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Infundibulotomy: Sinus Surgery Explained
Infundibulotomy is a minimally invasive surgical procedure that widens a narrow drainage channel of the paranasal sinuses to improve ventilation and mucus drainage.
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Infundibulotomy is a minimally invasive surgical procedure that widens a narrow drainage channel of the paranasal sinuses to improve ventilation and mucus drainage.
What is an Infundibulotomy?
Infundibulotomy is a minimally invasive surgical procedure targeting the nose and paranasal sinuses. The aim is to widen the ethmoidal infundibulum – a funnel-shaped drainage channel located in the middle nasal passage through which the maxillary sinus (and partly the frontal sinus) drains mucus into the nasal cavity. The procedure belongs to the group of Functional Endoscopic Sinus Surgery (FESS) techniques and is typically performed using a thin optical instrument called an endoscope.
Indications
Infundibulotomy is recommended when conservative treatments – such as nasal sprays, antibiotics, or decongestants – have not been sufficiently effective. Common indications include:
- Chronic sinusitis (persistent inflammation of the paranasal sinuses, especially the maxillary sinus)
- Recurrent acute sinusitis (repeated episodes of sinus inflammation)
- Anatomical narrowing of the ethmoidal infundibulum that obstructs natural drainage
- Mucoceles or secretion accumulations within the maxillary sinus
- Nasal polyps or inflammatory changes in the middle nasal passage
Surgical Procedure
Infundibulotomy is usually performed under general anesthesia, or in some cases under local anesthesia with sedation. Using an endoscope inserted through the nostril, the surgeon can directly visualize the ethmoidal infundibulum. Specialized instruments are then used to remove the uncinate process and any inflamed or thickened surrounding tissue. This enlarges the drainage pathway of the maxillary sinus, restoring its natural function.
Key Steps at a Glance
- Insertion of the endoscope through the nostril
- Visualization of the middle nasal passage and the ethmoidal infundibulum
- Resection of the uncinate process
- Widening of the natural maxillary ostium (drainage opening)
- Removal of polyps or inflammatory tissue if present
Risks and Possible Complications
As with any surgical procedure, infundibulotomy carries certain risks. However, when performed by an experienced surgeon and with correct indications, these risks are generally low:
- Postoperative bleeding in the surgical area
- Infections or inflammation following the procedure
- Injury to neighboring structures (e.g., orbit, skull base) – very rare
- Scar formation or re-narrowing of the drainage channel
- Disturbances in the sense of smell in rare cases
Aftercare and Recovery
Regular follow-up appointments with an ear, nose, and throat (ENT) specialist are important after the procedure. In the initial period following surgery, nasal irrigation with saline solution and decongestant nasal drops may be used to support wound healing and dissolve crusts. Full recovery typically takes several weeks. When indications are correct and aftercare is thorough, most patients experience a significant improvement in nasal breathing and relief from sinus symptoms.
References
- Fokkens, W. J. et al.: European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020. Rhinology, 58(Suppl S29), 1–464.
- Stammberger, H.: Functional Endoscopic Sinus Surgery. B. C. Decker, Philadelphia (1991).
- Rosenfeld, R. M. et al.: Clinical Practice Guideline: Adult Sinusitis. Otolaryngology – Head and Neck Surgery, 152(2 Suppl), S1–S39 (2015).
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