The nasal sinuses are an air-filled spaces in the skull. Functional endoscopic sinus surgery is a minimally invasive technique (no external incision) used to restore sinus ventilation and normal function.
In preparing for the surgery you might need to do the following:
- Laboratory testing (blood tests) and possible medical assessment to be done before surgery.
- You need to be assessed by anesthesiologist.
- You may need to adjust your current medications if you are taking any. (like blood thinners…)
- Stop smoking.
- Avoid taking aspirin, anti-inflammatory drugs and some herbal supplements as they can increase the possibility of bleeding.
- Computer tomography (CT) scan of the nose and paranasal sinuses will be performed.
- Oral and local steroids will be prescribed for at least one week before the surgery.
FESS can be done either as inpatient setting (stay overnight) or on an outpatient setting (to go home the same day). If your surgery is performed on an outpatient basis, you need to arrange for someone to drive you from surgery and to stay with you for at least the first night following the surgery.
Surgical steps:
- Anesthesia: general anesthesia is the method of choice in our team.
- Image guided navigation system application (a device used to improve the precision and accuracy of performing surgery and reduced complication rate). This system is used only in selected cases as indicated.
- Examination of the nasal cavity, sinuses as possible and the nasal septum (to do septoplasty if needed at the same time to get proper access to the sinuses or if the septum is also causing obstruction). These steps are done using endoscopes.
- Packing with decongestants is done to improve visuality and decrease the bleeding.
- Dissection of the disease (polyps, masses…. ), the diseased mucosa and ventilating the sinuses (dissection of the cells depends on the extension of the disease) using special instruments including powered dissection instruments.
- Hemostasis: making sure that there is no bleeding.
- Packing of the sinunasal cavity either with absorbable packs, non-absorbable packs or both.
Recovery:
- If non absorbable packing applied, then it will be removed within 24 hours (in some cases longer if the is a risk of bleeding).
- Bloody discharge either anteriorly or to the post nasal space.
- The patient might experience nasal blockage, congestion, decreased smelling sensation and headache.
- You will be given local medications to aid in healing and reduce the risk of infection, irrigations to clear the debris and analgesics (usually over the counter analgesics). You might need to continue using the oral steroids post operatively as indicated.
- The first period of time nasal blockage, discomfort and discharge will be experienced by the patients until the swelling subsides.
- The first follow up will be after 2 weeks and further follow ups will be decided by the surgeon accordingly, it is very important to follow the instructions of your surgeon given during the follow up and be compliant with the medications prescribed to avoid recurrence of the disease.
- During the recovery period a normal life style like bathing or eating the regular food can be carried, but the patient should avoid nasal manipulation and should avoid nasal blowing.
Complications
- Bleeding and blood transfusion.
- Visual complications.
- Cerebrospinal fluid leak (CSF leak) and intracranial complications.
- Decreased or loss of smelling sensation.
- Recurrence and the need for revision surgery.
- All these complications and other less frequent complications will be mentioned and explained thoroughly in the pre surgical consent by the surgeon.
For detailed videos and images of this procedure,
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