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 goal of this procedure is to restore sinus ventilation and return the mucociliary drainage of the sinuses to normal function.
  • The complication rate for this procedure is lower than that for conventional sinus surgery.
  • FESS is the only sinus surgery which can be performed before 17 years.
  • A CT scan before FESS is mandatory
  1. 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. 
  2. 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):
  • FESS is the best surgical treatment for chronic maxillary sinusitis.
  • Sinonasal Polyp(Antrochoanal and Ethmoidal)
  • 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:
  • 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.
  • 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.
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
Exam Question
  • Maxillary Sinus is preserved in FESS Surgery.
  • FESS surgery is not contraindicated below 12 years of age.
  • FESS is the treatment in all cases of Atrochoanal polyp.
  • FESS is the best surgical treatment for chronic maxillary sinusitis.
  • FESS means Functional endoscopic sinus surgery.
  • Orbital cellulitis can occur as a complication of FESS.
  • Endoscopic nasal surgery is indicated in Chronic sinusitis,Epistaxis,Inverted papilloma,Orbital abscess,Nasal polyposis.
  • Endoscopic repair is the management of persistent cases of CSF rhinorrhea.
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