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.
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.
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.
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.
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......
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.
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?
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.
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.
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!
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.
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.
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.
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.
Actually, my Dr. is the "OLD TIMER" in the area now and he has done these in the past. He's willing to do it but he doesn't want to make the final decision if there's something else he's missing. They would have sent me to University of Iowa but the Dr. that My Dr wants me to see just left to go to Mayo so that's why I'm going there. The other Dr. He respected was in Omaha but just left for one of the coasts. I have complete confidence in my Dr. and even more so that he's willing to pass me off to the best place possible to have a 2nd opinion. I have done plenty of reasearch and understand how this works. It was something my last ENT was discussing with me about 9 years ago before he left and passed me on to this Dr. That's why I keep asking you the questions of how you feel, if the swelling is down, etc. Does your head feel "FUNNY", what did they fill it with. Etc. These are questions my ENT can't answer for me so I need to turn to someone like you who's been there before me.
Because you haven't answered directly I'm going to assume you are still dealing with some issues. If that's the case I'm sorry to hear it. One of my co-workers brothers has had the surgurey and I believe that he's had a lot of issues after his and I think it was something similar to yours with a growth of some kind in the sinus cavity if I understand what you went through correctly. I would agree that it takes a special person to jump in and do this type of thing when there are so many other options available. I do hope that you are improving after what you have gone through. Cool my man, thanks for posting.
Last edited by moderator2; 02-06-2012 at 05:18 AM.
What do they fill it with? Very simple: when you wake up from the surgery, you'll find an incision on your stomach which was opened up--along with all the work done on your sinus/head--and from which was harvested a supply of your own fat which is used to fill the now obliterated sinus. You'll also find you have a cathether--you know where it will be. You head will be bandaged very tightly to keep everything in place as well as to protect the staples that will be there. There will also be two tubes coming down from the area of the obliteration to drain any residual fluid and/or blood. Frankly, you're a scary sight. Another item: your head swells to a rather remarkable degree. I thought I had two large bandages on my head but I was incorrect. There was only one. The perception of the second bandage was caused by the swelling. The extent of the forehead and top of the head involved in the operation makes the elimination--or control at the VERY least..of ANY infection is totally imperative. Why? The area involved is so big that were an infection to occur, it could, very quickly, get out of hand. Also, the issue of fever is of extreme importance. I left the hospital on Sept 17--eight days after the actual obliteration and thirteen days from the drainage of the eye socket on the 4th. I've had absolutely no complications since then and an MRI to make sure we hadn't missed anything. There's still some swelling but have made remarkable progress. My surgeon is extremely pleased. I look at him like Jerry Rice looked at Coach Bill Walsh: the Genius.
Yea, I knew one of the options was fat from the tummy. I also know that they use the hydroxy cement but that turns into an issue sometimes because if it gets re-infected it's tough to clean out and can get infected as well. That's why I didn't know what route they went with you. The swelling and time out is really un-nerving to say the least. I wasn't aware of re-coup time....also didn't know it would re-quire so much time enjoying the finer quiseen(SP) of the hospital. I remember the 2 nights (Different surguries) I had to spend when they cut me open by the eye/nose area. That seemed so brutal then but a walk in the park by your standards. Glad to hear that you are recovering and things seem to be doing well. I think the last thing I'm still curious about, I understand there's a lot of healing going on right now which is tough to give a final answer on but does the sinus area feel different now that it's been cleaned out and filled with fat. Does it feel heavy at all? Do you have any headaches? Again, congrats on the continued improvement
No problem with the sinus area...no heaviness or dizziness/vertigo. No problem of any kind really. I haven't even seen my surgeon in four months. After the MRI, things went quiet with him--mostly due to the results. "The Genius" did the endoscopic surgery in April which shut down the orbital cellulitis--and it hasn't reappeared. The obliteration was made necessary by the leakage of the sinus above the left eye draining directly into it. Some advantages came as the result of my lifestyle--and there may be those who disagree with my diagnosis--but I've been a vegetarian for forty-two years (and hadn't visited a doctor throughout that time until the orbital ) and I think that issue helped out mightily. Frankly, this story, in my opinion, will be a case of "one and done" and I'm even now sinking back into obscurity where I'll most likely stay. The entire remainder of my family has died off due to various lethal cancers. Why am I here? Who knows? The very best of luck to you.
Looks like after a very rough times things have improved a lot which is good news. I know this is an operation that not many Dr's do anymore with the newer options so I'm sure your answers will help anyone that's facing this operation in the future, not just me. You and GCSjr have been a great source of information on this thread so thanks to both of you.
Best of luck on continued improvement and good health!