Editing Sinusitis (section)

===Surgery===
For sinusitis of dental origin, treatment focuses on removing the infection and preventing reinfection, by removal of the [[microorganism]]s, their byproducts, and pulpal debris from the infected [[root canal]].<ref name="American Association of Endodontists-2018"/> Systemic [[antibiotic]]s are ineffective as a definitive solution, but may afford temporary relief of symptoms by improving sinus clearing, and may be appropriate for rapidly spreading infections, but [[debridement]] and disinfection of the root canal system at the same time is necessary. Treatment options include non-surgical [[root canal treatment]], [[periradicular surgery]], [[tooth replantation]], or extraction of the infected tooth.<ref name="American Association of Endodontists-2018">{{cite web |title=Maxillary Sinusitis of Endodontic Origin |url=https://www.aae.org/specialty/wp-content/uploads/sites/2/2018/04/AAE_PositionStatement_MaxillarySinusitis.pdf |website=American Association of Endodontists |access-date=26 March 2019 |date=2018 |archive-date=26 March 2019 |archive-url=https://web.archive.org/web/20190326020125/https://www.aae.org/specialty/wp-content/uploads/sites/2/2018/04/AAE_PositionStatement_MaxillarySinusitis.pdf |url-status=live }}</ref>

For chronic or recurring sinusitis, referral to an [[Otolaryngology|otolaryngologist]] may be indicated, and treatment options may include nasal surgery. Surgery should only be considered for those people who do not benefit with medication or have non-invasive fungal sinusitis<ref>{{cite web |last=Meghanadh |first=Dr Koralla Raja |date=2022-12-16 |title=Fungal sinusitis - causes, symptoms, and treatment |url=https://www.medyblog.com/post/fungal-sinusitis-causes-symptoms-treatment-noninvasive |access-date=2023-05-05 |website=Medy Blog |language=en |archive-date=2023-05-05 |archive-url=https://web.archive.org/web/20230505104623/https://www.medyblog.com/post/fungal-sinusitis-causes-symptoms-treatment-noninvasive |url-status=live }}{{Unreliable medical source|date=February 2024}}</ref>{{Unreliable medical source|date=February 2024}}.<ref name="pmid17844873"/><ref>{{cite web |url=http://www.sinuses.com/faq.htm#surgery |title=FAQ — Sinusitis |access-date=2007-10-28 | vauthors = Tichenor WS |date=2007-04-22 |url-status=live |archive-url=https://web.archive.org/web/20071101052144/http://www.sinuses.com/faq.htm#surgery |archive-date=2007-11-01 }}</ref> It is unclear how benefits of surgery compare to medical treatments in those with nasal polyps as this has been poorly studied.<ref>{{cite journal | vauthors = Rimmer J, Fokkens W, Chong LY, Hopkins C | title = Surgical versus medical interventions for chronic rhinosinusitis with nasal polyps | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 12 | pages = CD006991 | date = 1 December 2014 | pmid = 25437000 | doi = 10.1002/14651858.CD006991.pub2 | pmc = 11193160 }}</ref><ref>{{cite journal | vauthors = Sharma R, Lakhani R, Rimmer J, Hopkins C | title = Surgical interventions for chronic rhinosinusitis with nasal polyps | journal = The Cochrane Database of Systematic Reviews | issue = 11 | pages = CD006990 | date = November 2014 | volume = 2014 | pmid = 25410644 | doi = 10.1002/14651858.cd006990.pub2 | pmc = 11166467 }}</ref>

A number of surgical approaches can be used to access the sinuses and these have generally shifted from external/extranasal approaches to intranasal [[endoscopic]] ones.  The benefit of [[functional endoscopic sinus surgery]] (FESS) is its ability to allow for a more targeted approach to the affected sinuses, reducing tissue disruption, and minimizing post-operative complications.<ref>{{cite journal | vauthors = Stammberger H | title = Endoscopic endonasal surgery--concepts in treatment of recurring rhinosinusitis. Part I. Anatomic and pathophysiologic considerations | journal = Otolaryngology–Head and Neck Surgery | volume = 94 | issue = 2 | pages = 143–7 | date = February 1986 | pmid = 3083326 | doi = 10.1177/019459988609400202 | s2cid = 34575985 }}</ref> However, if a traditional FESS with Messerklinger technique is followed the success rate will be as low as 30%, 70% of the patients tend to have recurrence within 3 years.<ref name="Medyblog-Meghanadh-2023">{{cite web |last=Meghanadh |first=Dr Koralla Raja |date=2023-02-07 |title=Sinusitis Surgery: An Overview of the Different Technologies |url=https://www.medyblog.com/post/sinusitis-surgery-types-fess-endoscopic-tfse-debriders-navigation-guided-balloon-sinuplasty |access-date=2023-05-05 |website=Medy Blog |language=en |archive-date=2023-05-05 |archive-url=https://web.archive.org/web/20230505101613/https://www.medyblog.com/post/sinusitis-surgery-types-fess-endoscopic-tfse-debriders-navigation-guided-balloon-sinuplasty |url-status=live }}{{Unreliable medical source|date=February 2024}}</ref>{{Unreliable medical source|date=February 2024}} On the other hand with use of TFSE technique along with navigation system, debriders and balloon sinuplasty or EBS can give a success rate of over 99.9%.<ref name="Medyblog-Meghanadh-2023" />{{Unreliable medical source|date=February 2024}} The use of [[Bioresorbable stents|drug eluting stents]] such as [[propel mometasone furoate implant]] may help in recovery after surgery.<ref>{{cite journal | vauthors = Liang J, Lane AP | title = Topical Drug Delivery for Chronic Rhinosinusitis | journal = Current Otorhinolaryngology Reports | volume = 1 | issue = 1 | pages = 51–60 | date = March 2013 | pmid = 23525506 | pmc = 3603706 | doi = 10.1007/s40136-012-0003-4 }}</ref>

Another recently developed treatment is [[balloon sinuplasty]]. This method, similar to [[balloon angioplasty]] used to "unclog" arteries of the heart, utilizes balloons in an attempt to expand the openings of the sinuses in a less invasive manner.<ref name="pmid21735433" /> The effectiveness of the functional endoscopic balloon dilation approach compared to conventional FESS is not known.<ref name="pmid21735433" />

[[Histopathology]] of sinonasal contents removed from surgery can be diagnostically valuable:
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File:Histopathology of sinonasal inflammatory polyp with mixed inflammation, annotated.jpg|'''Benign chronic mixed inflammation''' of an inflammatory sinonasal polyp
File:Histopathology of acute sinusitis.png|'''Acute inflammation''' characterized by [[neutrophil]]s
File:Histopathology of extranodal NK-T cell lymphoma, nasal type.png|'''[[Extranodal NK/T cell lymphoma, nasal type]]'''.<ref>{{cite journal| author=Takahara M, Kumai T, Kishibe K, Nagato T, Harabuchi Y| title=Extranodal NK/T-Cell Lymphoma, Nasal Type: Genetic, Biologic, and Clinical Aspects with a Central Focus on Epstein-Barr Virus Relation. | journal=Microorganisms | year= 2021 | volume= 9 | issue= 7 | page=1381 | pmid=34202088 | doi=10.3390/microorganisms9071381 | doi-access=free | pmc=8304202 }}<br>- "This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/ {{Webarchive|url=https://web.archive.org/web/20171016050101/https://creativecommons.org/licenses/by/4.0/ |date=2017-10-16 }})."</ref> It may be incidentally discovered in people undergoing surgery for sinusitis.<ref name="pmid28652944">{{cite journal| author=Althoff A, Bibliowicz M| title=Extranodal Natural Killer/T-Cell Lymphoma: An Incidental Finding. | journal=Cureus | year= 2017 | volume= 9 | issue= 5 | pages= e1260 | pmid=28652944 | doi=10.7759/cureus.1260 | doi-access=free | pmc=5476476 }}</ref> 
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