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Functional endoscopic sinus surgery (FESS)

Before you agree to have your sinus surgery it is important to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your sinus surgery treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.
 
 

What is the problem?

You have a problem in the sinuses around your nose. Nasal sinus disease can cause many different symptoms, including:
 
  • Facial pain.
  • A feeling of fullness around the face.
  • Difficulty breathing through the nose.
  • A persistent bad smell in the nose.
  • A nasal discharge to the back of the throat, called a postnasal discharge.
  • Headaches.
 
Sometimes sinus problems cause hoarseness, a cough or many other symptoms. All of these problems can also occur for other reasons, without sinus disease. We often use functional endoscopic sinus surgery to treat people with recurring sinus problems.
 

What are the sinuses?

Your sinuses are air filled cavities inside the bones of your face and skull. They have a mucous membrane lining. You have:
 
  • a sinus in each cheek, called the maxillary sinus. This is sometimes called the maxillary antrum
  • several small sinuses between your eyes, called the ethmoidal sinuses
  • two sinuses in the middle of your forehead, called the frontal sinuses
  • one sinus at the back of your nose, called the sphenoid sinus.
FESS
They all connect with your nose through tiny holes, called passages or ostia. The maxillary sinus is connected to the inside of the nose by a very small hole.
 

What has gone wrong?

Many different conditions could affect your sinuses. The mucous membrane lining of a sinus can swell because of allergy, infection, polyps or growths. Any swelling may block the opening of a sinus into your nose causing a headache, face pain or pain behind your eyes.
 
The various passages leading to the sinuses vary in shape and size. As a result, one sinus may be more prone to infection and blockage than another. X-rays or a CT scan of the sinuses will guide the surgeon to the parts of the nose causing trouble.
 

The aims

We aim to examine inside your nose and sinuses and treat any problems found. We use very narrow telescopes, called endoscopes, to do the examination. These endoscopes are about as thick as a drinking straw and have special lenses that allow us to see around corners. This helps the surgeon to see into the narrow passages deep inside your nose that lead into the various sinuses. We look into each of the narrow passages to find out which ones are blocked and causing trouble.
FESS 2
Using very fine instruments we remove very small amounts of bone or infected tissue from the passageways and sinuses. This will re-establish normal ventilation and mucus drainage from the sinuses. This type of examination and treatment is called functional endoscopic sinus surgery (FESS).
 
You will usually have a general anaesthetic and be unconscious for the operation. Occasionally, it may be possible using local anaesthetic and sedation, especially for minor procedures. Discuss this option with your surgeon.
 

The benefits

This operation can relieve your symptoms by re-establishing normal ventilation and mucus drainage. The advantages of operating with endoscopes include:
 
  • There is often less removal of normal tissues than with open surgery.
  • Endoscopes give a direct view of any problems.
  • Small endoscopes and fine instruments allow the surgeon to operate in the tiny spaces of the nose and sinuses.
  • There is no need for cuts in the skin.
 

Are there any alternatives?

Repeated courses of antibiotics are unlikely to clear blocked sinuses. Alternative forms of surgery are also available and you should discuss these with your surgeon. Some alternatives include:
 
  • Antral lavage.
  • Intranasal antrostomy.
  • Caldwell-Luc antrostomy.
  • External ethmoidectomy.
  • External opening and drainage of the frontal sinus.
  • External opening and drainage of the sphenoid sinus.
 

What if you do nothing?

If you do nothing your chronic sinus problems will probably continue. Your doctor can prescribe more antibiotics for you.
 
Who should have it done?
In general, endoscopic sinus surgery is intended for patients with chronic sinus problems that have not responded to medical therapy, such as drug treatment. If you have sinus problems that do not settle with nasal sprays or drops, or require repeated treatments, you should consider the need for surgery.
 
Who should not have it done?
You should try other, non-surgical treatments first. If infection or inflammation does clear with antibiotics, or decongestants then you may not need surgery.
 
If you have a medical condition that would make a general anaesthetic unsafe then you should not have one. It may be possible to do the operation using a local anaesthetic with intravenous sedation. Discuss this option with your surgeon if a general anaesthetic is not possible for some reason.
 
Author: Mr Robert Ruckley MB. ChB.  F.R.C.S. Consultant ENT surgeon.
© Dumas Ltd 2006
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