Endoscopic Sinus Surgery

Endoscopic Sinus Surgery 2018-02-22T22:20:39+00:00

The services rendered at Alabama Nasal and Sinus Center employ the latest technology and techniques. Dr. Sillers, Dr. Lay, and their staff regularly attend training on the latest medical solutions available. Our aim is to provide you the highest level of care, education and research in the area of nasal and sinus diseases. Below is a list of services we provide. Feel free to contact us if you have any questions or visit our patient information page.

Our services include:

  • Balloon Sinuplasty
  • Endoscopic Dacrocystorhonostomy
  • Endoscopic Management of Mucoceles
  • Endoscopic Orbital Decompression
  • Endoscopic Repair of CSF Leaks
  • Endoscopic Sinus Surgery for Chronic Sinusitis
  • Revision ESS

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.

Image-guided surgery refers to use of a probe that is tracked by a computer as the probe passes through the nose during a sinus surgery. A computer, which is attached to the probe either physically or remotely, provides the surgeon with a map of the nose and sinuses as he/she performs the operation. The map is provided by data from a CT taken of your sinuses before the operation. The image-guidance system gives the surgeon precise, real-time, three-dimensional information about exact location of instruments being used to open the sinus cavities. This type of system gives an added layer of safety to complex endoscopic sinus surgical procedures.

There are two main types of image-guidance systems. There are infrared (optical) systems and electromagnetic systems. Both types of system do essentially the same function. Each has its own advantages and disadvantages.

Image-guidance systems are used for a variety of operations. Some of these include; primary sinus surgery with extensive disease, revision sinus surgery, trans-sphenoidal pituitary surgery, removal of sinus tumors, CSF leak repair, and optic nerve decompression. The advantage of image-guidance systems are apparent: they can help a surgeon know the precise anatomy of each patient’s nose and sinuses and help identify important landmarks during surgery.