Functional Endoscopic Sinus Surgery (FESS)
Sinusitis afflicts millions of people in the United States every year. It is a disease which causes
thickening and swelling of the linings of the sinuses in the face and forehead region, causing
symptoms of congestion, drainage, post-nasal drip, diminished sense of smell, and headaches or
facial pain. Functional endoscopic sinus surgery (FESS) may help reduce these chronic
symptoms. But since sinusitis is a chronic disease analogous to asthma or high blood pressure,
surgery alone rarely brings cure; however, the symptoms of the disease can often be helped
significantly with marked improvement in overall functioning and lifestyle.
Functional endoscopic sinus surgery was developed in Austria in the 1970's and brought to the
United States in the mid-1980's. The procedure requires no incisions on the face but utilizes
"telescopes" which are long thin rods of glass wrapped with stainless steel providing illumination
and visualization in the nose and sinus pathways. Instruments that have been designed solely for
the purpose of FESS are used alongside the telescopes to perform the operation through the nose.
The purpose of the operation is to enlarge the drainage pathways of the sinuses thereby
preventing the build-up of mucus and pus in the sinuses so common in chronic sinusitis. This can
be understood as the sinuses being analogous to the rooms off of a hallway: surgery helps to
remove the walls between the rooms and the hallway, resulting in one large hallway without
The operation may be performed under general anesthesia with you completely asleep and a
machine supporting your breathing or sometimes under local anesthesia with sedation where you
remain in a "twilight".
The operation is usually performed under general anesthesia and may take anywhere from 2 to 4
hours depending on the extent of surgery that is required. An overnight hospital stay is only
rarely required. Sometimes FESS procedures can be performed in patients under local anesthesia
with sedation. Select patients may also be candidates for similar procedures in the office setting
under local anesthesia only. Pain tends to be of the dull achy variety and is well treated with pain
medication. Traditional’ packing’ is only very rarely needed, though commonly your nose will
feel stuffy and congested for several days following the operation. Middle meatal ‘spacers’ may
be placed to aid in healing and post-operative debridement. If a septoplasty is performed at the
same time as your sinus operation, splints may be required which may remain in the nose about a
week. They are simply removed at the first follow-up clinic visit. Follow-up visits are very
important for post-operative debridement whereas clots and mucous are suctioned from the sinus
cavities to promote proper healing. Appointments are usually scheduled 1, 3, and 6 weeks after
surgery, although these may change on an individual basis.
The risks of functional endoscopic sinus surgery include, but are not limited to, bleeding,
infection (as with any operation), as well as risks associated with the location of the sinuses next
to the eyes and the brain. Specifically, things to be concerned with here include double vision
(usually lasting only a few hours at most), blindness, and brain fluid leaking into the nose and
sinus cavity, with the concomitant risk of meningitis or brain abscess. The risk of blindness is
extremely low while the risk of brain fluid (CSF) leaking into the nose and sinus cavity is
greater. If your physician were to identify a CSF leak at the time of your operation, it would be
repaired right there using similar FESS techniques.
Remember, while the techniques of FESS have been shown to provide long-lasting symptomatic
relief for chronic sinusitis, it is surgery designed to address only areas that are involved with
disease. If your disease should progress over time to involve additional sinus areas, additional
sinus surgery may be required in the future, again utilizing FESS techniques.