Septoplasty and Sinus Surgery

What nasal conditions lead to difficulty breathing and how can it be corrected? What is a septoplasty? How is sinusitis treated?
A deviated nasal septum (parting wall between right and left nasal chambers) if significant (greater than 50%) can result in difficult breathing and is treated with a septoplasty surgery. This can be done as an isolated procedure or can be combined with sinus surgery or rhinoplasty surgery.

Septoplasty is one of the most common procedures Dr. Rizk performs to improve breathing. Dr. Rizk is double board certified in otolaryngology and facial plastic surgery. Allergies can also result in enlargement of the nasal tissue called turbinates and various procedures can be performed to reduce the size of the turbinates. This can be done with the septoplasty procedure alone or with the septoplasty and rhinoplasty procedures together. Dr. Rizk will determine if your turbinates are significantly enlarged and would benefit from a reduction. Additionally, there may be polyps or other nasal conditions which may be discovered on nasal exam which can result in difficulty breathing. Dr. Rizk performs a thorough intranasal exam to evaluate these conditions.

A CT scan may be recommended if Dr. Rizk suspects polyps or if you have a sinus condition which is not getting better with medical therapy. The first line of treatment is antihistamines and nasal steroid sprays to shrink the nasal tissue. Allergy testing may also be recommended. If your condition is persistent and not improving endoscopic sinus surgery to drain the sinuses, turbinate reduction and/or septoplasty may be recommended.

What is sinusitis?
Sinusitis afflicts approximately 40 million people in this country. A cold or allergy attack that does not go away quickly within a few days and lingers on is probably sinusitis. Mucous produced in the sinus passages drains into the nose. If you have a cold, allergy that lingers, it causes the sinus passages in the nose to become swollen and then they become blocked. This leads to mucous buildup in the sinuses and results in infection and symptoms of pressure, difficulty breathing, and headaches.

What are the sinuses?
The sinuses are air pockets located within bones of the skull and face and are connected to your nasal passages by small tubes or channels (osteomeatal channels). These channels permit air to flow from the nose to the sinuses, and allow drainage of mucous from each sinus into the nose. We have four sinuses on each side: the maxillary (or cheek), ethmoid (or nose), frontal (above nose in between eyes), and sphenoid (in back of nose). The osteomeatal channel or connection from the sinus into the nose can vary in length and width. This difference can impact on one's ability to drain properly and can predispose to blockage if narrow. A cold or allergy attack can easily block this channel if it is already narrow (THESE PASSAGES ARE MILLIMETERS). Blockage of these channels, partial or complete, by either structural conditions, polyps, deviated septum or generalized swelling from a cold or allergies is the cause of rhinosinusitis.

What is sinusitis and can it be corrected? What symptoms can it present with?
Sinusitis is a chronic condition where the sinuses do not drain properly and there is blockage in the nose where the sinuses should drain. This may result from polyps, a deviated nasal septum, or generalized narrowing of nasal drainage pathways or allergy which swells nasal mucous membranes. The treatment for this condition involves both medical antiallergy therapy and antibiotics and possibly surgery. Surgery is only indicated if there is a specific anatomical blockage which is not responding to medical therapy.

Sinusitis may present with nasal obstruction, headaches and excessive drainage from the front of nose (rhinorrhea) or back of nose onto the throat (post-nasal drip) as well as recurrent sinus infections. If the condition does not improve with medical therapy, a ct scan may show the etiology of the sinusitis and surgical drainage may be recommended. Functional Endoscopic sinus surgery may improve breathing and alleviate the sinus symptoms but it must be combined with medical and antiallergy medications.

Do you use nasal packing after septoplasty or sinus surgery?
No, Dr. Rizk uses various tissue sealants but does not use packing after nasal or sinus surgery. Packing creates more swelling and is very uncomfortable for the patient. Also, removing the packing can be a stressful event for the patient.

How is sinus surgery done?
Functional endoscopic sinus surgery is done by inserting small telescopes connected to a TV screen with a high definition camera system to visualize the narrowed or blocked sinus openings and microinstruments are used to enlarge the natural sinus openings into the nose. The word functional is added because the procedure enlarges the natural sinus openings and does not create new openings. Sometimes, a 3dimentional CT guided system is used to visualize all the sinuses and surrounding structures on a computer screen for more precision.

Does sinusitis recur? Can polyps come back?
Sometimes if allergy is severe, polyps or sinusitis may recur and this is why it is important to control the allergy with medication or allergy shots in order to prevent or delay the recurrence of these conditions.

Is sinus surgery safe and can sinus surgery be combined with a rhinoplasty?
Sinus surgery is much more accurate than it was in the past, especially with better technology to visualize the sinuses. Complications may occur such as bleeding but is very rare. Dr. Rizk wrote one of the earliest articles on rhinoplasty and sinus surgery combined and it is a very safe procedure.

Is sinus surgery covered by insurance?
If the sinus condition does not improve with medical therapy and if a CT scan documents the degree of blockage, sinus surgery may be covered by insurance. A rhinoplasty, however, is never covered by insurance.