanced technological devices have important effects on the duration and success of the surgery and prevention of undesired results (complication). Though the availability of all these opportunities do not affect the cost of surgery, the cost of the hospital are affected and therefore, the total cost is affected.
If you have a restricted disease involving just the cheek (maxillar) sinus and/or ethmoid sinuses, as long as the endoscopic systems and surgical instruments are present, it is possible to perform your surgery without the usage of an additional technology or admittance to the hospital. In all other pathologies, in order to provide the highest success rate with the least complication risk, the usage of additional technologies will be required and this will affect your cost of surgery.
If a situation that requires the usage of surgical navigation is present, the additional cost of this technology is around 400 USD. However, despite this cost, the decrease in the possibility to require a second surgery for the complete removal of the pathology and canceling out the risk of damaging neighboring anatomical structures make this technology sine qua non. Since navigation device is a very expensive investment, it is only present in some certain hospitals.
Microdebrider systems are advanced technological devices that only precisely removes the diseased tissue under endoscopic vision and prevents damaging of the healthy tissues and at the same time washing and cleaning the site of surgery with vacuum and providing a significant saving of time. Especially, situations in which a widespread disease or polyp is present shortens the duration of surgery significantly, it is also effective in the complete recovery of the disease and shortening of the duration of the surgery. The usage of this technology yields an additional cost of approximately 400 USD.
The technique of “Balloon Sinuplasty” is highly useful in restricted diseased involving frontal, cheek and sphenoid sinuses and in some other special cases due to fast recovery, minimal tissue trauma and not having a risk for complication and is frequently preferred. In this surgery performed with disposable materials, different numbers and types of instruments are used according to the types of the involved sinuses, the additional cost is between 500-1000 USD.
Materials like Seprafilm/Seprajel that are used to prevent the risk of adhesions in patients with advanced adhesions due to previous surgeries, has an additional cost of approximately 250 USD.
Endoscopic sinus surgery is covered by private health insurances unless the beginning of your disease is not based on the beginning of your health insurance. Though the most important criterion for a successful result is selecting the right surgeon with the sufficient knowledge and experience, the performance of your surgery in a center having special medical materials and technology according to the condition of your disease will contribute significantly to obtain a successful result with a single operation and the to reduce the risk of experiencing problems after the surgery.

If you do not have private health insurance, then the most appropriate approach would be a detailed examination and evaluation of your sinus tomography and the determination of your cost of surgery in parallel to the above mentioned subjects.



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