Ep.4 - Sinus Surgery: When and Why
In this installment of the Swain Sinus Show Dr. Ron Swain, Jr. discusses sinus surgery which is the next step in sinus treatment when medical therapy fails. Stacy and Dr. Swain explain the surgery options, common techniques, and what to expect during and after an operation.
What you will learn:
Sinus surgery is considered when medical therapy fails.
The purpose of your sinus surgery is to make sure that you have an orderly flow of the mucus in a proper fashion.
When sinus surgery is needed, it’s the first of a 10-step healing process. It's not the end; it's the end of the beginning.
The sinuses are very important and expensive real estate. Fortunately, at this time, we have some computer navigation systems that help us navigate through very complicated areas.
Most sinus surgery is performed with an endoscope
Ep.4 - Show Transcription
Welcome to the Swain Sinus Show. I'm Stacy Wellborn, coming to you from Deep Fried Studios. And today I'm joined by Dr. Ron Swain Junior, a fellowship-trained otolaryngologist specializing in rhinology, nasal, and sinus surgery.
Stacy: So Dr. Swain, in some of our other episodes we have talked about over-the-counter medications, common sinus issues, when sinus becomes chronic sinus issues. You are an otolaryngologist ENT doctor, you are also fellowship-trained in rhinology, which is sinus surgery, so let's talk a little bit about sinus surgery options. What are the options, and when do you decide that that's an appropriate option for a patient?
Ron: The first answer to that question is, is when medical therapy fails. When you've tried courses of antibiotics and steroids, oral steroids sometimes, nasal steroids, saline rinses, all the things we've talked about previously, and there are a bunch of those people that just don't get better. And so you move to more aggressive options. And the purpose of sinus surgery, when we talked about plumbing earlier, it's essential to reorganize or open all the sinuses in such a way that the common drainage pathway is now open. And a lot of times for people, it's to create a large enough opening to distribute topical rinses. You know, it was said by one of the people I admire the most, is that sinus surgery is not the end, or sinus operation's the first step in a 10-step process for afterward. That's what we tell patients. It's not the end; it's the end of the beginning. And so a lot of times people think, "Oh, I'm gonna have an operation, and it's all gonna go away." Not realistic, and setting people's expectations as to what sinus surgery is going to accomplish at the extent of surgery that they need, it's all individually based.
So when you go in, and you're looking for someone that has chronic sinusitis, people that have nasal polyps, or chronic inflammation, or recurrent sinus infections, which is the majority of what we're talking about here, there are four different name sinuses. There's the maxillary sinus, which is the sinus under your eyeball. There are the ethmoid sinuses, which is between your eyeball and your brain. There is the frontal sinus which is above your eye, and there's this sphenoid sinus, which is all the way in the back of your head, kind of in the center of your head, so to speak. If I put a rod through your ear and through your eye, where they would meet underneath your brain would be your sphenoid sinus. It's the center of your head, so to speak. And so the sinuses are little bony cavities, and you have all these little partitions. And what you're going in there endoscopically and doing, is removing all those bony partitions. So instead of a maxillary sinus, and ethmoid sinus, and a frontal sinus, and a sphenoid sinus that is individually blocked off, it's one big cavity. We're sitting in a studio right now, and the door of the studio is closed or cracked. So if sinus surgery would be to go in there and open the door to the room so things can drain out, mucus can drain out more effectively, and medicine can come in there.
Now, the extent of surgery kinda depends on what you're treating. If there's a tumor in there or if they've had previous surgery and they're scarring, sometimes you just don't open the door, sometimes you open the door, and you take out the walls, or you take out the walls, and you take out the windows in the walls, and you're creating a very...a larger cavity, because the sinuses continue to function, and they're constantly changing depending on if you have a cold, if you don't have a cold, or you're exposed allergens, it's not a static environment. And so you go in there, and you create this cavity. And so postoperatively, you have to take care of that cavity, which is kind of what we talked about with using rinses in your nose, and using medication in the rinses the nose because you're creating an opening that continues to function, and you have these little cilia, these little hairs in the nose that sweep the mucus out of your nose, and sinus surgery doesn't stop that. That mucus is gonna be made no matter what.
What we're trying to do here is making sure that you have an orderly flow of the mucus in a proper fashion. And that entails sometimes going in there and removing things, whether it's a bone, or the bone and the wall, or whether it's the bone and the wall and something else. There's not a one-size-fits-all approach. And one of the complicating factors of all this is if you think of a room and we're sitting in a building here, and all these rooms have different doors. And so you can operate on one sinus like the maxillary sinus, but if you get some scarring in one of the other rooms, then you've got...you created another problem. In other words, if I'm opening up one sinus, I might not have to open up another sinus, but you might end up having to do that depending on if the surgery has...
Stacy: Maybe the balance has gotten off.
Ron: Correct. Well, if you've induced scarring in other areas. So a lot of times we're going in and opening up most of the sinuses in an area because they're so closely connected. In other words, someone may say, "Look, I want just one sinus opened." Well, sometimes you can do that, you can just open up once sinus. Sometimes you can't; sometimes you have to open up the whole area because they're so closely connected anatomically.
Stacy: When you say that there are walls, and doors, and rooms, is that basically how we're made from the beginning, some of us have better walls and doors than others?
Ron: Yes. Yes, just like some people are taller, or some people are shorter, or some people have different physical characteristics, some people have brown hair, some people have blond hair, your sinuses are all put together differently. It's very expensive real estate because you're operating really between the eyeball and the brain. And so when you talk about sinus surgery, you talk about the risk factors, you're operating between the eyeball and the brain. So we worry about putting holes in the eyeball and the brain. So brain fluid leak, blindness, double vision, all those things we talk about at the time of surgery. Fortunately, at this time, we have some computer navigation systems that help us navigate through very complicated areas. Some surgery you don't need to use that. Some surgery you do need to use that. It all just depends on what you're trying to accomplish.
Stacy: So in sinus surgery, are you generally going through the nose?
Stacy: That's your entry point?
Ron: Most surgery now can be done endoscopically. There are times depending on what you're dealing with, that you need to make an...have an open approach. That's when you're putting in an incursion, either underneath a lip or across the forehead, or around the eye, that's not as common, fortunately. Modern sinus surgery has been revolutionized with the use of the endoscope, so it's all done endoscopically through the nostrils, but there are times when you do have to use an open approach.
Stacy: How do I get an appointment?
Ron: It's really easy to get an appointment to see me. If you would call and speak to my nurses, the direct line is 251-470-8823. Again, that number is 251-470-8823, and you can find the number on the internet, at, swainsinusshow.com. My nurses are Mandy Webster, and Chasity Wooten, and Emily Dement. If you'd call that number directly, my nurses can help you get set up to have an appointment to see me.
Need an Appointment or Sinus Consultation? Call Dr. Swain’s nursing staff at 251-470-8823 or schedule and appointment at drronswain.com
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