Functional Endoscopic Sinus Surgery (FESS)
This type of surgery is used to improve the normal functioning of the sinuses. It usually involves a general anaesthetic. Whilst the patient is asleep, cameras and various small instruments are used to remove polyps (see nasal polyps) and diseased lining (see sinusitis). The sinuses are opened up inside the nose via the nostrils and no scars or bruising should be noticed on the outside. This surgery allows for better sinus drainage and in turn a reduction in nasal symptoms. It is important that all the diseased sinuses are dealt with so that the chance of the sinus disease returning is reduced. Occasionally balloon sinuplasty (see balloon sinuplasty) is performed together with FESS.
What to expect
A comprehensive assessment will be performed in clinic including the use of a small camera, called a nasal endoscope, inside the nose. This is not a painful procedure as the camera is very small but can feel a little unusual. A CT scan will also be performed to assess the extent of the disease and the anatomy of the sinuses. The risks involved with this type of surgery will be discussed in detail at the consultation.
Following surgery nearly everyone experiences a degree of bleeding from the nose. This should last no more than a few days afterwards and is more like blood-stained secretions than brisk bleeding. Packing in the nose is sometimes but not always used and is nearly always an absorbable material that disappears within a few days. Washing the nose out with salty water (‘saline douche’) is necessary to help both with healing and to wash the packing away.
We encourage patients not to blow their nose, engage in heavy exercise or lift anything heavy for the first 2 weeks following surgery to reduce the chance of bleeding. Other much rarer risks of this surgery include injury to the eye and the soft tissues surrounding the eye such as muscle and fat. This can occasionally lead to double vision and very rarely a loss of vision. There is also a rare risk of leakage of fluid that surrounds the brain into the nose (CSF fluid). This can normally be repaired at the time of surgery or later on if the leakage of fluid is not apparent during surgery. The details of these risks will be discussed further during your appointment.
After the procedure it is very important to continue using the nasal steroids that were used before the operation. These should be used continuously and not stopped unless told to do so be an ENT surgeon otherwise the problem may return. Long term use of nasal steroids is safe as the newer nasal steroids are not absorbed into the body enough to produce side effects. The use of a nasal douche to wash the nose out with salty water is essential and advice as to how best to perform this will be provided. Occasionally oral steroids, antibiotics and other medications may be necessary. A review will be made a few weeks after surgery to ensure that everything is healing well.