Best Technique for Sinus Surgery?

Is there a specific technique for Sinus Surgery that doctors strongly recommend compared to others?

Doctor Answers 15

Right surgeon more important than the technique

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For the majority of patients with sinus complaints, surgery is not necessary.  Therefore, always make sure that you are choosing a surgeon that is thoughtful and conservative for your treatment.  With few exceptions, if the first thing discussed is surgery, be very skeptical and at the very least seek a second opinion.  Exceptions to this rule would include having a growth or a dangerous, life-threatening infection.

Important questions to have answered include:  Could this be allergies?  Could this be a fungal sensitivity?  Is it possible that I have migraines and not sinusitis?  Is acid reflux playing a part in my symptoms?  Again, if your surgeon is not addressing these issues, consider a second opinion.  I see a great number of patients, referred to me specifically for sinus surgery and 75% end up improving without surgery.

When you finally get down to the decision for surgery, ensure that the treatment you are receiving is individualized for you.  There is no 'standard' sinus surgery, but as a general rule, less is more.  Just because 'all of your sinuses are blocked' does not mean that all of your sinuses need to be opened.  My experience, doing a lot of sinus surgery, is that for 95% of patients, the only sinuses that need to be addressed surgically are the maxillary and anterior ethmoids.  Even in patients with completely blocked frontal, posterior ethomoid and sphenoid sinuses I rarely need to do surgery on these sinuses to make my patients better.  As for technique, endoscopic sinus surgery is the standard across the country.  While there has been a great deal of interest in balloon sinuplasty, the jury is still out.  Clearly it is only appropriate for a small number of patients, those without inflammatory disease and a purely anatomic blockage. 

Portland Facial Plastic Surgeon

Sinus surgery technique

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Every patient is different. A good sinus surgeon is capable of performing several techniques and has many tools at his disposal. What technique is used is dependent on how bad your sinuses are, which sinuses are affected, and whether you have polyps or not. I always use computer guided navigational imaging with my sinus surgery even with the simplest procedures.  This is key. Be wary of a surgeon who uses just a balloon approach for most of his sinus procedures. The sinus ballon dilation has some benefits and is helpful for some types of sinus procedures but is not indicated for extensive sinus disease.  How thorough and experienced your surgeon is very important.

Frank Scaccia, MD, FACS
Red Bank Facial Plastic Surgeon
4.6 out of 5 stars 14 reviews

Best type of sinus surgery?

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Thank you for your question.  Unfortunately, there is not a simple answer to your question.  The type of surgery necessary for a particular patient depends largely on the needs of the patient, the history, and the anatomy.

In my experience, patients with sinus problems fall into 1 of 3 categories:  1)  Those with only anatomic problems that are causing blockage of proper airflow and mucous flow; 2) Those with oversensitivity of the mucous membranes of the nose and sinuses that lead to blockage of proper airflow and mucous flow; and 3) Those who have a combination of both an anatomic problem and a mucous membrane oversensitivity.

In order to properly treat a patient's symptoms, it must first be determined which category a patient falls into.  This would involve a thorough history and physical examination, as well as conservative measures to treat the common non-surgical causes of sinus pressure and pain.  

First, an infectious etiology must be ruled out.  If an infection is present, it is usually treated with a combination of an oral antibiotic and a sinus rinse to loosen and wash out the thick, stubborn secretions (SNOT).  Many patients may benefit from a short course of oral steroids as well.  

If an infectious cause has been ruled out, then most of my patients get started on sinus rinses to wash out irritants that are causing swelling and inflammation of the mucous membranes, as well as a nasal steroid spray to decrease inflammation of the mucous membranes.  Patients who have a true allergic component to their inflammation may benefit from an oral antihistamine or medicines such as Singulair to help manage the inflammatory response.

If patients continue to be symptomatic, despite aggressive medical management, they then proceed to a CT scan to evaluate the anatomy of the sinuses.  If there is thickening of the mucous membranes of the sinuses, despite maximal medical management, then those patients are candidates for endoscopic sinus surgery or more aggressive open procedures, such as an osteoplastic flap or a Calwell-Luc procedure, depending on their particular disease process.

Patients who remain symptomatic, despite aggressive medical management, but who lack mucous membrane thickening on the CT scan, were often relegated to the "sorry, can't help you" category in the past.  Today, however, a procedure known as balloon sinus dilation is growing in popularity and effectiveness for these very patients.  It's a procedure that is usually done in the office and provides relief for many patients who did not have other alternatives in the past.

Ultimately, you would be best served by seeing a board-certified otolaryngologist who can evaluate you face-to-face and determine exactly what course of action is best for you.

Best wishes.

Best Technique for Sinus Surgery?

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The best technique for sinus surgery is to seek out a qualified, experienced sinus surgeon.  There are a variety of new technologies and techniques now available such as balloon sinuplasty, propel sinus stents, navigation, etc that are very useful adjuncts in surgery.  The key is to know when to use them on which patients. 

A. Joshua Zimm, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 38 reviews

Endoscopic sinus surgery is the most effective sinus surgery technique.

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There are different variations of this type of surgery but they are all done through the nostrils with no cuts or scars outside of the nose. A small endoscope is used to provide high quality visibility of the area being operated on. There are multiple versions of this. For special cases of very limited disease of the maxillary, frontal or sphenoid sinuses, the balloon may be effective. Many surgeons then remove tissue from inside the nose that makes using the balloon unnecessary in a skilled surgeon's hands. Balloons do nothing for the ethmoid sinuses which are a major area of concern for most patients with sinusitis. Also, image guidance using a 3-dimensional CAT scan will give the surgeon additional information and should be used for surgery in the frontal and sphenoid sinuses and in revision sinus surgery and nasal polyp surgery. Only in rare patients will multiple sinus surgeries be needed if an appropriate first surgery is performed. 

Garrett H. Bennett, MD
Manhattan Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Sinus surgery technique

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Endoscopic sinus surgery is performed for medical necessity once polyps and chroinc infection has been documented.  For more information about sinus surgery techniques and diagrams , please see the link below. 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Several sinus surgeries for different situations

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Endoscopic sinus surgery (using small scopes and instruments in the nasal passages) has been the standard for a couple of decades.

A newer less aggressive technique (balloon sinuplasty) is finding its place as well. Not every insurance company covers this yet - still considering it experimental - although it is not.

Christopher J. Peers, MD
South Bend Facial Plastic Surgeon

Best technique for sinus surgery- balloon sinuplasty or endoscopic?

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Sinus surgery is an elective medical procedure sought by people experiencing chronic sinusitus, sinus headaches, or sinus infections.

Sinus surgery covers a very broad range of potential procedures of the nose and sinuses. Most people with chronic sinus problems do not have surgery on their actual sinuses. These patients have a deviated septum (the midline partition in your nose) or large turbinates, which contribute to their sinus or allergy symptoms, and they benefit from septoplasty and turbinate reduction.

New sinus surgery techniques have moved toward being less destructive, preserving the anatomical structures and restoring movement of air through sinuses . Techniques include balloon dilation or 'balloon sinuplasty" endoscopic (using tiny cameras to inspect and modify tiny openings in the sinuses), CT imaging, and microdebrider (to remove nasal polyps).

For mild to moderate cases, a new procedure using a balloon to open the sinuses may offer relief. Since this is an experimental treatment, your insurance coverage may not apply

Ramtin Kassir, MD
New York Facial Plastic Surgeon
4.7 out of 5 stars 178 reviews

Ballon Sinuplasty is a great option for mild to moderate sinus disease.

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The ideal procedure depends on your anatomy and the severity of your disease.  Ballon sinuplasty is a wonderful treatment option for mild to moderate sinus disease.  More extensive disease requires Endoscopic Sinus Surgery.  Not all surgeons are skilled in ballon sinuplasty, so be sure to see if your surgeon is comfortable with this procedure.  Warmest regards, Dr. Pippin.

Gregory Pippin, MD
Metairie Facial Plastic Surgeon

Best Possible Sinus Surgery Method

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Best method for sinus surgery involves using the endoscopic equipment without external incisions.

More recent technique involves using a balloon technique to dilate the sinus passages without disturbing the lining of the inside of the nose.

Depending on the anatomy and the degree of symptoms and problems you are having, your surgeon can provide you with the best option possible.

Hope this was helpful.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.