Functional Endoscopic Sinus Surgery (FESS)

What is FESS?

FESS is a minimally invasive procedure that is used to visualise, diagnose and treat sinus problems. Unlike conventional sinus surgery, it does not require an external incision.

As FESS is a type of nasal endoscopy, it involves the insertion of an endoscope and specialised surgical instruments into the nostrils. These tools help your doctor to:

• Access and visualise the inside of your nose and sinuses, using a camera system attached to the endoscope.
• Use specialised tools to remove blockages in the sinuses. Blockages may occur due to inflammation and swelling in the sinuses. Left untreated, blockages can block the flow of mucus and cause sinusitis, leading to pain, drainage and impaired breathing.

Why do you need FESS?

FESS is used to treat:

• Severe acute sinusitis
• Recurrent acute sinusitis
• Chronic sinusitis
• Nasal polyposis

FESS surgical techniques can also be used to remove tumours involving the nose and sinuses.

What are the risks and complications of FESS?

As with any surgery, FESS carries some risks, such as:

Bleeding

During surgery, small amounts of blood loss are common. If there is excessive bleeding, your surgery may be stopped. However, this occurs very rarely.

After surgery, mild bleeding is common in the first 24 hours. Most patients can tolerate mild bleeding during and after surgery. To control bleeding after your surgery, your surgeon may insert temporary nasal packing in your nose.

Infection

Although FESS helps to reduce the infection load in the sinuses, there is still a small risk of infection. To treat, control or reduce the risk of infection, antibiotics are usually given during and after surgery.

Vision changes

During FESS, surgery is performed very close to or at the bone that separates the sinuses from the eye. While extremely rare, unintentional injury to the eye or bleeding around the eye may lead to double vision or vision loss. These changes may be temporary or permanent.

Another rare complication is an injury to the tube that drains tears from the eyelids to the nose. This complication can result in excessive tearing. However, it can be corrected through surgery on the tear sac.

Cerebrospinal fluid (CSF) leak

During FESS, surgery is performed very close to or at the bone that separates the nose or sinus from the brain. While very rare, a CSF leak may occur due to unintentional movements of the bone. Surgery is usually required to repair a CSF leak. However, this can almost always be performed endoscopically through the nostrils.

How do you prepare for FESS?

Before FESS, you may be advised to:

• Go for tests and a physical examination to check on your health and assess if you are fit for surgery.
• Inform your doctor of any medications that you are currently taking, as some may increase your risk of bleeding during and after FESS.
• Take anti-inflammation medication, which your doctor will prescribe to you if necessary.
• Quit smoking at least 3 - 4 weeks before surgery.

What can you expect in FESS?

FESS is usually a day surgery, although some patients prefer to be hospitalised for the first night after surgery.

Most patients are placed under general anaesthesia. However, depending on your condition, your doctor may recommend limited FESS under local anaesthesia.

Estimated duration

Most FESS procedures take between 1 – 3 hours.

Before the procedure

If your procedure involves:

• General anaesthesia, you may need to fast from food and drinks for 6 hours before your surgery.
• Local anaesthesia, your surgeon will numb your nose through anaesthetic sprays and patties (very small strips of gauze). If needed, your doctor may administer additional local anaesthesia through an injection. Your doctor will ask if you are comfortable before proceeding with the surgery.

During the procedure

Your doctor will:

• Use an endoscope and camera system to visualise your nose and sinuses. To perform the surgery, your doctor will use specialised instruments.
• Remove fine partitions in your sinus cavity to widen the openings to your sinus. As your doctor removes these partitions, important structures in your nose will be preserved.
• Clear pus or polyps in your sinus using the widened openings to your sinus, and wash the sinus cavities with saline.
• Position appropriate dressings in your sinus cavity to help your sinus linings heal.

After the procedure

You will be moved to the recovery room to allow you to wake up. Most patients feel comfortable going home within the same day, but some patients may choose to stay overnight for observation.

During your follow-up, your doctor will remove any dressings in your sinus cavity. Your doctor will advise if you require temporary nasal packing to control bleeding after your surgery. Nasal packings are typically kept for 24 – 48 hours.

Care and recovery after FESS

During your recovery period, avoid:

• Exposure to smoke.
• Blowing your nose with excessive force.
• Heavy physical exertion, which could trigger a nosebleed.
• Placing anything inside your nostrils, including tissues, as this may cause an infection.
• Painkillers containing or related to aspirin, as these thin the blood and may cause an increased risk of bleeding. You can, however, take paracetamol if you need to.
• Visiting crowded places to lower your chances of catching a cold or flu. A cold or flu will be especially uncomfortable while your nose is still healing.

Common side effects

Your nose may feel blocked for the first few weeks. There may also be some crusting inside. To clear the blockage and crusting, you can:

• Use nasal saline water.
• Sit over a bowl of steaming water and inhale the steam 2 – 3 times a day.

You may also have blood-stained discharge in the first few days, which is normal. Nose bleeds with large amounts of bright red blood, however, are not normal. If this happens to you, sit down and pinch your nose while breathing through your mouth.

If you are with someone, ask them to put some ice cubes in a plastic bag and hold it over the bridge of your nose. Alternatively, you can suck on an ice cube. If the bleeding does not stop within 15 minutes, visit the Accident & Emergency (A&E) department.