Functional Endoscopic Sinus Surgery (FESS)

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Functional Endoscopic Sinus Surgery (FESS)

What are sinuses?

Sinuses are air filled spaces in the bones of the face and skull. There are four pairs of sinuses:

  • Maxillary sinuses in the cheek bones
  • Ethmoid sinuses between the eye socket
  • Frontal sinuses in the forehead and above the eyebrows
  • Sphenoid sinuses deep in the head or back of the nose

What is FESS?

It is a procedure done to restore normal functioning of the sinuses, which have become swollen and clogged due to allergy and / or infection, etc. leading to sinusitis. This results in severe headache and heaviness. A thin instrument, an endoscope with a light, is inserted into the nose to enable the doctor to see different parts of the nose and sinuses and identify what is causing the blockages and remove them. The surgery is performed through the nostril and hence does not involve an external incision or cutting the bone. It is a day-care procedure.

Why is it done?

Surgery is the last option. In the initial stages, medication is tried. If the symptoms are long standing and affecting work, the doctor will ask for a CT scan to see all the sinuses. In some cases, a pre-operative nasal endoscopy may also be done and then a decision for surgery will be taken.

Advantages

  • Less painful
  • No visible scars
  • Less bleeding
  • Less discomfort after surgery
  • Needs less packing of the nose after surgery
  • Faster recovery

Preparation for surgery

You will be advised to:

  • Stop blood thinners at least 5-7 days prior to the surgery.
  • Not take your diabetes medication on the morning of the surgery but medicines for thyroid dysfunction or hypertension can be taken with a sip of water
  • Fast for at least 6-8 hours prior to surgery. Clear water, black tea or coffee are allowed up to two hours before the surgery.

Note: These instructions may vary according to an individual's condition and extent of surgery.

Post operative instructions

  • Nasal dressing is done after surgery and is removed after 1-2 days.
  • There will be nose block after surgery, during this time the patient will breathe through the mouth.
  • Nose blowing should be completely avoided for at least a week after surgery.
  • Head should be elevated when lying down.
  • Keep the nose free from dry crusting by using a saline spray 6-8 times a day.
  • Avoid strenuous activity for at least one week.
  • It is safer not to fly for at least 2 weeks after surgery.
  • Do not smoke.
  • Drink plenty of water.
  • You would require regular follow-ups as advised by your doctor for a clean-up or nasal toilet of your nose. This is done in the OPD.

Risks and complications though rare may include but are not limited to:

  • Bleeding: during surgery and anytime in the first few weeks of surgery
  • Eye injury: bruising around the eye, double vision or partial or permanent loss of vision
  • Brain injury: cerebro spinal fluid leak, meningitis or brain abscess
  • Tear duct injury
  • Infection of nose and sinuses
  • Altered taste and smell that may be permanent depending on the severity of disease.
  • Scar tissue may grow inside the nose, preventing sinus drainage and needing surgery.
  • Hole in the nasal septum needing another surgery
  • Recurrence of symptoms