Functional endoscopic sinus surgery (FESS) has become the accepted standard approach and technique when surgical treatment of sinusitis is indicated. Surgery, or other invasive treatments, should only be considered when medical therapies have failed to improve the patient's symptoms and quality of life.
FESS is a minimally-invasive approach to the sinus cavities using endoscopes (telescopes) to view the important structures of the nose and sinuses. The view with the endoscope allows for better identification of the underlying disease, which in turn allows the surgeon to be precise, careful, and thorough with minimal damage to normal surrounding tissue. All four sets of sinuses can be viewed directly during FESS and obstructing tissue or disease removed as indicated. FESS allows for less tissue removal, more rapid tissue healing, and shorter recovery periods. The surgery is often performed on an outpatient basis.
Indications for FESS
Most commonly FESS is indicated for patients with chronic sinus problems who do not respond to medical treatments. The diagnosis of chronic sinusitis is based on symptoms, nasal examination (i.e., nasal endoscopy), sinus CT findings, and response to previous treatments. The majority of patients with sinusitis do not require surgery. However, in some patients symptoms persist despite prolonged medical treatments and FESS is indicated to help control the problem. With proper patient selection and evaluation, research has proven FESS to be 70-90% successful in improving symptoms of sinusitis and related nasal and sinus problems. FESS is not a "cure" for sinusitis, but is helpful in managing symptoms of the chronic nature of the disease. The most common indications for FESS include chronic infection, nasal obstruction or blockage, and nasal polyps.
Risks of FESS
As with any surgical procedure, FESS has associated risks. Although the chance of a complication occurring is small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.
Most sinus surgery involves some degree of blood loss, which is generally well tolerated by the patient. However, on occasion, significant bleeding may require termination of the procedure. Although most patients do not require nasal packing, a few patients will require a small nasal pack to be removed 1-3 days after surgery. Blood transfusion is very rarely necessary and is given only if the patient's health would otherwise be compromised.
Recurrence of disease
Although FESS provides significant symptomatic benefits for the vast majority of patients, surgery is not a cure for most forms of sinusitis. Therefore, you can expect to continue with your sinus medications even after successful sinus surgery, although in general your requirements for such medications should be lessened. In some instances, additional "touch-up" surgery may be necessary to optimize your surgical outcome. This may be necessary in 5-10 percent of cases.
Spinal fluid leak
Because the sinuses are located in close proximity to the brain, there is a rare chance of creating a leak of spinal fluid (the fluid surrounding the brain) or injuring the brain. Also called a cerebrospinal fluid (CSF) leak, the reported incidence of this is less than 1 percent of cases. Should the rare complication of a CSF leak occur, it may create a potential pathway for infection, which could result in meningitis. If a CSF leak were to occur, it might require surgical closure and extend your hospitalization.
There have been isolated reports of visual loss after sinus surgery. The potential for recovery in such cases is not good. In addition, orbital (eye) injury resulting in double vision, blurring vision, or excessive tearing from the eye are additional potential complications. Fortunately, such a complication is rare. Their reported incidence is also less than 1 percent of cases.
- Other risks
Other uncommon risks of surgery include alteration of sense of smell or taste; persistence and/or worsening of sinus symptoms and facial pain; and swelling or bruising of the area around the eye.
Are there any surgical alternatives?
The introduction of balloon sinuplasty provides an alternative minimally-invasive procedure for some sinus patients. In this type of surgery, a catheter is placed into the sinus opening, and a balloon is inflated to enlarge the opening to the sinus cavity. As a new technique, it has shown promise in patients with mild disease of specific sinuses. In patients with more severe disease, it may be used in conjunction with traditional FESS. Further study is needed to really understand the role of this procedure. Feel free to ask your provider if you are a candidate.
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