Functional Endoscopic Sinus Surgery (FESS) is a medical procedure for treating a recurring sinus infection (chronic sinusitis) or nasal polyposis. The procedure is conducted with the patient put under general anesthesia.
An endoscope is a small rod-like instrument which is 4 millimeters or less in diameter and has a light at its end. A range of lenses are used to get a clear view of all the corners around the nose. A powerful fibrotic light is used to get clarity on the nasal close-ups. Once the area is investigated properly, specially designed instruments, powered with suction debrides are used to enlarge the sinus openings and anything that blocks the sinuses, such as swollen mucosa or polyps, are cautiously removed. At times, other surgical procedures like septoplasty and turbinate reduction are performed along with Functional Endoscopic Sinus Surgery.
Indications for Endoscopic Sinus Surgery
Endoscopic sinus medical procedure is the most common surgery performed for sinus illness. The endoscopic sinus medical procedure is performed for treating the following ailments:
- Chronic sinusitis
- Recurrent sinusitis
- Nasal polyposis
- Antrochoanal polyps
- Sinus mucoceles
- Excision of chose tumors
- Cerebrospinal liquid (CSF) spill conclusion
- Orbital decompression (e.g. Graves ophthalmopathy)
- Optic nerve decompression
- Dacryocystorhinostomy (DCR)
- Cho-butt-centric atresia repair
- Foreign body expulsion
- Epistaxis control
Before the Procedure
Before conducting the functional endoscopic sinus surgery, patients are injected with intravenous sedation and local anesthesia.The patient is then prepared for the surgery. If there is a need of an image guided surgery, then the relevant headset apparatus needs to be applied.
During the Procedure
- The medical procedure begins with the nose being decongested by injecting a mixed solution of lidocaine with epinephrine (the ratio is 1% lidocaine with 1:100,000 epinephrine). The solution is injected near the uncinated area at the lateral nasal wall. The injection is done using a 3-mL syringe.
- After this, the inlet as well as the anterior face of the middle turbinate is injected with the solution submucosally. If septoplasty is required, the septum is also injected.
- Then, 4 mL of 4% cocaine is placed bilaterally in the nares by infusing the pledgets. After the procedure, a throat pack may be placed, or the stomach isclouted prior to extubation.
After the Procedure
- Nasal pressing is removed before the discharge of the patient.
- The patient is given a saline nasal splash and anti-toxins.
- Subsequent visits are advised in the upcoming weeks.
- If a spacer was put in the center meatus, it is removed or clouted away on the primary post-operative visit.
All risks and advantages must be candidly discussed with patients prior to the surgical operation. A patient should not undergo the surgical procedure without the knowledge of all the probable complications.Risks associated with endoscopic sinus surgery are as follows:
- Orbital damage
- Orbital hematoma
- CSF leakage
- Tentative brain damage
- Synechiae formation
- Nasolacrimal duct harm/epiphora
A review of the investigation of the complications related with purposeful endoscopic sinus medical procedure found a general inconvenience rate of 0.50%; the rates of CSF spillage, orbital damage, drain requiring medical procedure, blood transfusion and TSS were 0.09%, 0.09%, 0.10%, 0.18% and 0.02% approximately.
Cost of treatment for Functional Endoscopic Sinus Surgery
The following factors determine the cost involved in Endoscopic Sinus Surgery:
- Hospital that patient chooses for his/her treatment
- Fees for the visiting specialist
- Cost of medicines
- Cost of tests and diagnostic procedures
- Cost of surgery
- Cost of follow-up care