Functional endoscopic sinus surgery  OR (FESS)

FESS is a surgical treatment of sinusitis and nasal polyps, including bacterial, fungal, recurrent acute, and chronic sinus problems.FESS uses nasal endoscopes to restore drainage of the para nasal sinuses and ventilation of the nasal cavity.

Technique

Frontal, Maxillary, and Anterior Ethmoid sinuses drain into the middle meatus. Posterior ethmoids drain into the superior meatus. Sphenoid drains into the sphenoethmoid recess.

Telescopes with diameters of 4 mm (adult use) and 2.7 mm (pediatric use) and with a variety of viewing angles (0 degrees to 30, 45, 70, 90, and 120 degrees) provide good illumination of the inside of the nasal cavity and sinuses. High-definition cameras, monitors and a host of tiny articulating instruments aid in identifying and restoring the proper drainage and ventilation relationships between the nose and sinus cavities. Cultures (putting abnormal sinus secretions into an incubator to check for bacteria and fungi) and biopsies (examining small bits of tissue under a microscope) can be easily obtained to yield valuable diagnostic information to guide postoperative therapy for optimal long-term results.

All the sinuses can be accessed at least to some degree by means of this surgery: The frontal sinuses located in the forehead, the maxillary sinuses in the cheeks, the ethmoid sinuses between the eyes, and the sphenoid sinuses located in the back of the nasal cavity at the base of the skull.

Analogous to FESS, otologic surgery, which is traditionally performed via an open approach using a microscope, may also be performed endoscopically, and is called Endoscopic Sinus surgery or EES.

Extended approaches

Endoscopic access to pituitary tumors, where an ear, nose and throat surgeon works together with a neurosurgeon, has been successfully accomplished for many years. More recently, further specialization combined with advanced training and techniques have allowed the paranasal sinuses to be a relatively low-morbidity approach to selected tumors even inside the skull or brain. This can be divided into:

  • approaches to the anterior cranial fossa
  • approaches to the mid cranial fossa
  • approaches to the posterior cranial fossa
  • access to the infratemporal fossa (incl. pterygopalatine fissure)
  • access to the sella turcica
  • orbital access
  • optic nerve access

Complications

Extreme care is required with this surgery due to the proximity of the sinuses to the eyes, optic nerves, brain and internal carotid arteries. However, these possible serious risks are rare occurrences and there are potentially many benefits from a well-performed endoscopic sinus surgery with appropriate indications. While a surgeon must have adequate training and experience to manage the procedure, endoscopic sinus surgery is one of the most common procedures performed day to day by the average ENT specialist in private practice.

What is the success rate of surgery?

Polyps and persistent thick sticky secretions in the ethmoid two years following FESS, seen through an endoscope. This asthmatic patient was pleased with the improvement in his ability to breathe through the nose, but still suffered from thick postnasal catarrh.
Polyps and persistent thick sticky secretions in the ethmoid two years following FESS, seen through an endoscope. This asthmatic patient was pleased with the improvement in his ability to breathe through the nose, but still suffered from thick postnasal catarrh.

Between 80 and 90% of patients get great relief of their symptoms and are very pleased with the results of FESS.

  • Where the principal symptoms are blockage of the nose, facial pain or headache, the results are good.
  • If the principal complaint is of post-nasal catarrh, the results are less encouraging – only around 50% of patients experience worthwhile improvement.
  • The sense of smell can usually be restored by FESS, but this may take several months and further post-operative treatment with nasal steroids.
  • If there are Polyps present, they may recur in up to 50% of patients. This can happen many years after initially successful surgery.

What are the risks?

Nasal and sinus operations are very safe procedures in modern medical practice. But no operation is totally risk free.

  • At worst, you could die or suffer brain damage – but you are more likely to be injured in a road accident.
  • A general anaesthetic carries a minimal risk, with consultant anaesthetists using modern drugs and monitoring equipment.
  • There is a risk of excessive bleeding, either during or up to two weeks after the operation.
  • About 2% of patients may need a second operation to control bleeding, readmission to hospital, or a blood transfusion.
  • If you are having a septoplasty (straightening of the central partition between the nostrils) there is a small risk of cosmetic deformity.
  • Operations for the removal of polyps and opening of the sinuses carry a small risk of damage to the surrounding structures, including the eyes and the brain.
  • At worst this could mean blindness, or a leakage of CSF (fluid around the brain) with meningitis and death. The risk of any of these serious complications happening is less than 1:1000.
  • When  you  go home after FESS

    You can discharge after 1 -2 days after surgery , As per your recovery and you can have normal life style with little precaution after discharge.Expect to feel as if you have a bad cold or ‘flu like symptoms for few . This is because the lining of your nose will swell up following the trauma of surgery, like the swelling which occurs in viral infections of the nasal lining following a cold. You may well notice large amounts of dark red, brown or green sticky material coming from the back of your nose into the throat, or when you blow your nose, for up to three months after the operation. This is normal and nothing to worry about.

    Things to do

    • Take all medicines as prescribed, especially antibiotics or nose drops.
    • Attend your follow-up appointments – Important treatment will be given.
    • Steam inhalations – at least three times daily for two weeks:
    • Put a large container e.g. a washing up bowl on the table
    • Pour 3 pints of boiling water into it (take sensible precautions against splashing/accidents)
    • Add a small amount of Karvol or Menthol & Eucalyptus (from the pharmacist)
    • Sit down in front of the bowl with a towel over your shoulders
    • Pull the towel over your head to form a “tent” over the bowl
    • Breathe the steam in through your nose, out through your mouth for five minutes
    • If Otrivine nose drops have also been prescribed, use them before the inhalations.

    Things to avoid (for two weeks)

    • Smoking, or any smoky, dirty or dusty atmosphere
    • Heavy physical work, including fitness training
    • Blowing the nose hard (gentle blowing is acceptable but try a steam inhalation first)
    • Close contact with people suffering from cold or flu (avoid large crowds for this reason)
    • Excessive Alcohol (up to three units per day at meal times is acceptable)
    • Swimming and diving
    • Athletic sexual exertion. Gentle activities are OK if you feel up to it