Surgical procedure
Chronic Sinusitis Surgery
Also known as FESS, this surgery is used to treat chronic sinusitis by widening the natural drainage pathways of the paranasal sinuses. It is performed through the inside of the nose, with no external cuts.
FESS stands for Functional Endoscopic Sinus Surgery. It is the operation used in the treatment of chronic sinusitis, whose technical name is chronic rhinosinusitis (CRS). It is performed entirely through the inside of the nose, with an endoscope and with no cuts in the skin, and what it does is widen the natural openings through which the paranasal sinuses drain, removing whatever is blocking that passage.
On this page we are going to explain how the surgery is done and what it involves. If you want to understand how the condition works and when the surgery is indicated, you can go to the page on chronic sinusitis.
What “functional” means in the name of the surgery
That is the word that carries the major change in the understanding of how the nose works, and it defines what we set out to do with this technique.
The classic operation on the paranasal sinuses removed mucosa and bone as a block. Functional surgery reversed that logic: instead of removing healthy tissue as a block, the main idea is to restore function as close as possible to the natural one, opening the natural passages through which each sinus already drains and preserving as much as possible of the mucosa, which is the lining whose job is to push mucus out (ref. 1).
To put it simply, it is the difference between unjamming a window that is stuck and having to knock down the wall around it.
How the surgery is done
The approach is through the nostrils, with an endoscope, a thin camera that goes into the nose and shows on a video screen areas that cannot be seen from outside. The instruments go in by the same route and, as we said, there is no incision in the skin or on the face.
During the surgery we open the drainage pathways of the sinuses involved and remove the structures that are obstructing drainage, whether inflamed tissue, bone or a polyp, preserving the healthy mucosa around it (ref. 1).
The surgery is not the same for everyone. How extensive it is, which sinuses are operated on and how much is opened depend on which ones are involved and on the anatomical profile of that nose, information obtained beforehand from the CT scan of the paranasal sinuses and from flexible nasolaryngoscopy.
When there is a deviated septum, we correct the septum in the same operation, because opening the sinuses and leaving the nose obstructed is solving half the problem. On top of that, depending on the deviation, it can get in the way of the surgery itself if it is not corrected. Turbinate surgery can also be part of the same operation when it is indicated.
We always operate under general anesthesia, and the surgery takes 1 to 2 hours, depending on how many sinuses need to be opened and on what is found inside that patient’s nose.
What happens after the surgery
Beyond the questions about the surgery itself, many people want to know what happens in the week that follows it.
The first few days
Most of the time patients are discharged on the same day. We do not use nasal packing or nasal splints: in their place we use a technique of transseptal sutures that does the work of the splint, so no device is left behind to be removed later. We recommend 1 week off work and 15 days without physical activity.
High-volume nasal irrigation
It is different from day-to-day rinsing, because it has to reach the cavities that were opened during the surgery. It starts on the 7th day after the surgery and continues for about 60 days. Depending on the case, the rinse may include bicarbonate, xylitol or a corticosteroid.
Follow-up visits and the check-up endoscopy
The first follow-up visit is between the 5th and the 7th day after the surgery, and from then on the visits are every 3 weeks, for about 3 months. Depending on the case, we perform nasal endoscopy at the postoperative visits, to assess how healing is progressing. We do this at all three offices.
What are the limitations of the surgery?
It is important to know that the surgery has some limitations, and what they are:
- It does not cure the inflammation. The underlying inflammatory disease is not cured by the surgery. Treatment, for the allergy and for the polyposis, for example, has to continue after the operation (ref. 1).
- It does not stop polyps from coming back. In nasal polyposis, recurrence after surgery is something that can happen (ref. 1). It does not mean that something went wrong: about 1 in 5 patients operated on for polyps needs further surgery over the years (ref. 2), and that is why follow-up does not end on the day of the operation.
Risks of the surgery
As with any surgery, FESS carries risks, which are explained in the consultation, before you decide. Among them, the most common are bleeding and nasal obstruction.
Where I operate
I operate at Hospital Israelita Albert Einstein, at Vila Nova Star and at São Luiz. Consultations and nasal endoscopy are carried out at all three offices: Morumbi, Itaim Bibi and Alphaville.
References
1. Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020). Rhinology. 2020;58(Suppl 29):1-464. 2. Loftus CA, Soler ZM, Koochakzadeh S, et al. Revision surgery rates in chronic rhinosinusitis with nasal polyps: meta-analysis of risk factors. Int Forum Allergy Rhinol. 2020;10(2):199-207. doi:10.1002/alr.22487
Frequently asked questions about FESS
What does the acronym FESS stand for?
FESS stands for Functional Endoscopic Sinus Surgery: a minimally invasive operation, performed through the inside of the nose with an endoscope and with no external cuts, to restore the natural drainage of the paranasal sinuses.
What does “functional” mean in the name of the surgery?
It means that the surgery restores function instead of removing healthy tissue as a block, which is what the older operation did. It opens the natural passages through which each sinus already drains and preserves as much as possible of the mucosa, the lining that pushes mucus out.
Does FESS leave a scar on the face?
No. The surgery is done entirely through the nostrils, with the endoscope and the instruments passing through the inside of the nose.
What anesthesia is used, and how long does the surgery take?
The anesthesia is always general. The surgery takes 1 to 2 hours, and how long it lasts depends on how many sinuses need to be opened and on what is found inside.
Will I have packing in my nose?
We do not use nasal packing or nasal splints. In their place we use a technique of transseptal sutures that does the work of the splint, so no device is left behind to be removed later.
What are the first few days after the surgery like?
Most of the time patients are discharged on the same day. We recommend 1 week off work and 15 days without physical activity. Nasal rinsing starts on the 7th day and the first follow-up visit is between the 5th and the 7th day.
Can polyps come back after the surgery?
They can, and in polyposis that is how it is (ref. 1). About 1 in 5 patients operated on for polyps needs further surgery over the years (ref. 2), and that is why follow-up is part of the plan.
Dr. José Eduardo Marcondes, physician, otolaryngologist (ENT), CRM-SP 107.711, RQE 43.840. This content is informational, does not replace a medical consultation, and does not supersede the plan of care defined by your own physician.
If FESS has been recommended for you.
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