FESS

FESS

• Functional endoscopic sinus surgery (FESS)is a minimally invasive technique in which sinus air cells and sinus ostia are opened under direct visualization.
• The complication rate for this procedure is lower than that for conventional sinus surgery.
  • The goal of this procedure is to restore sinus ventilation and return the mucociliary drainage of the sinuses to normal function.

• FESS is the only sinus surgery which can be performed before 17 years.
• A CT scan before FESS is mandatory
  • CT scanning identifies the anatomic relationships of the key structures (orbital contents, optic nerve and carotid artery) to the diseased areas, a process that is vital for surgical planning.
  • CT also defines the extent of disease in any individual sinus, as well as any underlying anatomic abnormalities that may predispose a patient to sinusitis .

INDICATIONS OF FESS

• Inflammation of sinus (sinusitis – chronic and fungal):
  Sinonasal Polyp(Antrochoanal and Ethmoidal)
  • FESS  is the best surgical treatment for chronic maxillary sinusitis.

• Mucocele of frontal and ethmoid sinus
• Choanal atresia repair
• Septoplasty
• Foreign body removal
• Epistaxis
• Orbital decompression
• Orbital Abscess
• Inverted Papilloma
• Optic nerve decompression
• Blow out of orbit
• Drainage of periorbital abscess
• Dacryocystorhinostomy
• CSF leak
• Pituitary surgery like trans sphenoid hypophysectomy

CONTRAINDICATIONS TO FESS

• Complications of Acute Sinusitis
• Nasal and Sinus Malignancies:Radical surgery might be needed which is best performed via an external approach, such as midfacial degloving, lateral rhinotomy and various craniofacial procedures.
  • Certain sinus conditions may not respond completely to endoscopic treatment; 
  • these include intraorbital complications of acute sinusitis, such as orbital abscess or frontal osteomyelitis with Potts puffy tumor. 

TYPES OF FUNCTIONAL ENDOSCOPIC SINUS SURGERY

Type 1	Nasal endoscopy and uncinectomy with or without agger nasi cell exenteration.
Type 2	Nasal endoscopy, uncinectomy, bulla ethmoidectomy, removal of sinus lateralis mucous membrane and exposure of frontal recess/ frontal sinus
Type 3	Type 2 plus maxillary sinus antrostomy through the natural sinus ostium
Type 4	Type 3 plus complete posterior ethmoidectomy
Type 5	Type 4 plus sphenoidectomy & stripping of mucous membrane

COMPLICATIONS OF FESS

• Bleeding
• Synechiae formation
• Orbital injury
• Diplopia
• Orbital hematoma
• Orbital cellulitis
• Blindness
• CSF leak
• Direct brain injury
• Nasolacrimal duct injury/epiphora

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