The sinuses are large air-filled spaces in the bones of the face. They open into the nose. In some people the opening of the sinuses into the nose can become blocked. This leads up to a collection of fluid in the sinuses, which can become infected. This leads to symptoms of blocked nose, runny nose, facial congestion and pain, tender cheeks, fever and tiredness. Other symptoms include headache and loss of sense of smell. Before any operation patients will be treated using drops, tablets or sprays for a period of weeks if not months. Only if these treatments are unsuccessful will an operation become necessary.
What is functional endoscopic sinus surgery or FESS? Functional Endoscopic Sinus Surgery is the name given to operations used to treat sinus problems. In the past sinus operations were done through incision (cuts) in the face and mouth but endoscopic (telescopes) sinus surgery allows the operation to be performed via the nose, without the need for these cuts. The surgery is aimed to re establish normal sinus function/drainage and thereby prevent episodes of sinusitis.
Before the surgery: We always organise a CT scan before the operation. This tells us which sinuses are affected and shows the shape of the bones in your nose. It is useful to use nasal drops for up to two weeks before the operation. Antibiotics can also be used one week prior to the surgeyr. THis makes the nose less inflamed and infected at the time of surgery, and can make surgery easier and more effective.
Why have FESS? If episodes of sinusitis are recurrent and unresponsive to nasal drops and sprays, then surgery can be performed to open up the sinuses. This allows easy drainage of the sinuses and prevents episodes of sinusitis. It may also be needed if there is a mass or polyp in the sinuses that needs to be removed. This surgery is also used to remove nasal polyps.
How is the operation done? The operation takes about an and a half. It is performed under general anaesthesia (You will be asleep). It is often performed as day stay surgery. It is all done inside your nose – there will be no scarring on your face. We use special telescopes and small instruments to look inside the nose and remove small pieces of bone to open up the sinuses. This allows the sinuses to drain more effectively. Nasal polyps can also be removed this way.
If the partition of the nose – the septum – is bent to one side this can obstruct our access to the sinuses. If this happens then septal surgery is performed to to straighten the septum. This allows the sinus surgery to be completed.
The nasal turbinates are structures that are on the side of the nasal cavity. Their purpose is to warm and humidify the air you breathe in. If they are very large they may need to be reduced in size (turbinate reduction).
After the operation: You may have nasal packs in your nose after surgery. These block your nose so you have to breathe through your mouth but they are removed before you go home. It is normal to feel some discomfort after the operation and you will be given some painkillers to reduce any pain. You can normally expect to go home in the evening or the day after your operation, but you should rest at home for at least a week. You should not do any strenuous activity, straining or heavy lifting for three weeks after the operation. Do not blow your nose vigorously for three weeks after the surgery. If you are going to sneeze, sneeze with your mouth open to protect your nose. You may get some blood coloured discharge from your nose for the first two weeks or so – this is normal. Your nose will be blocked both sides like a heavy cold for 10-14 days after the operation. You will be given nose drops and spray to use after surgery (see nasal surgery discharge advice) It may take up to two to three months for your nose to settle down and for your breathing to be clear again. Try to stay away from dusty or smoky places.
How long will I be off work?
You can expect to go home on the day of your surgery or the day after your operation depending on the time and size of your operation. You will need to rest at home for at least a week. If you do heavy lifting and carrying at work you should be off work for at least two weeks. You will be seen 4 weeks following your surgery.
What if I don’t have the operation: Endoscopic sinus surgery is only one approach to the treatment of sinusitis. Endoscopic sinus surgery is as safe, and possibly safer, than other methods of operating on the sinuses. The other methods of operating on the sinuses involve cuts in the face or mouth and if you feel that this maybe more appropriate in your case you should discuss this with your surgeon. In some patients an operation can be avoided by use of antibiotics and steroid medicines, again this should be discussed with your surgeon.
Possible complications: All operations carry some element of risk in the form of possible side effects. There are some risks that you must know about before giving consent to this treatment. These potential complications are very uncommon. You should discuss with your surgeon about the likelihood of problems in your case before you decide to go ahead with the operation. The CT scan done prior to the operation is one of the ways of significanlty reducing the risk of complications, as it provides a clear anatomical map of the sinuses.
- Bleeding is a risk of any operation. It is very common for small amounts of bleeding to come from the nose in the days following the operation. Major bleeding is extremely uncommon and it is very rare for a transfusion to be required
- Eye problems: The sinuses are very close to the wall of the eye socket. Sometimes minor bleeding can occur into the eye socket and this is usually noticed as some bruising around the eye. This is usually minor and gets better without any special treatment, although it is important that you do not blow your nose. More serious bleeding into the eye socket sometimes can occur, however this is very rare. This can cause severe swelling of the eye and can even cause double vision or in very rare cases loss of sight. If such a serious eye complication did occur you would be seen by an eye specialist and may require further operations.
- Spinal Fluid Leak: The sinuses are very close to the bone at the base of the brain. All sinus operations carry a small risk of damage to this thin bone with leakage of fluid from around the brain into the nose, or other related injuries. If this rare complication does happen you will have to stay in hospital longer and may require another operation to stop the leak. On very rare occasions infection has spread from the sinuses into the spinal fluid causing meningitis but this is extremely uncommon.
How often do complications happen?
In general, major complications are very rare. In a survey of all ENT surgeons who do this type of operation in England and Wales, eye complications happened in one in every five hundred operations, but there was no associated loss of vision. Spinal fluid leaks happened in one case in every thousand operations, but were detected and repaired at the same operation, so the risks are small. Minor complications, including bleeding from the nose occurred more often. One in four patients reported mild persistent bleeding after the operation, which resulted in readmission to hospital in some cases.