Functional Endoscopic Sinus Surgery (FESS)

Functional endoscopic sinus surgery (FESS) is a minimally invasive procedure which uses nasal endoscopes to enlarge the nasal drainage pathways of the paranasal sinuses to improve sinus ventilation and allow access of topical medications.

What to Expect if you Delay Surgery?

1. Delaying surgery for chronic sinusitis can lead to the following complications:
2. Meningitis (infection of the membrane covering the brain and spinal cord)
3. Intracranial abscess
4. Facial cellulitis (infection of the skin)
5. Cavernous sinus thrombosis
6. Infections of the bones or osteomyelitis
7. Blindness 
8. Orbital cellulitis

1. Minimally invasive surgery.
2. Long-lasting results.
3. Minimal pain.
4. No outward scarring of the nose.
5. Few surgical complications.
6. Little post-surgical bleeding.
7. Less tissue removal.

Sinusitis is the inflammation (swelling) of the lining of the sinuses, which results in the blockage of the sinuses. Sinusitis can be of four types, i.e., acute, chronic, subacute, and recurrent acute sinusitis.

1. Acute sinusitis: The symptoms are present for less than four weeks.
2. Chronic sinusitis: The symptoms persist for 12 weeks or more.
3. Subacute sinusitis: The symptoms last for four to 12 weeks.
4. Recurrent sinusitis: In recurrent sinusitis, you may keep experiencing sinus infections four or more four times in a year, lasting less than two weeks each time.

Common signs and symptoms in younger children include:

1. Runny nose and symptoms of a cold which last for around seven to 10 days.
2. Occasional coughing in the daytime

1. You will either be administered general or local anaesthesia before the surgery. While performing functional endoscopic sinus surgery, the surgeon:
2. Inserts an endoscope into the nose through the nostrils. This will help visualise the nasal cavity and sinuses.
3. Removes a small bone in the nasal cavity (uncinate process)
4. Identifies the natural ostium of the maxillary sinus and makes an incision of 1 cm
5. Identifies and opens the largest anterior ethmoid cell (ethmoid bulla) 
6. Uses a microdebrider or true-cutting forceps to remove the bony portions delicately
7. Opens and clears the anterior ethmoid air cells are to the base of the skull
8. FEES is often enough to improve sinus function. However, the CT scan may occasionally show disease progression in the posterior ethmoids and sphenoid sinus. In those cases, the surgeon will go deeper into these sinuses.

What to Expect Before the Surgery?

1. While you are at your pre-surgical appointment with your surgeon, the surgeon will:
2. Recommend blood tests, EKG, chest X-ray[6]
3. Prescribe oral steroids or antibiotics during the pre-surgical period.[6]
4. Recommend you stop using aspirin and salicylate-containing painkillers at least two weeks before the surgery, as this can increase your risk of bleeding.[19,20]
5. Recommend you to stop smoking for at least three weeks before surgery. Smoking contributes to increased scar tissue and poor healing, resulting in surgery failure.[6,19]
6. Anaesthesia: Your anaesthesiologist may recommend general or local anaesthesia with sedation for the surgery.[6]

What to Expect During Surgery?

1. In the case of local anaesthesia, you may: 
2. Also receive additional medication that will help you feel comfortable and sleepy.
3. Hear some crunching sounds as the bone is removed, which may be rather loud to you
4. Feel blood or mucus in the back of your throat (occasional).

What to Expect After Surgery?

Recovery process at home:

1. For the next two weeks after the procedure, there may be some bloody discharge from your nose. A bloody discharge is normal, and it will get better with time.[6,22]
2. Refrain from blowing your nose for at least one week after your surgery.[6,22]
3. You can expect some nasal or sinus pain in the days following your surgery which can be managed with painkillers.[21,22]
4. Feeling weak after your surgery is normal. It is better to take one week off from work to recover well.[21,22]
5. Do not lift anything heavy for approximately two weeks after your surgery. There are no dietary restrictions.[6,21,22]
6.  In patients with polyps, a short course of systemic steroids combined with antibiotics may hasten postoperative recovery. Topical steroids are also prescribed

First Follow-up Appointment

1. Follow-up appointments with your ENT specialist to clear crusts from the nose are typically scheduled between one and six days after surgery. During the first six weeks, you will normally have three visits.
2. Following that, depending on how quickly your sinuses heal, your appointments will be spaced a few months apart.

 

 Recovery process at home:

1. For the next two weeks after the procedure, there may be some bloody discharge from your nose. A bloody discharge is normal, and it will get better with time.
2. Refrain from blowing your nose for at least one week after your surgery.
3. You can expect some nasal or sinus pain in the days following your surgery which can be managed with painkillers.
4. Feeling weak after your surgery is normal. It is better to take one week off from work to recover well.
5. Do not lift anything heavy for approximately two weeks after your surgery. There are no dietary restrictions.
6.  In patients with polyps, a short course of systemic steroids combined with antibiotics may hasten postoperative recovery. Topical steroids are also prescribed

First Follow-up Appointment

1. Follow-up appointments with your ENT specialist to clear crusts from the nose are typically scheduled between one and six days after surgery.
2. During the first six weeks, you will normally have three visits. Following that, depending on how quickly your sinuses heal, your appointments will be spaced a few months apart.

 

When to see a Doctor?

1. Visit your ENT surgeon if you experience:
2. Fever and chills
3. Swelling in the eye or problems with vision
4. Pain that does not go away with medicines
5. Stiffness in the neck or severe headache
6. Vomiting 
7. Nasal redness, oedema, profuse bleeding, or discharge.