Functional Endoscopic Sinus Surgery (FESS): 

Figure 1.

Endoscopic Sinus SurgeryFunctional Endoscopic Sinus Surgery is a minimally invasive technique of performing surgery on the sinuses from within the nasal cavity without having to make any external incisions on the face. The technique was introduced in the mid 1980’s. Before that era, surgery on the sinuses was generally performed by making incisions on the face or under the lip. Functional Endoscopic Sinus Surgery has now become the “gold standard” for treating sinus pathology worldwide. Since the introduction of this technique there have been several advances in instrumentations to make this surgery much safer and provide an improved outcome. The surgery may be performed both under local or general anaesthesia depending on the extent and nature of pathology and the choice of surgeon and patient. As the name applies endoscopes are introduced in the nasal cavity to identify the outflow tracts and the opening of the sinuses within the nasal cavity. Using special instruments and techniques, the sinus openings are widened to enable the surgeon to visualise and remove the disease within the affected sinus. The surgery aims to preserve the mucosal lining of the outflow tracts and the function of the sinuses, hence the term “Functional”. Surgery is directed primarily at removing the underlying cause of the disease and is individually tailored. It is based on intricate understanding of the sinus anatomy, as well as normal and altered physiology. The extent of surgery may vary from a minor procedure directed at limited disease, to a radical procedure to involve all the para-nasal sinuses for severe diffuse disease. Over the years, the indications for endoscopic sinus surgery have been expanded to beyond its role as “functional” surgery.

    Figure 2

   Endoscopic Sinus SurgeryIn both cases shown above endoscopic techniques were used. In figure the patient has left maxillary sinusitis documented both on the endoscopic and CT scan of the sinuses shown by the asterisk (Figure 1A and 1B) The endoscope was used to identify the opening of the left maxillary sinus and was widened to drain the pus within the sinus. Postoperative endoscopic examination and CT scan show the widened opening.(Fugure 1C and 1D). In figure 2, the patient’s frontal sinus was also opened from within the nose to drain the pus.                     Indications for Endoscopic Sinus Surgery:

  1. Chronic sinusitis
  2. Nasal Polyps
  3. Fungal sinusitis
  4. Mucoceles of the paranasal sinuses
  5. Complications resulting from Acute sinusitis such as orbital abscess
  6. Benign tumours of the nose and sinuses

 Extended indications are....Read More