Bilateral concha bullosa
An air cavity inside the middle concha is common and is often bilateral. In itself, it does not require treatment, but when the cavity is large and overlaps the ostiomeatal complex, chronic sinusitis develops. In this case, the shell is opened on both sides and its lateral part is removed, preserving the medial wall and mucosa. The operation almost always occurs as a stage of a more extensive intervention on the sinuses.
What is endoscopic sinus surgery
Functional endoscopic surgery (FESS) is the current standard of care for chronic sinusitis and nasal polyposis. Unlike old radical operations through an incision under the lip, access is through natural pathways - the nostril, and the video endoscope gives the surgeon an enlarged image.
The key word here is “functional”: the goal is not to remove the sinus, but to restore its normal functioning by expanding the natural anastomosis and removing what interferes with the outflow.
What can be done endoscopically
- expand the anastomosis of the maxillary sinus (maxillary sinus, infundibulotomy)
- open the cells of the ethmoidal labyrinth (ethmoidotomy)
- open the sphenoid sinus (sphenotomy)
- remove polyps with a shaver - with minimal trauma to the mucous membrane
- correct nasal septum (septoplasty)
- reduce the volume of the nasal turbinates (conchoplasty)
Why is the volume of the operation different?
Chronic sinusitis is rarely limited to one sinus. Using tomography data, the surgeon determines in advance which sinuses are involved and on which side, and plans the volume: from one manipulation on one side to several stages on both. That is why operations are classified by the number of stages - this directly reflects the volume and duration of the intervention.
Recovery
Nasal breathing is not restored immediately: the first days the nose is blocked due to swelling and crusts. Complete healing of the mucous membrane takes 4–8 weeks, and during this period, postoperative examinations with cleaning of the nasal cavity are critical - without them, the anastomosis may become overgrown again.