Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical technique in which sinus air cells and sinus ostia are opened under direct visualization. The goal of this procedure is to restore sinus ventilation and normal function.1–4
The ability to treat paranasal sinus disease has been revolutionized by fiberoptic endoscopes and computed tomographic (CT) scanning. Fiberoptic endoscopes have made it possible to examine the nose thoroughly from the anterior nares to the postnasal space. Nasal endoscopy procedures require local anesthetic and may be performed in the office. Your physician will assess the specifics of your nasal anatomy and clearly define the disease process.
The goal of FESS is to return the mucociliary drainage of the sinuses to normal function. The paranasal sinuses are maintained in a healthy state by ventilation through the individual ostia(or opening of the sinus into the nasal cavity) and by a mucociliary transport mechanism that keeps a continuous protective layer of mucus flowing out of the sinuses.
All patients with severe or persistent symptoms should be evaluated, and many can be helped with advice and medical treatment. If medical treatment has failed, the patient may be a suitable candidate for an endoscopic procedure. A CT scan before FESS is mandatory to identify the patient’s ethmoid sinus anatomy and its relationship to the skull base and orbit. CT scanning also allows the extent of the disease to be defined, as well as any underlying anatomic abnormalities that may predispose a patient to sinusitis.
Patient selection therefore involves a thorough history and physical examination, a trial with medical treatment and, finally, CT scanning. The result is a highly selected group of patients who can expect an improvement of up to 90 percent in their symptoms.
FESS, like all minimally invasive surgery, is designed to combine an excellent outcome with minimal patient discomfort. The main advantage of FESS compared with traditional techniques is that it is less invasive, resulting in minimal postoperative discomfort. Scars and damage to the nerve supply of the teeth are also avoided. The use of the endoscope permits a better view of the surgical field, and is chiefly responsible for the lower rate of complications.
What to Expect: If you or a loved one are a candidate for FESS, you can expect to have surgery at an outpatient surgery center. Most patients are able to go home on the day of the surgery. You will be given pain medications and, possibly, medication for nausea for use at home as you recover. You will need to begin saline nasal rinses the day after surgery to wash out clots and crusted mucus from the sinus and nasal cavities.