The surgery, called functional endoscopic sinus surgery (FESS), may be done either under local anesthesia or general anesthesia. Many very experienced sinus surgeons prefer to use local anesthesia. The operation generally takes approximately 2-3 hours. During that period of time, the ear, nose and throat doctor will do any one of a number of things including: straightening the septum (the bone and cartilage separating the two sides of your nose), making an opening into the sinus(es) on either side of the nose so that drainage can occur more effectively, and possibly remove some of the inflamed lining of the sinuses. The number of sinuses which need to be opened up depends on the nature of your problem. (For a better understanding, look at the CT scan section after you finish the FAQ page)
The surgeon uses a rigid tube (endoscope) which is inserted into the nose. The entire operation is done through the nose. Previously, the surgery was done using an incision underneath the lip called a Caldwell-Luc procedure. This caused an extended post-operative healing time as well as occasional loss of sensation in the face and was not nearly as effective as the current surgery.
The current surgery involves opening up the naturally occurring openings (ostia) from the sinuses into the nose. (They are at the top of the sinuses). The older procedure involved making a drainage hole in the bottom part of the nose, with an extensive amount of removal of tissue from inside the nose. It was logical, but unfortunately it didn't work as well because mucus flows upwards toward the top of the sinus aided by tiny hairs called cilia. In addition, removal of the tissue from inside the sinuses caused scarring, so that now very little tissue is removed from inside the sinuses.