Understanding Functional Endoscopic Sinus Surgery (FESS): A Complete Guide

Chronic sinusitis and other sinus-related conditions can cause persistent discomfort and disrupt daily life. While medications like nasal sprays, antibiotics, and corticosteroids effectively manage many cases, some individuals find insufficient relief. In these situations, functional endoscopic sinus surgery (FESS) may become necessary to address the root causes and restore proper sinus drainage and function.

What Is Functional Endoscopic Sinus Surgery (FESS)?

Functional endoscopic sinus surgery (FESS) is a minimally invasive procedure aimed at treating sinus-related conditions when medication and other treatments have failed. FESS involves the insertion of an endoscope, which is a small, flexible tube with a light and camera attached to it, to allow the surgeon to access the sinuses through the nostrils. This eliminates the need for external incisions, resulting in less pain, faster recovery, and minimal scarring compared to traditional sinus surgery.

Why Do You Need Functional Endoscopic Sinus Surgery?

Sinus blockages can occur when the natural drainage pathways of the sinuses become obstructed. These blockages disrupt the normal flow of mucus out of the sinuses, creating an environment where infections can thrive and inflammation can persist. When left untreated, these blockages can cause sinusitis, leading to pain, drainage and impaired breathing. FESS is used to remove any blockages, polyps, or tissue that may be causing chronic inflammation or infection in the sinuses.

FESS can treat several conditions, including:

• Severe acute sinusitis
• Recurrent acute sinusitis
• Chronic sinusitis
• Nasal polyposis
• Sinus and nasal tumours

How to Prepare for Functional Endoscopic Sinus Surgery

To ensure a smooth procedure and recovery, most surgeons recommend the following preparation steps:

• Medication Adjustments: Discuss all medications and supplements you are currently taking with your surgeon before the procedure. In some cases, you may be advised to temporarily stop taking certain medications, such as aspirin and NSAIDs, which may increase the risk of bleeding during and after FESS.
• Smoking Cessation: Smoking impairs healing and increases scar tissue, significantly raising the risk of surgical failure. To ensure a successful endoscopic sinus surgery, patients must stop 3–4 weeks before the procedure and remain smoke-free for at least a month afterwards.
• Fasting: If your surgery uses general anaesthesia, fast for 6–8 hours beforehand to reduce the risk of complications such as nausea, vomiting, or aspiration during the procedure.

What Happens During the Functional Endoscopic Sinus Surgery Procedure?

FESS takes about 1–3 hours to complete. The following outlines the procedure:

• The patient receives either general anaesthesia (patient is asleep) or local anaesthesia (patient is relaxed but awake) to ensure comfort throughout the procedure.
• The surgeon inserts a thin, flexible endoscope into one nostril to magnify and visualise the sinus tissues.
• After locating the problem, the surgeon will use specialised instruments to carefully remove the causes of sinus blockage.
• Once obstructions are removed, the sinus openings are widened to remove any remaining debris or blood.
• Soft nasal packing may be placed inside the nasal cavity to help reduce bleeding and support healing.
• The surgeon carefully removes the endoscope and instruments.

What to Expect After Functional Endoscopic Sinus Surgery

Patients are closely monitored in the recovery room for a few hours after surgery and then discharged on the same day with detailed instructions on how to relieve discomfort and keep their sinuses clear following the procedure.

While some nasal discomfort and swelling are expected in the first few days, over-the-counter pain medications usually provide relief. To aid healing and prevent infection, saline nasal sprays and sinus irrigation are encouraged.

Most patients can resume normal activities within 1–2 weeks, although full recovery and sinus function restoration may take a few months. Regular follow-up appointments are essential to monitor healing, address any concerns, and ensure the sinuses recover well.

What Are the Benefits of Functional Endoscopic Sinus Surgery?

FESS offers several benefits, including:

• Minimally Invasive: FESS is performed entirely through the nostrils, eliminating the need for external cuts that may cause facial scars.
• Outpatient Procedure: FESS is commonly performed as an outpatient procedure, allowing patients to go home the same day after surgery.
• Faster Recovery Time: It does not require extensive recovery time, allowing patients to return to normal activities as soon as possible.
• Fewer Medications: FESS can reduce or eliminate the reliance on medications such as nasal sprays, decongestants, and antibiotics.
• Improved Sinus Drainage and Breathing: The procedure removes obstructions that block the sinus openings to improve airflow, allowing patients to breathe more easily.
• Long-term Relief from Symptoms: By addressing the underlying causes of sinusitis, FESS can significantly provide long-term relief from symptoms such as congestion, headaches, and facial pain.

Potential Risks of Functional Endoscopic Sinus Surgery

FESS is generally considered safe, but like any surgical procedure, it carries some potential risks and complications. While these are usually minimal, it is important to be aware of them. These risks may include:

• Loss of Smell: Temporary or permanent loss of smell can occur due to damage to the olfactory nerves, which are located close to the sinuses.
• Tearing Eyes: The tear ducts near the sinuses may be irritated or damaged during surgery, causing the eyes to tear up.
• Unusual Heavy Bleeding: Some bleeding is normal after surgery, but heavy bleeding may be a sign of an underlying problem.
• Leaking Cerebrospinal Fluid (CSF): This rare but serious complication affects the fluid surrounding the brain, requiring immediate medical attention.
• Vision Problems: While vision problems such as loss of sight in one eye or double vision are possible due to the proximity of the sinuses to the eyes, this is another rare complication.