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Functional endoscopic sinus surgery

Key points

  • Functional endoscopic sinus surgery can open up and unblock your sinuses.
  • You won’t have any scars from functional endoscopic sinus surgery.
  • You can often have functional endoscopic sinus surgery and go home from hospital the same day.
  • You can have the operation under general or local anaesthesia.
  • It usually takes about a week to make a full recovery.

Video: where the sinuses are found

Functional endoscopic sinus surgery (FESS) treats persistent sinusitis (inflammation of your sinuses). A surgeon will put a narrow, flexible, tube-like telescopic camera into your nose and use special instruments to unblock your sinuses.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

Animation - where the sinuses are found

About endoscopic sinus surgery

Your sinuses are air-filled spaces in your cheekbones, forehead and between your eyes, that connect to your nose. Sinusitis is an inflammation of your sinuses. When this happens, the lining of your sinuses swells and mucus can't drain away properly, which can cause infection, pain and a blockage in your nose. Functional endoscopic sinus surgery is designed to open up and unblock your sinuses. It can also remove a blockage, for example a polyp (nasal polyps are fleshy swellings of the lining of your nose).

               Illustration showing the location of the frontal, ethmoid and sphenoid sinuses

What are the alternatives to functional endoscopic sinus surgery?

Most people with sinusitis are successfully treated with medicines, which include antibiotics, decongestants and steroids. You normally only need surgery if medicines haven’t worked for you.

Preparing for functional endoscopic sinus surgery

Your surgeon will explain how to prepare for functional endoscopic sinus surgery. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Functional endoscopic sinus surgery is routinely done as a day-case procedure. This means you can have the procedure and go home the same day. However, this will depend on your exact operation and you may need to stay overnight in hospital. Ask your surgeon how long you will need to stay in hospital for.

Functional endoscopic sinus surgery is usually done under general anaesthesia. This means you will be asleep during the operation. However, you can also have the operation done under local anaesthesia, which completely blocks pain from your nose and sinuses and you will stay awake during the operation. If you're having the operation under local anaesthesia, you may be offered a sedative to help you relax.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your anaesthetist’s advice.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during endoscopic sinus surgery

Functional endoscopic sinus surgery usually takes between one and two hours. Your surgeon will carefully insert a narrow, flexible, tube-like telescopic camera, called an endoscope, into one of your nostrils. This will allow your surgeon to see the inside of your nose and sinuses clearly. He or she will use small, specialised instruments to remove blockages and open up your sinuses. Sometimes your surgeon will inflate a small balloon to clear any blockages – this is called balloon sinuplasty.

At the end of the operation, your surgeon may put absorbent dressings in your nose to reduce any bleeding. He or she may also insert splints (thin plastic sheets) inside your nose to help support it.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

After a local anaesthetic it may take several hours before the feeling comes back into your face. Take special care not to bump or knock the area.

If you have dressings in your nose, they may feel uncomfortable and your nose may feel blocked. Some dressings dissolve over a few days. Alternatively your nurse or surgeon will take these out within 24 hours of your operation. If you have splints in your nose, these may be left in for longer and removed at a later date.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

You will usually be able to go home when you feel ready. If you go home the same day of your operation and had a general anaesthetic or sedative, you will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your operation.

General anaesthesia and sedation temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice.

Recovering from functional endoscopic sinus surgery

It usually takes about a week to make a full recovery from functional endoscopic sinus surgery, but this varies between individuals, so it's important to follow your surgeon's advice.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

It's normal for your nose to feel blocked after functional endoscopic sinus surgery and this can last for a few weeks. Don't blow your nose for the first 48 hours after your operation. Your surgeon will tell you when you can start to gently blow your nose. You may notice some mucus or blood-stained fluid coming from your nose for up to two weeks after your operation but this is normal.

It’s important to stay away from dusty and smoky environments while you recover.

Most people are able to go back to work between one and two weeks after functional endoscopic sinus surgery. If you lift or carry heavy objects as part of your job, you're likely to be off work for at least two weeks. Your surgeon will talk to you about the best time to return to work.

What are the risks?

As with every procedure, there are some risks associated with functional endoscopic sinus surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of functional endoscopic sinus surgery include:

  • mild pain
  • blocked nose
  • bruising around your eyes
  • blood-stained fluid or mucus from your nose

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic or excessive bleeding.

The main complications of functional endoscopic sinus surgery are listed below.

  • You may have a small amount of bleeding from your nose, which isn’t usually serious. If this happens, you may need to have packing in your nose.
  • Your sinuses are close to your eye sockets and sometimes functional endoscopic sinus surgery can cause a small amount of bleeding into your socket. This is usually mild and causes a bruise. Occasionally the bleeding can be more severe and cause your eye to swell or give you double vision. If you blow your nose, it can make the bleeding worse. It’s also possible that bleeding into your eye or damage to your eye can permanently damage your eyesight but this is very rare – ask your surgeon for more information.
  • Your sinuses are very close to the bone at the bottom of your brain. Very rarely this bone can be damaged during the operation, which can cause fluid from your spinal column to leak out. If this happens, you may need another operation to repair it.

 

Produced by Rachael Mayfield-Blake, Bupa Heath Information Team, February 2013.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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