Functional Endoscopic Sinus Surgery (FESS) is a common, minimally invasive procedure addressing persistent issues within the paranasal sinuses. This technique uses specialized instruments to access and treat the sinuses entirely through the nostrils, avoiding external incisions or visible scarring. FESS focuses on restoring the natural function of the sinuses by improving ventilation and drainage. It is generally considered a treatment option when sinus symptoms have not responded to standard medical therapies, such as antibiotics or nasal steroid sprays.
Why FESS Surgery Is Performed
FESS is primarily recommended for individuals suffering from chronic rhinosinusitis, which is inflammation of the nasal passages and sinuses lasting 12 weeks or longer. This condition often leads to symptoms like persistent nasal congestion, facial pressure, and thick discharge that significantly impact daily life. Surgery becomes an option when a thorough course of medical management, including saline rinses and various medications, has failed to alleviate the persistent symptoms of the disease.
Other common indications for the procedure include nasal polyps, which are soft, non-cancerous growths that block the nasal passages and sinus openings. FESS allows for the precise removal of these polyps, especially when they resist topical corticosteroid treatment. Structural blockages that hinder proper sinus drainage, such as an enlarged bone structure called a concha bullosa or thick, diseased tissue, may also necessitate surgical intervention.
How the FESS Procedure Works
The FESS procedure is performed using a slender, rigid tube called an endoscope, which is inserted into the nostrils. This endoscope has a camera and a light source, providing the surgeon with a magnified, high-definition view of the complex anatomy within the nasal cavity and sinuses. By operating entirely through the nose, the surgeon avoids external cuts.
The fundamental principle of FESS is to restore the normal physiological function of the sinuses by widening the natural drainage pathways. One common step involves the removal of the uncinate process, a small, curved bone structure near the entrance of the maxillary sinus, to expose the area where the frontal and maxillary sinuses drain. Using specialized micro-instruments, the surgeon carefully removes only the obstructive or diseased tissue, while preserving the healthy sinus lining.
The procedure often focuses on enlarging the ostia, which are the small, natural openings of the sinuses, to allow for improved airflow and mucus clearance. In cases involving chronic inflammation or polyps, the surgeon may also perform an ethmoidectomy, which means opening and connecting the ethmoid air cells, a group of small sinuses located between the eyes. Widening these passageways ensures effective drainage and allows subsequent topical medications, like nasal sprays or rinses, to reach the affected areas more directly.
Recovery and Follow-Up Care
Patients typically experience some temporary discomfort, congestion, and bloody discharge for the first few days following FESS. Post-operative swelling can make the nose feel stuffy, similar to a severe cold, and pain is generally managed with prescribed medication. Nasal packing or dissolvable splints are sometimes placed inside the nose during surgery to manage bleeding, and these will either dissolve or be removed by the surgeon during a follow-up appointment.
High-volume saline nasal irrigations or rinses are essential, often started the day after surgery. These rinses help to clear out blood clots, debris, and crusted mucus from the newly opened sinus cavities, which is essential for proper healing and long-term success. Patients are usually advised to avoid blowing their nose for about a week and to sneeze with their mouth open to protect the surgical site.
Follow-up appointments with the surgeon, typically scheduled around one, three, and six weeks after the procedure, are necessary. During these visits, the surgeon performs an endoscopic cleaning, or debridement, to remove any remaining crusts or scar tissue that could potentially block the sinus openings again. Patients can generally return to light activities and work within a few days to a week, though strenuous exercise and heavy lifting are restricted for approximately two weeks to prevent bleeding.