Functional Endoscopic Sinus Surgery (FESS)

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What are sinuses?

Sinuses are air-filled spaces in the bones of the face and head. They are connected to the inside of the nose through small openings. The sinuses are important in the way we breathe through the nose and in the flow of mucus in the nose and throat. When the sinuses are working properly we are not aware of them, however if they become inflamed of infected the can cause symptoms. This is known as sinusitis. Symptoms of sinusitis can include a blocked nose, pressure or congestion in the face, runny nose or mucous problems, headache or loss of sense of smell.

What is functional endoscopic sinus surgery (FESS)?

Endoscopic sinus surgery is the name given to operations used for severe or difficult to treat sinus problems. You will likely have been given nose drops, sprays or antibiotics to try and improve your symptoms, however if these medications have been unsuccessful in treating your sinus problems then an operation may be required.

What can I expect before the operation?

The procedure is usually done under general anaesthesia. You will have to attend a pre assessment clinic before your operation with one of the nursing staff. You will be screened for MRSA and have some routine blood tests and a heart trace (ECG). You will be asked not to eat anything for 6 hours prior to coming into hospital (including chewing gum, mints etc) and be asked not to have anything to drink except clear fluids for 2 hours prior to coming into hospital (clear fluids = water, black tea, black coffee).

If you have special requirements related to religion or to an allergy/disability then you may wish to discuss this further with one of the nurses at your pre assessment clinic.

What happens on the day of my operation?

You will be admitted onto the ward on the day of your procedure, if it scheduled for the morning operating list you will be asked to come to the surgical ward for 7.30am. This means that you operation will take place between approximately 8.00am and 1.00pm depending on the order of the operating list. If it scheduled for the afternoon operating list you will be asked to come in for 11.30am. This means that your operation will take place between approximately 1.30pm and 5.00pm.

You will be seen by the anaesthetist and the surgeon who will go through the procedure and give you the opportunity to ask any questions. Your surgeon will then ask you to sign a consent form.

What does the operation involve?

The operation usually takes about 30-60 minutes. You will probably be asleep, although some cases can be performed with just the nose anaesthetised. The operation is all done inside the nose and there is usually no need for cuts outside the nose. The surgeon will use special telescopes and other instruments to unblock your sinuses. Small amounts of bone and the swollen lining of your nose are removed. If you have nasal polyps these can also be removed.

What are the risks?

Sinus surgery is safe, but there are some risks. Sometimes your nose can bleed after this operation, and we may have to put packs into your nose to stop it. This can happen within the first 6-8 hours after surgery or up to 5-10 days after surgery. If there is bleeding during the operation you may wake up with a pack already inside your nose.

Infection in your nose is rare after this operation, but if it happens it can be serious, so you should see a doctor if your nose is getting more and more blocked or painful.

The sinuses are very close to the wall of the eye socket. Rarely bleeding into the eye socket can occur. If this is mild you may notice some bruising around the eye, however if the bleeding is more severe you may experience some double vision or in very rare cases loss of sight. This may require further operations to fix this.

The sinuses are also very close to the bone at the base of the brain. Very rarely this bone can be damaged during the operation, if this happens there may be a leak of the fluid that surrounds the brain into the nose. This may require a further operation to fix this leak. On very rare occasions infection can spread from the sinuses into the fluid surrounding the brain causing meningitis but this is extremely uncommon.

In general, serious complications are very rare. In a survey of all ENT surgeons who do this type of operation in England. Eye complications happened one in every five hundred operations and spinal fluid leaks happened one case in every one thousand operations.

What can I expect after the operation?

You will be seen by either the surgeon of another member of the team who will explain how the operation has gone. You will most likely go home the same day, however if there is bleeding during the operation and your nose needs packing you may need to stay overnight.

We will likely give you some nasal drops or a spray or some tablets to take home with you which will help to prevent your symptoms from recurring. These will contain a steroid medication that will help to reduce the inflammation in your nose. You may need to continue these medications long term. You will need to take at least a week off work to allow the nose to heal.

Your nose will be a bit painful for a week or so, simple painkillers such as paracetamol or ibuprofen should be enough to relieve this pain.

For the next 2 weeks

• Breathe gently through your nose, do not blow or sniff as this will not relieve the feeling of blockage and may increase the swelling
• If you are going to sneeze, sneeze with your mouth open to protect your nose
• Avoid lifting heavy weights or doing strenuous exercise as this increases the swelling and risk of bleeding
• You may get some blood coloured watery fluid from your nose for the first two weeks or so. This is normal
• Your nose will be blocked both sides as if you have a heavy cold

What about follow up?

We will most likely see you in the outpatient clinic between 4 and 8 weeks after the operation to check your symptoms have improved and you are happy with the results of the surgery

Is there any alternative treatment?

There are numerous medications that can help improve the symptoms associated with sinus problems including nasal steroids and antibiotics.

These should be discussed with your surgeon. If you have vision, mobility or access issues please contact the ENT secretaries for further advice / information.

Who can I contact for further information or advice?