Functional Endoscopic Sinus Surgery (FESS) addresses persistent sinus issues. This minimally invasive procedure improves the function and structure of the sinuses, which are air-filled spaces located around the nasal cavities, within the cheeks, forehead, and between the eyes. FESS is recommended for chronic sinusitis, an inflammatory condition where the nose and sinuses swell, interfering with mucus drainage. It becomes an option when non-surgical treatments, such as antibiotics, nasal corticosteroids, and saline rinses, have not provided adequate relief. The procedure’s goal is to alleviate symptoms like congestion, headaches, facial pain, and difficulty breathing by restoring normal sinus ventilation and drainage.
What Happens During Sinus Surgery
Functional Endoscopic Sinus Surgery is performed as an outpatient procedure, often under general anesthesia. The surgeon inserts a thin, rigid endoscope into the nostrils. This endoscope, equipped with a camera and light, provides a magnified view of the nasal passages and sinuses on a monitor. No external incisions are made, as the entire operation is conducted inside the nose.
Once the problem area is identified, specialized instruments are guided alongside the endoscope to address blockages. The surgeon focuses on widening the natural drainage pathways of the sinuses. This may involve removing diseased tissue, such as swollen mucous membranes, or growths like nasal polyps. In some cases, bone that obstruct drainage or ventilation is also removed or reshaped. The procedure typically lasts between 30 minutes and a few hours, depending on the extent of the condition.
Managing Pain and Discomfort After Surgery
Following Functional Endoscopic Sinus Surgery, patients can expect some discomfort, though severe pain is uncommon. Many describe the sensation as a dull ache or pressure rather than sharp pain. This discomfort is concentrated around the nose and sinus areas and subsides within the first several days post-surgery. Over-the-counter pain relievers like acetaminophen are often sufficient, with prescription medications rarely needed.
Nasal congestion is an expected experience after the procedure, as the nasal passages feel stuffy for one to three weeks. Minor bloody discharge is also normal during the first three to five days, especially after nasal irrigation. Patients are advised to dab the nose gently with tissue but avoid blowing it vigorously for at least a week or two to prevent increased bleeding. Fatigue is common, lasting several days to a couple of weeks.
Regular saline rinses clear debris, dried blood, and mucus from the nasal passages, promoting healing. Elevating the head, especially during sleep, can help reduce swelling and drainage. Applying a cold compress to the nose or forehead can also provide relief for swelling and discomfort. Avoiding strenuous activities, heavy lifting, and bending over for about a week after surgery is advised to minimize pressure and the risk of bleeding.
Recognizing Potential Risks
While Functional Endoscopic Sinus Surgery is considered safe, like any surgical procedure, it carries risks, though severe complications are rare. Bleeding is the most common concern, with minor blood loss expected during and immediately after surgery. More significant bleeding may occur, either during the procedure or up to 5-10 days later, which might require additional intervention. Infection is another surgical risk, but patients receive antibiotics before and after surgery to minimize this possibility.
The proximity of the sinuses to other structures can lead to rare complications. The eyes are close to the sinuses, and rarely, injury to the eye orbit can occur, leading to bruising around the eye, temporary blurry vision, double vision, or vision loss. Injury to the tear ducts can result in excessive tearing.
A rare but serious complication involves the brain. The sinuses are near the bone at the base of the brain, and rarely, this bone can be damaged during surgery, leading to a cerebrospinal fluid (CSF) leak. This creates a pathway for fluid surrounding the brain to leak into the nose and, rarely, could lead to meningitis. Such complications are identified and addressed promptly, sometimes requiring further surgery. These severe complications occur in a very small percentage of cases.
What to Expect Long Term
The recovery timeline for Functional Endoscopic Sinus Surgery varies, but most patients can resume light activities within a few days and return to work or school within one to two weeks. A complete return to normal activities and full benefits can take several weeks to a few months. Ongoing follow-up care is an important part of long-term management. This includes post-operative debridement, where the surgeon cleans the healing sinus cavities to remove crusts and scar tissue, typically performed in the weeks following surgery.
The long-term efficacy of FESS is favorable, with success rates between 80% and 90% in improving symptoms. Patients often experience significant relief from nasal obstruction, facial pain, and headaches. Many also report an improved quality of life and a reduction in their reliance on medications for sinus symptoms. While surgery can greatly improve sinus health, chronic sinusitis may require ongoing medical management.
Symptoms can recur over time, especially in individuals with conditions like nasal polyps. While recurrence rates vary, FESS remains an effective option for long-term symptom relief and improved breathing for many individuals.