Functional Endoscopic Sinus Surgery (FESS)

What is it?

FESS is a minimally invasive technique which opens the sinuses under direct visualization.

Differences from traditional method:

  • Thin rigid scope (endoscope) is used to view nasal cavity and sinuses.
  • Endoscope allows better visualization and magnification of diseased or problem areas.
  • Uses CT scan guidance, which may reveal a problem that was not evident before.
  • Treats the underlying cause of the problem.
  • Allows direct visualization of ethmoid, maxillary, frontal, and sphenoid sinuses so diseased or obstructive tissue can be removed.
  • Less removal of normal tissue and the surgery is usually outpatient.
  • Eliminates need for external incisions, scars and very little swelling.
  • Usually only mild discomfort.

Goals:

• Sinus openings are widened.

• Removes some of the thin bony partitions and creates larger openings into the sinuses. This allows the sinuses to remain open when the sinus lining swells.

• Allows easier treatment and quicker resolution of exacerbations and less severe infections.

How is the operation done?

  • You are under general anesthesia for the procedure.
  • Usually there are no external incisions.
  • A powerful headlight and angled endoscopes with CT scan guidance are used to find the sinus openings.
  • Specially designed instruments are used to remove polyps and diseased tissue more precisely, while sparing the normal sinus structures.
  • At the same time, if your septum is deviated, a septoplasty will be done to straighten the septum by removing some cartilage from the inside of the nose. This will not change the outward appearance of your nose but will help open the area for breathing and sinus drainage.
  • If your inferior turbinates are enlarged at the time of surgery they will be reduced by trimming them.

What should I expect after surgery?

  • You will have nasal packing in your nose which may cause discomfort and even a headache. Usually mild pain medication (ex. Tylenol) works well.
  • DO NOT BLOW YOUR NOSE FOR AT LEAST 1 WEEK AFTER SURGERY. You may dab it.
  • You will be given an office appointment within a couple of days to have the packing removed.
  • You will have an increased risk of nosebleeds. It is important to keep your head above the level of your heart when bending over for at least two weeks.  If a nosebleed occurs, sit quietly with your head at about 45 degrees. If this doesn’t stop in 10–15 minutes call the office.
  • You may experience nasal congestion/obstruction of some degree, postnasal drainage, headaches, and fatigue after surgery. This will improve over the next several weeks.
  • Avoid strenuous activities and medications that predispose you to bleeding, such as aspirin, ibuprofen, and certain herbal remedies, for about two weeks.

Risks of surgery:

  • BLEEDING: Significant bleeding can occur and may require termination of the procedure and placement of nasal packing. Bleeding after surgery may require packing and hospital admission.
  • FAILURE TO CURE OR RECURRENT DISEASE: You may not be cured by surgery or the disease may recur over time. This may require subsequent medical or surgical therapy.
  • POST OPERATIVE DISCHARGE: You may have bloody postnasal discharge for approximately two weeks after surgery. This is normal and will improve slowly.
  • SPINAL FLUID LEAK: This is a rare complication of ethmoid sinus surgery, which can create a potential pathway for infection (meningitis) and require hospitalization. If this doesn’t close spontaneously, you may require more surgery. This risk is reduced with the use of endoscopes, which improve visualization for the surgeon.
  • LOSS OF VISION: Usually one-side.  This has been reported after surgery with poor potential for recovery. Fortunately, this complication is extremely rare. Temporary or prolonged double vision has also been reported.
  • OTHER RISKS: Numbness or discomfort of the upper front teeth; swelling, bruising, or temporary numbness of the lip; and swelling or bruising around the eye may occur. Blowing your nose may result in temporary collection of air under the skin and facial swelling for a period of time.

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