Sinus Surgery (Functional Endoscopic Sinus Surgery FESS)

What is functional endoscopic sinus surgery (FESS)?

Functional endoscopic sinus surgery (FESS) is a minimally invasive procedure to treat long-standing sinus problems, nasal blockages, and other related conditions. Using a thin, specialised camera called an endoscope, the surgeon can access and treat the sinuses through your nostrils. This procedure avoids the need for external cuts and helps improve breathing, reduce infections, and relieve sinus pain.

Why might you need FESS?

The sinuses are hollow, air-filled cavities in the bones of your face, located around the nose, eyes, and forehead. They are lined with a thin layer of mucus that traps bacteria, allergens, and debris, which is then drained into the nose. When these drainage pathways are blocked, problems like infections, congestion, and pressure can develop.

FESS may be necessary for several reasons, including:

• Chronic sinusitis: Persistent inflammation of the sinuses causing symptoms like facial pressure, nasal congestion, headaches, and a reduced sense of smell.
• Nasal polyps: Soft, non-cancerous growths in the nasal passages or sinuses that block airflow and contribute to breathing difficulties.
• Recurrent sinus infections: Frequent infections that do not respond to antibiotics or other treatments.
• Deviated nasal structures: Conditions such as a blocked uncinate process (a thin bone in the nasal cavity) or inflamed turbinates (curved structures that regulate airflow inside the nose).
• Poor sinus drainage: Fluid build-up in the sinuses leading to pressure, pain, or infection.

When medications such as nasal sprays, antihistamines, or antibiotics fail to resolve these issues, FESS can provide lasting relief by addressing the underlying causes.

What preparation is required?

·      Medical assessment:
Before surgery, your doctor will review your symptoms, medical history, and any past treatments. You may also undergo imaging tests such as a CT scan, which gives detailed pictures of your sinuses to help plan the procedure.

·      Medication review:
Inform your doctor about any medications you are taking, especially blood-thinning medications (like aspirin or warfarin), as these may need to be temporarily stopped to reduce the risk of bleeding.

·      Fasting instructions:
If general anaesthetic will be used (medicine to make you sleep during surgery), you’ll need to stop eating and drinking for 6–8 hours beforehand. Your hospital team will provide specific instructions.

·      Smoking and alcohol:
If you smoke, you’ll be advised to quit, as smoking slows healing and increases the risk of complications. Reducing alcohol intake is also recommended.

·      Post-surgery planning:
Arrange for someone to take you home after the procedure, as the effects of anaesthesia may make you feel drowsy for a few hours.

What does the procedure involve?

FESS is performed under general anaesthetic (you’re asleep) or local anaesthetic (your nose is numbed, and you remain awake). It usually takes 1–2 hours. Here’s what happens during the procedure:

·       Using an endoscope:
A thin, flexible tube with a small camera (endoscope) is gently inserted through your nostrils. This provides a clear, magnified view of your nasal passages and sinuses on a screen.

·       Removing obstructions:

o   Uncinate process removal: The uncinate process is a thin piece of bone in your nasal cavity that may block sinus drainage. Removing it opens up the pathways for better airflow.

o   Anterior ethmoid bulla clearance: The ethmoid sinuses are air-filled spaces between your eyes. Clearing blockages from the ethmoid bulla (a larger part of the ethmoid sinuses) helps reduce inflammation and improve drainage.

o   Maxillary sinus treatment (antrostomy): The maxillary sinuses, located in your cheeks, may require an opening to be created or widened to allow trapped fluid to drain out.

·      Removing nasal polyps (polypectomy):
Polyps are soft, non-cancerous growths that can block your nose and sinuses. These are carefully removed to improve breathing and reduce symptoms.

·      Reshaping turbinates (turbinate reduction):
Turbinates are structures inside your nose that help warm, filter, and moisten the air you breathe. When they are swollen, they can obstruct airflow. The surgeon may reduce or reshape them to restore normal breathing.

·      Finishing the procedure:
After treating all the problem areas, the instruments are removed, and no external cuts or scars are left behind.

Benefits of FESS

FESS offers several advantages for people with chronic sinus problems:

• Improved breathing: Opens up nasal passages, allowing for better airflow.
• Relief from symptoms: Reduces sinus pressure, congestion, facial pain, and headaches.
• Fewer infections: Helps prevent recurrent sinus infections and reduces the need for medications.
• Better quality of life: Improved sleep, reduced discomfort, and a more active, symptom-free life.

What are the potential risks and complications?

FESS is generally safe, but as with any surgery, there are some risks. These include:

• Infection: Rare but possible. If it occurs, it can usually be treated with antibiotics.
• Bleeding: Mild bleeding is common after surgery, but heavy or prolonged bleeding should be reported to your doctor.
• Temporary changes in smell: Some patients may notice reduced or altered sense of smell during recovery, but this usually improves.
• Scarring inside the nose: Rarely, scarring can narrow nasal passages, which may require further treatment.
• Injury to nearby structures: Because the sinuses are near the eyes and brain, there’s a very small risk of complications affecting these areas, such as vision changes or severe headaches.

Your surgeon will take every precaution to minimise these risks and will discuss them with you in detail before the procedure.

Recovery after the procedure

Hospital stay:
Most people go home the same day, but an overnight stay may be needed in some cases.

Pain and discomfort:
You may experience mild discomfort, nasal congestion, or a feeling of fullness in your nose for a few days. Painkillers like paracetamol or ibuprofen can help manage this.

Bleeding:
Light nasal bleeding is normal for the first few days. Avoid blowing your nose, as this can cause more bleeding.

Follow-up care:
Your surgeon will schedule follow-up appointments to monitor your healing. They may clean your nasal passages and recommend saline rinses (saltwater sprays) to keep your nose clear.

Return to normal activities:
Most people return to work and light activities within a week. However, you should avoid heavy lifting or strenuous exercise for at least two weeks.