I) Sinusitis infection and surgery

Sinusitis - Surgery

ref-- and acknowledgements ----http://www.webmd.com/allergies/picture-of-the-sinuses

Human Anatomy

The sinuses are a connected system of hollow cavities in the skull. The largest sinus cavities are around an inch across; others are much smaller. The sinus cavities include:

• The maxillary sinuses (the largest), in the cheekbones.

• The frontal sinuses, in the low-center of the forehead.

• The ethmoid sinuses, between the eyes, at the nasal bridge.

• The sphenoid sinuses, in bones behind the nasal cavity.

The sinuses are lined with soft, pink tissue called mucosa. Normally, the sinuses are empty except for a thin layer of mucus.

The inside of the nose has ridges called turbinates. Normally these structures help humidify and filter air. The nose is divided in the center by a thin wall, called the septum. Most of the sinuses drain into the nose through a small channel or drainage pathway called the middle meatus.

The purpose of the sinuses is unclear. One theory is that sinuses help humidify the air we breathe in; another is that they enhance our voices.

Sinus Conditions

Acute sinusitis (sinus infection): Viruses or bacteria infect the sinus cavity, causing inflammation. Increased mucus production, nasal congestion, discomfort in the cheeks, forehead or around the eyes and headaches are common symptoms.

Chronic sinusitis (or chronic rhinosinusitis): More than just a series of infections, chronic sinusitis is a persistent process of inflammation of the sinuses.

Allergic rhinitis: Allergens like pollen, dust mites, or pet dander cause the defenses in the nose and sinuses to overreact. Mucus, nasal stuffiness, sneezing, and itching result.

Deviated septum: If the septum that divides the nose deviates too far too one side, airflow can be obstructed.

Turbinate hypertophy: The ridges on the nasal septum are enlarged, potentially obstructing airflow.

Nasal polyps: Small growths called polyps sometimes grow in the nasal cavity, in response to inflammation. Asthma, chronic sinus infections, and allergic rhinitis can lead to nasal polyps.

The goal of surgery is to make drainage of the sinuses camera.gif better, usually by removing the blockage and draining the mucus. This may mean removing:

Infected, swollen, or damaged tissue.

Bone, to create a wider opening for drainage of mucus from the sinuses.

Growths (polyps) inside the nose or sinuses.

A foreign object that is blocking a nasal or sinus passage. This usually occurs in children.

Surgery may be the only means of getting a badly blocked, infected sinus to drain properly. But surgery does not always completely eliminate sinusitis. Some people may need a second operation.

Surgery is most successful when used along with medicine and home treatment to prevent future sinusitis. A second surgery and future sinusitis may be avoided if antibiotics are taken to prevent reinfection.

Sinusitis: Should I Have Surgery?

Surgery choices

Endoscopic surgery is preferred over traditional surgery for most cases of chronic sinusitis that require surgery. It is less invasive, less expensive, and has a lower rate of complications.

Endoscopic surgery may be done to remove small amounts of bone or other material blocking the sinus openings or to remove growths (polyps). Normally, a thin, lighted tool called an endoscope is inserted through the nose so the doctor can see and remove whatever is blocking the sinuses.

Sinus surgery may be done when complications of sinusitis—such as the development of pus in a sinus, infection of the facial bones, or brain abscess—have occurred. In this type of surgery, the doctor makes an opening into the sinus from inside the mouth or through the skin of the face.

What to think about

Very few people need surgery to treat sinusitis. But you may need surgery if ALL of these are true:

Your doctor says that you have chronic sinusitis.

You've followed what's called "maximum medical treatment" for 4 to 6 weeks. This means that you've taken medicines and followed home treatment for at least 4 to 6 weeks. This treatment includes antibiotics, a steroid nasal spray, and other prescription medicines.

You've had a CT scan of your sinuses after the 4 to 6 weeks of treatment. It is very important to have the CT scan done after this treatment. Reducing the swelling and infection as much as possible lets your doctor see what could be causing your infections.

The CT scan shows that something, such as nasal polyps, is keeping your sinuses from draining as they should