Functional Endoscopic Sinus Surgery
Functional Endoscopic Sinus Surgery or FESS is a procedure commonly performed by an Ear, Nose, and Throat Specialist to improve the structure and function of the sinuses. The sinuses are often blamed for various symptoms, such as headaches, infections, facial pain, and congestion. They normally contain air, and are located around the nasal cavities, within the cheeks, forehead, and between the eyes. The mucus membrane lining is thin and pink in times of health.
Anatomic Deformities That Can Lead to Sinusitis
In the case of recurrent sinus infections, the patient most commonly has an anatomic deformity at the junction of the nose and the sinus cavity that promotes closure of the sinus and therefore increases susceptibility to infection, or promotes long-term infections. This deformity may be something that the patient is born with or that develops over time. Occasionally the obstruction is caused by a nasal polyp.
Sinus CT Scan
These deformities that bear correction are most often discovered on a CT scan of the sinuses, a specialized x-ray that provides tremendous detail of the nasal and sinus cavities and acts as a “roadmap” for the performance of sinus surgery. We have 4 paired sinus compartments on both sides of our faces, and the surgeon will direct surgery at the sinuses that demand attention based on the CT scan and the patient’s situation.
An endoscopic sinus surgery is a procedure that is aimed at correcting the above mentioned obstruction and is performed in the operating room under a general anesthesia. For the most part, the procedure is performed as a day surgery, meaning the patient is discharged home the same day as surgery.
Modern technology has dramatically enhanced the performance of sinus surgery. Surgeons are afforded wide access to the patient’s entire sinus system using small telescopes through the nostril. An area the size of a baseball can be accessed through the nostril, and the delicate work of the surgeon’s instruments can be directed via a telescope which is 1-2 millimeters in diameter. The sinuses are displayed via a hand-held camera on a large HD screen in the OR so that the surgeon and staff have a clear view of the job at hand. Various straight and angled instruments are used to gently remove bone, mucus membrane, polyps, and debris from the sinus cavities. Powered shavers also are tremendously beneficial in gently enlarging openings into various sinus cavities. In certain cases, 3-D image guidance allows the surgeon to perform stereotactic surgery, with the patients CT results displayed on a television screen for “real-time” navigation of the surgeon’s instruments through the patient’s complex anatomy.
The goal of the surgery is to provide an adequate opening into a sinus or sinuses, which will stay open indefinitely, regardless of conditions which would promote further closure and infection. In our opinion, procedures such as balloon dilation of the sinuses provide less access to the sinus, and are less reliable in keeping them open long-term.
At the conclusion of the procedure, the surgeon will occasionally place some absorbable, or non-absorbable material in the openings of the sinuses, aimed at keeping the sinuses open as they heal. This material can be saturated with medications which can promote healing, prevent infection, and provide comfort postoperatively.
Closure of the Sinuses
Certain problems, such as nasal polyps, can promote secondary closure of the sinuses after an initially successful sinus operation. Polyps can be controlled oftentimes with medical treatments directed at controlling allergies. The majority of revision or repeat sinus operations are performed due to regrowth of nasal polyps. In patients with nasal polyps, we feel strongly that short, intermediate, and long-term surveillance in the office is helpful to assess for regrowth, and can allow more conservative treatments.
Specific postoperative instructions are provided elsewhere on our website, and we would encourage our patients to access them for more information.
Following the procedure, most patients will experience a stuffy nose, most often due to swelling, pooled blood or mucus, or splints placed in the nasal cavity (only if the patient had a septoplasty, or correction of a deviated septum). The nasal obstruction subsides somewhat during the first week, and improves quite a bit at the first postoperative visit, where we perform a procedure to clear the nose of debris. This procedure is termed nasal endoscopy with debridement and is performed comfortably in the office.
It is common for the nose to ooze blood for the first few days after surgery. It is common for the patient to notice facial achiness or pain, which is akin to having a sinus infection. Many patients notice a temporary reduction in their sense of taste and smell after the procedure. Temporary upper dental discomfort and ear pain is often mentioned by patients as they heal from sinus surgery. Complications of sinus surgery are rare, but might include postoperative bleeding which might require a trip to the operating room to stop, injury to the base of skull with leakage of spinal fluid, and injury to the eye cavity. Long-term loss of sense of smell can occur less than 1% of the time, but is more common in patients with extensive sinus disease and nasal polyps. These complications have been lessened significantly by the emergence of new technologies.
Read about postoperative instructions for functional endoscopic sinus surgery.
Dr. Rohn and Dr. Gamble are ear, nose, throat, and sinus surgeons with offices located in Plano and Dallas. If you would like to schedule an appointment with our office, please call our Plano office at 972-378-0633 or Dallas office at 214-239-1641.