Functional Endoscopic Sinus Surgery (FESS)

Thomas S. Higgins, Jr., M.D., M.S.P.H.
www.higgins-sinus.com

Functional Endoscopic Sinus Surgery (FESS) is a series of techniques aimed at improving the function of the paranasal sinuses to limit sinus infections and symptoms from chronic sinusitis. Sinus surgery used to be quite a major surgery that could be painful and have high risk. Since the endoscope was incorporated into sinus surgery techniques in the 1970s and 1980s, endoscopic sinus surgery has become a much safer outpatient operation.

The sinuses that can be opened include:
  • Maxillary sinus
  • Ethmoid sinuses
  • Sphenoid sinuses
  • Frontal sinuses

Chronic Sinusitis

Chronic sinusitis is inflammation of the paranasal sinuses that is present for over 3 months. If someone has four or more sinus infections in a year, it is termed "recurrent sinusitis." The paranasal {“around the nose”) sinuses are the void spaces present in the bones that are located around our nose, in the bones of cheeks, behind the eyebrows and forehead and behind the nose in front of the brain. There are some channels that connect these void spaces to the nose. The sinus lining can become swollen from many different causes, which leads to blockage of the openings of the sinuses. The goal of sinus surgery is to open these blockages to allow proper drainage and function.  

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Causes of Chronic Sinusitis
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There are several causes of chronic sinusitis, including viruses, bacteria, fungus, polyps, genetics, allergies, and environmental exposures. 
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The person’s anatomy can also contribute to the development of sinusitis, including:
  • Narrow bony openings in the sinuses
  • Nasal polyps
  • Deviated nasal septum
  • Extra “air cells” in the sinuses (some names include concha bullosa cells, Haller cells, Onodi cells, and frontal cells)

Symptoms of Chronic Sinusitis
Some common symptoms and signs of chronic sinusitis are 3 months or more of one or more of the following:
  • Postnasal drip (behind the nose drip into the throat)
  • Nasal congestion
  • Discoloration of nasal discharge
  • Altered smell or taste
  • Coughing
  • Redness and swelling nasal lining

Symptoms from sinus infections and allergies can be confusing. Allergies of the nose tend to cause “rhinitis” (swelling of the passages of the nose only) and include more sneezing, itchiness, and watery nose/eyes. Asthma is another term that is linked with chronic sinus disease. These two conditions can worsen each other, so it important to maximally treat both.

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Diagnosis of Chronic Sinusitis
The diagnosis of chronic sinusitis is made by the patient's history and an examination of nose, sinuses and throat. An endoscopy (a tube with a small camera on the end of it is gently inserted into the nose) can helpful to locate the sinus infection and determine if the person has anatomy that worsens their risk for sinus infections. If a sinus infections is severe or lasts for an extended period, a CT scan (picture) of the sinuses may be recommended. These tests will enable the doctor to know the type of infection and which relative medicine should be given to the patient. For example, if the sinusitis is caused by bacteria, antibiotics will be recommended. If nasal polyps are present, your doctor may recommend an anti-inflammatory medicine, such as corticosteroids.

Sinusitis Treatment
  • Antibiotics
Antibiotics are recommended for bacterial sinusitis. Overuse of antibiotics can cause resistant bacteria, so antibiotics should be avoided for allergies and viral Colds. The period of medication can vary from 5-28 days, depending on the antibiotic and type of sinusitis. Extended treatments are occasionally recommended. Rarely, resistant sinusitis may require intravenous (IV) courses or direct application of antibiotics into the nose (via irrigations, sprays, or nebulizers).
  • Antihistamines
Antihistamines help to prevent the allergic reactions and block inflammation.
  • Topical Nasal Corticosteroids
These are the sprays that prevent swelling and inflammation in nasal passages.  
  • Oral Corticosteroids    
Oral corticosteroids reduce inflammation throughout the whole body, including the sinus cavities. These medications often are given for severe inflammation or nasal polyps.If none of the above medical treatments work, then surgery may be recommended to help medicines  work better. This surgery is performed to open the sinus cavities and allow function drainage of the sinus cavities. An in-office minimally invasive procedure, called balloon sinuplasty or balloon sinus dilation, is also an option without the need for cutting. During a surgical evaluation, other procedures are also considered, including Septoplasty and Inferior Turbinate Surgery.
To see Dr. Thomas Higgins, a fellowship-trained Rhinologist (Sinus Specialist),