What Do We Do in Sinus Surgery?
Endoscopic Sinus Surgery, Polyps and Navigation (Guided Surgery) with Modern Approach
Prof. Dr. Gediz Murat Serin – Ear Nose Throat Specialist | Teşvikiye ENT Group
Brief Summary (Patient Friendly)
Sinuses are natural cavities filled with air, located in the cheek (maxillary), forehead (frontal), nasal roof/between the eyes (ethmoid) and adjacent to the skull base at the back of the nose (sphenoid) regions. Inflammation most commonly occurs in the ethmoid and maxillary sinuses. During upper respiratory tract infections such as cold and flu, the openings (ostium) of the sinuses to the nose swell and become blocked; secretions accumulate inside and acute (short-term) or chronic (longer than 12 weeks) sinusitis develops.
Exceptionally, odontogenic (tooth-origin) sinusitis may occur following infection/cyst, root canal filling, implant or sinus floor surgeries.
We do not “remove” the sinuses during surgery. We open the natural drainage pathways, clean the accumulated inflammation/polyps inside, and re-establish drainage and ventilation. Thus, attacks become less frequent, complaints diminish, medications become more effective. Acute sinusitis may still occur; however, it mostly progresses more mildly and is easily controlled.
Why Don’t We “Remove” the Sinuses?
Sinuses contribute to vocal resonance, reduce skull weight and help the humidity–temperature–filtration balance of the air we breathe. The goal in surgery is to restore physiology:
- Purpose: By opening the ostia, secretions drain outward and clean air enters the sinus.
- Benefit: The infection cycle is broken; pressure pain, congestion and loss of smell decrease, breathing comfort increases.
What is Endoscopic Sinus Surgery (ESS)?
ESS is a modern procedure performed through the nostrils with a camera (endoscope) and fine instruments, without external incisions.
- Approach: Blocked natural ostia are widened with micrometric precision.
- Goal: To keep physiological drainage pathways permanently open without unnecessary tissue loss.
- Advantages: Less tissue trauma, faster recovery, less bleeding and lower risk of adhesions (synechiae).
Polyps (Nasal Polyposis) and ESS
Polyps are soft tissue masses that develop as a result of chronic inflammation in the nose and sinuses. Not every chronic sinusitis has polyps; however, complaints become more prominent when polyps are present.
- Symptoms: Nasal congestion, loss of smell, postnasal drip, head-facial pain, recurrent sinusitis attacks.
- Treatment Steps:
- Medical treatment: Irrigation with saline/serum, nasal corticosteroid spray, short-term systemic steroids in selected cases and antibiotics when necessary.
- ESS: Removal of polyps and opening of natural channels.
- Realistic Expectation: Polyps can recur. Surgery reduces polyp burden and increases medication response. Regular follow-up and maintenance nasal steroids maintain success.
What is Navigation (Guided Surgery) Used For?
Navigation is a system that matches in real-time pre-operative CT/MRI images with surgical instruments (think of it as GPS in surgery).
- Benefits:
- Position verification and safety in complex anatomies and revision cases.
- Targeted and more confident dissection in extensive polyposis cases. Safe distance from eye and brain proximity.
- Result: Safer, more conservative surgery; preservation of anatomical integrity.
“Will I Get Sinusitis Again After Surgery?”
You may. Sinusitis is a mucosal disease lining the inside of the sinuses; it is affected by allergies, polyps, structural narrowings, reflux, cigarette/smoke exposure, occupational irritants and genetic predisposition.
However, after ESS:
- Attacks become less frequent,
- Progress more mildly,
- Response to treatment increases.
Rather than “resetting” the disease, surgery makes it controllable.
Who Should Consider ESS?
- Chronic rhinosinusitis (≥12 weeks) and resistance to medical treatment
- Nasal polyposis (widespread polyp disease)
- Recurrent/prolonged sinusitis attacks
- Odontogenic sinusitis, fungal ball, mucus retention cyst
- Anatomical obstructions: concha bullosa, narrow middle meatus, septal deviation (corrected simultaneously if necessary)
Stages of Surgery (Simplified)
- Endoscopic examination and personalized planning with CT
- Navigation setup in necessary cases
- Careful widening of blocked/edematous sinus ostia
- Removal of polyps and inflamed tissues
- Bleeding control and support for healing with gel/silicone-based temporary materials
Note: In selected mild and limited cases, minimally invasive methods such as balloon sinuplasty may be considered; the decision is personalized.
Recovery and Care
- First 2–3 weeks: Regular nasal irrigation (isotonic/hypertonic), not missing prescribed sprays and medications.
- Follow-ups: Endoscopic debridement (gentle cleaning of crusts-clots) accelerates healing.
- Accompanying Causes: Allergies, reflux and dental problems should be managed simultaneously.
- Lifestyle: Avoiding cigarette/smoke exposure, good sleep, adequate fluids, ambient humidity.
- Maintenance Treatment: Especially in polypoid diseases, long-term use of nasal steroid sprays reduces recurrence risk.
Frequently Asked Questions (FAQ)
1-) Will my sinuses be removed?
No. We do not remove the sinuses; we open the natural pathways and restore ventilation.
2-) Will my polyps be completely gone?
Polyp burden decreases; they can recur. They are under control with regular follow-up and maintenance treatment.
3-) Is navigation mandatory?
Not required in every case; however, it provides safety and precision in revision, complex anatomy and extensive polyposis cases.
4-) Will my sense of smell improve?
Improvement is expected as inflammation decreases and pathways open; it varies from person to person.
5-) When can I return to work?
Generally, return at a light pace is possible within a few days; maturation of internal surfaces takes weeks.
Possible Risks (Rare)
Bleeding, synechiae (adhesions), temporary smell changes, medication-related reactions and very rare complications involving eye/brain proximity. Experienced team and navigation help minimize these risks.
Final Word: “Conservative and Smart Surgery”
Endoscopic sinus surgery aims to preserve the sinuses and make natural drainage–ventilation permanent. Even if the tendency is not completely eliminated, with proper surgery + proper care, attacks become less frequent, complaints diminish, quality of life significantly improves.
