Fess: Functional Endoscopic Sinus Surgery - Sinusitis
What Is It?
Sinusitis results from chronic inflammation of the sinuses, which may result from many different causes including infection of bacterial, viral, allergic or other origins. Inflammation of the sinuses must occur with some inflammation of the nasal passages, so some classifications of sinusitis now refer to this condition as rhinosinusitis.
Typically sinusitis affects what are known as the paranasal sinuses which include the following:
- Frontal sinuses
The areas most often affected or the areas where people most often feel the pain of sinusitis include the cheeks, front of the head above the eyes, behind the eyes and pain and pressure along the front of the sinus cavity, often between the eyes along the head. Often sinusitis is acute meaning it comes on suddenly but it can also be a chronic infection meaning it can occur for up to 3 months at a time. Acute or chronic sinusitis typically have the same symptoms which usually include pain and pressure accompanied by headache along the sinus cavity.
A respiratory tract infection or cold can sometimes precede a sinus infection. Other symptoms that can occur with sinusitis include yellow or green discharge from the mucous membranes, blurry vision, dizziness, fever and feelings of general unwellness. Some people may report having aching teeth and others may feel fullness or tightness in their face.
Today the most common surgery to correct sinusitis is the FESS or “functional endoscopic sinus surgery” procedure. This surgery is performed for patients with chronic sinus infections. It is a precise procedure that allows doctors to remove diseased tissue and bone allowing the sinuses to be opened and the nose to be restored to good health.
FESS is not as invasive as other procedures but the surgery can be involved for individuals that have long-lasting and deeply penetrative infections that have pervaded their sinuses for along time. Many patients will require ongoing therapy however to address the causes of continuous inflammation, so it is important patients realize they have to attack not just the symptoms and disease but also the causes for the disease when undergoing the FESS procedure.
Endoscopic surgery can also treat tumors in patients along the sinus cavities. The FESS procedure helps open the ethmoid sinuses usually, allowing the surgeon to visualize the maxillary, sphenoid and frontal sinuses. The surgeon may remove damaged tissues and patients can often return home on an outpatient basis. Some patient may require some mild packing but usually this is not necessary. The goal of surgery includes opening sinuses widely to allow freer breathing and to help reduce inflammation.
Alternatives to Surgery
Alternatives to surgery include the use of antibiotics to reduce infection of the sinuses. Other alternatives include saline rinses to help clear infection and mucous build up in the sinuses. Often patients with chronic sinus infections are not left with many alternatives and thus must undergo surgery to realize permanent or semi-permanent relief from chronic sinus infections.
Previous to the FESS technique surgery was very invasive and often resulted in the removal of a lot of tissue from the sinuses.
Before The Operation
A surgeon will survey the area and confirm a diagnosis. The endoscope used in the FESS procedure will allow the doctor to visualize the diseased areas for an accurate assessment. CT scans and other imaging techniques will also allow the doctor to diagnose all problems prior to surgery to make sure the best possible outcome is achieved during surgery. Obstructive tissues will be marked and noted for removal during surgery.
After The Operation
Most patients undergoing the FESS technique will be released on an outpatient basis. The sinus lining should with time heal and return to normal. The patients will need time to rest and recover and may experience some residual swelling after surgery.
Possible complications could include re-infection or infection from surgery. It is also possible the surgery will fail although generally the FESS surgery opens the sinus cavities to prevent further infection and allow more air to pass through the sinus cavities. This can dramatically improve a patient’s symptoms and reduce the need for chronic treatment for sinus infections and sinusitis.
Before considering surgery it is important you receive an accurate diagnosis from a physician. You should consider undergoing imaging studies to rule out other causes for your symptoms. A surgeon should be well qualified and trained using the FESS technique. Be sure to check their credentials and ask them how many patients they have treated successfully using this technique. Generally most patients undergoing surgery will recover with few complications and improve rapidly. Keep in mind many factors including your overall health prior to surgery will influence your health and recovery following surgery.
Estimated Costs for FESS
The costs for FESS vary considerably from country to country, although generally FESS is a very affordable surgery. Some computer-assisted surgeries are more expensive than other FESS surgeries. This surgery is rapidly becoming more popular and requested although some long-term studies question the benefits of the study in the longer ranges. It is important you talk with your doctor to determine whether you are a good candidate for this surgery and if you are determine whether the benefits of surgery outweigh any complications or potential risks associated with surgery.