Endoscopic Sinus Surgery

Functional Endoscopic Sinus Surgery (FESS)

Functional Endoscopic Sinus Surgery (FESS) - Indications for Endoscopic Sinus Surgery - Contraindications for Endoscopic Sinus Surgery - Technique of Endoscopic Sinus Surgery - Caldwell Luc Operation - Risks and Complications of Endoscopic Sinus Surgery - Postoperative Patient Care for Endoscopic Sinus Surgery - Post-operative Instructions for endoscopic sinus surgery
Endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS) is the primary safe approach used currently for the surgical treatment of chronic sinusitis.

This procedure is a minimally invasive, safe and it can be performed entirely through the nostrils, leaving no external scars. There is little swelling and only mild discomfort. It can be combined with other nasal operations (septoplasty, turbinate radiofrequency etc.).

A recently developed alternative to functional endoscopic sinus surgery is balloon sinuplasty. This technique uses balloon catheters to dilate the maxillary, frontal, and sphenoid natural ostia without bone or soft-tissue removal. Reports show persistent patient symptom improvement and sinus ostia patency.

Indications for Endoscopic Sinus Surgery

Functional Endoscopic Sinus Surgery (FESS) - Indications for Endoscopic Sinus Surgery - Contraindications for Endoscopic Sinus Surgery - Technique of Endoscopic Sinus Surgery - Caldwell Luc Operation - Risks and Complications of Endoscopic Sinus Surgery - Postoperative Patient Care for Endoscopic Sinus Surgery - Post-operative Instructions for endoscopic sinus surgery
Indications for Endoscopic Sinus Surgery

The most common indication for endoscopic sinus surgery is “chronic rhinosinusitis”.

The most common indications for endoscopic sinus surgery are as follows:

• Chronic sinusitis refractory to medical treatment
• Recurrent sinusitis
• Nasal polyposis
• Antrochoanal polyps
• Sinus mucoceles
• Excision of selected tumors
• Cerebrospinal fluid (CSF) leak closure
• Orbital decompression (eg, Graves ophthalmopathy)
• Optic nerve decompression
• Dacryocystorhinostomy (DCR)
• Choanal atresia repair
• Foreign body removal
• Epistaxis control

Maxillary and Ethmoidal Sinusitis

Left Maxillary and Ethmoidal Sinusitis

"Sinusitis" is the name given to the inflammation of the sinuses, which are air-filled spaces in the bones of the face and head. In the above tomography section, it is observed that the left maxillary sinus and left ethmoid sinuses are closed due to inflammation in a patient who complains of fullness and pain in the face and bad smelling discharge from the left nostril and nasal passage. Endoscopic sinus surgery was planned for this patient who did not recover despite medical treatment.

Contraindications for Endoscopic Sinus Surgery 

Functional Endoscopic Sinus Surgery (FESS) - Indications for Endoscopic Sinus Surgery - Contraindications for Endoscopic Sinus Surgery - Technique of Endoscopic Sinus Surgery - Caldwell Luc Operation - Risks and Complications of Endoscopic Sinus Surgery - Postoperative Patient Care for Endoscopic Sinus Surgery - Post-operative Instructions for endoscopic sinus surgery
Contraindications for Endoscopic Sinus Surgery 

There are probably no absolute contraindications to endoscopic sinus surgery. Generally, there are no absolute contraindications for functional endoscopic sinus surgery, except for complicated frontal sinusitis. Since it is a minimally invasive technique, it is generally applied in many cases without any problems. However; In some sinus diseases, endoscopic treatment may not be sufficient; Pott's Puffy Tumor (PPT-subperiosteal abscess development with frontal bone osteomyelitis due to frontal sinusitis) and intraocular complications of acute sinusitis such as orbital abscess and frontal osteomyelitis can be listed. The open approach, with or without endoscopic assistance, may be preferred in such cases. Preoperative tomography or magnetic resonance imaging (MRI) examinations help the ENT specialist for a detailed evaluation.

The most common relative contraindications for endoscopic sinus surgery are as follows:

• Absence of specific osteomeatal complex abnormalities.
• Oesteomyelitis involving the sinuses.
• Frontal sinus disease with stenosed internal ostium.
• Threatened intracranial and / or intracerebral complications.
• Inaccessible lateral frontal sinus disease.

Smoking is also consider as a relative contraindication to endoscopic sinus surgery.

Technique of Endoscopic Sinus Surgery

Functional Endoscopic Sinus Surgery (FESS) - Indications for Endoscopic Sinus Surgery - Contraindications for Endoscopic Sinus Surgery - Technique of Endoscopic Sinus Surgery - Caldwell Luc Operation - Risks and Complications of Endoscopic Sinus Surgery - Postoperative Patient Care for Endoscopic Sinus Surgery - Post-operative Instructions for endoscopic sinus surgery
Technique of Endoscopic Sinus Surgery

Endoscopes with different diameters of 4mm (adult use) and 2.7mm (pediatric use) and with a variety of viewing angles (0 degrees to 30, 45, 70, 90, and 120 degrees) provide good illumination of the inside of the nasal cavity and sinuses. High definition cameras, monitors and different tiny articulating instruments aid in identifying and restoring the proper drainage and ventilation relationships between the nose and sinus cavities.

Paranasal Sinus CT scanning can also be used to identify the diseased areas, a process that is required for planning the surgical procedure.

Endoscopic Sinus Surgery - Maxillary Drainage Video



On the video above: Right maxillary sinus retention cysts discharging into the nasal cavity.

Inner wall of right maxillary sinus pushed toward the nasal cavity by retention cyst, endoscopic evacuation of cyst is showing on video.

Endoscopic Concha Bullosa Operation Video



Endoscopic Sinus Surgery - Injection of Local Anesthetic Video


Caldwell Luc Operation: An Alternative Method For Surgical Traetment of Chronic Maxillary Sinusitis

Caldwell Luc Operation: An Alternative Method For Surgical Traetment of Chronic Maxillary Sinusitis
Caldwell Luc Operation: An Alternative Method For Surgical Traetment of Chronic Maxillary Sinusitis

Caldwell-Luc operation is defined before the endoscopic sinus surgery to relieve chronic sinusitis by improving the drainage of the maxillary sinus, one of the cavities beneath the eye. The maxillary sinus is entered through the upper jaw above one of the second molar teeth. A window is created to connect the maxillary sinus with the nose, thus improving drainage.

Risks and Complications of Endoscopic Sinus Surgery

Functional Endoscopic Sinus Surgery (FESS) - Indications for Endoscopic Sinus Surgery - Contraindications for Endoscopic Sinus Surgery - Technique of Endoscopic Sinus Surgery - Caldwell Luc Operation - Risks and Complications of Endoscopic Sinus Surgery - Postoperative Patient Care for Endoscopic Sinus Surgery - Post-operative Instructions for endoscopic sinus surgery
Risks and Complications of Endoscopic Sinus Surgery

The risks and complications of endoscopic sinus surgery are as follows:

• Blindness : The most serious risk associated with FESS. It is resulting from damage to the optic nerve. The chances of this complication occurring, however, are extremely low.
• Hemorrhage
• Cerebrospinal fluid leak: It represents the most common major complication of FESS. The leak is usually recognized at the time of surgery and can easily be repaired.
• Orbital hematoma
• Nasolacrimal duct stenosis
• Changes in your sense of smell and / or taste

Complications may rarely occur in FESS surgery. The main complications that can be seen are:

Bleeding: It is very common to have a small amount of bleeding from the nose, anterior and nasal area in the days following FESS surgery. Serious bleeding is extremely rare and blood transfusion is rarely required.

Eye problems: The sinuses are close to the eye wall. Sometimes a small bleeding can occur in the eye and it can be noticed as some bruises around the eye. This condition is usually minor and resolves without any special treatment. More serious bleeding into the orbit may very rarely occur. This may cause swelling in the eye and, in very rare cases, even vision loss and double vision. If such serious eye complications occur, the patient may need to be evaluated by an ophthalmologist and may require further procedures.

Cerebrospinal fluid leak: The sinuses are close to the bony structures at the base of the brain. In all sinus surgeries, there is a risk of leakage of fluid around the brain as a result of damage to fine bone structures. If this leak does not improve with follow-up, the patient may need to stay in the hospital for a long time and an operation may be required to stop the leak. In very rare cases, the infection can spread to the cerebrospinal fluid, causing meningitis.

Postoperative Patient Care for Endoscopic Sinus Surgery

Postoperative Patient Care for Endoscopic Sinus Surgery

If the operation was performed under general anesthesia, oral nutrition should not be given for the first 4 hours after surgery. If sedative medication is not given after local anesthesia, oral nutrition and fluid intake can be started after the procedure. If sedative medication is used, oral feeding can be started 2 hours after surgery.

It is normal to have bleeding in the form of drip or leakage from the nasal area behind and in front of the nose in varying amounts depending on the use of materials such as tampons or absorbable tampons placed in the nose after the surgery and whether or not concha radiofrequency and cartilage curvature surgery is performed.

For the post-operative first week patients should not blow his / her nose. For firts few days, minor nasal or post nasal bleeding are normal. A saline spray may be used several times per day to relieve nasal irritation. In addition, exercise or any other exertional activity for at least two weeks following surgery should not be performed. This includes no bending, lifting (more than about 10 lbs.), or straining.

In order to reduce the blood pressure in the head area after the operation, it is appropriate to give the patient a lying position by ensuring that the head of the patient is above the body. The room temperature of the patient and the temperature of the water applied to the face area while taking a shower should not be too much. Since the width of the nasal vessels will increase in a hot environment, the amount of bleeding may increase. This leakage bleeding will decrease within days. Exercises, sports activities and professional duties that will increase post-operative blood pressure are inconvenient for the first 10 days.

After Functional Endoscopic Sinus Surgery (FESS) surgery, it is recommended to wash the nose with ocean water or other saline water in the first week, and to use additional intranasal cortisone sprays in the following weeks. It is not appropriate to use cortisone sprays into the nose in the first week and it may increase bleeding. Ocean waters provide the removal of clots, increase the nutrition of mucosal cells and remove microorganisms. The presence of crusting in the nose in the first few weeks after surgery is expressed by most patients. Intra-nasal washing with sinus rhinse can also be performed from the second week after the operation or from the 3rd week.

The amount is post-operative pain usually less and disappears within a few days. You should plan on taking at least one week off from work to recover from surgery.

Source links about "Functional Endoscopic Sinus Surgery (FESS) - Indications for Endoscopic Sinus Surgery - Contraindications for Endoscopic Sinus Surgery - Technique of Endoscopic Sinus Surgery - Caldwell Luc Operation - Risks and Complications of Endoscopic Sinus Surgery - Postoperative Patient Care for Endoscopic Sinus Surgery - Post-operative Instructions for endoscopic sinus surgery":

  • Fonksiyonel Endoskopik Sinüs Cerrahisi (FESS) ve Diğer Sinüzit Ameliyatları

  • Functional endoscopic sinus surgery - Wikipedia

  • Endoscopic surgery for sinusitis - WebMD

  • Functional Endoscopic Sinus Surgery (FESS) - ENT UK

  • Endoscopic Sinus Surgery - Johns Hopkins Medicine

  • Endoscopic Nasal & Sinus Surgery - American Rhinologic Society

  • Fact Sheet: Sinus Surgery

  • Sinus Surgery Patient Recovery, Types, Risks - MedicineNet

  • Functional endoscopic sinus surgery (FESS)



  • Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

    Private Office:
    Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
    Appointment Phone: +90 212 561 00 52
    E-Mail: muratenoz@gmail.com
    Mobile phone: +90 533 6550199
    Fax: +90 212 542 74 47





     
    

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