Functional Endoscopic Sinus Surgery
Functional Endoscopic Sinus Surgery At ENT Delhi
Functional endoscopic sinus surgery (FESS) is minimally invasive surgery for serious sinus conditions. Healthcare providers use nasal endoscopes — thin tubes with lights and lens — to ease your sinus symptoms without making incisions in or around your nose. Studies show between 80 % and 90% of people who’ve had this surgery feel it solved their sinus issues.
Functional endoscopic sinus surgery is also called endoscopic sinus surgery. Some healthcare providers use the term “functional” because the surgery is done to restore the normal ‘function’ of your sinuses.
It is routinely performed for chronic sinusitis, nasal polyposis, allergic fungal sinusitis, for closure of CSF Rhinorrhoea (ESS) etc.
Functional Endoscopic Sinus Surgery
Functional Endoscopic Sinus Surgery At ENT Delhi
Your healthcare provider may recommend FESS if you have chronic sinus inflammation or a chronic sinus infection that doesn’t improve with medical treatments, such as antibiotics and medications to manage allergies.
You develop sinusitis when the tissue that lines your sinuses begins to swell, trapping mucus that typically flows through your sinuses and out through your nose. The trapped fluid can grow bacteria that can cause infections. Healthcare providers may also recommend surgery if you have nasal polyps.
FESS
FESS – Functional Endoscopic Sinus Surgery is routinely performed to treat various types of disease of the sinuses.
FESS versus ESS – What is the difference?
FESS relates to improving Function of the sinuses. In earlier times radical sinus obliteration surgeries were performed to treat sinus disease. However, Professor Messerklinger demonstrated that chronic sinus disease arose out of poor drainage from the sinus cavity. He postulated and proved that the way to treat chronic sinus disease was by improving the FUNCTION of the sinus – this was done by opening up natural drainage passages. So the surgery came to be called Functional Endoscopic Sinus Surgery (FESS).
ESS on the other hand is any endoscopic assisted surgery done on the sinus – this may be for polyps, tumours etc.
FESS/ESS - SURGICAL PROCEDURE
The patient lies supine on the OT table and part is prepared and draped with surgical drapes.
Cotton patties or Merocel pledgets soaked in 4 % Xylocaine with adrenaline or Saline with adrenaline are placed for decongestion. Sometimes 2 % Xylocaine with adrenaline is infiltrated locally into the parts to be operated.
The rest of the steps follow the nature of the disease for which the surgery is being performed.
In a routine FESS for Chronic unresolving Sinusitis the following steps may be followed
- The uncinate process is incised – this offers access to the Maxillary sinus – either a backbiting forceps or sometimes a Microdebrider blade is used
- The Maxillary sinus opening is widened and disease cleared
- The Ethmoid air cells including the Bulla Ethmoidalis are cleared
- The Frontal sinus is opened using angled endoscopes and the recess is opened
- The Sphenoid sinus is opened and cleared of disease and sinus opened up widely
- A nasal pack is applied after disease removal
The steps may not follow this routine sequence as there may be many variations and will depend on the specific case.
FESS/ESS - POST OPERATIVE PERIOD
- There is usually a nasal pack which remains in the nose for 1-2 days
- After pack removal the patient is called for follow up visits in which nasal crusts, blood clots etc are removed and cleaned.
- Post op visits are very important and must be adhered to.
- Normal simple home food is to be eaten.
- You cannot blow your nose since delicate nasal tissues are healing inside.
- Saline irrigations/ nasal douching is started a few days after the surgery.
- You can work from home but travelling outside, specially into dusty or polluted places is to be avoided.
- Once the tissue report (Biopsy/ Histopathology) is available you must discuss that with your ENT Surgeon.
- The recovery period is usually for about a week.
- Depending upon the diagnosis you may be called for periodic post op routine visits specially in case of Nasal Polyposis or Allergic Fungal Sinusitis.
FESS - COMPLICATIONS
Though fairly safe in experienced hands there are complications related to the procedure.
- Bleeding
- Infection
- Recurrence of disease/ Polyps
- CSF Rhinorrhoea
- Blindness
- Synechaie formation
- Nasal Crusting
FESS is a commonly performed nasal surgery and offers long standing benefit in properly indicated cases.
INDICATIONS OF FESS/ESS
- Chronic sinusitis not responding to routine medication
- Nasal Polyposis
- For repair of CSF Rhinorrhoea
- For Orbital decompression
- Biopsy of suspicious lesions/ Removal of Tumours from the nose and sinuses
- As an approach to the skull base for tumour removal or decompression
- Other nasal and sinus lesions amenable to endoscopic removal/ management.
ANAESTHESIA
The surgery can be performed under the following Anaesthesia –
- Local Anaesthesia – after discussing with the patient – only Local Anaesthetic is used along with some sedation.
- MAC- Monitored Anaesthesia Care- the anaesthetist gives pain reliving drugs intravenously, along with sedation.
- General Anaesthesia – Full General Anaesthesia where the patient is completely unconscious. An oral pack is also kept in the throat.
The decision regarding the type of anaesthesia to be used is taken following a discussion between the ENT surgeon and the patient.
Address
D 3/14, Ground Floor
Vasant Vihar
New Delhi 110 057
Mobile: +91 98711 50032
Hour of Operation
Monday To Saturday
Morning Timing
09:30 AM to 11:30 AM
Evening Timings
4:30 PM to 7:00 PM
Thursday Morning Clinic Is Closed
Thursday Evening
4:30 PM to 7:00 PM
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