Functional Endoscopic Sinus Surgery

Sinusitis afflicts millions of people in the United States every year. It is a disease which causes thickening and swelling of the linings of the sinuses in the face and forehead region, causing symptoms of congestion, drainage, post-nasal drip, diminished sense of smell, and headaches or facial pain. Your doctor has recommended functional endoscopic sinus surgery (FESS) as a means to help reduce these chronic symptoms. But since sinusitis is a chronic disease analogous to asthma or high blood pressure, surgery alone rarely brings cure; however, the symptoms of the disease can often be helped significantly with marked improvement in overall functioning and lifestyle.

What is Functional Endoscopic Sinus Surgery?

Functional endoscopic sinus surgery was developed in Austria in the 1970’s and brought to the United States in the mid-1980’s. The procedure requires no incisions on the face but utilizes “telescopes” which are long thin rods of glass wrapped with stainless steel providing illumination and visualization in the nose and sinus pathways. Instruments that have been designed solely for the purpose of FESS are used alongside the telescopes to perform the operation. The purpose of the operation is to enlarge the drainage pathways of the sinuses thereby preventing the build-up of mucus and pus in the sinuses so common in chronic sinusitis. This can be understood as the sinuses being analogous to the rooms off of a hallway: surgery helps to remove the walls between the rooms and the hallway, resulting in one large hallway without partitions.

The operation may be performed under general anesthesia with you completely asleep and a machine supporting your breathing or under local anesthesia with sedation where you remain in a “twilight”. Your doctor’s preference may vary depending on your particular situation. You may wish to speak with him more regarding this.

The operation may take anywhere from 2 to 4 hours depending on the extent of surgery that is required. An overnight hospital stay is only rarely required. Pain tends to be of the dull achy variety and is well treated with pain medication. Packing is only rarely needed, though commonly your nose will feel stuffy and congested for several days following the operation. If your doctor has had to repair your septum at the same time as your sinus operation, splints may be required which may remain in the nose about a week. They are simply removed at the first follow-up clinic visit.

Risks of FESS

The risks of functional endoscopic sinus surgery include, but are not limited to, bleeding, infection (as with any operation), as well as risks associated with the location of the sinuses next to the eyes and the brain. Specifically, things to be concerned with here include double vision (usually lasting only a few hours at most), blindness, and brain fluid leaking into the nose and sinus cavity, with the concomitant risk of meningitis or brain abscess. The risk of blindness is extremely low while the risk of brain fluid (CSF) leaking into the nose and sinus cavity is greater. If your physician were to identify a CSF leak at the time of your operation, it would be repaired right there using similar FESS techniques.

Remember, while the techniques of FESS have been shown to provide long-lasting symptomatic relief for chronic sinusitis, it is surgery designed to address only areas that are involved with disease. If your disease should progress over time to involve additional sinus areas, additional sinus surgery may be required in the future, again utilizing FESS techniques.

What to Expect After Your Operation

When you awaken from anesthesia, you will be in the recovery room. Your nose will be stuffy and achey. You may have a dressing under your nose to collect the occasional bloody drip that is normal for the first 24-48 hours after surgery. You will experience some dull ache around your nose and sinus cavity that should be well treated with pain medication that will be prescribed for you.

You will be sent home with prescriptions for pain medication and an antibiotic pill, possibly also steroid pills. It is extremely important to take the antibiotic pill as prescribed, as serious infection could result if not taken.

You should keep your nose moist with a salt-water nasal spray (Ocean, Salinex, Ayr, etc.) or possibly an irrigation solution for the first week following your operation. Your first follow-up will be approximately one week following surgery at which time cleaning of the nose will be performed in the clinic under local anesthesia (sprays), a procedure that may need to be repeated weekly for the first 4-6 weeks following surgery. For the first couple of post-operative visits, it is recommended that you take pain medication prior to your arrival for extra comfort and have a driver with you as appropriate.

Usually at your first follow-up visit, steroid sprays will be restarted (Rhinocort, Nasocort, etc.). Antibiotics will be continued until the cavity is healed, usually about 3-4 weeks. Similarly, if steroid pills are prescribed, these will usually be slowly discontinued over three to four weeks.

Post- Operative Instructions

1. Change the pad under your nose as needed for the first 24-48 hours following surgery. Bloody drainage is normal during that time. Call for excessive (flowing) bleeding.
2. Keep nose moist with over-the-counter salt-water spray (e.g. Ocean, Ayr).
3. Minimize your activities and refrain from working for about one week following your procedure, even if you feel well!
4. Take a pain pill prior to your coming for your first post-operative visit. Bring someone with you to drive as appropriate.

Problems? Call us!

We are available to discuss any concerns that you may have at any time. If you have any concerns, please call Dr. Senior’s clinic: 919-966-6484.

After hours, call 919-966-4131, and ask for the ENT physician on-call.

Copyright 2002, Brent Senior, MD