Procedure for FESS (Therapeutic Endoscopic) Bilateral

A sac or cavity in any organ or tissue is called a sinus. Air cavities in the cranial bones near the nose are called paranasal sinuses. These sinuses are connected to the nostrils. There are eight sinuses, four on each side of the face. They are as follows:

• Maxillary: in the cheeks
• Ethmoid: between the eyes
• Sphenoid: centre of the head
• Frontal sinuses: in the forehead

In chronic sinusitis or acute sinusitis the drainage of the sinuses are blocked. The main goal of sinus surgery is to clear this blockage by widening the drainage pathway. The benefits of increasing the drainage pathway increases the draining of the infectious mucous and delivers medications such as spray and nebulised drugs like nasal decongestants and steroids in an enhanced way. In Sinusitis one or more sinuses are affected.

Sinusitis or Sinus Infection Symptoms

The following are sinusitis symptoms:

• Swelling of the nose and sinuses
• Sneezing
• Pain in the cheek areas, forehead and eyes
• Pain increases when head is moved downwards
• Fever
• Infection
• Nasal polyps
• Infection of tear glands

Procedure of FESS Surgery

When conservative treatment has failed sinus surgery is performed.

Conservative treatment includes:

• Antibiotics
• Anti-inflammatory analgesics
• Antihistamines
• Steroids
• Nasal saline rinses or sprays or drops
• Nasal decongestant sprays or drops

Pre Surgery Care

Patient needs to undertake certain tests and procedures before proceeding for surgery.

They are as follows:

• Routine blood/urine examination
• X ray of the sinuses
• CT scan
• Culture of the mucus secreted from sinuses
• Avoid blood thinning drugs or foods.
• Antibiotics and steroids are given to treat infections.

FESS surgery or Functional Endoscopic Sinus Surgery is a minimally invasive technique and usually done under local anaesthesia but certain agitated patients and children may require general anaesthesia. It is called a bilateral surgery when both sides of a particular sinus are treated.

The nasal endoscope is a small telescope with a light source and a video camera attached. It is used to see the inside of the nose and sinuses during this procedure which are viewed on the screen. It is inserted through the nostrils. It identifies the channels that drain the sinuses into the nasal cavity by enlarging the channels and clearing the blockages.

At times the nasal septum which might be deviated is also realigned in the centre. Sometimes the turbinates, which filter the air and keep the nose moistened also, require surgery.

Balloon sinuplasty or sinoplasty may also be used along with traditional endoscopic sinus surgery. A deflated balloon is inserted into the channel and inflated which increases the girth of the channel and thus helps in drainage.

Some Statistical Facts

The success of FESS surgery is about 85% and most of the sinus problems can be treated effectively. 13% of minor complications and very rarely major complications occur.

Required Hospital Stay for FESS

It is an outpatient procedure but at times may require a 24-hour stay to stabilize the patient.

Indications

FESS (Therapeutic & Endoscopic) bilateral surgery is indicated in following cases:

• Chronic sinusitis or chronic rhino sinusitis
• Nasal polyps
• Persistent sinusitis
• Infections spreading to face, eye or brain
• Loss of sense of smell
• Blockage of tear duct
• Leaking brain fluid into the nose
• Benign and malignant tumours of the nose
• Decompressing the eye sockets
• Decompressing the optic nerve
• Birth defects
• Removing foreign bodies
• Diseased mucous membranes

Contraindications of FESS (Therapeutic & Endoscopic) Bilateral

This procedure is contraindicated in:

• Very young children
• Active infections
• Overly immune-compromised patients
• Drug addicts with major nose blocks
• Active nasal bleeding.
• Lateral frontal sinus disease
• Stenosis of Internal opening of frontal sinus

Risks/Complications Associated With FESS (Therapeutic & Endoscopic) Bilateral

Possible complications both immediate and delayed of FESS could be:

• Bleeding
• Infection to brain
• Brain injury
• Leakage of cerebrospinal fluid
• Damage to the eye
• Damage to wall of the sinus
• Injury to tear ducts,
• Result in double vision,
• Blindness
• Empty nose syndrome

Post-Surgery Rehabilitation

Patients must adhere to following post surgery preventive measures in order to prevent one from complications.

• Nasal packing will be used during the surgery
• Any pain swelling will subside in a few days
• Most patients recover from the initial symptoms of chronic sinusitis significantly
• Medications like NSAID, nasal decongest sprays, steroids and antibiotics are prescribed
• Avoid blowing nose for few weeks
• Avoid strenuous activities and exercises for few weeks
• Avoid air travel for few weeks to prevent nose from experiencing pressure