Functional Endoscopic Sinus Surgery (FESS) 

Indications

Chronic rhinosinusitis (with or without nasal polyposis) which has not responded to medical treatment. It should be noted that FESS is excellent for improving the airway and discharge, but the results of hyposmia/anosmia are much less predictable. Facial pressure/pain is usually not related to sinus disease, so patients should not be operated for this reason alone.

Other sinus disorders such as mucocoele, fungal ball.

Suspected sinonasal tumours (i.e. for biopsy in unilateral polyps)

 

Procedure

NB  All patients require a CT scan of the sinuses – check this is available in advance of the list!

Endoscopes are used to visualise the nasal cavity. Polyps are removed, if present, with a microdebrider. The adjacent sinuses are opened to improve drainage and penetration of medication.

 

Length of procedure

30-90 minutes depending on extent of disease.

 

Complications

Bleeding Discharge continues for several days post-operatively. This is often a little blood-stained. Sustained bleeding is uncommon and the patient should come to hospital.

Infection

Recurrence It is essential that the patient understands that FESS is not a cure for chronic rhinosinusitis. The disease requires long-term suppression with nasal steroid sprays etc, and even then polyposis can recur.

Orbital injury The ethmoid sinuses are intimately related to the orbit. Rarely, breach of the orbit may lead to bleeding behind the eye, which is an emergency.

Skull base injury/CSF leak  Rare, but can lead to meningitis. Repaired at the time of operation if recognised.

Anosmia Related to skull base injury (see above).

 

Post-operative management

Patients are usually discharged the same day. Packs are sometimes used, some of which need to be removed: check the op note. Any changes in vision, bruising around the eye or proptosis should be reported immediately to the operating surgeon.

Patients are seen in the outpatient clinic in a few weeks: check the op note.

 

TTO

  • Simple analgesia
  • Alkaline/saline nasal douche BD 
  • Steroid nasal drops/sprays – it is important the patient and GP understand that this should be continued as a regular prescription and that the formulation should not be changed without consultation
  • Some patients require postoperative prednisolone or antibiotics – check the op note or ask the surgeon

 

 

 

 Page last reviewed: 23 September 2016