What is Functional Endoscopic Sinus Surgery?
Functional Endoscopic Sinus Surgery (FESS) permits the direct visualization and treatment of various parts of the nasal cavities and sinuses which are otherwise inaccessible surgically. Hirschmann (1903) is considered the father of endoscopy.
The most commonly performed technique was proposed by Messerklinger.
What are the indications for Functional Endoscopic Sinus Surgery (FESS)?
- Cases of sinusitis, anosmia, nasal obstruction
- Biopsy of nasal and nasopharyngeal tumours
- Evaluation of epistaxis of unknown origin
- Evaluation of cerebrospinal fluid rhinorrhoea
- To evaluate the nasal cavity after surgery and surgical resections like radical maxillectomy
- Chronic sinusitis
- Antrochoanal and ethmoidal polyposis
- Cauterization of bleeders in epistaxis
- Closure of CSF rhinorrhoea leaks
- Optic nerve de-compression
- Rhinolith and foreign body removal
- Intranasal Dacrosystorhinostomy (DCR)
- Removal of nasal masses such as rhinosporosis and angiofibroma in expert hands
- Choanal atresia
- As an approach for Trans-Sphenoidal Pitutary tumours removal
What is the aim of Functional Endoscopic Sinus Surgery (FESS)?
The main aim of Functional Endoscopic Sinus Surgery (FESS) is to remove the diseased mucosa only to relieve obstruction and restore natural sinus drainage, physiology and ventilation.
How is Functional Endoscopic Sinus Surgery (FESS) done?
The procedure is usually performed under local anaesthesia with sedation or general anaesthesia in young or uncooperative patients or patients having extensive sinonasal disease.
- After adequate preparation 0º 4 mm sinoscope, the uncinate process is removed. The maxillary ostium can be inspected using 30º telescope
- The posterior ethmoidal air cells are approached through the basal lamella. The frontal recess is also visualized 45º scope
- Beyond the posterior ethmoidal air cells lies the sinus
- The nose is then packed with vaseline gauge or expandable nasal tamponade.
What are the complications of Functional Endoscopic Sinus Surgery (FESS)?
- Blindness or loss of vision
- CSF leak
- Intracranial bleed
- Damage to the internal carotid artery
- Vasovagal collapse
- Septal or mucosal adhesions
- Orbital emphysema
However it must be noted that complications are markedly reduced in skillful hands and with newer good instruments and imaging techniques.