Medical applications
The purpose of FESS in treatment of CRS is to remove any anatomical obstructions that prevent proper mucosal drainage. A standard FESS includes removal of the uncinate process, and opening of the ethmoid air cells and Haller cells[15] as well as the maxillary ostium, if necessary. If any nasal polyps obstructing ventilation or drainage are present, they are also removed.[1] In the case of paranasal sinus/nasal cavity tumors (benign or cancerous), an otolaryngologist can perform FESS to remove the growths, sometimes with the help of a neurosurgeon, depending on the extent of the tumor. In some cases, a graft of bone or skin is placed by FESS to repair damages by the tumor.[16]Functional endoscopic sinus surgery is most commonly used to treat chronic rhinosinusitis (CRS),[1] only after all non-surgical treatment options such as antibiotics, topical nasal corticosteroids, and nasal lavage with saline solutions[3] have been exhausted. (CRS) is an inflammatory condition in which the nose and at least one sinus become swollen and interfere with mucus drainage.[3] It can be caused by anatomical factors such as a deviated septum or nasal polyps (growths), as well as infection. Symptoms include difficulty breathing through the nose, swelling and pain around the nose and eyes, postnasal drainage down the throat, and difficulty sleeping.[13] CRS is a common condition in children and young adults.[14]
In the thyroid disorder known as Graves' ophthalmopathy, inflammation and fat accumulation in the orbitonasal region cause severe proptosis.[17] In cases that have not responded to corticosteroid treatment, FESS can be used to decompress the orbital region by removing the ethmoid air cells and lamina papyracea. Bones of the orbital cavity or portions of the orbital floor may also be removed.[7][citation needed]
The endoscopic approach to FESS is a less invasive method than open sinus surgery, which allows patients to be more comfortable during and after the procedure. Entering the surgical field via the nose, rather than through an incision in the mouth as in the previous Caldwell-Luc method, decreases risk of damaging nerves which innervate the teeth.[1] Because of its less-invasive nature, FESS is a common option for children with CRS or other sinonasal complications.
It has been suggested that one of the main objectives in FESS surgery is to allow for the introduction of local therapeutic agents (such as steroids) to the sinuses. Research has shown that a special modification of the nozzle of the nasal spray in patients who had FESS allows for better delivery of local therapeutic agents into the ethmoid sinuses.[18]
Functional endoscopic sinus surgery (FESS) is a minimally invasive procedure which uses nasal endoscopes to enlarge the nasal drainage pathways of the paranasal sinuses to improve sinus ventilation and allow access of topical medications.[1][2] This procedure is generally used to treat inflammatory and infectious sinus diseases, including chronic rhinosinusitis that do not respond to drugs,[3][4] nasal polyps,[5][3] some cancers,[6] and decompression of eye sockets/optic nerve in Graves ophthalmopathy.[1]
THE RECOVERY PROCESS
An ethmoidectomy, maxillary antrostomy, powered septoplasty with turbinoplasty, and balloon sinus dilation surgery are different procedures, but what happens following surgery is similar.
It can take several weeks for you to fully recover. You’ll have some swelling and tenderness inside your nose after the surgery, but this is normal. You may have symptoms like a severe cold or a sinus infection. This is due to swelling, dry blood, mucus, and crusting in your nose. To help your nose and sinuses return to normal, your doctor may recommend nasal irrigation or saline sprays and antibiotic lubricants.
After surgery, it’s important to take good care of your nose and sinuses to let them heal properly and prevent scars.
some suggestions for taking care of your nose and sinuses after surgery:
- Keep your head elevated to help reduce bleeding and swelling after your operation. The first night after surgery, elevate your head with extra pillows or sleep in a recliner.
- If you have packing material and splints in your nose, make sure they stay in place. If the packing gets clogged, breathe through your mouth. Do not remove the packing or splints.
- Some bleeding is normal for 2 to 3 days after your operation. If you think you are bleeding a lot, be sure to call your doctor.
- Don’t blow your nose for at least a week after surgery. Don’t do any heavy lifting, straining, or strenuous exercise. This increases the likelihood of bleeding in your nose.
- If you have to sneeze, try doing it with your mouth open.
- Don’t take aspirin. It slows clotting and increases bleeding.
Depending on your surgery, you’ll be asked to return for a follow-up visit about 3 to 7 days after your operation. During that visit, your doctor will remove any packing (if necessary), make sure that your surgery site is healing according to plan, and give you more instructions on caring for your nose and sinuses.
