FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS)

Functional Endoscopic Sinus Surgery is indicated for chronic sinus problems that have not responded to maximal medical therapy.

Most people with sinus problems can be successfully treated medically, i.e. without the need for surgery.

Prolonged courses of antibiotics are frequently effective. Antibiotics are often combined  with prednisone, nasal sprays, and saline irrigations.

Treatment of underlying allergies may be indicated.

Avoidance of triggers such as cigarette smoking may also be helpful.

The medical treatment chosen will depend on my assessment of the cause.

 

THE OPERATION

The operation will usually be performed under general anaesthetic.

General anaesthetic carries minimal risk in otherwise healthy patients.

You will have the chance to discuss this with your anaesthetist pre-operatively.

In some cases the surgery can be performed on an outpatient basis without the need for nasal packing.

The surgery is done with the use of an endoscope.

The principle of the surgery is to unblock the obstructed openings (ostia) of the sinuses.

This allows for drainage of secretions. It also allows air to enter the sinuses (i.e. for ventilation of the sinuses) which  returns the sinuses to normal health

 

GENERAL POINTS- AFTER SURGERY

  • There is usually mild pain only.  Paracetamol and an anti- inflammatory should be sufficient in most cases.
  • Packing of the nose is sometimes required for the first night post-operatively.The packing is removed the next morning.
  • A blocked nose is common for 2-4 weeks due to swelling and crusts. This improves after cleaning at the postoperative visit(s).
  • Healing takes approximately 6-8 weeks to be complete. If there is postoperative infection, the healing period may be prolonged.
  • There is usually some bleeding for several days after surgery.
  • Thick brown mucus may drain from the nose for 3-4 weeks or more.
  • Avoid hard nose blowing for 4-7 days following the surgery.
  • Saline irrigations will help to clear clots and mucous
  • Take antibiotics and/or Prednisone as prescribed.
  • Usually patients require 7-10 days off work.
  • Avoid bending, lifting and straining for 3 weeks after surgery.  Exertion may precipitate bleeding.

 

FOLLOW-UP VISITS

A follow-up visit is arranged one to two weeks after the surgery.

Further follow-up visits are arranged at approximately weekly or fortnightly intervals, until the area is healed at around 6 – 8 weeks.  At each of these visits, any crusting and persistent scar tissue may be removed under local anaesthetic.

 

RESULTS OF SURGERY

In general, FESS is successful in up to 80% of patients.

In some patients, there will be persisting disease.

This may require ongoing medical treatment.

Allergic rhinitis may require the permanent use of nasal corticosteroid sprays.

Severe polyposis with sinusitis has a high rate of recurrence (>50%).

 

RISKS OF SURGERY

Although there are potentially very serious risks from surgery in this area, the incidence is very low.

 

1-Bleeding – Bleeding is a potential risk in all forms of sinus surgery.

On occasion, significant bleeding may require nasal packing.

Bleeding following surgery may also require the placement of packing and hospital admission.

 

2-Cerebrospinal fluid leak – This is a rare complication (<1% of all sinus surgery patients). Should this rare complication occur, the leak will be repaired endoscopically.

 

3-Visual problems– these complications are extremely rare, though double-vision and loss of vision have been reported in the literature

 

4-Other risks –

Watering of the eye can occasionally result from sinus surgery or from sinus inflammation.  This is usually temporary .

Swelling or bruising around the eye may occur.

 

YOUR CONSULTATION

If you have troublesome sinusitis which has been resistant to medication, please call 031 201 3118 for an appointment.

A complete history of your problem will be taken, followed by a thorough examination of the nasal passages (including nasal endoscopy). A CT scan of the sinuses may be required for further information.

Further management will depend on the clinical findings, and will be in keeping with best ENT specialist practice guidelines.



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