Nasal polyps are benign growths that form on the lining of the nasal passages or sinuses, often resulting from chronic inflammation. When these growths become large or numerous, they cause significant obstruction, leading to breathing difficulties, reduced sense of smell, and recurrent sinus infections. Functional Endoscopic Sinus Surgery (FESS) is the standard procedure for removal. While generally safe when performed by an experienced specialist, FESS carries a spectrum of potential risks, ranging from common minor issues to extremely rare, severe complications.
What Nasal Polyp Surgery Involves
FESS is a minimally invasive technique performed entirely through the nostrils, meaning there are no external incisions. The surgeon uses a slender, lighted tube called an endoscope to visualize the nasal and sinus cavities. This visual guidance allows for precise removal of the polyps and any associated diseased tissue.
The goal is not only to remove the obstructing polyps but also to restore normal sinus function by widening the natural drainage pathways, known as the ostia. Opening these passages improves airflow and allows topical medications, such as steroid sprays, to reach the affected areas more effectively after recovery. This outpatient procedure is typically performed under general anesthesia, and most patients return home the same day.
Potential Surgical Complications
The most significant concerns associated with FESS relate to the close anatomical proximity of the sinuses to the base of the skull and the eye sockets. While major complications are rare, occurring in less than 1.5% of cases, they represent the most serious risks of the surgery. One such risk is damage to the thin bone separating the nasal cavity from the brain, which can result in a Cerebrospinal Fluid (CSF) leak. This fluid cushions the brain, and a leak requires immediate repair to prevent serious complications like meningitis.
Another serious, uncommon risk involves the orbit, or eye socket. Damage to the paper-thin bone separating the sinuses from the orbit can lead to orbital hemorrhage or direct injury to the structures surrounding the eye. In rare instances, this can cause temporary double vision or, in the most severe cases, permanent vision loss due to optic nerve damage. Excessive bleeding is also a major complication, occasionally severe enough to require a blood transfusion or a return to the operating room. More common minor complications include post-operative infection or the formation of scar tissue (synechiae), which can re-block the sinus passages.
Managing Expected Post-Operative Symptoms
It is important to distinguish between rare surgical complications and the expected, temporary discomfort following a successful procedure. Immediately after FESS, patients commonly experience nasal congestion and pressure, similar to a severe head cold, due to internal swelling and residual material. This congestion can last for several days to a few weeks as the tissues heal.
Minor bloody discharge or spotting is a normal occurrence for the first three to five days, particularly when irrigating the sinuses. Patients also frequently report temporary fatigue and a dull ache in the nasal or sinus area, which is usually controlled with prescribed pain medication. A crucial part of the recovery process involves frequent saline nasal rinses to clear debris and promote healing. Follow-up appointments for nasal debridement, where the surgeon cleans out crusted material, are also necessary to ensure the sinus openings remain clear.
The Necessity of Surgical Intervention
The decision to undergo FESS is typically made when the benefits of restoring nasal function outweigh the surgical risks. Surgery is generally reserved for patients whose symptoms persist despite maximal medical management, which includes sustained use of nasal steroid sprays and oral steroids. When polyps cause significant nasal obstruction that interferes with quality of life, such as severe difficulty breathing, sleep apnea, or a complete loss of the sense of smell (anosmia), surgical removal becomes necessary.
In some cases, the polyps may be causing recurrent, severe sinus infections that are unresponsive to antibiotics, or they may be complicating other conditions like asthma or cystic fibrosis. Furthermore, surgery may be required for diagnostic purposes to obtain tissue for biopsy, especially if there is a suspicion of a less common or malignant growth.