Guide to Choosing the Right Sinus Surgery

Part I: Functional Endoscopic Sinus Surgery


Sinus surgery can be life changing

Sinus surgery can be life changing


Understanding Functional Endoscopic Sinus Surgery (FESS)

Despite the availability of several different types of procedures in the treatment of recurrent acute and chronic sinusitis, the overwhelming and most common operation is known as a functional endoscopic sinus surgery, or “FESS”, for short).  Simply put, in performing a FESS operation, surgeons avoid cutting the skin by inserting a nasal endoscope attached to a fiber optic lens into through the nostrils to remove infected sinus bone and tissue.

Prior to the advent of the FESS procedure, surgeons were only well-versed in treating infections in the maxillary paranasal sinuses. If a fungus or bacteria occurred in the ethmoid, frontal, or sphenoid sinuses, patients usually experienced only a partial improvement of their chronic sinusitis.  Doctors seldom knew which sinus was infected, since the sinus CAT scan was not yet in wide use, affecting the success rate dramatically.  Traditional sinus surgery had not yet been perfected, so patients were left with scars and only a marginal improvement in their sinusitis.

The FESS procedure is thus considered the mainstay for patients seeking effective results in battling sinusitis and nasal polyps, and is the go-to procedure for not only chronic sinusitis, but also for recurrent acute sinusitis and sinus problems resulting from bacterial and/or fungal infection.

Dr. Bennett agrees with medical researchers and surgeons around the globe in praising the FESS procedure’s outstanding success rate coupled with its minimally invasive character. It is a shining example of the benefits that patients may take advantage of as a direct result of today’s modern medical technology.


Sinus CAT Scan

Sinus CAT Scan


Popularity and Efficacy of the FESS

When the FESS procedure was first introduced over two decades ago, it effectively transformed and modernized the surgical treatment of chronic sinusitis. This is partly due to the fact that it permits the surgeon to access all the paranasal sinuses using this method, including:

  • Frontal sinuses (located in the forehead)
  • Maxillary sinuses (located in the cheeks)
  • Ethmoid sinuses (located between the eyes)
  • Sphenoid sinuses (located at the back of the nasal cavity in the middle of the head)

Currently, over 200,000 patients per year undergo this type of surgery, making it overwhelmingly the most widespread and common type of sinus surgery. This is likely due to its high success rate, as studies published in medical journals report a success rate between 80% to as high as 98% on average. Note that revision FESS procedures also exist, with similar success rates.


How is Functional Endoscopic Sinus Surgery Performed?

to In a FESS procedure, the primary instrument used by your surgeon is an endoscope. An endoscope is a long, slender medical instrument used to examine the interior of the paranasal sinuses and nasal cavity. Endoscopes serve two important functions:

First, endoscopes improve intranasal visibility using high quality fiberoptics. Secondly, a camera attached to the endoscope will allow the surgeon more detail by televising a magnified image  onto a larger screen in the operating room. Finally, endoscopes permit the surgeon to carefully and accurately perform a biopsy and remove tissue in the infected sinuses to reestablish more normal sinus drainage.

Note that a biopsy, generally, is a procedure whereby a piece of tissue is removed and subsequently examined. Thus, in a typical FESS operation, the surgeon inserts the endoscope into the nostrils, views an enlarged image of the tissue in the paranasal sinuses and nasal cavity more closely, locates and subsequently opens the affected areas as needed.

Sometimes, surgeons will also perform additional operations depending upon the patient’s needs. Common procedures often coupled with a FESS surgery include:

  • Septoplasty – a procedure to straighten a deviated nasal septum and  improve breathing functionality
  • Turbinate surgery – an operation to reduce enlarged inferior turbinates and improve overall nasal airflow
  • Septonasal reconstruction– rebuilding the nose to improve the structure and function
  • Cosmetic Rhinoplasty – an elective, cosmetic surgery to improve the overall appearance of the nose


Rigid Endoscope

Rigid Endoscope


Days and weeks leading up to FESS surgery

(1) Medications: Your surgeon will advise whether you should discontinue certain medications you are currently taking leading up to surgery, to reduce post-operative nosebleeds. If bleeding occurs, Afrin or nasal packing may be used to stop the bleeding.  Common medications that induce bleeding, and must be discontinued, include:

  • Aspirin and Ibuprophen
  • Prescription blood thinners (i.e. Coumadin and Plavix; under your primary medical doctor’s supervision)
  • Vitamin E
  • Certain diet pills
  • Herbal remedies

Patients with high blood pressure also risk the chance of a severe nosebleed, and must take special care to stop any medications that will increase the likelihood of additional bleeding after surgery.

(2) Smoking:  It is crucial to stop smoking at least two weeks prior to the surgery. Smoking not only interrupts the natural healing process of the sinuses, but also serves as an irritant to the nasal cavity.

As an aside, Dr. Bennett reminds patients that smoking in general is harmful to anyone with a history of sinusitis or sinus problems, due its impact on an individual’s respiratory system. The harmful ingredients contained in cigarette smoke increase congestion, and contribute to nasal drainage problems. Cigarettes have been reported to also destroy the delicate “cilia” in the mucus membranes of the sinus, which act akin to an air filtration system – cleaning out the dirt and bacteria so as to prevent sinus infections and inflammation. Although the cilia have the capacity to regenerate, this is only possibly if one stops smoking.

Cigarette smoke and second-hand smoke also contribute to a host of various other severe medical and health issues, including respiratory and cardiovascular diseases that are separate and apart from the sinuses.

(3) Drinking and Eating: Patients should take extra care not to drink or eat anything (including water) starting at midnight on the night before the sinus surgery. This is for anesthesia purposes. This reduces the likelihood of nausea and vomiting once surgery is complete and you are transferred to the recovery room.


What happens immediately after surgery?

After a FESS procedure, you will most likely experience some sinus congestion and sinus headaches. It is critical to allow your sinuses and body to heal following surgery, so it is recommended that you rest for several days to a week, ideally taking time off from work, especially if you have a physically rigorous profession.

FESS operations are performed in one to two hours for most patients, and following surgery, if you are in good health,  you are usually permitted to leave the surgery center the same day. Unlike traditional sinus surgery, nasal packing is rarely needed, depending upon the severity of the infection.

If you chose to undergo a FESS procedure, keep in mind that it may take several months for you to reap the full benefits of the surgery. Most patients report an immediate relief of sinus pain, however it is likely that it will take a bit longer for your sinuses to completely heal and experience a new, healthy-breathing lifestyle.


Getting enough rest is essential

Getting enough rest is essential


Learn more about choosing the right sinus surgery with the next types in the following guides:


Part 2 : Balloon Sinus Surgery


Part 3 : Traditional Sinus Surgery


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