Question: My daughter had septorhinoplasty and sinus surgery four months ago. 2 weeks after surgery she started experiencing pressure in he the top of her head and her frontal sinuses. Her ENT diagnosed her with sinusitis and treated her accordingly. However, the pain did not subside. The ENT decided to do a second surgery to open the frontal sinuses to see if that would relieve any pressure. Nothing has improved since the second operation and have been referred to pain management and she was prescribed Cymbalta 60mg. She has been on the medication for 4 weeks and no improvement. I would like your professional opinion on what could be causing her constant pressure.
Answer:
First of all, thank you for your question. I wish I could diagnose your daughter’s problem from just a description, but clearly, she would need to be seen for me to give you a clear answer as to the cause of her pain and pressure.
One must realize, however, that facial pressure does not always come from a sinus infection, and may not, therefore, be helped with sinus surgery. A certain amount of facial pressure can be normal post-operative discomfort from a rhinoplasty. The bony cuts that we make extend all the way up to the root of the nose, near the forehead. Facial pain can come from muscle spasms, dental problems or problems with the bite, other types of headaches, and sometimes even reflux from stomach acid contents.
In general, one would like to figure out the cause of this (or any symptom) before just treating the symptom, without treating the cause. We believe at the NY Sinus Center, that too often, physicians do not get to the bottom of their patients’ problems, before treating. An in-depth analysis of the patient’s medical problems is an essential part of our evaluation, before treatment.
I hope this helps.
Robert L. Pincus MD
Co-Director New York Sinus Center/ NY Otolaryngology Group
Associate Professor Otolaryngology
Frequently Asked Questions
Constant pressure after septorhinoplasty and sinus surgery may not always be due to sinus infections. Besides sinus issues, facial pressure can result from post-operative discomfort, muscle spasms, dental problems, bite issues, different types of headaches, or even acid reflux. Proper diagnosis by a specialist is essential to determine the actual cause.
No, facial pressure is not always due to sinus infections. It can also arise from post-operative healing processes, muscle spasms, dental or bite-related problems, headaches, or acid reflux. Each cause requires specific evaluation and treatment depending on the underlying issue.
Sinus surgery may not relieve facial pressure if the underlying cause is not sinus-related. Since facial pressure can arise from multiple sources including nerve irritation, muscle spasms, or dental issues, surgery targeting sinuses alone might not address the root cause, highlighting the need for thorough evaluation.
Persistent facial pressure after sinus surgery should be evaluated through comprehensive medical analysis to identify the exact cause. This includes reviewing patient history, conducting physical exams, and considering other causes such as muscle spasms, headaches, dental problems, or acid reflux before deciding on further treatment.
Post-operative discomfort after septorhinoplasty can lead to a certain amount of facial pressure, especially since the surgery involves bony cuts up to the nasal root near the forehead. This discomfort can mimic sinus pressure but may resolve as healing progresses without additional treatment.
Identifying the underlying cause before treating facial pressure is crucial to ensure appropriate and effective treatment. Treating only the symptom without understanding its origin may lead to persistent pain and ineffective interventions. Comprehensive evaluation prevents unnecessary or incorrect treatments.
Alternative causes for facial pressure include muscle spasms, dental problems, bite misalignment, different headache types, and gastrointestinal issues like acid reflux. These conditions may present with similar symptoms to sinusitis but require different management approaches.
