Functional Endoscopic Sinus Surgery is a minimally invasive technique that produces up to a 90% improvement of symptoms. The procedure is especially effective for people with recurring acute or chronic sinus infections, have facial pain and nasal blockage as predominant symptoms, and who have not been helped with conventional medical treatment.

FESS - Functional Endoscopic Sinus Surgery

Balloon Sinuplasty is an endoscopic, catheter-based system for patients suffering from sinusitis.  The FDA-cleared technology uses a small, flexible, sinus balloon catheter to open up blocked sinus passageways, restoring normal sinus drainage.  When the sinus balloon is inflated, it gently restructures and widens the walls of the passageway while maintaining the integrity of the sinus lining.
Technology Overview

Functional endoscopic sinus surgery is a minimally invasive technique used to restore sinus ventilation and normal function.  The most suitable candidates for this procedure have recurrent acute or chronic infective sinusitis, and an improvement in symptoms of up to 90 percent may be expected following the procedure.  Fiberoptic telescopes are used for diagnosis and during the procedure, and computed tomography is used to assess the anatomy and identify diseased areas.  Functional endoscopic sinus surgery should be reserved for use in patients in whom medical treatment has failed. The procedure can be performed under general or local anesthesia on an outpatient basis, and patients usually experience minimal discomfort.  The complication rate for this procedure is lower than that for conventional sinus surgery.

Functional endoscopic sinus surgery (FESS) is a minimally invasive technique in which sinus air cells and sinus ostia are opened under direct visualization.  The goal of this procedure is to restore sinus ventilation and normal function.

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.

INITIAL EVALUATION AND TREATMENT

As with many disease processes, the history of a patient with sinusitis is probably the most important part of the preoperative assessment.  All patients with severe or persistent symptoms should be evaluated, and many can be helped with advice and medical treatment.

The fiberoptic endoscope enables the surgeon to examine the nose in great detail and is an essential tool for diagnosis.  Patients with seasonal or perennial rhinitis should be given advice about avoidance of allergens and treatment with topical nasal steroid sprays and antihistamines.  Acute infective sinusitis is treated with antibiotics and vasoconstrictor nasal sprays.  If medical treatment has failed, the patient may be a suitable candidate for an endoscopic procedure.

CANDIDATES FOR SINUS SURGERY

FESS (like any sinus surgery) is most successful in patients who have recurrent acute or chronic infective sinusitis.  Patients in whom the predominant symptoms are facial pain and nasal blockage usually respond well. The sense of smell often improves after this type of surgery.

A CT scan before FESS is mandatory to identify the patient’s ethmoid anatomy and its relationship to the skull base and orbit.  CT scanning also allows the extent of the disease to be defined, as well as any underlying anatomic abnormalities that may predispose a patient to sinusitis.

Patient selection therefore involves a thorough history and physical examination, a trial with medical treatment and, finally, CT scanning.  The result is a highly selected group of patients who can expect an improvement of up to 90 percent in their symptoms.

In patients with nasal polyposis that is not controlled with topical corticosteroids, FESS permits the accurate removal of polyps. 

     
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