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Endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS) is a common type of sinus surgery performed for the restoration of the ventilation of the sinuses and to facilitate the clearing of the nasal secretions.

FESS is a minimally-invasive procedure that is performed using an endoscope, which is a rigid tool with a camera on one end. It involves operating through the nostrils to open up the sinuses.

Sinuses are the hollow spaces present within the bones. They are present between the eyes, behind the cheekbones, and on the forehead. The sinuses make mucus, which helps to keep the inside of the nose moist. This protects one against allergens, dust, and pollutants. 

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Purpose: The FESS treatment is recommended in the following cases:

  • Chronic (long-term) sinusitis: It is a sinus infection that lasts for more than 12 weeks.
  • Deviated septum: It is a condition in which the partition between the two nostrils becomes off-center or crooked, which can lead to nasal obstruction and breathing difficulty. This may occasionally be associated with the malformation of the sinus.
  • Nasal polyps: This condition occurs when there is severe mucosal swelling in the sinuses that protrudes into the nasal cavities as teardrop growths that can block the entire nasal passageway to create constant drainage and infection.
  • Cerebrospinal fluid (CSF) leak: CSF is the fluid surrounding the brain and spinal cord. It is a condition that occurs when the CSF leaks through a defect in the skull and out through the ear or nose.
  • Removal of a foreign body
  • Choanal atresia: It is a condition in which there is a blockage or narrowing of the nasal airway by the tissue.
  • Nasal bleeds: When there is bleeding from the nose due to trauma or nose picking.
  • Dacryocystorhinostomy: It is a surgery of the nasolacrimal duct, which carries tears from the lacrimal sac of the eye into the nasal cavity.
  • Removal of the skull tumors base
  • Other sinus problems: FESS is a good treatment option for patients suffering from ongoing sinus problems.
  • FESS is usually recommended in patients who have not had success with other medical therapies, such as nasal sprays, antibiotics, and systemic steroids, or have had unsuccessful surgical procedures earlier.

Symptoms:
The following sinus-related problems may indicate the need for FESS:

  • Sinus pressure
  • Severe nasal congestion
  • Post-nasal drip
  • Migraine
  • Breathing problems
  • Sinus headaches
  1. Physical examination: The patient is examined physically. The symptoms and medical history of the patient are noted by the doctor.
  2. CT scan: A CT scan of the paranasal sinuses helps a doctor in obtaining a clear view of the sinuses.
  3. Blood tests: These tests help in obtaining the values of different blood parameters, and in the diagnosis of underlying medical conditions like diabetes and thyroid disorders.
  4. Urine tests: These tests help in ruling out urinary infections.
  5. Chest x-ray: It helps the doctor to check the condition of the heart and lungs.
  6. Electrocardiogram (ECG): This test helps in measuring the electrical activity of the heart and diagnosing any heart conditions.

 

  • The surgery is usually performed under general anesthesia (the patient is put to sleep during the procedure).
  • Very rarely, the surgery may be performed under local anesthesia (the surgical site is numbed).
  • A decongestant is applied by the surgeon inside the nose.
  • The endoscope is now inserted through the nostrils.
  • The nose and sinuses are first evaluated by the surgeon.
  • Specialized instruments are then inserted by the surgeon through the endoscope in order to reposition the normal tissue and remove any abnormal tissues that may be present.
  • The endoscope has an attached camera that helps in obtaining the images of the nasal structures.
  • Following the surgery, the nose is packed for 24 hours and the patient has to breathe through the mouth.

 

The complications associated with a FESS procedure include:

  • Injury of the internal carotid artery

  • Uncontrollable bleeding

  • Blindness, due to optic nerve damage

  • Uncontrollable bleeding

  • Cerebrospinal fluid leak

  • Skull base fracture

  • Meningitis (inflammation and infection of the brain)

  • Synechiae (adhesions formed between adjacent structures present within the eye due to inflammation)

  • Temporary decrease or loss of smell

  • Obstruction of the nasolacrimal duct 

  • Recurrence of the disease

  • Most patients go home on the same day or the day after the surgery.
  • Follow-up visits with the doctor are recommended at one week, three weeks, and six weeks after the surgery. The patient is then recommended to visit the doctor every three months till the patient’s symptoms improve and his/her condition is stable.
  • It is normal to have some pain and swelling after the procedure.
  • The doctor will prescribe pain-relieving medications, antibiotics (to reduce the chances of infection), and oral steroids (to decrease swelling) after the procedure.
  • Antihistamine nasal decongestant drops and sprays may be prescribed to reduce the discharge and congestion and clear out the blood clots and mucus from the nose.
  • The patient is instructed to not blow his/her nose for the first week after the procedure.
  • Nasal saline washes of the nose are recommended twice a day, starting one or two days after the surgery.
  • Avoid heavy lifting and strenuous activities for at least two weeks after the surgery.
  • The patient can resume work approximately one week after the surgery.
  • Avoid flying for two weeks after the surgery.
  • Avoid swimming for two weeks after the surgery.
  • Avoid scuba diving for four weeks after the surgery.

 

Endoscopic Sinus Surgery from one of the best multi-speciality hospital: Wockhardt Hospital Nashik, Mumbai Agra Road, Nashik

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