The most important element in development of sinusitis is the osteomeatal complex consisting of the outflow tracts of all of the sinuses into the nose. The cilia move mucus toward the naturally occurring ostium. If the cilia are interfered with, stagnation of mucus will occur. In situations where the ostia are obstructed, such as with inflammation, viruses, allergic rhinitis, foreign bodies, and polyps, mucociliary clearance will be impaired. The reduction in patency of the ostium typically will cause a reduction in oxygen content within the sinuses, increasing the likelihood of bacterial overgrowth.

A change in air pressure inside the sinuses will cause localized pain. This can occur both from obstruction of the ostia and increased mucus production, as well as a change in air pressure such as with flying or diving. For this reason acute treatment is more important prior to such activities.
A clinical history of the patient will be created before any surgery is performed. A careful diagnostic workup is necessary to identify the underlying cause of acute or chronic sinusitis. This may necessitate a paranasal sinus CT scan, nasal endoscopy, rhinomanometry and selected blood tests to determine an operative strategy. Note: Sinus X–rays have limited utility in the diagnosis of acute sinusitis and are of no value in the evaluation of chronic sinusitis.

Functional endoscopic sinus surgery (FESS): The use of an endoscope is linked to the theory that the best way to obtain normal healthy sinuses is to open the natural pathways to the sinuses. Once an improved drainage system is achieved, the diseased sinus mucosa has an opportunity to return to normal.

FESS involves the insertion of the endoscope into the nose for a direct visual examination of the openings into the sinuses. Abnormal and obstructive tissues are then removed by endoscopic instruments. In the majority of cases, the surgical procedure is performed entirely through the nostrils, leaving no external scars.

The advantage of the procedure is that the surgery is less extensive; there is often less removal of normal tissues. Nowadays, most of the cases do not require nasal packing even after surgery. After the operation, the patient, if required, will have nasal packing for 24 to 48 hours. Ten days after the procedure, nasal irrigation may be recommended to prevent crusting and regular follow up visits to check endoscopically.

In a powered/submucous inferior turbinoplasty, your surgeon uses an instrument called a microdebrider with a tiny rotating cutting tip that can be changed for individual anatomy and type of surgery. The microdebrider offers the surgeon more precision, control and speed than other surgery tools, which is why it is widely used by many ENT surgeons. The microdebrider’s precision allows the physician to remove enough tissue to correct the obstruction while preserving the mucous lining and turbinate tissue you need for healthy nasal/sinus function.

The advantages of this technique include the following.

• “Cold” technique that causes no thermal (heat) injury. This is called a cold technique because it doesn’t rely on heat/light energy. Electrocautery, bipolar ablation and laser cautery use heat/light energy which is harder to control or predict, making it easier for mucous membrane or bone to be damaged during your procedure.
• More complete, precise removal. Effective turbinate surgery requires a delicate balance between removing enough tissue to correct the obstruction and preserving the mucous lining you need. The microdebrider is so precise and controlled that surgeons can use it to reduce the turbinate precisely as needed for each patient and see the immediate results of their work during surgery.
• Normal turbinate function preserved. The microdebrider and the powered/submucous inferior turbinoplasty method provide the precision, accuracy and control necessary to preserve the surface lining of the turbinates and healthy turbinate function.
• Minimally invasive. There is no external incision; only a very small opening in the turbinate where the tiny tip of the microdebrider is inserted.

The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size.

About 80 % of all nasal septums are off-centre, a condition that is generally not noticed. A “deviated septum” occurs when the septum is severely shifted away from the midline. Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is not generally performed on minors, because the cartilaginous septum grows until around age 17.

A deviated nasal septum may cause

• Blockage of one or both nostrils
• Nasal congestion, sometimes one-sided
• Frequent nosebleeds
• Frequent sinus infections
• Facial pain, headaches, postnasal drip
• Noisy breathing during sleep (in infants and young children)

Septoplasty is a surgical procedure performed entirely through the nostrils, accordingly, no bruising or external signs occur. Septoplasty may also be combined with sinus surgery.

The time required for the operation averages about one to one and a half hours, depending on the deviation. It can be done with a local or a general anaesthesia. After the surgery, nasal packing is inserted to prevent excessive postoperative bleeding. During the surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose.

If a deviated nasal septum is the sole cause for your chronic sinusitis, relief from this severe disorder will be achieved.

Rhinoplasty is a plastic surgery that is used to improve the function (reconstructive surgery) or appearance (cosmetic surgery) of your nose. Rhinoplasty can be used for cosmetic reasons, correction of birth defects, or breathing problems. It reshapes or repairs. There is no visible scarring when rhinoplasty is performed from inside the nose. Small scars may show at the base of the nose when the procedure calls for the narrowing of large nostrils. These are usually not noticeable. There may be bruising in the skin following your surgery which are temporary.

Rhinoplasty is used to:

• Change the size
• Correct birth defects and injuries
• Change the shape
• Correct breathing problems
• It is usually not done until the nasal bone growth is complete. This is about after the age of 18.

Procedure

• Rhinoplasty can be performed under a general anesthesia or local anesthesia. Incisions are hidden inside the nostrils and sometimes are made on skin between the nostrils. Through these incisions, your surgeon is able to reshape the cartilage and bone.
• Sometimes a piece of your own cartilage or bone is used to strengthen or improve the build of the nose. This is also done for cosmetic reasons or to improve breathing.
• Improving nasal breathing is sometimes accomplished with a septoplasty. This may be done in combination with cosmetic changes. Cartilage removed can be used to improve the looks and framework of the nose.

Seek immediate medical care if:

• You develop increased pain or swelling in your face or around your eyes.
• You develop a temperature over 101º F (38.3º C).
• You have increased bleeding from your nose or a pus-like discharge from your nose.
• You lose your nasal pack prior to the time your surgeon says it is to be removed.
• You do not get relief from your headache or facial pain with medications or the problems seem to be getting worse.

Each year thousands of people undergo surgery of the nose. Nasal surgery may be performed for cosmetic purposes, or a combination procedure to improve both form and function. It also may alleviate or cure nasal breathing problems, correct deformities from birth or injury, or support an ageing, drooping nose.

The deviated septum can be corrected with a surgical procedure called septoplasty. Cosmetic changes to the nose are often performed at the same time, in a combination procedure called septorhinoplasty. To reshape the nose, the skin is lifted, allowing the surgeon to remove or rearrange the bone and cartilage. The skin is then redraped and sutured over the new frame. A nasal splint on the outside of the nose helps retain the new shape during healing. If soft, absorbent material is placed inside the nose to stabilize the septum, it will normally be removed 48 to 72 hrs after surgery. External nasal dressings and splints are usually removed 10 days after surgery.