Surgery of the Nose and Paranasal Sinuses

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The endoscope revolutionized the practice of endoscopic nasal surgery. As a result, external sinus surgery is performed less frequently today, and more emphasis is placed on functional endoscopy and preservation of normal anatomy. 2020-03-09 Surgery of the Nose and Paranasal Sinuses
All you need to now about Surgery of the Nose and Paranasal Sinuses

Endoscopic surgery techniques are widely used in modern medicine. The treatment process relies on modern endoscopic video equipment and microinstruments. Chronic diseases of the nose and paranasal sinuses, nasal septum deviation, nasal polyps (in the nasal cavity and paranasal sinuses), recurrent sinusitis, cysts of the paranasal sinuses are treated by using minimally invasive (sparing) techniques.

All endoscopic operations are performed through the natural nasal passages and do not require any external incisions. This shortens the recovery period and prevents possible complications and relapses. Functional endoscopic operations are as efficient and painless as possible.

The indications for endoscopic functional operations are:


Adenoidectomy is surgery to remove a pathologically enlarged nasopharyngeal tonsil (adenoid). Most often enlarged adenoids are found in 3- to 14-year-old children, but at present adults are also faced with this problem. One of the reasons is relapse as a result of incomplete removal of lymphoid tissue. Modern methods of examination of the nasopharynx can accurately diagnose it and help understand that it is enlarged adenoids that cause health problems.

The operation is recommended if the enlargement of the nasopharyngeal tonsil is accompanied by permanent nasal breathing disorders, snoring, sleep apnea, hearing loss, frequent ENT diseases and diseases of the upper respiratory tract.

As with any surgical intervention, the removal of adenoids is preceded by a comprehensive preoperative preparation. In Germany in the ENT centres there is everything that is necessary to perform a thorough examination of patients.

In order to determine the condition of the nasopharyngeal tonsil, endoscopic examination and radiography of the nose and paranasal sinuses are performed. Also, nasopharyngeal swabs are collected from patients to identify the bacterial flora and antibiotic sensitivity.

In addition, it is necessary to undergo a series of general examinations: common blood and urine analyses, blood for biochemistry analysis, a coagulation test, hepatitis, HIV, WR antibody tests, an ECG, a chest X-ray and respiratory function tests. You will also have to visit an anaesthesiologist and a therapeutist. Such an integrated approach makes it possible for doctors to accurately assess a patient’s condition as a whole and the nasopharyngeal tonsil in particular, to decide on the type of surgical intervention and detect possible contraindications.

Microsurgical Adenoidectomy

Microsurgical adenoidectomy is a low-impact technique in which our surgeons have achieved perfection. Adenoidectomy is performed under endotracheal anaesthesia.

A shaver is used to remove hypertrophied lymphoid tissues. It is a special microinstrument that makes it possible to cut and immediately remove tissues from the nasopharynx by means of the built-in vacuum aspirator.

During an endoscopy, all stages of the operation are performed under visual control. The image is displayed on the monitor with a strong magnification. This makes it possible to completely remove the whole of the hypertrophied lymphoid tissue, thus avoiding the recurrence of the disease and the regrowth of the adenoids. Microsurgical removal of adenoids under anaesthesia is almost bloodless. Additionally, the doctor uses radiowave coagulation of the blood vessels to debride the bed of the removed tonsil and prevent bleeding in the postoperative period.

Shaver adenoidectomy is a reliable and high-technology way to remove adenoids, after which the risk of complications and relapses is minimal, and the recovery period is shortened.

Classical Adenoidectomy

The operation is performed under general anaesthesia. The doctor removes enlarged adenoids using adenotome ‒ a special ring-shaped knife. Suturing is not required.

The removal of adenoids under general anaesthesia is a small operation that lasts approximately 10-15 minutes.

Depending on the diagnostic data and the patient’s individual characteristics, the otolaryngologist uses one or another type of adenoidectomy.

Maxillary Sinusotomy

Maxillary sinusotomy is surgery to open the maxillary sinus to remove mucus, foreign bodies or pathological masses out of it. The surgical intervention is performed to treat chronic sinusitis with complications, if foreign bodies get into the sinus or if there are polyps, cysts, etc.

The indications for maxillary sinusotomy are:

Microsurgical Maxillary Sinusotomy

The surgeon makes a small hole (4 mm) in the anterior wall of the maxillary sinus. It is accessed under the lip, on the side of the vestibule of the oral cavity, above 4-5 teeth. Under the control of a microscope with different viewing angles, using microinstruments, the doctor examines the sinus cavity and performs the required manipulations: removes pus, cysts, polyps or foreign bodies, irrigates the cavity with a solution for irrigation. After maxillary sinusotomy the hole is sutured. Within a few days a slight swelling in the cheek on the side of the surgical approach may be observed.

Microsurgical Endonasal Maxillary Sinusotomy

In this case access to the maxillary sinus is made without punctures. The doctor widens the natural anastomosis or forms an artificial one in the area of the middle or inferior nasal meatus and inserts a microscope and microinstruments into it. Further manipulations are similar to those performed during microsurgical maxillary sinusotomy.

Caldwell-Luc Radical Antrostomy

With the classical technique, the surgeon makes a 5–6-centimeter incision in the mucous under the upper lip to the bone and moves the tissue aside. Then using a drill or a chisel, the surgeon makes a hole in the anterior wall of the sinus through which instruments are inserted. After that, through the anastomosis, the doctor places a drain in the middle meatus, removes purulent contents from the sinus and irrigates the cavity. The operation is completed by suturing the incision of the mucous membrane.

As a rule, all types of maxillary sinusotomy are performed under general anaesthesia (endotracheal anaesthesia). If there are contraindications to this type of anaesthesia or if the surgery is small, we use local anaesthesia.

Vasotomy of Nasal Turbinates

Vasotomy is a surgical procedure aimed at destroying the blood vessels of the nasal turbinates and reducing the volume of the mucosa. Tissue hypertrophy results from chronic or vasomotor rhinitis, in patients with hypotension and some endocrine diseases. Vasotomy will help restore normal breathing and get rid of stuffiness in the nose. Otolaryngologists of German clinics perform this operation using modern techniques.

The indications for vasotomy are:

Nasal breathing disorders, caused by constant swelling of the mucous membrane, leads to insomnia, constant headaches, and in severe cases to maxillary sinusitis, hearing impairment and the formation of polyps. If the ENT doctor has diagnosed you with vasomotor rhinitis and conservative therapy has proven ineffective, do not refuse the operation.

Radiowave Vasotomy

This is the most sparing technique to restore the normal volume of the nasal turbinate mucous membrane. The procedure is performed on an outpatient basis under local anaesthesia or intravenous sedation by means of bipolar forceps of a radiowave device. As soon as the patient is under the effect of anaesthesia, the doctor inserts the electrodes into the inferior nasal turbinates and affects the soft tissues for 30 seconds. Then the electrodes are removed and the procedure is over. During radiowave exposure the vessels are coagulated, the mucosal volume is normalized and nasal breathing is restored. Radiowave vasotomy is easily tolerated by patients. It is not accompanied with bleeding, there is no need to tampon, and 1-2 hours after the procedure you will be able to leave the clinic.

Instrumental Vasotomy

If for some reason it is impossible to perform radiowave vasotomy, the doctor will offer you the traditional technique. In this case the surgery is performed on an inpatient basis under local anaesthesia or endotracheal anaesthesia. The ENT surgeon makes a soft tissue incision with a scalpel and inserts a rasp into it. Through the use of this instrument the vessels are mechanically destroyed. After the operation, tampons are inserted into the nasal passages. They must be worn for 1-2 days, during the inpatient stay. The duration of the procedure is up to 40 minutes.


Septoplasty is surgery to correct the nasal septum, during which the correction of the cartilage and bone tissues of the nasal septum is performed inside the nose. The operation is performed for medical reasons. If the patient wants to correct the shape of the nose for aesthetic reasons, they need to contact a plastic surgeon. Deviation may occur as a result of nose injuries, including birth injuries, rickets, hereditary predisposition, growth characteristics of the bones of the skull.

The indications for septoplasty are:

The abnormality in the structure of the nasal septum leads to difficulty in nasal breathing, dry mouth, snoring, frequent diseases of the paranasal sinuses, allergic rhinitis, etc. If these symptoms are familiar to you, and doctors have found that you have nasal septum deviation, do not refuse the operation. Its timely implementation will rid you of many problems.

Microsurgical Septoplasty

In clinics in Germany surgery on the nasal septum is performed by using a sparing surgical technique ‒ microsurgical septoplasty. With this method, access to the septum is from the inside ‒ from the nasal mucosa. Due to this, the patient does not have visible scars on the nose, and the suture on the mucosa does not cause any discomfort.

The doctor controls each stage of the operation with a microscope. Visual control makes it possible to perform all manipulations with an extremely high precision without affecting the adjacent tissues. Having made the incision, the surgeon removes the soft tissues that interfere with normal breathing, and shifts the bone and cartilage fragments, straightening the septum. At the end of the operation, absorbable sutures that do not require removal are put in.

So that the septum can remain in the desired position, special tampons are inserted into the nostrils. As a rule, the material of the company Miratzel is used. The use of “breathing tampons” makes it possible to minimize the most annoying feeling for the patient ‒ the absence of nasal breathing for several days. In addition, these tampons do not dry to the mucosa, which means that you will not feel discomfort when they are removed.

Depending on the degree of the nasal septum deviation, the operation lasts 30-90 minutes and it is performed under combined endotracheal anaesthesia.

Nasal Polyp Removal

Nasal polypectomy is surgery to remove polyps of the nasal septum mucosa. Polyps can form both in the nasal cavity and in the sinuses. As a rule, conservative treatment is ineffective and, sooner or later, patients require surgery.

Microsurgical Nasal Polypectomy

Polyp removal through the use of modern microsurgical equipment is one of the safest and most effective methods of nasal polypectomy. The procedure is performed under local or general anaesthesia depending on the situation and the patient’s preferences. The surgeon inserts a mini-video camera and a radiowave apparatus into the nasal cavity. The polyp is removed with the stem. The use of microsurgical equipment makes it possible to fully control the course of the operation and considerably reduce the risk of damage to adjacent tissues. In addition, the surgeon can immediately coagulate the bleeding vessels.

Shaver Nasal Polypectomy

In some cases, ENT surgeons perform shaver nasal polypectomy. The use of a special instrument, a shaver, makes it possible to remove the polyp with the stem, chop the tissues and aspirate them out of the nasal cavity. This technique is as safe as possible and provides a shorter rehabilitation period.

Traditional Nasal Polypectomy

It is used only if it is impossible to use the microsurgical technique, when the patient has contraindications to it. The technique of removing polyps in the traditional way is similar to the previous one, but the surgeon cannot immediately stop the bleeding. Immediately after the procedure, tampons are inserted and a bandage is applied. Classical nasal polypectomy is performed on an inpatient basis under endotracheal anaesthesia. The operation lasts from 40 minutes to 1 hour.

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