Functional Endoscopic Sinus Surgery (FESS)

 

 

     Sinus surgery is not a distant concern because anyone can experience it. Therefore, let’s first explain what a "sinus" is. Sinuses are air cavities in the skull located beside the nasal cavity, with four main pairs on both the left and right sides around the cheeks, forehead, eye sockets and the base of the skull.

 

Endoscopic Sinus Surgery

     Endoscopic sinus surgery uses an endoscope to treat sinus diseases and conditions affecting the nasal cavity and nearby organs. This allows the surgeon to view the anatomical structures, particularly in areas not visible to the naked eye, and to assess the disease's severity and plan treatment accurately. Since the surgery is performed through the nasal passages, there are generally no external skin incisions, except in severe or complex cases where minor external incisions may be needed.

 

 

 

 

 

 

Full House FESS Sinus Surgery

     Typically, sinuses drain through openings into the nasal cavity by natural mechanisms. However, when the sinuses become inflamed or blocked, they cannot drain properly, leading to "Sinusitis", which affects the respiratory system and sense of smell. Currently, the most effective treatment for sinusitis that reduces recurrence is surgery to completely open the sinuses using an endoscope, known as Full House FESS.

 

 

 

 

 

 

When Should You See A Doctor ?

Many people mistakenly believe that sinusitis will resolve on its own, like a cold. However, if you experience any of the following symptoms, you should see a doctor to prevent worsening conditions:

 

• Nasal congestion, thick green mucus, or mucus with blood.
• Headache or facial pain in the eyes, forehead, cheeks, or neck.
• Bad breath or reduced sense of smell.

 

 

 

Contact For Doctor Appointment

 

 

 

Preparations For Sinus Surgery

     Patients should ensure they get adequate rest and prepare for the surgery at least one day in advance. If you're wondering how long the recovery period is, typically, hospital recovery after sinus surgery takes 1-2 days, provided there are no complications.

 

Risks of Sinus Surgery

     Sinus surgery is generally low risk, but complications can occur due to the proximity of the sinuses to the eyes, optic nerves, and major blood vessels. Risks include injury to the eyes or leakage of cerebrospinal fluid into the nasal cavity, with an approximate risk of 1% and 0.1%, respectively. The use of surgical navigation systems has significantly improved safety and reduced risks.

 

 

 

 

 

Post-Surgery Care

• Packing may be placed in the nasal passages to control bleeding, allowing you to breathe through your nose.
• Expect some bleeding for 1-2 days after surgery, usually old blood mixed with nasal wash solution.
• Avoid blowing your nose forcefully, picking your nose, or engaging in strenuous activities.
• Use nasal sprays prescribed to clean the surgical site.

 

 

 

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Proper post-surgical care is crucial for successful recovery and quicker healing. Follow-up visits with your doctor are necessary to monitor your progress.

 

 

 

 

 

Frequently Asked Questions (FAQs)

Q: What are the symptoms of “sinusitis”?

A: The "sinus" refers to the air-filled cavities in the skull that have openings connecting to the nasal passages. There are four main pairs located in the cheeks, forehead, around the eyes, and at the base of the skull. When there is pus in these air cavities, it is referred to as "sinusitis."

 

Q: How can you distinguish between a cold and sinusitis?

A: If cold symptoms include fever, facial pain, and thick mucus, and do not improve within 3-4 days, or if symptoms persist for more than 7-10 days, it might indicate sinusitis.

 

 

 

 

Contact For Doctor Appointment

 

 

 

Q: Is sinus surgery dangerous?

A: As mentioned earlier, the current method of "Full House FESS" or "complete sinus surgery leaving only the edges" is a type of endoscopic surgery performed through the nose to open all the sinus cavities, connecting them to the nasal passages while preserving the sinus function. This method has the advantage of allowing the best air ventilation of the sinuses, effectively draining pus and fungi, preventing recurrence, and enabling thorough application of nasal sprays or washes to treat inflammation and allergies in cases of rhinitis or nasal polyps.

 

However, all surgeries carry risks, depending on factors such as:

• The surgical technique.
• The expertise of the surgeon.
• The patient's physical condition, underlying diseases, and the anatomical structure of the nose and sinuses.

 

In Thailand, there are a limited number of doctors specializing in "Full House FESS" surgery due to the need for in-depth knowledge and skills from surgeons with substantial experience. It is important to choose a specialist to prevent complications that may arise from surgery in areas near the skull base and the eyes.

 

 

 

 

 

 

Q: How does Full House FESS differ from ESS?

A: Full House FESS is a sinus surgery that involves opening all the sinuses and connecting them into a single unit using endoscopy. It is currently considered the best sinus surgery available.

 

Q: Why might multiple surgeries be needed?

A: Will sinus surgery result in a complete cure? This is a concern for many patients. However, repeated sinus surgery may be due to incomplete treatment from a previous surgery. The main reasons include:

 

• Partial sinus surgery, which leaves some sinuses still inflamed or obstructed, causes symptoms to improve initially but then recur.
• Incorrect positioning of the sinus opening.
• Narrowing and obstruction of the sinus opening due to scarring from previous perforation and suction procedures.
• Chronic wounds from previous surgeries that block sinus ventilation.
• Abnormal nasal structure or septal deviations in the patient that were not corrected in the previous surgery, leading to poor sinus ventilation.

 

 

 

 

Q: What are the severe complications of sinusitis?

A: In some patients, complications may arise, including:

 

• Meningitis, an infection that causes inflammation of the meninges and cerebrospinal fluid.
• Osteomyelitis, or infection of the bone, or inflammation of the skin and surrounding tissues.
• Vision problems due to infection in the eye socket, leading to decreased vision or temporary or permanent vision loss.

 

What are the warning signs of the beginning of sinusitis? 

     Sinusitis symptoms can range from mild to severe. In patients with mild symptoms, there may be nasal congestion, a stuffy or blocked sensation, phlegm, or persistent coughing. They might also notice a bad smell in the nasal cavity and a reduced sense of smell. In patients with severe symptoms, there may be pain and pressure around the face, forehead, eyes, or cheekbones. Some may experience pain in the upper jaw, with or without fever. In very severe cases, there may be swelling around the eye socket, leading to impaired vision or severe headaches.

 

Additionally, some patients may experience pain in the face, eyes, forehead, cheekbones, or the back of the head when the plane ascends or descends during landing. There might also be nosebleeds or phlegm with blood.

 

 

Conclusion

     In conclusion, the symptoms of sinusitis may start mild and can be treated relatively quickly. However, if left untreated and allowed to become chronic, it can affect nearby organs, leading to more complex and difficult treatment, and potentially impacting one's life. Therefore, if symptoms of sinusitis persist, it is important to see a doctor for diagnosis and appropriate treatment.