Procedures: Sinus Surgery
Sinus surgery opens blocked sinus drainage pathways; this page explains what the procedure accomplishes and how it is performed.
What Is Sinus Surgery?
The sinuses are hollow, air-filled spaces within the bones of the face and skull that connect to the nose through narrow drainage channels. When these channels become blocked or the sinus lining stays inflamed, mucus and pressure can build up. The reasons sinus surgery may be considered are described separately on this website (see Conditions of the Nose and Sinuses).
Sinus surgery is a procedure to open and clear these blocked drainage pathways. The most common type is called functional endoscopic sinus surgery (FESS). It is “endoscopic” because the entire operation is performed through the nostrils using a thin telescope with a camera (an endoscope), so there are no incisions on the face and no visible scars. It is “functional” because the aim is to restore the natural function of the sinuses rather than simply remove them.
FESS became the standard approach for sinus surgery in the 1980s and is usually performed as a same-day (outpatient) procedure.
What Sinus Surgery Accomplishes
Sinus surgery is not a single fixed operation. The surgeon tailors it to the individual person and the specific sinuses involved. In general, the goals are to:
Restore drainage and ventilation. Widening the natural openings of the sinuses allows trapped mucus to drain and lets air move in and out normally.
Support the sinuses’ natural cleaning system. The sinus lining has tiny hair-like structures that continuously sweep mucus toward the drainage openings. Opening blocked pathways helps this self-cleaning process (mucociliary clearance) work again.
Remove obstructing tissue. The surgeon can remove polyps, thickened or diseased lining, and small bony partitions that block the flow of mucus and air.
Allow topical medicines to reach the sinuses. After the passages are opened, saline irrigations and steroid rinses or sprays can reach deep inside the sinuses, where they could not go before. For many people, this improved access to medication is one of the main benefits.
Allow sampling when needed. The surgeon can take tissue or mucus samples for testing.
Types of Sinus Procedures
Functional endoscopic sinus surgery (FESS). The core operation. Using the endoscope, the surgeon opens one or more sinuses to the degree needed. A limited procedure may open only a single blocked sinus, while a more comprehensive procedure opens several sinuses widely, for example in people with extensive polyps who need wide passages so that topical medicines can reach all areas afterward.
Balloon sinuplasty (balloon sinus dilation). A less invasive option in which a small balloon is passed into a sinus opening and gently inflated to widen it, without removing tissue. It can sometimes be done in the office and tends to have a shorter recovery and fewer complications, but it is suited only to certain sinuses (frontal, sphenoid, and maxillary) and to more limited disease. The ethmoid sinuses cannot be treated with a balloon alone because they are a honeycomb of many small cells rather than a single opening. Balloon dilation is sometimes combined with standard FESS.
The individual sinus operations. During FESS the surgeon addresses whichever sinuses are involved. Common steps, each named for the area treated, include:
Uncinectomy. Removal of the uncinate process, a small curved piece of bone and lining that acts as a “gateway” to the sinuses. This is usually the first step and provides access to the maxillary and other sinuses.
Maxillary antrostomy. Enlarging the natural opening of the maxillary sinus (the large sinus in the cheek) so it drains freely.
Ethmoidectomy. Removal of the thin bony walls between the ethmoid air cells, located between the eyes, to convert the honeycomb into open, drainable spaces. This may address the front (anterior) cells, the back (posterior) cells, or both.
Sphenoidotomy. Opening the sphenoid sinus, which sits deep behind the nose near the base of the skull.
Frontal sinusotomy. Opening the drainage pathway of the frontal sinus in the forehead, often the most technically demanding area, sometimes requiring angled telescopes and instruments.
Procedures sometimes combined with sinus surgery. To improve breathing and to make room to reach the sinuses, the surgeon may also perform:
Septoplasty. Straightening a crooked or deviated nasal septum (the wall between the two nostrils).
Turbinate reduction. Shrinking enlarged turbinates (the scroll-shaped structures on the side walls of the nose) that can block airflow.
Imaging and Image Guidance
Before surgery, a CT scan of the sinuses is typically obtained. It maps each person’s unique sinus anatomy, shows which sinuses are affected, and helps the surgeon plan the operation.
During surgery, some operations use a computer image-guidance (navigation) system. This links the surgical instruments to the person’s CT scan, showing in real time exactly where the instrument tip is located. Because the sinuses lie close to the eyes and the base of the brain, this technology helps the surgeon identify landmarks and work safely, and it is especially useful in complex or repeat surgery.
Anesthesia
Sinus surgery is most often performed under general anesthesia, so the person is fully asleep and feels nothing. Some limited procedures, including certain balloon dilations, can be done under local anesthesia with sedation.
To reduce bleeding and give the surgeon a clear view through the endoscope, the anesthesia team may deliberately keep blood pressure toward the lower end of normal, position the head slightly elevated, and use medicines applied inside the nose that shrink blood vessels.
How the Operation Is Performed, Step by Step
The entire operation is carried out through the nostrils, with the surgeon watching a magnified view on a monitor. A general sequence is:
Preparation. Medicated packing or spray is placed in the nose to shrink the lining and limit bleeding. Local anesthetic is often injected as well.
Inspection. The endoscope is introduced and the surgeon identifies the key landmarks inside the nose.
Gaining access. The uncinate process is removed (uncinectomy) to expose the sinus openings.
Opening the sinuses. The surgeon widens each involved sinus in turn: the maxillary opening is enlarged, the ethmoid cells are cleared, and, when needed, the sphenoid and frontal sinuses are opened. Diseased lining, polyps, and bony partitions are removed while healthy lining is preserved as much as possible.
Additional steps. Septoplasty or turbinate reduction is performed if planned.
Finishing. The surgeon confirms the sinuses are open, controls any bleeding, and places packing or a splint if needed.
Throughout, the surgeon keeps critical structures in view, particularly the thin bone next to the eye and the base of the skull, to protect them.
Instruments Used
Endoscopes: thin rigid telescopes with a camera, available in straight and angled views to see around corners.
Microdebrider: a powered instrument that gently shaves and suctions away polyps and diseased tissue.
Through-cutting forceps and other hand instruments: used to remove bony partitions cleanly while sparing healthy lining.
Probes and curettes: used to locate natural openings and feel anatomical landmarks.
Balloon catheters: used when a sinus opening is dilated rather than cut.
Image-guidance (navigation) equipment: used in selected cases.
Nasal Packing and Stents
At the end of surgery, the surgeon may place material in the nose to control minor bleeding and to hold tissues apart so healing surfaces do not stick together.
Dissolvable packing breaks down on its own and does not need removal.
Non-dissolvable packing is removed at an office visit a few days later.
Spacers or drug-eluting stents are sometimes placed in a sinus opening; some slowly release a steroid to reduce inflammation and scarring during healing.
Many surgeons now try to avoid heavy packing when possible.
What Happens Right After Surgery
Sinus surgery is usually an outpatient procedure, and most people go home the same day after a period of monitoring. In the first days it is normal to have:
Mild bloody drainage from the nose (a small gauze “drip pad” under the nose is common)
Nasal congestion and stuffiness, which can last while healing occurs
Facial pressure, mild discomfort, and fatigue
Pain is usually mild and can often be managed with acetaminophen; other medicines may be added as advised. Instructions typically include avoiding nose blowing and strenuous activity for a period of time. More detail is available on the Sinus Surgery Recovery page.
The Healing Process and Postoperative Care
Full healing of the sinus lining takes several weeks, and the passages can look and feel congested during this time as crusting forms and then resolves.
Key parts of postoperative care usually include:
Saltwater (saline) rinses. Started soon after surgery, these irrigations soften and wash out crusting and mucus and are one of the most important parts of recovery.
Topical medicines. Steroid sprays or rinses are often used to reduce inflammation and lower the chance of the problem returning.
Office debridement. At follow-up visits the surgeon may gently clean out blood clots, crusts, and debris from the nose and sinuses using the endoscope. This “debridement” helps the passages heal open and reduces the risk of scar bands (adhesions) forming. It is done with numbing medicine in the office and can cause brief discomfort. The number of cleaning visits depends on the extent of surgery and how healing is progressing.
Follow-up visits. These allow the surgeon to monitor healing and, when the surgery was done for a long-term (chronic) condition, to keep the condition under control over time. Sinus surgery is often one part of an ongoing treatment plan rather than a one-time cure, so continued follow-up and medication are usually important.
Most people notice gradual improvement in nasal breathing, drainage, and sense of smell as healing progresses.
Warning Signs Commonly Reviewed After Surgery
Postoperative instructions commonly list heavy or persistent nosebleeds, high fever, worsening severe pain, changes in vision or eye swelling, and persistent clear watery drainage from the nose as symptoms to report to the surgical team. The surgeon provides specific warning signs and instructions for each person.
This page is general education and is not medical care or a recommendation for any individual; see the website disclaimer.