Maxillary Sinusitis: When Surgery is Necessary

Frontal sinusitis

Dear Dr.
Hu,
I am a former patient of yours from Taoyuan.
I previously underwent surgery for sinusitis.
I am now experiencing an increase in the frequency of headaches and have come to the hospital for examination.
The diagnosis indicates inflammation of the maxillary sinus, with fluid accumulation and pus present.
The doctor has suggested that I could either opt for surgery or take painkillers during headache episodes.
(It is worth mentioning that the examination results show that the previous surgical site was well done.)
However, prior to your surgery, during my first operation at Chang Gung, the cartilage between the maxillary sinus and the eyeball was removed by the doctor.
As a result, the inflamed area is now pressing against the eyeball and is close to the optic nerve, which increases the surgical risk.

I would like to seek your professional opinion on whether surgery is the necessary first choice in this situation.
Additionally, could you advise if this condition might affect my vision in the future? I would greatly appreciate your response.
Thank you!

Hank, 40~49 year old female. Ask Date: 2011/04/28

Dr. Hu Kexin reply Otolaryngology

Hello, in response to your question, based on your description, your situation is more complex than that of a typical patient.
Further clinical examinations and imaging studies such as a CT scan may be necessary to determine the appropriate treatment options.
I cannot provide a definitive answer based solely on your brief description.
The training and development of an otolaryngologist is rigorous, and specialists must meet certain standards.
Therefore, I recommend discussing your case with your current attending physician to seek the best solution.
If you truly need further assistance, feel free to reach out again.
Wishing you a speedy recovery! Sincerely, Dr.
Huxin, Otolaryngology.

Reply Date: 2011/04/28

More Info

Maxillary sinusitis, or inflammation of the maxillary sinus, can present a complex clinical scenario, especially when complications arise or when previous surgical interventions have altered the anatomy of the area. In your case, the presence of fluid accumulation and pus within the maxillary sinus, along with recurrent headaches, suggests that the sinusitis may be more than just a mild infection.
When considering whether surgery is necessary, several factors must be evaluated. First, the severity of the symptoms plays a crucial role. If the headaches are frequent and debilitating, and conservative treatments such as pain management and antibiotics have not provided relief, surgical intervention may be warranted. The goal of surgery in cases of maxillary sinusitis is to restore normal drainage of the sinus and to remove any obstructive tissue or infected material.

Your previous surgery, which involved the removal of cartilage between the maxillary sinus and the eye, adds a layer of complexity to your current situation. The proximity of the inflamed sinus to the eye and optic nerve raises valid concerns regarding the risks associated with further surgical intervention. The potential for complications, such as damage to the optic nerve or the eye itself, must be carefully weighed against the benefits of alleviating your sinus symptoms.

In general, surgery for maxillary sinusitis is indicated when:
1. There is a failure of medical management after an adequate trial (typically several weeks of antibiotics and symptomatic treatment).

2. There are complications such as abscess formation, orbital involvement, or significant anatomical changes that impede sinus drainage.

3. The quality of life is severely affected due to persistent symptoms.

In your case, the recommendation for surgery should ideally come from a thorough evaluation by an experienced ENT specialist who can assess the risks and benefits specific to your anatomy and medical history. Imaging studies, such as a CT scan, can provide valuable information about the extent of the disease and the relationship between the sinus and surrounding structures.

Regarding the potential impact on your vision, any surgical procedure in the vicinity of the eye carries inherent risks. However, if the surgery is performed by a skilled surgeon with experience in managing complex sinus cases, the risks can be minimized. It is essential to have a detailed discussion with your surgeon about these risks and to ensure that they are comfortable with the surgical approach given your unique circumstances.

Ultimately, the decision to proceed with surgery should be made collaboratively between you and your healthcare team, taking into account your symptoms, the risks involved, and your overall health status. If surgery is deemed necessary, appropriate preoperative assessments and postoperative care will be crucial in ensuring a successful outcome and minimizing complications.
In summary, while surgery may be necessary for your maxillary sinusitis, the decision should be made with careful consideration of the risks involved, particularly given your previous surgical history and the proximity of the inflamed sinus to critical structures. Engaging in an open dialogue with your ENT specialist will help you navigate this decision effectively.

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