Endoscopic sinus surgery

Definition

Functional endoscopic sinus surgery (FESS) is often a non-invasive medical procedure that discloses sinus air cells and sinus ostia (openings) by having an endoscope. Using FESS just like a sinus surgical method is becoming broadly accepted; as well as the term "functional" is supposed to differentiate this sort of endoscopic surgery from non-endoscopic, more standard sinus surgery procedures.

Description

After inducing adequate vasoconstriction with cocaine or ephedrine, the doctor locates the middle turbinate, the most crucial landmark for that FESS procedure. Assisting the nose in the degree of the center turbinate lays the uncinate process, how the doctor removes. The doctor opens the rear ethmoid air cells, to permit better ventilation, but leaves the bone engrossed in the mucous membrane. Following this step, the ostium located near to the jaw is checked for obstruction and, if required, opened using a middle meatal antrostomy. This surgical treatment often greatly improves the function from the osteomeatal complex and offers better ventilation from the sinuses.

FESS offers several benefits:

• It doesn't affect healthy tissue.
• It minimizes bleeding and scarring.
• It is often a non-invasive procedure.
• It is conducted quicker with better results.

Purpose

The objective of FESS would be to restore normal drainage in the sinuses. Normal function from the sinuses requires ventilation with the ostia (mouth-like opening) which is caused with a mucociliary transport procedure that keeps a continuing flow of mucus from the sinuses. All sinuses require ventilation to avoid infection and inflammation, a disease referred to as sinusitis. In healthy people, sinus ventilation occurs with the ostia to the nose. The sinuses open to the center meatus (curved passage in each nasal cavity) beneath the middle turbinate (thin, bony procedure which may be the lower the main ethmoid bone in each nasal cavity), which together are the osteomeatal complex, the main thing the main nose. The hair-like cilia direct the flow of mucus toward the ostia. Sinusitis develops if patient discover an issue in the area where the maxillary and frontal sinuses meet close to the nose or, occasionally, by dental infection. When sinusitis occurs, the cilia work less efficiently, stopping the flow of mucus. The mucous membranes from the sinuses become engorged, resulting in ostia closure. Poor ventilation and piling up of mucus then produce situations necessary for infection.

Risks

One of the most serious risks associated with FESS is blindness caused by harm to the optic nerve. The probability of this complication occurring, however, is incredibly low. Cerebrospinal fluid leak represents the most typical major problem of FESS. The leak is generally recognized during surgery and could easily be repaired. Other less serious and rare difficulties includes orbital hematoma and nasolacrimal duct stenosis. Many of these complications will also be related to conventional sinus surgery and never simply with FESS.

Diagnosis/Preparation

Just like many diseases, a brief history from the patient with sinusitis signifies an importance of the main preoperative evaluation. Before considering FESS, the ear, nose and throat (ENT) specialist will move forward using a thorough diagnostic examination. The development of such diagnostic tools because the fiberoptic endoscope and CT scanning has significantly improved treating sinus disease. The fiberoptic endoscope can be used to consider the nose and all sorts of its recesses thoroughly. The specific features problems must examine and evaluate would be the middle turbinate as well as the middle meatus, any anatomic obstruction, as well as the presence of pus and nasal polyps. CT scanning may also be used to identify the diseased areas; a process that's required is perfect for planning the surgery. It shows the extent from the damaged sinuses, along with any irregularities that could produce a patient weaker to sinusitis. FESS is generally performed under local anesthesia with intravenous sedation with an outpatient basis with patients going home one or two hours after surgery. It generally doesn't cause facial swelling or bruising, and generally need nasal packing.

Who performs the process and where could it be performed?

This process is usually performed with an outpatient basis by an ear, nose, and throat (ENT) specialist, for example an otolaryngologist or an ophthalmic doctor. ENT physicians are graduates of the school of medicine and typically undergo an otolaryngology residency with further specialization in sinus disease and endoscopic sinus surgery.

Normal results

The FESS procedure is recognized as successful once the patient's sinusitis is fixed. Nasal obstruction and facial pain are often relieved. The outcome continues to be in contrast to the ones from the Caldwell-Luc procedure and, although each method is believed effective, there's a strong patient choice for FESS. The extent from the disease before surgery dictates the end result, using the greatest results obtained in patients with restricted nasal sinusitis.

Aftercare

FESS generally doesn't cause severe postoperative sinus pain. Following a procedure, patient need to keep his/her nose as free of crust build-up as he/she can. To get this done, the doctor may perform lengthy cleaning Two to three times each week or perhaps the patient may execute a simple nasal douching many times each day. Normal function usually reappears after a couple of months. In patients with severe sinusitis or polyps, a short lifetime of systemic steroids in conjunction with antibiotics may quicken recovery.

Morbidity and mortality rates

FESS normally includes a great outcome. Achievements are also obtained in patients who may have had previous sinus surgery.

Important questions a patient should ask a physician

• Why is sinus surgery required?
• Is the process painful?
• What would be the risks involved?
• How enough time should a patient need to recover within the procedure?
• How many endoscopic sinus surgery procedures can you perform each year?
• What will be the alternatives?

Alternatives

• Image-guided endoscopic surgery. This process uses image guidance methods including a three-dimensional mapping system combining CT scanning and real-time data acquisition regarding the location in the surgical instruments throughout the procedure. It allows doctors to navigate more specifically within the involved area. The doctor can monitor the precise location of such vital organs because the brain and eyes along with positively figuring out the impacted areas.
• Caldwell-Luc procedure. This process is keen on improving drainage inside the maxillary sinus region located below the interest. The doctor reaches the location with the upper jaw above one of the second molars. They generate a passage allowing a patient to connect the maxillary sinus towards the nose to be able to enhance drainage.