Functional Endoscopic Sinus Surgery

Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive procedure to treat chronic sinus problems that haven't improved with other treatments. Surgeons use a thin, lighted tube called an endoscope to see inside your nose and sinuses. They remove blockages, widen sinus openings, and restore normal drainage and airflow, aiming to relieve symptoms like congestion and facial pain.

What is Functional Endoscopic Sinus Surgery?

Functional Endoscopic Sinus Surgery (FESS) is a common surgical procedure performed to improve drainage and airflow in the sinuses. It uses a thin, lighted tube with a camera, called an endoscope, inserted through the nostrils. This allows the surgeon to see and work inside the nasal passages and sinuses without making external cuts, making it a minimally invasive approach.

Your sinuses are hollow, air-filled spaces located behind your forehead, eyes, and cheekbones. They produce mucus that drains into your nose, helping to filter the air you breathe. When these drainage pathways become blocked, mucus can build up, leading to infection and inflammation. During FESS, the surgeon carefully removes small amounts of bone or tissue that are blocking the sinus openings. This might include removing nasal polyps (noncancerous growths) or correcting structural issues. The goal is to create wider, more open passages, allowing the sinuses to drain properly and reduce the frequency and severity of sinus infections. This procedure is called "functional" because it aims to restore the normal function of your sinuses. By improving drainage and ventilation, FESS helps your sinuses work as they should, reducing symptoms and improving your quality of life. It is a precise surgery, guided by the endoscope, which helps protect surrounding healthy tissue.

Why it's done

FESS is typically performed when chronic sinusitis, a long-lasting inflammation of the sinuses, does not get better with medical treatments like antibiotics, nasal sprays, or allergy medications. It aims to relieve persistent symptoms such as facial pain, pressure, congestion, and difficulty breathing through the nose by clearing blockages and improving sinus drainage.

The primary reason for FESS is to treat chronic sinusitis that has resisted other forms of treatment. Chronic sinusitis means your sinus inflammation lasts for 12 weeks or longer, even after trying various medications. This persistent inflammation can significantly impact your daily life, causing discomfort and reducing your sense of smell. Other conditions that may lead to FESS include recurrent acute sinusitis (frequent, severe sinus infections), nasal polyps that block the nasal passages, or structural abnormalities within the nose or sinuses. In some cases, FESS may be used to remove tumors or foreign objects from the sinuses, though this is less common. By opening the blocked sinus pathways, FESS helps to reduce the buildup of mucus and allows air to circulate more freely. This can decrease the frequency and severity of infections, alleviate pain and pressure, and improve your ability to breathe through your nose. The procedure aims to provide long-term relief from chronic sinus symptoms.

How to prepare

Preparing for FESS involves several steps to ensure your safety and the best possible outcome. You will have a pre-operative appointment to discuss your medical history, current medications, and any allergies. Your doctor will provide specific instructions, including when to stop eating or drinking before surgery and which medications to avoid.

Before your surgery, your doctor will likely order imaging tests, such as a CT scan of your sinuses. This scan provides a detailed map of your sinus anatomy, which helps the surgeon plan the procedure precisely. You may also need blood tests or other evaluations to ensure you are healthy enough for surgery. It is crucial to inform your doctor about all medications you are taking, including over-the-counter drugs, supplements, and herbal remedies. You will usually be asked to stop taking blood-thinning medications, such as aspirin, ibuprofen, and certain supplements, for one to two weeks before surgery to reduce the risk of bleeding. Your doctor will tell you exactly when to stop these. On the day of surgery, you will need to stop eating and drinking several hours beforehand, typically after midnight the night before, as you will receive general anesthesia. Arrange for someone to drive you home after the procedure, as you will not be able to drive yourself. Follow all pre-operative instructions carefully to prepare for a smooth surgery and recovery.

What happens during

Functional Endoscopic Sinus Surgery is typically performed under general anesthesia, meaning you will be asleep and feel no pain during the procedure. The surgeon inserts a thin, lighted endoscope into your nostrils to view the sinus passages on a monitor. Using specialized instruments, they carefully remove any blockages, such as bone, tissue, or polyps, to widen the sinus openings.

Once you are under general anesthesia, the surgical team will monitor your vital signs throughout the procedure. The surgeon will gently guide the endoscope through your nose to access the affected sinuses. The high-definition camera on the endoscope provides a clear, magnified view of the intricate sinus anatomy, allowing for precise and targeted treatment. The surgeon uses small, specialized instruments to remove inflamed tissue, nasal polyps, or small amounts of bone that are obstructing the sinus drainage pathways. The goal is to enlarge the natural openings of the sinuses, allowing for better airflow and mucus drainage. This process is done carefully to preserve healthy tissue and minimize trauma. In some cases, the surgeon may place a temporary packing or splint inside your nose to absorb blood, support the healing tissues, or keep the sinus passages open. This packing is usually dissolvable or removed by your doctor within a few days to a week. FESS is typically an outpatient procedure, meaning you can go home the same day, though sometimes an overnight stay is required.

Recovery & timeline

Recovery from FESS typically involves some discomfort, congestion, and drainage for the first few days. Most people can return to light activities and work within a week, but full recovery and healing can take several weeks to months. Your doctor will provide specific post-operative care instructions, including nasal rinses and follow-up appointments.

Immediately after surgery, you may experience nasal congestion, mild pain, and some bloody discharge. Your doctor may prescribe pain medication to manage discomfort. It is common to feel tired for a few days. You should avoid blowing your nose forcefully, bending over, or lifting heavy objects for at least one to two weeks to prevent bleeding and aid healing. Nasal saline rinses are a crucial part of post-operative care. You will likely be instructed to perform these rinses multiple times a day to keep your nasal passages clean, remove crusting, and promote healing. Your doctor may also prescribe nasal sprays or oral medications to reduce swelling and prevent infection. Attending all follow-up appointments is important so your surgeon can monitor your healing and remove any remaining packing or crusts. Most people can resume normal, non-strenuous activities within about a week. However, strenuous exercise and activities that increase blood pressure should be avoided for two to three weeks. While initial recovery is relatively quick, the internal healing of the sinus lining can take several weeks to a few months. Long-term success often depends on continued medical management, such as nasal sprays, to prevent recurrence of inflammation.

Risks & side effects

While FESS is generally safe, like any surgery, it carries potential risks and side effects. Common temporary issues include bleeding, pain, and congestion. More serious complications, though rare, can include infection, changes in sense of smell, or, very rarely, injury to the eye or brain due to the close proximity of these structures to the sinuses.

The most common side effects after FESS are temporary and include nasal congestion, mild bleeding, facial pain or pressure, and fatigue. These symptoms usually improve within a few days to a week. Some people may experience temporary numbness in the upper teeth or a change in their sense of smell, which often resolves as healing progresses. More serious complications are rare but important to be aware of. These can include significant bleeding requiring further intervention, infection, or a cerebrospinal fluid (CSF) leak, which is when the fluid surrounding the brain leaks into the nose. Injury to the eye or vision changes are also extremely rare but possible due to the close proximity of the sinuses to the eye sockets. Your surgeon will discuss all potential risks with you before the procedure. The use of an endoscope and detailed pre-operative imaging helps surgeons perform the procedure with high precision, significantly reducing the likelihood of severe complications. Choosing an experienced surgeon also helps to minimize these risks.

Success rate

Functional Endoscopic Sinus Surgery is generally considered effective for improving symptoms of chronic sinusitis in many people. Studies show that a significant majority, often about 80% to 90% of patients, experience substantial improvement in their symptoms after FESS. However, the success rate can vary, and some individuals may require ongoing medical treatment or, rarely, revision surgery.

The primary goal of FESS is to reduce the severity and frequency of chronic sinusitis symptoms, such as nasal congestion, facial pain, and discharge. Most patients report a significant improvement in their quality of life following the procedure. The effectiveness of FESS is well-documented, with many studies indicating positive outcomes for a large proportion of patients. While FESS can provide lasting relief, it is not a cure for all sinus problems. Some people may still experience occasional sinus issues, especially if they have underlying allergies or other contributing factors. Long-term success often depends on adherence to post-operative care, including regular nasal rinses and, in some cases, continued use of nasal steroid sprays to manage inflammation and prevent recurrence. In a smaller percentage of cases, symptoms may return over time, or the initial surgery may not provide sufficient relief. For these individuals, further medical management or, in rare instances, a revision FESS procedure may be considered. Your doctor will discuss the expected outcomes based on your specific condition and help you understand the likelihood of success.

Frequently asked questions

How long does Functional Endoscopic Sinus Surgery take?

The actual surgical time for FESS can vary depending on the extent of the sinus disease and the number of sinuses involved. Typically, the procedure lasts between one to three hours. This time does not include the preparation before surgery or the recovery period afterward.

Is Functional Endoscopic Sinus Surgery painful?

FESS is performed under general anesthesia, so you will not feel any pain during the surgery itself. After the procedure, it is normal to experience some discomfort, pressure, or mild pain in your nose and face. Your doctor will prescribe pain medication to help manage this during your recovery.

Will my sinuses be completely cured after FESS?

FESS aims to improve sinus drainage and reduce symptoms, but it is not always a complete cure for chronic sinusitis. Many people experience significant and lasting relief, but some may still need ongoing medical management, such as nasal sprays, to prevent symptoms from returning. The goal is to improve your quality of life.

When can I return to work or school after FESS?

Most people can return to light activities, including work or school, within about one week after FESS. However, this timeline can vary based on your individual healing and the nature of your job. It's important to avoid strenuous activities and heavy lifting for at least two to three weeks to ensure proper healing.

Can I fly on an airplane after FESS?

It is generally recommended to avoid flying for at least one to two weeks after FESS. Changes in air pressure during flights can cause discomfort, pain, or even bleeding in the healing sinuses. Always consult your surgeon for specific guidance on when it is safe for you to fly.

What happens if FESS doesn't work for me?

If FESS does not provide sufficient relief, your doctor will re-evaluate your condition. This might involve further medical treatments, adjusting medications, or exploring other underlying causes for your symptoms. In some cases, a revision surgery may be considered, but this is less common and depends on the specific reasons for the initial surgery's limited success.

Sources

• MedlinePlus — Functional Endoscopic Sinus Surgery
• Mayo Clinic — Functional Endoscopic Sinus Surgery
• Cochrane Library — Functional Endoscopic Sinus Surgery