Deep pressure behind the eyes, unexplained headaches, and sinus infections that are never fully clear can sometimes trace back to a very specific place: the sphenoid sinuses, tucked deep behind the nose. When this small but important sinus becomes chronically inflamed or blocked, it can cause symptoms that are frustrating, lingering, and difficult to live with. Dr. David Santos at Sinusitis In Seattle routinely sees patients whose mystery headaches or persistent sinus issues are ultimately linked to sphenoid sinus disease. For many of them, a targeted procedure called sphenoidotomy (also called sphenoid sinusotomy) becomes an important step toward long‑term relief. 

What is Sphenoid Sinus?

The sphenoid sinuses are a pair of air‑filled spaces located deep in the skull, behind the nasal cavity and between the eyes. They sit close to critical structures like the optic nerves, carotid arteries, and the base of the brain, which is why specialized training and experience are essential for safe surgery in this area. 

When the sphenoid sinus becomes inflamed or blocked due to infection, polyps, fungal disease, or other issues it can cause:

• Persistent or deep headaches (often felt behind the eyes, at the top of the head, or in the back of the skull).
  
• Facial or eye pain and pressure.
  
• Blurry vision or visual disturbances in severe cases.
  
• Ongoing post‑nasal drip or congestion that doesn’t respond to usual treatments.

Because the sphenoid sinus sits so far back, problems here may not show up as obvious nasal congestion right away and can be easy to miss without advanced imaging and nasal endoscopy. 

What Is Sphenoidotomy (Sphenoid Sinusotomy)?

A sphenoidotomy is a sinus surgery that creates or enlarges the natural opening of the sphenoid sinus so it can drain properly. In modern practice, this is almost always done using endoscopic techniques- very slim cameras and instruments passed gently through the nostrils, with no external incisions. 

During sphenoidotomy, we use the endoscope to:

• Find the natural opening (ostium) of the sphenoid sinus.
  
• Widen that opening so mucus, infection, and inflammation can clear.
  
• Remove diseased tissue, thick mucus, or polyps if needed.
  
• Restore ventilation so the sinus can function more normally.
  

Because the approach is completely through the nose, there are no visible scars, and most patients go home the same day. 

When Is Sphenoidotomy Recommended?

Sphenoidotomy may be recommended for patients when:

• You have acute or chronic sinusitis that has not improved with medications such as antibiotics, nasal steroids, and saline irrigation.
• Imaging (like a CT scan) shows persistent blockage, fluid, or inflammation limited to or involving the sphenoid sinus.
• There is a sphenoid sinus mucocele (a mucus‑filled cyst).
• Fungal debris or thick mucus is trapped in the sphenoid sinus.
• Other sinus surgery is being performed and the sphenoid sinus also needs to be addressed.

In more complex cases, such as tumors, cerebrospinal fluid (CSF) leaks, or skull‑base problems, sphenoid surgery may be part of a broader treatment plan, usually in coordination with other specialists.

Before recommending surgery, we perform a full evaluation, which may include:

• Detailed symptom review and medical history
• Nasal endoscopy in the office
• High‑resolution sinus CT scan
• Review of prior treatments and medications

The goal is to confirm that targeted sphenoid surgery is both necessary and likely to help before moving forward.

Benefits of Sphenoid Sinus Surgery

For the right candidate, sphenoidotomy can provide significant, long‑lasting relief. Potential benefits include:

• Reduced frequency and severity of sinus infections.
• Improvement in deep or unreachable headaches related to sphenoid inflammation.
• Better drainage and less post‑nasal drip.
• Decreased reliance on long courses of antibiotics or repeated medications.
• Overall improvement in comfort, sleep, and daily functioning.

Because the procedure specifically targets the affected sinus while preserving as much healthy tissue as possible, many patients experience meaningful change without major disruption to their day‑to‑day life.

How Sphenoidotomy Is Performed?

While every surgery is individualized, a typical sphenoidotomy with Dr. Santos at Sinusitis In Seattle follows these general steps:

• Anesthesia
  

  • The procedure is usually done under general anesthesia so you’re fully asleep and comfortable.
    

• Endoscopic Access Through the Nose
  

  • A thin, rigid endoscope is introduced through the nostril, providing a magnified, high‑definition view of the nasal cavity and sphenoid region.
    
  • Specialized instruments are used alongside the camera so no external incisions are needed.
    

• Locating and Opening the Sphenoid Sinus
  

  • Using anatomical landmarks and often image-guided navigation technology for added safety near critical structures, Dr. Santos locates the natural sphenoid ostium.
    
  • The opening is carefully enlarged, and any obstructing tissue, polyps, or infected material is removed.

• Irrigation and Final Check
  

  • The sinus is gently irrigated to clear mucus and debris.
    
  • Dr. Santos confirms that the sinus drains freely and that the surrounding structures are protected.

Once the sinus is fully opened and cleared, the instruments are removed and the nasal cavity is left to heal naturally. This precise, minimally invasive approach helps restore proper drainage and reduces the risk of recurrent sphenoid-related symptoms.

Recovery & Aftercare for Patients

Sphenoidotomy recovery is similar to recovery from other endoscopic sinus surgeries. Most patients go home a few hours after surgery with a responsible adult. These are a few things you should keep in mind:

• First Few Days
  

  • Expect stuffiness, mild pressure, and some blood‑tinged drainage.
    
  • You’ll be asked to keep your head elevated, avoid heavy lifting, and not blow your nose.
    
  • Pain is usually manageable with over‑the‑counter medications or prescriptions, if needed.

• Saline Irrigation & Medications
  

  • Regular saline rinses help keep the sinus openings clear and promote healing.
    
  • Nasal sprays or other medications may be prescribed to reduce inflammation and prevent scarring.

• Follow‑Up Visits
  

  • Dr. Santos will see you for follow‑up endoscopic exams and gentle cleaning (debridement) to ensure the sphenoid opening remains wide and healthy.

     

Most patients are back to desk work in about a week, with continued healing over several weeks as swelling gradually subsides and the sinuses return to more normal function. Recovery timelines vary based on the complexity of the surgery and your overall health.

Is Sphenoidotomy Right for You?

If you live in Bellevue, Kirkland, Redmond, or nearby communities and you’re struggling with:

• Persistent deep headaches or pressure that haven’t responded to typical sinus treatments
• Recurrent sinus infections despite multiple courses of medication
• Symptoms your providers suspect are coming from the sphenoid sinus

A consultation with Dr. Santos can help clarify your diagnosis and map out a plan. Sometimes, medical therapy or less invasive procedures are enough. In other cases, a carefully planned sphenoidotomy becomes the key to lasting relief.

To learn more or schedule an appointment, you can contact Sinusitis In Seattle at (206) 242‑3696.