Endoscopic Sinus Surgery
The nose includes the external nose on the face and the nasal cavity, which extends posteriorly from it. The nose functions in smell and provides filtered, warm, moist air for inspiration.
Paranasal means around the nose. The paranasal sinuses are pairs of air-filled cavities that are found around the nose. There are four pairs : maxillary, ethmoids, sphenoid and frontal sinuses. They are connected to one another.
Functions of Paranasal Sinuses:
Produces mucus, Filters, warm, and moistens the incoming air, Act as resonance chamber for speech, Lighten the skull
What is endoscopic sinus surgery or FESS?
Endoscopic Sinus Surgery is the name given to operations used for severe or difficult to treat sinus problems. In the past sinus operations were done through incision (cuts) in the face and mouth but endoscopic sinus surgery allows the operation to be performed without the need for these cuts.
The purpose of FESS is to restore normal drainage of the sinuses. Normal function of the sinuses requires ventilation through the ostia (mouth-like opening) and is facilitated by a mucociliary transport process that maintains a constant flow of mucus out of the sinuses. All sinuses need ventilation to prevent infection and inflammation, a condition known as sinusitis. In healthy individuals, sinus ventilation occurs through the ostia into the nose.
Indications for Endoscopic Sinus Surgery
Endoscopic sinus surgery is most commonly performed for inflammatory and infectious sinus disease. The most common indications for endoscopic sinus surgery are as follows:
Nasal Diseases: Chronic sinusitis refractory to medical treatment, Recurrent sinusitis, Nasal polyposis, Antrochoanal polyps, Sinus mucoceles, Excision of selected tumors
Intracranial (Brain) Diseases:Cerebrospinal fluid (CSF) leak repair, Enchealocele, meningiocele.
Ophthalmic Diseases:Orbital decompression (eg, Graves ophthalmopathy), Traumatic Optic neuropathy, Nasolacrimal duct blockage (Endonasal DCR)
Choanal atresia repair
Foreign body removal
Typically, endoscopic sinus surgery is reserved for patients with documented rhinosinusitis, based on a thorough history and a complete physical examination, including CT scans if appropriate, and in whom appropriate medical treatment has failed.
Medical therapy alone may be inadequate for treatment of nasal polyposis. Similarly, antrochoanal polyps require surgical removal.
Increasingly, selected nasal masses and tumors are being removed endoscopically. Endoscopic surgery can be performed for limited lesions in which definitive control and margins can be obtained endoscopically; this circumstance can be predicted preoperatively via nasal endoscopy and imaging.
Cerebrospinal fluid leaks
CSF leaks associated with CSF rhinorrhea can be managed endoscopically. With endoscopic repair of CSF leaks, the more extensive neurosurgical external approaches via craniotomy can be avoided. In certain clinical settings, endonasal encephaloceles are repaired via endoscopic approaches.
Endoscopic approaches may also be applied for ophthalmic procedures, including orbital decompression, endoscopic DCR, and optic nerve decompression for traumatic indirect optic neuropathy. Traditionally, these procedures were performed through external approaches, but as clinical experience in nasal endoscopic techniques has increased, they are now performed endoscopically..
Minor complications (such as scar tissue attaching to nearby tissue, or bruising and swelling around the eyes)
Major complications (such as heavy bleeding, eye area injury, or brain injury)
Most complications of endoscopic sinus surgery can be managed or prevented.
FESS usually does not cause severe postoperative sinus pain. After the procedure, it is important to keep the nose as free from crust build-up as possible. To achieve this, the surgeon may perform a lengthy cleaning two to three times per week or the patient may perform a simple nasal douching several times a day. Normal function usually reappears after one or two months.