Endoscopic sinus surgery (FESS)

Summary

Functional endoscopic sinus surgery (FESS) is performed through the nostrils to treat selected persistent sinus disease. An endoscope—a narrow camera with lenses—allows the ENT surgeon to see inside the nose and open blocked sinus drainage pathways without an external facial incision.

Surgery may be considered when chronic rhinosinusitis, with or without nasal polyps, remains troublesome despite appropriate medication and saline treatment. The operation is tailored to the affected sinuses, which may include the ethmoid, maxillary, frontal or sphenoid sinuses.

FESS is usually performed under general anaesthesia, although the plan depends on the procedure and patient. Recovery continues for several weeks. Regular saline rinsing, prescribed medication and avoiding nose blowing for the advised period support healing. Complications are uncommon but can include bleeding, infection, scarring and, rarely, injury to nearby structures. Symptoms can recur and some patients need further medical treatment or another operation.

What happens during surgery?

The surgeon passes an endoscope and fine instruments through the nostril. Inflamed tissue or polyps may be removed and natural sinus openings widened while preserving as much healthy lining as possible. Because the surgery is performed inside the nose, it normally leaves no external scar.

The extent of surgery is based on symptoms, nasal endoscopy and CT findings. The aim is to improve ventilation and drainage and to make topical treatment, such as nasal rinses and sprays, more effective. It does not guarantee that inflammation will never return.

After the operation

Nasal blockage, blood-stained discharge and pressure are common at first. Follow the clinic’s instructions about pain relief, saline irrigation, corticosteroid spray and follow-up cleaning. Do not blow or pick the nose until the surgeon says it is safe, and avoid heavy lifting and strenuous exercise for the recommended period.

Risks and expected results

All operations carry risk. Possible problems include bleeding, infection, adhesions or persistent symptoms. The sinuses are close to the eye socket and the base of the skull, so injury to the eye, vision, skull base or leakage of cerebrospinal fluid is possible but rare. Your surgeon should explain the risks that apply to your planned operation.

Many patients experience meaningful improvement, but long-term treatment is often still needed, especially with polyps, asthma or certain inflammatory conditions. Revision surgery is sometimes required. More extensive procedures are reserved for unusual, severe disease after careful specialist assessment.

Seek urgent medical advice after surgery for heavy or persistent bleeding, worsening swelling around an eye, impaired vision, clear watery discharge, severe headache, high fever, neck stiffness, confusion or unusual drowsiness.