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Old 10-06-2011, 04:40 AM   #1
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Sinus Drillout Vs Obliteration

Hey all, I have watched the threads here off and on for the past year but finally feel the need to post. I have had 6 sinus surgeries since 1999. I keep plugging up over my left eye because of scar tissue. I went down the route of the deviated Septum first, then a few weeks later I was plugged from scar tissue so they cut me open by my eye (under the eybrow down my nose a bit). It was good for about a year then plugged up and they went in with the 3D guided drill bit. Open for about a year or so then rotating atibiotics for about 7 months. My ENT moved so I started going to someone new. This Dr cut me open by the eye again and opened up between the 2 upper sinus cavities so the left could drain right and down. That worked for about 8 years. To keep long story short, last year I plugged up again. Dr was used the balloon on me but had to cut me open by the eye again to get in and clean things out. They put a stent in for about 6 months. I would get stuffy over summer but it stayed open. A couple of weeks ago I plugged up again. Much of my problem stems from having very narrow drain tubes from the upper sinuses, the Dr. said I'm rather difficult to work on.
Anyhow i'm down to the point that my last options are the sinus drillout or Obliteration (which I really want to avoid). It's tough to find where people have talked about the drillout and side effects so I'm wanting to know if anyone here has had it? If so, how was your success and long term? Any advice? I know that the snot doesn't always drain correctly so I may have to go in and get sucked out now and then.

Thanks,
Randy

 
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Old 10-06-2011, 07:50 AM   #2
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Re: Sinus Drillout Vs Obliteration

I had 3 endoscopic procedures between 1995 and 2000 before finally having the drillout procedure (Endoscopic Modified Lothrop/Draf III) in February 2001 (and I too have done all that I can to avoid the obliteration procedure).

The drillout procedure wasn't noticeably more painful or difficult from a recovery standpoint than the earlier endoscopic procedures and gave me 10 years of decent relief with no real side effects (I still get periodic infections that require antibiotics and steroids and had to have a minor balloon procedure earlier this year to open the left passageway which had finally closed up).

Based on my experience the key to the success of all of this is a surgeon who has lots of experience with the drillout procedure, who has access to the 3-d imaging equipment, and whose practiced is structured in a way that allows the ENT to provide the follow up that is necessary to help insure a good outcome (e.g. lots of of follow up appointments for debridement to help minimize scar tissue).

Given your location, I would recommend that you go see Dr. Donald Leopold at the University of Nebraska Medical Center in Omaha. Dr. Leopold did my drillout because there was nobody in Kansas City (where I lived at the time) who had the experience to do the drillout procedure, and for 9 years I gladly drove 3 hours each way to see him 4-5 times a year because he was so much more knowledgeable and skilled than the "best" ENT I had seen in Kansas City (the chairman of the ENT department at KU Med who performed an endoscopic procedure that had to be re-done by after just 6 months), plus he's a kind, and thoughtful Doctor who really cares about his patients.

 
Old 10-07-2011, 05:24 AM   #3
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Re: Sinus Drillout Vs Obliteration

Thanks for the response. I actually have a lot of faith in the DR I have, he's been around Des Moines for a long time and is in the "BIG CLINIC" here (Which I know doesn't always mean they know their stuff, they can market well). Before I started with him about 9 years ago I made trips over to the University of Iowa because the "GURU" of Iowa was over there. They wanted to basically jump into the obliteration at that point. Thankfully my current Dr. didn't and what he did was good for about 8 years. I actually had the 3D CT scan yesterday (that little contraption I had to wear was uncomfortable..I know my nose will hurt like heck after everything is done because of that alone).
One of the things that has had me concerned with this is that 'HALLOW NOSE" syndrom some people talk about. Any issues with that? Also, do you irrigate every day to keep everything flowing? Has everything stayed open for you since the balloon fix?
Thanks so much for your time.
Randy

 
Old 10-09-2011, 04:25 AM   #4
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Re: Sinus Drillout Vs Obliteration

I haven't had any issues with Empty Nose Syndrome (which is generally caused by removal of too much turbinate tissue), but I don't think there's enough understanding of ENS out there to predict who will have symptoms and why the threshold or trigger is.

Your surgeon shouldn't have to remove much turbinate tissue for the drill out procedure but you may want to talk to him and make sure that he's not planning to do any aggressive removal of tissue.

My normal maintenance rotine includes irrigation and Rhinocort AQ aling with occasional bursts of oral steroids. As for the balloon procedure, it seems to have helped but my surgeon warned me that it's probably not a permanent fix (and was only viable because I already had the drill out procedure. He expects that it will have to be re-done at some point because the openings do have a tendency to shrink over time.

 
Old 10-11-2011, 06:02 PM   #5
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Re: Sinus Drillout Vs Obliteration

Randy..

I had to have a sinus obliteration operation on Sept 9th. If there's ANY way out of having this operation, I would take it--and then again, avoiding it might kill you.The swelling of your head is unbelievable and if you have the surgery, your hand won't really recognize your own head. The tightness of the wrap around your head for the first few days causes incredible discomfort (add the tightness of the initial wrap after surgery + the swelling.....you get my drift). Factor in the discomfort of the catheter and you have a recipe for a supreme test of how you handle pain. I'm going on week five after surgery and largely, you have to accept the reality that you won't be able to feel almost half of your head due to loss of sensation from the initial cut to expose the diseased sinus and any other diseased bone areas that prompted the operation in the first place (the trans-eyebrow or the cut from ear-to-ear [like an autopsy]. Let's face it, this is a SERIOUS operation and some aspects of it may NEVER be recovered from. And what about hair loss? It goes on and on......

 
Old 10-12-2011, 06:58 AM   #6
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Re: Sinus Drillout Vs Obliteration

Thanks for the feedback...sounds very brutal. I have really been trying to do everything I can to avoid either of these. Even giving the peroxide flush a try...at this point I don't figure I have much to lose. Please keep us informed of your recovery and how you are doing.

Best,
Randy

 
Old 01-28-2012, 05:07 PM   #7
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Re: Sinus Drillout Vs Obliteration

The ENT is sending me on to Rochester in Mn for a 2nd opinion before they move on to another round of surgury. It'll either be the drillout or obliteration. One of the things dr said was that with the drill out people tend to have a lot of mucus buildup in their sinuses that has to be cleaned out. Have you had issues with this GCSJR?

Marsh, how are you doing after the obliteration?

 
Old 01-30-2012, 03:02 AM   #8
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Re: Sinus Drillout Vs Obliteration

Rsierra1025-

I haven't had any issues with mucus buildup since the drill out procedure (which was 10 years ago), and I'm not even 100% sure what your doc could be referring to given that he drillout procedure simply creates new drainage pathways for your frontal sinuses which significantly improves drainage.

From what I've been told, the biggest concern with the drillout procedure is the tendency for the openings to close up (which happened to me after 9 years), but a quick balloon endoscopy can address that without the need for an additional invasive procedure.

Best of luck at Mayo.

 
Old 01-30-2012, 05:03 AM   #9
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Re: Sinus Drillout Vs Obliteration

That's great to hear you didn't have issues with mucus. Dr told me that it's something about opening up the sinuses to one cavity like that where the mucus doesn't drain correctly and tends to build up for some people. If that happens the ENT has to go in and clean it out once in a while and you have to make sure you irrigate all the time. Apparently he has about 5 people with this thickening issue. If the long term issue is closing and the balloon procedure will open it back up for a while that's not bad and should be pretty painless considering how open you are at that point. How has your balloon update worked out? Apparently my upper sinus drainage tubes are very narrow and the right sinus is much larger than the left sinus which part of the problem. Thanks for all of your feedback.

 
Old 02-02-2012, 06:52 AM   #10
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Re: Sinus Drillout Vs Obliteration

Hey Dogg..

I never had the balloon procedure done. It went from 1. orbital cellulitis to 2. endoscopic sinus surgery to 3. the sinus obliteration. The left sinus was draining directly into my left eye. The surgeon thought that the problem had been contained by way of the first operation but, unfortunately, it had not. Sinus obliteration is a gruesome operation. The only way to access the problem sinus is to make an extensive incision either at the top of the head and pull the top part of the face and forehead down or go up from the eyebrows. Either way, the surgeon has to evaluate whether or not you are a serious candidate for the type of healing that must occur to get over the operation. If your immune system had been compromised or you had extensive infections or a history of fevers, I'm not sure he would do it. The very best of luck to you!

 
Old 02-02-2012, 11:15 AM   #11
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Re: Sinus Drillout Vs Obliteration

marsbonfire29-

I'm not sure when you had your procedure done but there are currently MANY surgeons doing sinus obliteration with a much less invasive approach. Instead of the coronal incision that you had, they make a very small incision in the eyebrow and perform the rest of the procedure using endoscopic instruments.

The specific procedure is referred to as "endoscopic frontal sinus obliteration" and the recovery period is much shorter and less painful than what you experienced (without the loss of sensation).

I just didn't want to freak out Rsierra unnecessarily.

Last edited by gcsjr; 02-02-2012 at 01:32 PM.

 
Old 02-04-2012, 04:18 PM   #12
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Re: Sinus Drillout Vs Obliteration

It's all good. I know my options are getting limited. As i've mentioned I've had 7 go rounds over all...3 this past year alone. I know they typically obliterate both frontals while they are up there but I'm curious on why they couldn't do just one. If they could do that I would for SURE be in for the eyebrow cut. I've had a dead forehead before from my cut on the side of my nose so it wouldn't be that big of a deal Vs that nasty ear ot ear thing. I guess with your experience GCSjr I really am more interested at this point on the drill out but I guess we'll see what Mayo tells me. I go on the 21st. Of course I'll give an update when I find out more. Thanks for contributing to the board so people that aren't quite as bad off as you (or me at this point) have a place to share concerns.
Randy

 
Old 02-05-2012, 10:38 AM   #13
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Re: Sinus Drillout Vs Obliteration

Hey yo...

That 9-hr obliteration operation has made me slow down and enjoy the sights above ground while I can. Take care of yourself. Seeing tomorrow is enough for me.

Peace!

 
Old 02-05-2012, 02:33 PM   #14
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Re: Sinus Drillout Vs Obliteration

Marsh, you speak the truth on that. I'm still curious, how are you feeling now that you are a couple of months out. I'm sure it's not 100%. Is your forehead still puffy or back to normal. How are you feeling? Did they use Fat or hydroxy cement to fill your sinus when they were done? Does your head feel "DIFFERENT" not having the sinus cavities now? I'm sure I have more questions but that 9 hours....YIKES. I think my longest one to date was 4 and that was my 2nd or 3rd one.

Thanks for all your feedback as well.

 
Old 02-05-2012, 02:56 PM   #15
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Re: Sinus Drillout Vs Obliteration

Hey bro...

The fact that you've mentioned the Mayo Clinic underscores a hard fact: only the very top guns of an otolaryngology department do the operation. Your surgeon not only has to displace your forehead, he has to cut out the offending part of your skull and diamond-sand the infected part of it away. After that, the skull bone is replaced as well as your forehead and scalp. I can only imagine the nerves of steel and stamina a doctor has to have to perform this. A job for superman? This is it.

Peace

 
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