Functional Endoscopic Sinus Surgery (FESS) 

Indications

Chronic rhinosinusitis (with or without nasal polyposis) which has not responded sufficiently to medical treatment. It should be noted that FESS is excellent for improving the nasal airway and rhinorrhoea, but the results for 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 for anatomical planning and safety – check this is available in advance of the list!

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

 

Length of procedure

30-120 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 disease can recur at a variable rate.

Orbital injury, diplopia and visual loss The ethmoid sinuses are intimately related to the orbit. Very rarely, breach of the orbit may cause damage to the intraorbital contents and diplopia.  Injury to the ethmoidal arteries may lead to bleeding behind the globe, which can lead to loss of vision if not treated promptly.  Direct injury to the optic nerve has also been reported.  Overall the risk of serious orbital complications is extremely low (<1:1,000), but this must be explained to the patient in clear terms.

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 usually followed up routinely unless complex.

 

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: 21 September 2017