What is functional endoscopic sinus surgery (FESS)?
FESS is a minimally invasive way to open up the sinuses and allow for adequate drainage. It is done with either general anesthesia or light sedation in the operating suite.
What are the benefits of FESS?
FESS establishes proper drainage, allowing for normal function to return. FESS, by itself, does not cure infection! Surgery allows proper drainage so that the body's immune system with help from appropriate antibiotics can then clear infection. Trapped infections are the cause of intense sinus pain and pressure. In the case of nasal and sinus polyps, FESS removes obstruction to proper drainage and blockage of breathing, providing considerable relief. Satisfaction rates from modern, packless sinus surgery exceed 90%! However, appropriate medical management should always be tried first and FESS used as a last resort.
Are there alternatives to surgery?
Absolutely - and all alternatives should be exhausted prior to considering surgical intervention. There's only two basic reasons to consider surgery - when medical management has failed or when avoiding/treating complications.
Are there risks to medical management?
Absolutely! All medications have possible side effects and complications. Antibiotic resistance as well as development of allergic reactions to medicines are seen more and more frequently. Untreated or improperly treated ongoing infection carries the risks of damaging surrounding structures. Infection can spread from the sinuses into the eyes, threatening vision; it can spread into the brain, causing meningitis. While these complications are unusual, they do occur. These complications can present as emergencies, requiring prompt surgical intervention.
What are the risks associated with FESS?
Generally, FESS is very safe when done by experienced surgeons specializing in sinus work. The specific risks are related to the structures that surround the sinuses. Above the maxillary sinuses and adjacent to the ethmoid sinuses are the eyes. There is a thin plate of bone that separates the ethmoid sinuses from the eyes. Violation of this bone can lead to serious eye injury. This complication is quite rare, in fact in my experience I have never had an eye injury of any type. However, complications from FESS to the eye have been well documented. Above the ethmoid and sphenoid sinuses and behind the frontal sinuses lies the brain. While there is no real risk of brain damage, there can be a fluid lead from the brain cavity into the sinuses. This is sometimes seen from infection, polyps or fungal disease but can also be a consequence of surgery. Fluid leaks occur in less than 1% of cases and will most often resolve without further surgery. Bleeding is common with polyps or badly infected sinuses, however with modern techniques there is rarely a need for old fashioned packing.
How can a patient reduce the risks of sinusitis or FESS?
Choose your doctor wisely! While it is difficult to tell a surgeon's skill without access to the operating room, look for clues as to the doctor's experience and quality. Avoid surgeons who use out dated techniques like routine packing. Ask about the age of the operative equipment - modern equipment gives the surgeon the best chance of keeping you safe! Make sure you've exhausted non-surgical options and avoid surgeons who seem to be only considering surgery. Trust your instincts and get a second opinion. My motto is that a thoughtful second opinion will always make me look good - if I'm doing my job right! Avoid surgeons who seem uneasy about you getting a second opinion!
Is a CT or x-rays required before surgery?
A CT scan provides a road map of the sinuses for the surgeon to follow. High resolution 3D images are used during surgery to ensure safety and minimize the risks of complications. Additionally, a computer guidance system may be used during the surgery to increase the margin of safety, especially in advanced disease or revision surgery.