Functional Endoscopic Sinus Surgery (FESS)

A minimally invasive surgical procedure that opens up sinus air cells and sinus ostia (openings) with an endoscope. The use of FESS as a sinus surgical method has now become widely accepted; and the term "functional" is meant to distinguish this type of endoscopic surgery from non-endoscopic, more conventional sinus surgery procedures. The most suitable candidates for this procedure have recurrent acute or chronic infective sinusitis, and an improvement in symptoms of up to 90 percent may be expected following the procedure. Fiberoptic telescopes are used for diagnosis and during the procedure, and computed tomography is used to assess the anatomy and identify diseased areas. Functional endoscopic sinus surgery should be reserved for use in patients in whom medical treatment has failed. The procedure can be performed under general or local anesthesia on an outpatient basis, and patients usually experience minimal discomfort. The complication rate for this procedure is lower than that for conventional sinus surgery. 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. The sinuses open into the middle meatus (curved passage in each nasal cavity)

under the middle turbinate (thin, bony process that is the lower portion of the ethmoid bone in each nasal cavity), which together are known as the osteomeatal complex, the key area of the nose. The hair-like cilia direct the flow of mucus toward the ostia.

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:

1. 2. 3. 4. 5. 6. 7. 8. 9.

Chronic sinusitis refractory to medical treatment Recurrent sinusitis Nasal polyposis Antrochoanal polyps Sinus mucoceles Excision of selected tumors Cerebrospinal fluid (CSF) leak closure Orbital decompression (eg, Graves ophthalmopathy) Optic nerve decompression

10. Dacryocystorhinostomy (DCR) 11. Choanal atresia repair 12. Foreign body removal 13. Epistaxis control