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Functional Endoscopic Sinus Surgery (FESS)


Functional endoscopic sinus surgery

Functional Endoscopic Sinus Surgery (FESS) is for the treatment of sinusitis or polyps.

Sinusitis means infection of the sinuses. The sinuses are caves, which occur within the bone of the face. They vary in their shape and size. There are four named sinuses:

  • The maxillary sinuses behind the cheekbones
  • The ethmoid sinuses between the eyes
  • The frontal sinuses behind the forehead
  • The sphenoid sinuses deep in the nose, in the centre of the skull.

The sinuses are like a network of caves within the skull. The walls of these bony sinuses are covered with a lining called mucosa. The mucosa produces mucus naturally keeping the inside nose moist. This evaporates as we breath through the nose. When blockage and infection occurs, a lot of mucus is produced. The most common example is that of the common cold. These sinuses (caves) have their own natural openings to allow the mucus to drain.


For various reasons, these openings can become blocked and can become acutely infected producing symptoms of sinusitis, such as facial pain, headache, discoloured nasal mucus with often a postnasal dripping of mucus, ie mucus dripping down from the nose into the throat, a blocked nose and a loss of smell. Not all patients have all these symptoms at once.

In some patients, the lining of these sinuses undergoes change and swells up to enormous extent and looks like a bunch of grapes. These are called polyps of the nose.

Functional endoscopic sinus surgery is the treatment of choice when people have failed medical treatment. Medical treatment means the use of medicines such as antibiotics, nasal sprays and steroids. Despite using such medications, symptoms may persist.

The aim of surgery is to unblock or widen the natural openings of these sinuses (caves) to restore the necessary drainage and ventilation of these sinuses.



About The surgery

For functional endoscopic sinus surgery (FESS), a thin telescope is used to view the nasal cavity and using fine instruments diseased tissue is removed. Often in conjunction with the sinus procedure, the septum, which is a midline wall dividing the two partitions of the nose, may be straightened. This is called a septoplasty. This is straightened to improve air flow through the nose and is also sometimes necessary to gain access to the sinuses.

At the same time as this procedure, a turbinectomy is often done on each side of the nose. The turbinates are curtains that hang from the walls of the nose. They play a role in the humidification of air that we breathe through the nose. They too tend to swell and block the nose, and therefore are often trimmed during the same procedure. This is called a turbinectomy.

A CT scan of the sinuses is an essential investigation for this operation and needs to be brought to the operation.


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