Functional endoscopic sinus surgery has provided an important advance in the surgical management of sinusitis. Patients with recurrent or chronic sinusitis who fail to respond to vigorous medical management may be candidates for this procedure. The patient should undergo a detailed preoperative evaluation, which usually includes a sinus CT scan. Surgery is performed using either local anesthesia with sedation or general anesthesia. This technique restores patency and allows normal ciliary action to transport mucus to the natural ostium.
Complications are uncommon when the procedure is performed by a skilled surgeon.
The potentially life-threatening complications of sinusitis have become uncommon in the antibiotic era. However, frontal sinusitis can lead to osteomyelitis of the frontal bones, especially in children. Patients have headache, fever, and a characteristic doughy edema, termed Pott's puffy tumor, over the affected bone. The organisms involved are those responsible for the underlying sinusitis, although S. aureus is more common in osteomyelitis than in sinusitis. Treatment should include decongestants for the sinusitis, high-dose intravenous antibiotics for the osteomyelitis, and surgical debridement when bone destruction is substantial.