Fenestration is widening of the sinus fistula. This operation is used in chronic sinusitis. The treatment in German hospitals is carried out using endonasal access. This is a minimally traumatic and at the same time effective manipulation which allows to achieve a complete recovery in most patients. Thanks to the experience of doctors, good equipment, and correct choice of treatment tactics, the risk of relapse after the sinus fenestration is minimal.
Mostly, this surgery is performed in patients with chronic sinusitis, less often – in patients with inflammation of other paranasal sinuses. In total, there are four of such sinuses. In addition to the maxillary, or antrum of Highmore, there are also the following paranasal sinus:
All of them are paired. The sinuses are cavities inside the bone. They are covered with a mucous membrane. Normally, each sinus is connected with the nasal passages, and consequently with the external environment. This ensures their normal aeration (air access) and secretion outflow into the nasal cavity. These connections are called fistulas.
The inflammatory process in the paranasal sinuses is called sinusitis. This is the general designation of the disease. There are also certain terms implying inflammation in one or another sinus. The inflammatory process of the maxillary sinus is called highmoritis, frontal – frontitis, sphenoid – sphenoiditis, ethmoidal – ethmoiditis.
In children, the ethmoid sinus becomes inflamed most often. In adults, this is the maxillary sinus. Not always only one of the sinuses is involved in the pathological process. They are connected, so often two or more sinuses can be inflamed simultaneously. If all of them are inflamed at the same time, then condition is called pansinusitis.
Purposes of the operation
Most often, the fenestration is performed in chronic sinusitis. This type of the disease differs from acute pathology because it is characterized by constant relapses. Relapses occur due to the changes in the mucous membrane and presence of a chronic focus of infection. It is the result of sinus drainage and aeration impairment.
In acute inflammation, it is usually sufficient to prescribe antibiotics. In this case, narrowing of the fistula is temporary. After the attenuation of inflammation, normalization of nasal breathing and destruction of pathogenic microflora, the outflow of the maxillary sinus secretion is normalized. If there is a need for a surgical treatment, a puncture is performed.
The situation is different in chronic sinusitis. The disease exists for years, exacerbating from time to time. This happens due to the pathological changes in the mucosa, as well as in fistula of the maxillary sinus. It closes and the secret outflow becomes impaired. The inflammatory changes progress, this consequently violates aeration of the cavity inside the bone.
The situation can be corrected by improving the outflow of the sinus contents. This is performed using surgical techniques. Depending on the situation, different types of interventions are used. Preference is given to the least radical surgical operations, including fenestration of the maxillary sinus. It does not lead to atrophic changes of the mucous membrane with subsequent impairment of the main functions of the nasal cavity.
In the most favorable case, the operation leads to a complete cure of chronic sinusitis. In most patients, the disease does not progress in the future.
Is it possible to avoid surgery?
Many people are afraid of surgery. They are frightened by possible complications, discomfort, rehabilitation period, etc. Therefore, they do not always decide on the operation immediately. But the treatment of chronic inflammation of the nasal and paranasal sinuses using fenestration should be carried out as early as possible. Otherwise, the following unfavorable effects may occur:
- Irreversible changes in the mucous membrane, as a result, the doctor will have to perform a more radical operation with its removal
- Spreading of infection to the eyes, organs of the respiratory system, including the bronchi and lungs
- Changes in the system of local and humoral immunity
Depending on the stage of the disease, otolaryngologists divide patients into several categories.
The most favorable outcomes are observed in young patients, with disease duration under 5 years. Their morphological changes are usually reversible. During the sinuscopy redness and thickening of the mucous membrane are observed. There is purulent discharge. However, after the fenestration, the mucociliary clearance is restored. The mucous membrane completely returns to normal condition. Its removal is not required, since all the pathological changes quickly regress after a surgery. After correspondent drug therapy, function of the ciliated epithelium is normalized.
The second group of patients includes those ones who are ill for more than 5 years. The fenestration does not always help them to recover completely. During the operation, it is necessary to additionally remove the hypertrophic mucosal foci. The complete restoration of epithelial function is impossible.
The third group of patients is middle-aged or elderly patients who became ill more than 5 years ago. Due to the reduced reactivity, the irreversible changes in the mucous membrane occur. During the sinuscopy doctor reveals cysts, hyalinization of blood vessels, and fibrosis of the basement membrane. Sinus lumen is narrowed because of the polyps. The mucociliary clearance is completely absent. In this case, it is necessary to carry out a more extensive operation. Almost always the maxillary sinusotomy is performed, since it allows a doctor to remove all the altered areas of the mucosa.
Thus, earlier the operation is performed, more sparing it will be. Patients recover faster. The risk of complications is lower. The residual effects are less pronounced. It is also possible to completely restore function of the nasal cavity after the operation and necessary drug therapy.
Benefits of treatment in Germany
Many people prefer to contact the hospitals of Germany in order to carry out the fenestration of the paranasal sinuses. The procedure is performed with modern equipment here. It is an endoscopic operation that does not require large incisions and minimally damages soft tissues.
In Germany, doctors use sparing techniques while working with the bone tissue. A new fistula is formed in a minimum size which is sufficient for prevention of recurrent sinusitis in the future. At the same time, small size of the fistula allows to avoid further atrophic processes of the mucosa.
Fenestration is a safer surgery than the classical interventions which can be performed in chronic sinusitis. In addition, it is more effective. The researches show that in the late postoperative period the extended fistula persists in 90-98% of patients. At the same time, traditional interventions do not give relapses only in 50-76% of cases.
The operation can be performed under the local or general anesthesia. The choice of anesthesia depends on the volume of intervention. In any case, anesthesia will be of high quality so that a patient does not have any negative memories about the operation.
During the postoperative period, a person is provided with a good care. The sinus irrigation is carried out. The drug therapy is prescribed. The patient rooms in German hospitals are equipped with everything necessary for a complete recovery.
Organization of treatment
In Germany, the latest technologies are used, the best doctors of the world work, the most modern operations are carried out including the fenestration of paranasal sinuses. Many patients prefer to visit this country for a treatment, as it allows to achieve the best results, reduce the risk of recurrence, as well as to minimize the potential complications.
If you want to visit Germany for treatment, the company Booking Health will help you. We are the leaders in the field of medical tourism. If you contact us, you will have many advantages, such as:
- We will help you in selecting the hospital that specializes in such operations and has the best statistics of a relapse-free recovery.
- We will assist in communication with the administration of the hospital and your doctor.
- Costs of the treatment are reduced by 50%, because we will agree on the favorable price of the operation, all medical and rehabilitation measures, without overpricing and additional coefficients for the foreign patients.
- When the disease will be diagnosed, you will not have to repeat tests and instrumental examinations which were performed previously.
- You can receive treatment in Germany as soon as possible, as we will reduce the waiting time.
- We will help you to buy and send the medicines to your country.
- The treatment program will be under our complete control.
- If necessary, we will organize additional diagnostic and therapeutic procedures.
- We will provide communication with the hospital after the completion of therapeutic program in order to monitor the treatment results.
- We provide service of the highest level: transfer from the airport to the hospital, booking plane tickets and hotels.
All financial arrangements are transparent. You will have access to your funds and will be able to always see how much money you have spent on this or that procedure. All unclaimed funds will be returned to your banking account.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova