Functional Endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS) is a minimally invasive sinus surgery performed using a rigid endoscope
Functional endoscopic sinus surgery (FESS) is a minimally invasive sinus surgery performed using a rigid endoscope

Functional endoscopic sinus surgery (FESS) is a minimally invasive sinus surgery performed using a rigid endoscope (a tool with camera at one end). The primary objective of FESS is to restore ventilation of the sinuses and facilitate the clearing of nasal secretions. The surgery is effective in removing polyps from the nose and sinuses and other nasal abnormalities that may cause significant breathing problems such as a deviated nasal septum or chronic sinusitis. With FESS, the surgeon can also operate on the base of the skull through the nose, thus preventing external scars.

FESS is performed using a rigid endoscope. During FESS, an ear, nose, and throat (ENT) surgeon inserts a rigid endoscope (a small metal tube with a camera and light source) into the nasal cavity through a nostril. Surgical instruments are also inserted alongside the endoscope. The camera is connected to a monitor where magnified images of the structures of the nose and sinuses can be observed. The surgeon can detect any abnormal tissue or polyps and perform the surgery.

Why is functional endoscopic sinus surgery done?

Indications for functional endoscopic sinus surgery (FESS) include:

  • Chronic or recurrent sinusitis despite repeated medical treatment
  • Cerebrospinal fluid (CSF) leak
  • Choanal atresia
  • Foreign body removal
  • Nasal bleeds
  • Orbital decompression
  • Optic nerve decompression
  • Dacryocystorhinostomy (surgery of the nasolacrimal duct)
  • Removal of the base of skull tumors

How is functional endoscopic sinus surgery performed?

The surgery is performed in a hospital under general anesthesia and rarely under local anesthesia. The surgeon applies a decongestant inside the nose. The endoscope is then inserted through the nostrils. The surgeon first evaluates the nose and sinuses. Following this, the surgeon inserts specialized instruments through the endoscope to reposition the normal tissue and remove the abnormal tissue if any. The scope has an attached camera that projects images of the nasal structures back to the surgeon. After the surgery, the nose would be packed for 24 hours, so the patient will have to breathe through their mouth. Most patients can go home the same day or the day after the surgery. Patients may experience pain, swelling, bruising, nose block, and blood-stained nasal discharge for about a week. Painkillers are usually prescribed to manage postoperative pain. Antibiotics may be prescribed to prevent infection. The doctor will also prescribe antihistamine nasal decongestant drops and sprays to reduce congestion and discharge and clear out mucus and blood clots out of the nose.

What are the benefits of functional endoscopic sinus surgery?

Advantages of functional endoscopic sinus surgery (FESS) over traditional sinus surgery include:

  • Minimally invasive
  • Better access to internal structures
  • Access to the eye and base of skull structures
  • Better and long-lasting results
  • Lesser pain
  • No external incisions or scars
  • Lesser risk of complications
  • Minimal post-operative bleeding
  • Lesser tissue removal
  • Lesser damage to normal structures
  • Faster recovery

What are the complications of functional endoscopic sinus surgery?

The surgery is safe, and complications are generally rare.

Some major complications can occasionally occur. The rate of major complications is less than 0.5%. These include:

  • Internal carotid artery (ICA) injury
  • Skull base fracture leading to bleeding or cerebrospinal fluid (CSF) leak
  • Damage to the eye or optic nerve leading to blindness
  • Uncontrollable bleeding
  • Meningitis (infection and inflammation of the brain)

Minor complications: These are usually easily treatable:

  • Synechiae (adhesions)
  • Minor bleeding
  • Nasolacrimal duct obstruction
  • Temporary loss of and decreased smell
  • Recurrence of disease


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