What is functional endoscopic sinus surgery (FESS)?
Functional endoscopic sinus surgery (FESS) means operating on the sinuses with a thin camera (endoscope) and fine instruments passed through the nostrils. No incision is made on the face or the outside of the nose. The aim is to remove the diseased tissue, polyps or thin bony partitions blocking the sinuses while preserving healthy lining, so that the sinuses drain and ventilate naturally again.
The word “functional” describes this approach: no more sinus lining is removed than necessary, because healthy lining keeps the sinus’s self-cleaning function working.
When is it needed?
Sinus secretions normally drain towards the back of the nose. When the sinus openings are blocked, secretions build up, causing facial pressure and pain, a blocked nose, postnasal drip and loss of smell. Medical treatment (nasal sprays, nasal rinsing and antibiotics when needed) is tried first; surgery is considered if complaints continue despite adequate treatment.
- Chronic sinusitis that does not respond to medical treatment
- Acute sinusitis that recurs several times a year
- Nasal and sinus polyps
- Complications of sinusitis (such as a mucocele or cyst)
- Fungal sinusitis
- A foreign body in the sinuses, some benign tumours and a congenital closure of the back of the nose (choanal atresia)
- Some nosebleeds that cannot be stopped
How is it diagnosed?
Chronic sinusitis is diagnosed from your symptoms and an endoscopic examination of the nose. A CT scan of the sinuses is taken to show which sinuses are affected and to what extent; the CT scan is also the map for surgery. If a disease other than sinusitis is suspected, further tests such as an MRI may be requested.
If a deviated septum or enlarged turbinates are narrowing the sinus openings, these are identified at the same assessment and can be corrected in the same operation.
How is the operation performed?
FESS is performed under general anaesthesia and takes 2–3 hours on average, depending on its extent (one or both sides, how many sinuses are opened).
- A local medicine that reduces bleeding is applied inside the nose.
- The endoscope is passed through the nostril; guided by the image on the screen, the bony partitions, diseased tissue and polyps blocking the sinus openings are removed with fine instruments.
- Healthy lining is preserved; the sinus openings are widened to open the pathway for ventilation and drainage.
- If needed, packs or similar materials are placed inside the nose.
If there is a deviated septum, septoplasty, and if the turbinates are enlarged, turbinate reduction can be carried out in the same session. For patients considering rhinoplasty, sinus surgery can be planned together with rhinoplasty.
What should you pay attention to before surgery?
- It is recommended to stop smoking at least three weeks before surgery; smoking worsens both sinus complaints and healing.
- When to stop aspirin and other blood thinners is decided together with the doctor who prescribed them.
- The anaesthesia team will tell you separately how long to fast and what time to arrive at the hospital.
- Because it is not safe to drive after general anaesthesia, someone should be with you when you are discharged.
Recovery
After FESS, most people return to work or school within about 10 days; healing inside the sinuses takes from a few weeks to a few months.
| Period | What to expect |
|---|---|
| First days | A blocked nose and blood-stained discharge are normal; mild pain settles with simple painkillers. Saline nasal rinsing is started in the first days as your doctor advises and continued for a few weeks. |
| First week | Do not blow your nose; keep your mouth open when sneezing. Avoid strenuous activities. |
| Days 7–10 | You return to work or school; nasal rinsing continues. |
| Following weeks | At the check-ups the inside of the nose is examined with an endoscope and crusts are cleaned if needed. Relief of facial pain and pressure becomes clear during this period. |
To prevent sinusitis from coming back, it is important to attend the check-ups regularly and continue the recommended nasal rinsing and medical treatment.
What are the risks?
Because the sinuses lie next to the eye and the skull base, the risks are discussed in detail before surgery. Serious complications are rare.
- Common, mild problems: bleeding, adhesions at the sinus openings, headache, temporary swelling around the eye, tooth or facial pain.
- Rare, serious complications: severe bleeding, loss of smell, injury to the tear duct, bleeding around the eye, leakage of cerebrospinal fluid and related meningitis, injury to a major blood vessel.
In sinusitis with polyps, polyp tissue can form again over time; in that case medical treatment that shrinks the polyps and keeps them under control is usually used.
How does the process work with Prof. Dr. Öner Çelik?
Prof. Dr. Öner Çelik trained in advanced endoscopic sinus surgery and skull base surgery at The Ohio State University Wexner Medical Center (2013).
- Consultation: an endoscopic nasal examination is carried out at the clinic in Suadiye, and a CT scan of the sinuses is requested.
- Planning: the CT scan is reviewed together; whether medical treatment or surgery is needed, the extent of the operation and the risks are discussed.
- Surgery: performed at Maltepe University Hospital.
- Check-ups: cleaning inside the nose and follow-up of healing are carried out at the clinic.
For details, see the your treatment in Istanbul page.
Frequently asked
How are chronic sinusitis and nasal polyps treated surgically?
With functional endoscopic sinus surgery (FESS), using a thin camera passed through the nostrils; there is no external incision. The aim is to remove diseased tissue while preserving healthy lining, so that the sinuses can drain and ventilate again. It takes 2–3 hours on average under general anaesthesia, and the return to work is about 10 days.
More detail: Endoscopic sinus surgery (FESS).
Is FESS painful?
There is usually mild pain after the operation, controlled with simple painkillers. The main complaint in the first days is a blocked nose.
Does sinusitis come back after surgery?
In most patients, sinusitis symptoms improve markedly. In sinusitis with polyps, polyps can form again over time; regular check-ups and, when needed, medicines that shrink polyps are recommended.
Articles on this topic
- Endoscopic Sinus Surgery: When Is an Operation Needed for Sinusitis? Endoscopic sinus surgery is considered for chronic sinusitis and nasal polyps that have not responded adequately to appropriate…
References
- Rosenfeld RM et al. Clinical Practice Guideline (Update): Adult Sinusitis. Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1-S39.
- Fokkens WJ et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020). Rhinology. 2020;58(Suppl S29):1-464.
This content is for information only and does not replace medical advice. Every medical procedure requires an individual assessment and may carry risks. Results vary from person to person.
