Functional Endoscopic Sinus Surgery

Sinus Surgery

When is sinus surgery necessary?

When the com­pli­ca­tions of sinusi­tis devel­op, sinus surgery may be need­ed on an urgent basis. Less urgent sinus surgery may be nec­es­sary when chron­ic sinusi­tis fails to respond to exten­sive and thor­ough med­ical ther­a­py. For chron­ic sinusi­tis this usu­al­ly involves a pro­longed antibi­ot­ic course, prefer­ably cul­ture-direct­ed, a course of steroids, nasal saline irri­ga­tions, and if aller­gic, treat­ment for allergies.

CT scans are also need­ed to con­firm that symp­toms are relat­ed to the sinus­es. As an exam­ple a patient with headache as a symp­tom may have oth­er caus­es for such (eg. migraine or tension/​stress) that would not respond to sinus surgery. Endoscopy will be used also to help deter­mine the causative agents and poten­tial treat­ment options for them.

Func­tion­al Endo­scop­ic Sinus Surgery (FESS)

Who will or will not ben­e­fit from FESS? What are its advantages?

In the late 1980’s and ear­ly 1990’s, a min­i­mal­ly-inva­sive approach to surgery for sinusi­tis called func­tion­al endo­scop­ic sinus surgery (FESS) evolved. FESS rep­re­sents a sig­nif­i­cant advance com­pared to the open sinus pro­ce­dures per­formed pri­or to the devel­op­ment of FESS. The goal of FESS is to reestab­lish phys­i­o­log­i­cal­ly nor­mal sinus drainage path­ways by remov­ing or cor­rect­ing dis­eased pieces of tis­sues in key areas of sinus obstruc­tion. Small rigid tele­scopes, also called endo­scopes, are insert­ed into the nose and the surgery is per­formed using fine instru­ments to open the sinuses.

There are sev­er­al advan­tages to FESS over the open sinus pro­ce­dures that pre­ced­ed it. To begin with, the abil­i­ty to see with­in the nose and sinus­es is much improved. Open sinus pro­ce­dures often required facial inci­sions with result­ing vis­i­ble scars and lots of nasal pack­ing. With FESS, there are usu­al­ly no vis­i­ble signs that surgery has been per­formed since the surgery is almost always done com­plete­ly through the nos­trils. Recov­ery is usu­al­ly faster and there is usu­al­ly less post­op­er­a­tive pain and bleed­ing. Nasal pack­ing is used infre­quent­ly in FESS.

When patients with sinusi­tis do not improve after repeat­ed cours­es of antibi­otics and rea­son­able tri­als of the oth­er med­ica­tions used to treat sinusi­tis, the oto­laryn­gol­o­gist may rec­om­mend under­go­ing FESS. The rec­om­men­da­tion will also be based upon the phys­i­cal exam­i­na­tion, nasal endoscopy and CT scan find­ings. The deci­sion to per­form surgery should be made only after care­ful­ly con­sid­er­ing the risks and benefits.

Patient pref­er­ences also play a role in the deci­sion. The deci­sion to have sinus surgery is usu­al­ly made by the patient when the impact of the sinusi­tis on their qual­i­ty-of-life is so sig­nif­i­cant that a suc­cess­ful surgery can improve their abil­i­ty to func­tion in dai­ly life.

Ques­tions about Func­tion­al Endo­scop­ic Sinus Surgery?

Although many sinus-relat­ed prob­lems can be treat­ed with med­i­cines, surgery may be need­ed in some patients. When­ev­er pos­si­ble, CSC sur­geons use new­er, less deform­ing, and less painful tech­niques. The most com­mon type of sinus surgery is Func­tion­al Endo­scop­ic Sinus Surgery (FESS).

In FESS, your CSC sur­geon will use small cam­eras and instru­ments to work care­ful­ly in the nose. They will remove obstruct­ing tis­sues, allow­ing the sinus­es to drain more nat­u­ral­ly. This should decrease the sever­i­ty, fre­quen­cy, and dura­tion of infections.

In some cas­es your sur­geon may sug­gest surgery that includes ​“sur­gi­cal nav­i­ga­tion” — usu­al­ly with a spe­cial type of CT or MRI scan­ner — in order to dimin­ish the chance of com­pli­ca­tions and improve results.