Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive surgical procedure that is done to open up the sinuses using an endoscope and clear paranasal pathways and improve drainage of the sinuses (pockets) that surround the nasal cavity. Normal drainage of the sinuses is important for the prevention of infections, as the main function of the mucus that is produced by these sinuses is to trap pollutants, microbes, dust particles, etc. The advantage of FESS over open surgery is that it is minimally invasive, causes less bleeding and scarring, the recovery time is less, and it does not damage healthy tissue.
FESS is an elective procedure.
Functional Endoscopic Sinus Surgery may be of the following types
The indications for a FESS include the following
Some contraindications for FESS include the following
The following investigations are usually done before a FESS procedure
Before performing a FESS, the following are done
Duration: Functional Endoscopic Sinus Surgery can last between 2-4 hours
Anaesthesia: FESS is usually done under local anaesthesia. Some procedures may be done under general anaesthesia.
With the individual lying down (or in a seated position) and after the local anaesthetic has taken effect, and restriction of blood flow through ephedrine is achieved, the middle turbinate is located using the fiber optic endoscope. Next, a bone called uncinate process which lies on the side of the nose and at the level of the middle turbinate is removed. The ethmoidal bone is moved to allow for better visualization of the sinuses. The opening of the osteomeatal complex into the jaw is checked and it is cleared if there is any obstruction. Depending on the procedure that is being done, the anterior ethmoid cells, the posterior ethmoid cells, or both, the sphenoid sinus and lastly the frontal sinus are worked upon and the corresponding ostia (openings) are cleared or enlarged to provide for better drainage and flow of the mucus.
In addition to the management of chronic sinusitis, nasal masses such as nasal polyps and antrochoanal polyps are also removed via FESS. Cerebrospinal fluid (CSF) leakage as seen in CSF Rhinorrhea can also be managed via functional endoscopic sinus Surgery. Besides FESS is also used in certain ophthalmic procedures such as optic nerve decompression in traumatic neuropathy, orbital decompression, and DCR procedures. A spacer may be placed in the middle meatus and nasal packing is done.
After a FESS procedure, the following is usually done
Discharge: Usually shortly after the procedure is complete. Medications: Saline nasal spray, antibiotics, and corticosteroid drops may be prescribed as required.
Review: Usually 1 week after the surgical procedure. In some cases every 2- 3 days for cleaning the nasal pathways for up to a week.
Resumption of normal activities: Usually with some restrictions a week after the procedure
Some measures that may be needed to be taken after a functional endoscopic sinus Surgery include
Some complications that may be seen after a FESS may include
The prognosis of FESS is excellent and the results are often very good although based on the underlying condition that is being treated.
Hospitalization is not required for a FESS procedure
FESS is done by specialists from the Department of Otorhinolaryngology