What is Functional Endoscopic Sinus Surgery (FESS)?
Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive surgery of the nose and paranasal sinuses . The operation is done through the nose, using an endoscope. No external surgical cuts are made on the face. General anaesthesia is usually given.
During the surgery, blocked sinuses are opened to allow mucous to drain from the sinuses. Sometimes, a septoplasty* may be done to improve access to the sinus cavities.
*Septoplasty is procedure to straighten the septum, which is a bony-cartilaginous partition between the left and right nasal cavities.
FESS being performed in the operating theater.
When is FESS Necessary?
Your ENT doctor may recommend FESS if you have:
- Rhinosinusitis that has not responded to medications
- Recurrent rhinosinusitis
What are the Risks of FESS?
The risks of surgery can be divided into major and minor complications:
- Injuries to the brain, eye and large blood vessels
- Minor bleeding
- Bruising or swelling around the eye
- Scarring in the sinuses
- Hole in the septum
- Recurrence of disease
With the use of image guidance system (IGS) during sinus surgery, the risks of major complications is significantly reduced.
With IGS, the surgeon is able to position the operating instruments without affecting critical structures such as the eye, brain or major blood vessels. This is particularly important if a second FESS (‘re-do’ sinus operation) needs to be done as there may be scarring and distortion of important surgical landmarks from the previous surgery.
Things to Note After the Operation
1. Nasal Packing
On completion of the sinus surgery, the surgeon will usually place dressings in the sinus cavities. This is to prevent unwanted scarring in the nasal cavity and sinuses postoperative adhesions, and to minimise bleeding.
These dressing may be absorbed into the body or non-absorbable. Non-absorbable dressings are usually removed between five to ten days and up to a month after surgery.
There are instances where the surgeon may place additional dressing in the nasal cavity (nasal packs) to minimise bleeding after surgery. These are usually removed in one to two days.
Light red to clear discharge from the nose is normal for three to seven days after surgery.
A nasal gauze (“bolster”) will be placed under the nose to collect any blood that leaks out. This is usually removed before you are discharged from the hospital.
Example of a Nasal bolster
3. Recovery Period
Depending on the extent of surgery and the nature of your work, you may return to work seven to ten days after surgery.
In the first few days after surgery, you are encouraged to rest. Strenuous physical activities should avoided for a month after surgery as these may cause bleeding.
4. Nasal Irrigation
Following the removal of nasal packs, you will be taught nasal irrigation or douche. They help to clear the sinus cavities and to reduce dried and hardened mucous.