Bilateral Functional Endoscopic Sinus Surgery

What Can I Expect Before The Operation

The procedure is usually done under general anaesthesia. You will have to attend a pre assessment clinic before your operation with one of the nursing staff. You will be screened for MRSA and have some routine blood tests and a heart trace . You will be asked not to eat anything for 6 hours prior to coming into hospital and be asked not to have anything to drink except clear fluids for 2 hours prior to coming into hospital .

If you have special requirements related to religion or to an allergy/disability then you may wish to discuss this further with one of the nurses at your pre assessment clinic.

When Is Sinus Surgery Necessary

Most patients with chronic sinus infections dont need surgery. Medical treatment and lifestyle changes usually work or keep symptoms under control. But if the changes dont work, surgery may be the best alternative.

Having surgery is a big decision. Many things have to be considered first. For example: How severe are your symptoms? What does a CT scan show? How is your general health?

You and your doctor will decide if sinus surgery is the best choice for you. If youre an older adult, or if you have a child that may need sinus surgery, special considerations need to be taken. Its important to work with your doctor to get the treatment thats best for you or your family member.

What Is Chronic Rhinosinusitis

Sinusitis is the inflammation or swelling of nasal cavity and paranasal sinuses. If the condition lasts at least 12 consecutive weeks despite the medical treatment, then it is called chronic rhinosinusitis. In this condition, the lining of the sinuses gets inflamed and swollen, leading to increased mucus production. It may also lead to nasal congestion when swollen sinuses obstruct nasal discharge.

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What Will Happen During Surgery

The surgery is typically not uncomfortable and should not be an unpleasant experience. Most sinus surgery procedures are performed under general anesthesia .

The surgery will only begin after the anesthesiologist administers the anesthetic drugs. Your surgeon will proceed as discussed in the office. Of course, intra-operative findings may require adjustments to the surgical plan so that the procedure may be completed to give you the best possible result.

At the end of the surgery, it is rarely necessary to place traditional nasal packing. In some instances, resorbable material, which helps control bleeding and acts as dressing, may be placed in the sinuses, and in other instances, no material whatsoever is placed in the sinuses.

In some cases, it may be necessary to repair the nasal septum at the time of sinus surgery. Similarly, surgical reduction of the inferior turbinates may also be performed. Septal surgery and turbinate reduction will be reviewed with you before surgery if your surgeon feels that these may be necessary.

What Natural Home Remedies Should You Use After Sinus Surgery

It is important for all patients with chronic sinus disease to understand that they have a chronic illness. Successful sinus surgery will only help control the complications and discomfort of chronic sinus disease. The following three areas of prevention should always be remembered:

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Goals Of Endoscopic Sinus Surgery

This procedure is designed to improve the drainage of the sinuses and to improve airflow through the nose. The goals of endoscopic sinus surgery include:

• Reduction in the number and severity of sinus infections
• Improvement in symptoms associated with sinusitis
• Improvement of airflow through the nose
• Improvement in the sense of smell
• Access for nasal rinses to reach the sinus cavities for cleaning and medication delivery

Pain After Endoscopic Sinus Surgery

Endoscopic sinus surgery is utilized to manage pathologies of the nose and paranasal sinuses. Currently, ESS is one of the most commonly performed procedures in the United States, with greater than 250,000 performed annually.5 Despite the prevalence of ESS, to date, there are no specialty-specific guidelines for the management of pain after surgery. Of those performed, approximately 3.7% result in readmission for pain.6 While 3.7% is low overall, this corresponds to nearly 10,000 patients per year who are readmitted for poorly controlled pain after ESS. There are also likely many more patients whose pain is poorly controlled but do not require readmission.

To appropriately counsel patients on pain expectations after ESS, it is important to first understand the painfulness of ESS. Many studies have been performed evaluating the severity of ESS-induced pain, all with similar results: ESS is not associated with severe pain. Utilizing a visual analog scale of 010, with 10 being the most severe pain, most studies have demonstrated that the peak of pain after ESS is approximately 24 on postoperative day 1 and rapidly declines over the course of the first week.1,710 One study of 64 patients found that only nine patients reported pain greater than five out of 10 within the first week of ESS.8

Paul W. Flint MD, FACS, inCummings Otolaryngology: Head and Neck Surgery, 2021

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Functional Endoscopic Sinus Surgery Versus Balloon Sinuplasty: Which One Is Right For You

Functional Endoscopic Sinus Surgery: Sinusitis, infection and/or inflammation of the sinus cavities, impacts the lives of approximately 37 million people in the US each year leading to $6 billion in annual healthcare expenses. The underlying causes of sinusitis include nasal allergies , viral, bacterial, or fungal-related infections, and less commonly facial trauma, altered sinus/nasal anatomy, or impaired immune system. Acute bacterial infection often follows a viral upper respiratory infection, causing symptoms to relapse worse than before just when they seemed to be improving. While acute sinusitis lasts for up to 4 weeks and generally resolves spontaneously or with the help of antibiotics, the treatment of chronic sinusitis requires prolonged medical therapy with 2 or more weeks of antibiotics and often anti-inflammatory medications such as oral steroids and/or nasal steroid sprays. Allergy testing and allergy shots may also be required in patients with identifiable allergy triggers. Symptoms of sinusitis can dramatically impact quality of life, and may include facial pressure/pain, headaches, discolored nasal drainage, nasal congestion or blockage, and less common signs such as fever, loss of smell, and nosebleeds. When these symptoms occur frequently throughout the year,or fail to improve with adequate medical therapy, then surgical intervention is indicated to provide lasting relief.

How Long Is Recovery Time

Your recovery time depends on your overall health and which sinus surgery you have . Usually, you should plan to be away from work or school for at least several days after your surgery. Your doctor will give you specific instructions on how best to care for yourself to help speed recovery.

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What To Expect On The Day Of Surgery

On the morning of your surgery, shower thoroughly but avoid putting any lotion, moisturizer, or makeup on your face.

An hour or two before the surgery, you will need to spray your nasal spray in each nostril as per the instructions on the product label. Each dose lasts for around 12 hours.

Once you are checked-in to the hospital or surgical center and have signed the consent forms, you are led to the back to undress and change into a hospital gown.

What Can I Expect After Sinus Surgery

Some bloody discharge may occur for approximately two weeks after this procedure. This is normal and slowly improves. You should not blow your nose for at two weeks following surgery. As normal sinus drainage becomes reestablished, you may blow out some thick bloody mucus. This is also normal.

After surgery, you will receive detailed instructions for your postop care. The details may vary, but in most instances, these measures include nasal irrigations, oral antibiotics, and pain medicine.

This video segment illustrates the healthy middle meatus after sinus surgery.

In addition, routine post-operative office visits are necessary. During these visits, the surgical cavity is cleaned and inspected. Early scar tissue may be removed, and the medical treatment strategy will be adjusted.

Although complications from the manipulations performed during the post-operative visits are very rare, the theoretical risks are the same as the surgery itself. Consent for surgery includes consent for post-operative care, since the surgery and post-operative care are so closely related.

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Nonendoscopic Conventional Sinus Surgery Vs Fess

It was previously believed that once the mucosa had become chronically inflamed, it was irreversibly damaged and had to be removed. This was the rationale behind the Caldwell-Luc surgical technique, which involves removal of the diseased lining of the maxillary antrum . Similarly, the external surgical approaches to the ethmoid and frontal sinuses were designed to be radical operations in which the disease was completely cleared. These procedures left scars and caused significant bruising and discomfort. The Caldwell-Luc procedure also caused numb teeth. These conventional procedures, as well as the sinus washout, concentrate on the secondarily infected sinus while ignoring the important pathology within the nose.

The rationale behind FESS is that localized pathology in the osteomeatal complex blocks the ostia and leads to inflammation in the dependent sinuses . The surgical interventions of the procedure are designed to remove the osteomeatal blockage and restore normal sinus ventilation and mucociliary function .

The focal point of the surgery is the osteomeatal complex. The procedure may be performed with local anesthesia, with or without sedation. FESS is suitable for outpatient surgery.

Will Functional Endoscopic Sinus Surgery Cure My Sinus Problems

It is possible that the disease may not be cured by the operation, or that disease may recur at a later time. If this should happen, subsequent surgical therapy may be required. It should be realized that medical therapy is usually continued after surgery, especially if allergy or polyps play a role. This medical treatment minimizes the risk of recurrence.

Overall, the majority of patients report significant improvement with the combination of surgery and continued medical management. We will certainly work with you to attain this goal after surgery.

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Early Revision Surgery For Complications Or Neoplasia

A less common cause for revision after primary FESS occurs as a result of unanticipated findings or events during the initial procedure that require acute or early reoperation. Broadly speaking these scenarios may be divided into interventions that follow surgical complications or completion of surgery when unexpected neoplasia is found.

Violation of the lamina papyracea during surgery represents an additional etiology for intraorbital bleeding however, the practitioner must also maintain a high suspicion for possible injury to the medial rectus muscle. The typical injury patterns include: entrapment, contusion, or hematoma within the muscle partial or complete transection of the muscle belly and injury to the oculomotor nerve branches that innervate the lateral aspect of the muscle. Although multiple studies have shown that treatment should be initiated within 3 to 4 weeks to prevent permanent scar contracture and fibrosis, the only indication for immediate reexploration is a suspicion of entrapment. In the setting of a complete transection, orbital exploration with direct reanastomosis is advocated if the posterior 20mm of the muscle is believed to be present and functional. Unfortunately, despite optimal surgical and medical interventions, the prognosis is relatively poor, and patients should be counseled that the primary goal of these interventions is to reestablish a single, binocular visual field.87

Frederick K. Kozak, … Marcela Fandiño Cardenas, in, 2015

Enhancing Healthcare Team Outcomes

Functional endoscopic sinus surgery is in constant progress, along with the technical advances in imaging, instrumentation, and navigation. With a better resolution and more detailed images, the application of FESS is spreading into the intracranial world and the oncological world. The group of multidisciplinary providers involved depends on the pathology and its extension. It can include rhinologists, neurosurgeons, oncologists, endocrinologists, pulmonologists, ophthalmologists, and allergy specialists.

A delicate stepwise technique following the anatomical landmarks guides the surgeon throughout the procedure and helps in avoiding the possible complications. For patients with CRS, the two main goals intraoperatively are to restore patency of the sinuses while preserving mucosa and to prevent injury to the surrounding structures.

Postoperative care is as essential as the applied technique to decrease the risk of recurrence of CRS. Medical therapy with nasal rinsing, topical or oral corticosteroids, and antibiotics, is continued postoperatively to reduce the inflammation and the risk of recurrence. There is no clear consensus on the role of postoperative debridement in decreasing the risk of recurrence of disease and adhesions. It depends on the surgeon’s preference, the level of inflammation, and the extent of the surgery.

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What Is Functional Endoscopic Sinus Surgery

Developed in the 1950s, the nasal telescope has greatly changed the evaluation and treatment of rhinosinusitis. This instrument, which provides a view of the structures in the nose and sinuses, is used both in the operating room and in the office.

During initial office visits, the otorhinolaryngologist will use the telescope for diagnosis. The telescope allows for better visualization within the nose and sinuses, and together with sinus CT scans, often reveals problems that otherwise would not be evident.

The nasal telescope also gives a view for opening the natural drainage passages during sinus surgery. These procedures are performed without facial incisions since both the telescope and other instruments may be passed through the nostrils. Before nasal telescope, sinus surgery was often destructive and focused on the removal of so-called diseased tissue however, todays endoscopic procedures are performed with much more finesse.

These techniques generally eliminate the need for traditional external incisions although in rare instances, the telescope may be used through an external incision.

Recovery after the surgery is often faster than anticipated. The surgery is most commonly performed on an outpatient basis , and the patient may return to near normal activity in 1-2 weeks.

What Happens After Functional Endoscopic Sinus Surgery

Youll spend some time in a recovery room so your healthcare provider can monitor your condition. You wont be able to drive after surgery, so youll need someone to take you home and stay with you that first night. Your healthcare provider will tell you what to expect after surgery. Heres some general information:

• Avoid blowing your nose for at least seven days. If you need to sneeze, keep your mouth open or sneeze into your sleeve or a tissue.
• When you sneeze, you may blow out bloody discharge or mucus. This may go on for a few weeks while your sinuses heal.
• Take a break from strenuous activity for the next 10 days.
• Your healthcare provider may recommend you rinse your nose and sinuses with saline.

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What Are The Paranasal Sinuses

The paranasal sinuses are air cavities within the bones of the face and skull that connect to and ventilate via the nasal cavity. Their function is not really known, they may exist to make the head lighter or to protect the brain from frontal impact much like the crumple zone in a car. Regardless they not infrequently cause problems.

Bilateral Functional Endoscopic Sinus Surgery Bilateral Submucous Resection Of The Inferior Turbinates And Septoplasty

Submucous resection of the inferior turbinates is a procedure to treat the symptoms of nasal obstruction , as a result of chronic turbinate hypertrophy. The procedure typically involves the use of a suction debrider that gently removes stroma while preserving the normal mucosal lining of the nose, though other techniques may be used at the surgeons discretion. Results of the procedure can vary, but they are typically excellent and lasting. SMRIT may cause temporary nasal stuffiness, crusting, bloody drainage, and mild pain for a few days. These symptoms generally resolve within one week. Non-narcotic, over-the-counter analgesic medication is generally sufficient for controlling any pain that may result from this procedure if no other procedures are performed at the same time.

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What Is Fess Surgery

Functional Endoscopic Sinus Surgery is a minimally invasive procedure carried out to treat some of the causes of chronically blocked sinuses and sinus colds.

Functional endoscopic sinus surgery can help reduce the frequency of sinus infections, clear your nasal passages, improve breathing and improve your sense of smell. As a result, it positively impacts your well-being especially if youve been struggling with sinus problems for a long time.

View our ear, nose and throat treatments and services here for more information and for answers to the most frequently asked questions.

Does Functional Endoscopic Sinus Surgery Work

FESS is the most common surgery for sinus conditions. Studies show between 80 % and 90% of people who have FESS for chronic sinusitis feel the surgery cured their problem. But everyones experience is different. Your FESS may not solve your sinus condition because its a chronic condition, but FESS can significantly ease your symptoms and limit how often your chronic sinus flares. You can help prevent recurring sinus problems by following your post-surgery care and giving your nose time to heal.

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