Functional Endoscopic Sinus Surgery (FESS) is a surgical procedure to open up blocked sinuses. It is typically performed in the operating room under general anesthesia. It is an outpatient procedure, meaning you will go home after a brief stay in the recovery room.
During surgery, small endoscopes are inserted into the nose to visualize the sinus passages. Various small cutting instruments are used to selectively remove tissue and thin bone fragments to make the natural drainage pathways of the affected sinuses larger. In some cases (especially more complex cases), revision surgery, or when significant polyps are present, an Image Guidance, a.k.a. Neuronavigation system may be used, which precisely localizes the surgical instrument on your CT scan in real time. Once the sinuses are open, any significant polyps and infection are removed and the sinuses are cleaned out. Some absorbable packing material may be left inside the sinus cavity after surgery to help with bleeding and the healing process. With current techniques, it is rare to require any packing that needs to be removed (although this was common many years ago). There will be some minor oozing after surgery, but significant bleeding is not common. There may be some crusting that builds up in the sinus cavity as healing occurs, and this may require one or two “cleanings” in the office during the weeks after surgery. The more you can do to keep your nose moist (saline spray, saline rinses) after surgery, the less cleaning will need to be done.
Sinus surgery serves two purposes to help manage sinus disease:
- The drainage passage from the sinus into the nose is more open, allowing mucus to more easily drain out of the sinus.
- Larger openings in the sinuses also allow topical medications such as saline rinses and steroid nasal sprays to more effectively get into the sinuses and do their job.
Some patients needing sinus surgery are candidates for a new, minimally invasive technique called balloon sinus dilation, a.k.a. balloon sinuplasty. Using a technology similar to what is used to open blocked arteries in the heart, surgeons can endoscopically dilate sinus passages with a balloon to alleviate obstructed or narrow sinus openings while preserving as much of the normal structure of the sinuses as possible. For surgeons trained in this technique, balloon sinus dilation is a safe and effective way to manage chronic or recurrent sinusitis.
Treating sinusitis with surgery is often the “last resort” when conservative medical treatments aren’t working. Any surgery can be scary to consider, and unfortunately there are a lot of misnomers about sinus surgery from past experiences. If you are having persistent or frequent sinus infections, our physicians will sit down with you to explain the anatomy and procedure options, and help you decide whether surgery is right for you.