What Is FESS Surgery?

FESS is functional endoscopic sinus surgery. This minimally invasive procedure has been used to remove sinus polyps as well as other nasal abnormalities that can cause breathing problems. Chronic sinusitis is one of these.

During FESS, an ENT doctor inserts a small endoscope with a camera into the nasal cavity via a nostril. The surgeon can use the images from the camera to detect abnormal tissue and polyps that are preventing the sinuses from draining properly. These abnormalities will be removed or repositioned by the surgeon using tiny precision-cutting instruments that are inserted in the nostril.

What is the latest technique for sinus surgery?

• Functional endoscopic sinus lifting surgery is a minimally invasive technique that restores sinus ventilation and function. Candidates for this procedure are those with chronic or recurrent infective sinusitis. Improvements in symptoms up to 90% can be expected after the procedure.
• Fiberoptic telescopes and computed tomography are used during diagnosis and the procedure to evaluate the anatomy and to identify the diseased areas.
• Patients who have failed medical treatment should only undergo functional endoscopic sinus surgery. Patients usually feel minimal discomfort after the procedure, which can be performed in an outpatient setting under local or general anesthesia. This procedure has a lower complication rate than conventional sinus surgery.

Why is FESS surgery performed?

FESS restores normal sinus drainage. Normal sinus function requires that the Ostia be ventilated (a mouth-like opening). The mucociliary transport system maintains a constant outflow of mucus from the sinuses. To prevent sinusitis, which is an inflammation and infection of the sinuses, all sinuses require ventilation. Sinus ventilation is done through the Ostia, which leads into the nose in healthy individuals. The middle meatus, which is a curved passage that runs through each nasal chamber, opens into the sinuses. This opening occurs under the middle turbinate, a thin, bony structure at the bottom of each ethmoid. Together, these structures form the stomatal system or the main area of the nasal cavity. The hairlike cilia direct mucus flow to the ostia.

What are the benefits of FESS?

Sinusitis can develop when there is an infection in the dental cavity or the area where frontal and maxillary sinuses meet. The cilia become less efficient, which prevents the mucus from flowing. Mucous membranes in the sinuses swell, which causes the ostia to close. Mucus accumulation and poor ventilation create the conditions for bacterial infections.

What is the FESS technique?

A typical procedure is:

• Local Anesthesia: The patient is sedated to ensure that they feel no pain during surgery.
• Insertion of endoscope: The doctor will insert the endoscope in the nostril and send pictures back to him.
• Tissue Removal or Repositioning: The surgeon will use small precision instruments and these images to reposition nasal tissue or polyps that are interfering with proper nasal drainage. In some cases, a surgeon may insert a spring implant called Propel in the surgery area. This device holds the area open while releasing a controlled dose of cortisone. It prevents polyps from re-forming and reduces scarring. The device disintegrates over one month.
• Sinusotomy: Using specialized Sinus instruments, the surgeon removes obstructive tissue, such as polyps or nasal septal deviations.
• Ethmoidectomy: The surgeon can perform an ethmoidectomy in order to remove any diseased tissue or obstructions from the ethmoid sinuses located between the eye and nose.
• Antrostomy of the Maxillary Sinus: If the patient has maxillary sinusitis, the surgeon can create an opening in the sinus (antrostomy). This will allow the doctor to remove the diseased tissue and improve drainage.
• Sphenoidotomy: The surgeon can perform a surgery called sphenoidotomy, if necessary, to reach and treat the sphenoid sinuses located behind the nose.

 

What is the recovery after FESS?

The surgeon will place dressings into the sinus cavities after sinus surgery to reduce bleeding and prevent adhesions. The dressings can be nonabsorbable or absorbable. In certain conditions, “nasal packing” can be placed in the nasal cavity to reduce bleeding following surgery. These “nasal” packs are nonabsorbable, and they are removed within 1 to 2 days. The patient can either be discharged the same day as a Day Surgery Procedure or admitted to a ward to be observed overnight, depending on the extent and type of sinus surgery. Patients may feel a blockage in their nose due to the packing and blood clots. Under the nose, a nasal gauze (bolster) will be used to catch any blood that drips.

Usually, this is removed before the patient leaves. After the surgery, there may be some mild pain, but it is usually controlled with pain relievers.

What precautions should you take after FESS surgery?

Patients are instructed to wash their nose with specially prepared salt solution (nasal irrigation or “douche”) 2 – 3 times a day. This is very important in keeping the sinuses clean and moist, thereby helping to speed up healing and recovery of sinus function. Nasal irrigation is continued for at least several weeks after surgery and patients will be advised on how long to continue on this by their surgeon.

How many days does it take to recover from sinusitis?

In the first clinic visit (usually between 5 – 10 days after surgery), the packing materials will be removed (if nonabsorbable) or suctioned out (if absorbable). The surgeon will clean up the sinus cavities with the aid of an endoscope and suction.

Following this, most patients will feel much better. The patient should be able to return to work 1 – 2 weeks after sinus surgery. The full recovery of the sinuses may take up to 6-12 weeks, although most patients will feel well enough to conduct their normal daily activities after 1 – 2 weeks.

Jalal Surgical recommended the following Instruments for FESS Surgery.