A boon for patients with recurrent acute or chronic infective sinusitis, nasal polyps including bacterial, fungal, recurrent acute, and chronic sinus problems.
Functional endoscopic sinus surgery (FESS) is a surgical treatment of sinusitis and nasal polyps, including bacterial, fungal, recurrent acute, and chronic sinus problems. FESS uses nasal endoscopes to restore drainage of the paranasal sinuses and ventilation of the nasal cavity.
Advantages of Functional Endoscopic Sinus Surgery (FESS):
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- It is a safe and minimally invasive procedure, usually no cuts, blood loss.
- It does not disturb healthy tissue.
- It is performed in less time with better results.
- No visible signs that surgery has been performed
- Quick Recovery and return to normal lifestyle.
When is Functional Endoscopic Sinus Surgery required/ helpful?
FESS (like any sinus surgery) is most successful in patients who have recurrent acute or chronic infective sinusitis. Patients in whom the predominant symptoms are facial pain and nasal blockage usually respond well. The sense of smell often improves after this type of surgery. A CT scan before FESS is mandatory to identify the patient's ethmoid anatomy and its relationship to the skull base and orbit. CT scanning also allows the extent of the disease to be defined, as well as any underlying anatomic abnormalities that may predispose a patient to sinusitis.
Patient selection therefore involves a thorough history and physical examination, a trial with medical treatment and, finally, CT scanning. The result is a highly selected group of patients who can expect an improvement of up to 90 percent in their symptoms. In patients with nasal polyposis that is not controlled with topical corticosteroids, FESS permits the accurate removal of polyps using suction cutters.5 It is not known whether the disease-free interval is extended for patients having endoscopic ethmoidectomies for polyposis compared with conventional polyp surgery, but the postoperative discomfort is minimal.
How Functional Endoscopic Sinus Surgery FESS is performed?
Fiberoptic telescopes are used for diagnosis and during the procedure, and computed tomography is used to assess the anatomy and identify diseased areas. Functional endoscopic sinus surgery should be reserved for use in patients in whom medical treatment has failed. The procedure can be performed under general or local anesthesia on an outpatient basis, and patients usually experience minimal discomfort. The complication rate for this procedure is lower than that for conventional sinus surgery.
After inducing adequate vasoconstriction with cocaine or ephedrine, the surgeon locates the middle turbinate, the most important landmark for the FESS procedure. On the side of the nose at the level of the middle turbinate lies the uncinate process, which the surgeon removes. The surgeon opens the back ethmoid air cells, to allow better ventilation, but leaves the bone covered with the mucous membrane. Following this step, the ostium located near the jaw is checked for obstruction and, if necessary, opened with a middle meatal antrostomy.
This surgical procedure often greatly improves the function of the osteomeatal complex and provides better ventilation of the sinuses. Many new refinements have also been made with Functional Endoscopic Sinus Surgery (FESS) surgery. Nowadays, doctors are doing their operations through a video attachment to the endoscope that allows surgeons to look at a video monitor. It is less of a physical strain.
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