FESS is a minimally invasive treatment for chronic sinusitis that has not responded to standard medical care, such as antibiotics or nasal sprays. This procedure addresses anatomical issues that prevent the sinuses from draining properly, which leads to persistent infection and inflammation. FESS works entirely through the nostrils to restore natural sinus function. It does not require external incisions or result in visible scarring. This common procedure provides lasting relief from chronic symptoms.
Patient Assessment and Pre-Surgical Preparation
The surgical process begins with a thorough evaluation to confirm the diagnosis and map the patient’s sinus anatomy. A high-resolution Computed Tomography (CT) scan is mandatory, acting as the surgeon’s detailed roadmap. The scan provides views of bony structures and soft tissues, identifying the extent of the disease and any anatomical variations. Patients receive specific instructions regarding medication management to minimize bleeding risk, often involving temporarily stopping blood-thinning agents like aspirin or NSAIDs for about ten days. The procedure is typically performed under general anesthesia, though some cases may use local anesthesia with sedation.
The Endoscopic Approach
FESS is defined by its use of specialized visualization equipment to navigate the narrow passages of the nasal cavity. The primary instrument is the endoscope, a thin, rigid tube equipped with a light source and a high-definition camera lens. Inserted through the nostril, the endoscope projects magnified images of the internal anatomy onto a monitor. This minimally invasive approach eliminates the need for external cuts and allows the surgeon to visualize the sinus openings (ostia) with precision. The surgeon manipulates the endoscope while using fine micro-instruments, guided by the live video feed, to preserve healthy surrounding tissue.
Functional Objectives and Surgical Techniques
The goal of FESS is to restore the normal physiological function of the sinuses by widening the natural drainage pathways. This involves strategically removing small pieces of bone or inflamed tissue and polyps that block airflow and mucus clearance. The surgeon often begins by targeting the ethmoid sinuses, located between the eyes, performing an ethmoidectomy to establish a corridor for accessing other areas.
Specific Techniques
A common initial step is the uncinectomy, which removes the uncinate process, a small bone structure that serves as the gateway to the maxillary sinus. Following this, a maxillary antrostomy is performed to safely enlarge the natural opening of the maxillary sinus, improving drainage from the cheek area. The surgeon may also perform a frontal sinusotomy to open the drainage pathway to the frontal sinuses in the forehead, often using specialized angled instruments.
Image Guidance and Ancillary Procedures
For complex cases or revision surgeries, the surgeon may use an image guidance system, which functions like a GPS for the sinuses. This technology uses the pre-operative CT scan to track instrument location in real-time, enhancing safety near delicate structures like the skull base and eye orbit. If the patient has a deviated nasal septum or enlarged turbinates, ancillary procedures such as septoplasty or turbinate reduction may be performed concurrently. The entire process focuses on improving ventilation and allowing the body’s natural transport system to clear the sinuses effectively.
Immediate Post-Operative Care and Healing
Following the procedure, the patient is moved to recovery and most are discharged home the same day. A temporary dressing or packing, often dissolvable, may be placed inside the nose to control minor bleeding and prevent scarring. Patients must avoid strenuous activity, heavy lifting, or bending over for about two weeks to minimize the risk of post-operative bleeding. Bloody or dark discharge is expected for several days, and patients should not blow their nose forcefully during the initial recovery phase. Discomfort is managed with prescribed or over-the-counter pain medication.
A central component of healing is the frequent use of saline nasal irrigation, which should begin the day after surgery. Rinsing the nasal cavity several times a day is crucial for flushing out crusting, blood clots, and surgical debris. This practice keeps the newly opened pathways clean and moist, promoting mucosal healing and reducing the risk of blockage. The first post-operative appointment, usually within one to two weeks, allows the surgeon to perform an endoscopic cleaning (debridement) to assess healing.