Endoscopic Sinus Surgery

What are sinuses?

Sinuses are hollow air spaces within the skull. They are located around the nose. Each sinus has an opening into the nose for the free exchange and drainage of air and mucus, and each is joined with the nasal passages by a continuous mucous membrane lining.

Blockage of the normal sinus drainage pathway gives rise to build up of mucus, pus, and air trapping within the sinus, with associated inflammation and infection of the sinuses. This in turn gives rise to symptoms associated with sinusitis, and/or nasal polyp formation.

What is Functional Endoscopic Sinus Surgery?

Functional Endoscopic Sinus Surgery (FESS) is an operation on the sinuses using a small telescope (endoscope). The endoscope allows the surgeon to get a much better view of the inside of the nose and the sinuses. The aim of the operation is to enlarge the natural sinus openings into the nasal cavity, and thus allow better drainage and ventilation of the sinus secretions.The exact extent of surgery is very much individualised for each patient, depending on which sinuses are affected. The endoscope allows surgery to be performed through the nose without the need for any incisions on the outside of the nose.

 

When is sinus surgery indicated?

The principal indications for endoscopic sinus surgery are recurrent attacks of acute sinusitis, chronic sinusitis, and/or nasal polyps. Surgery is usually indicated if there has been no response to medical treatment. You will have a CT scan of your sinuses prior to surgery. This will act as a anatomical road map for the surgeon during the surgery.

 

 

  Normal CT Scan with the sinuses CT scan showing sinusitis

  filled with air (Black) (gray) in the maxillary sinuses

What are the alternatives to surgery?

The main alternative to surgery is continued medical treatment. Surgery is only usually recommended if there has been a suboptimal response to medical therapy. Untreated or suboptimally treated sinusitis can lead to complications with infection spreading to nearby structures, most importantly the eye and to the brain.

What are the benefits of surgery?

The degree of benefit gained from surgery varies from individual to individual, depending on what symptoms are present before surgery and which of the sinuses are involved. Your doctor will be able to inform you of the potential symptoms that may be improved following surgery.

Some of the symptoms of sinusitis which may improve with surgery include blocked nose, runny nose, catarrh, facial pain and headaches, and occasionally reduced sense of smell.

What are the risks of surgery?

Generally speaking endoscopic sinus surgery is safe in most people. As with any surgery however there are risks. Some of the risks are minor but common, others very rare but serious. You should be aware of these risks before consenting to the procedure.

Bleeding and nasal obstruction: 

A small amount of bleeding immediately after surgery is quite common. You may notice some blood on blowing your nose for a few weeks after the operation. For a few weeks, your nose will feel congested and there may be some crusting and dried blood within the nose which will contribute to this. You will be asked to regularly douche your nose with salt water spray or a similar alternative for sometime to help with the internal healing process.

Infection

Occasionally swelling of the nasal lining and sinuses give rise to an infection which usually responds to medical therapy.

Failure of symptom relief: 

Less commonly, failure of symptom relief may occur. In those patients that pain or catarrh are the main symptoms, as supposed to nasal blockage or nasal discharge, the likelihood of benefit from surgery is slightly reduced.

Altered/loss of sense of smell 

Often sinus surgery will improve the sense of smell, but rarely it may cause a loss of sense of smell.

Eye/visual complications 

As the sinuses lie in close proximity to the eyes and are separated from them by a thin bone, there is a very small risk (1in 1000) of causing injury to your eye. In the worst case scenario, this could cause blindness or double vision.

Brain injury/fluid leak  

Some of the sinuses lie close to the bone at the base of the brain. There is a small risk (1 in 1000) of injury to this bone with leakage of the fluid that surrounds the brain into the nose, or other related brain injury. If this rare complication where to occur your hospital stay will be longer and you may require further surgery to deal with the injury.

 

After the operation

In hospital  

Immediately after the operation you will experience the after effects of a general anaesthetic. Your nose may contain some packing to stop any bleeding. This will be removed prior to your discharge. You will be discharged the same day of the surgery, or the following day depending on the surgeon’s instructions. Your nose will feel blocked, and you may experience a mild ache which is well controlled with simple pain killers.

At Home

You may experience some minor bleeding or crusting within the nose. You will be prescribed some nasal sprays (salt water spray, and/or other sprays) which you must use as instructed. This will help with the healing process within your nose. You must avoid blowing your nose for the first 48 hours (or longer if indicated by the surgeon) after the operation. It is important that you avoid dusty and smoky environments. Generally speaking you will need to stay off work for a minimum period of one week . You will most likely need to continue with your nasal medication for a significant period.