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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Sinus surgery done, persisting nasal block, increased opacification of maxillary, ethmoid and frontal sinus compared to earlier. Reason?

Hi, I had Moderate paranasal sinus disease. Before surgery, CT results was following: There is some mucosal thickening within the floor of the left frontal sinus that extends into the left frontal ethmoidal recess. There is moderate to marked ethmoid sinus opacification, left greater than right. There is moderate opacification within the sphenoid sinus. There is mild to moderate mucosal thickening within the floor of the maxillary sinuses bilaterally with probable left maxillary sinus fluid level. The right osteomeatal unit appears patent. There is soft tissue obstruction of the left ostiomeatal unit. Asymmetric soft tissue opacification seen within the left nasal cavity which may represent mucosal thickening or polyp formation.. The nasal septum is deviated to the right. Four weeks after surgery, I took CT scan again, and the result was following:The left frontal sinus is completely opacified. The left ethmoid sinuses are nearly completely opacified except for a tiny air bubble in one. The left maxillary sinus is completely opacified. Defect upper medial wall left maxillary sinus is noted which may be postsurgical versus bony destructive change. There is adjacent soft tissue density along the left nasal passages which may represent mucosal thickening and/or polypoid masses. Milder mucosal thickening along the right nasal airways. There is mucosal thickening right maxillary sinus as well as a small amount of fluid and a couple of focal areas of mucosal prominence versus mucous retention cyst or polyps approximate sub-centimeters size. There is a defect in the upper aspect of the maxillary sinus next to the region of the ostiomeatal unit which may be postsurgical. There is some narrowing of the right ostiomeatal unit from mucosal thickening. It appears grossly patent however. Opacification of several right ethmoid air cells noted in mucosal thickening and others. Mucosal thickening in the sphenoid sinus is noted and globular foci suggesting some centimeter mucus retention cysts or polyps. Compared to the prior study there is significantly increased opacification of the left maxillary, ethmoid and frontal sinuses. I wonder if this surgery was done successfully, because now I feel my left nasal blocked. Thanks
Mon, 24 Dec 2012
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ENT Specialist 's  Response
Hi,

Thank you for your query.

1. The healing time after a Sinus Surgery is 4-6 weeks to 4-6 months depending upon the extent of the surgery. Did you have post-op nasal packing? For how long?

2. There is usually a lot of nasal congestion, discharge, crusting and so on for a few weeks after surgery. Have you had a post-op nasal endoscopy and nasal suction & cleaning done?

3. If you can share your CT images (not the reports), I will be able to give you an accurate assessment.

4. Even though it appears that the surgery was inadequate, it may not be so. Use nasal saline washes. 4 weeks was too early for a post-op scan.

Regards.
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