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Functional Endoscopic Sinus Surgery (FESS)

What is Functional Endoscopic Sinus Surgery?

Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive surgical procedure used to treat chronic and recurrent sinus disease that has not responded adequately to medical treatment.

The operation is performed using high-definition nasal endoscopes inserted through the nostrils. There are no external incisions or scars.

The aim of FESS is to:

  • Restore normal sinus drainage

  • Improve sinus ventilation

  • Remove obstructing or diseased tissue

  • Allow topical medications to reach the sinuses more effectively

Rather than “removing” the sinuses, FESS re-opens the natural sinus drainage pathways, preserving healthy tissue wherever possible.

Why is FESS Performed?

FESS is indicated when symptoms persist despite appropriate medical therapy (nasal sprays, antibiotics, saline rinses, oral steroids).

Common indications include:

  • Chronic rhinosinusitis lasting more than 12 weeks

  • Recurrent acute sinus infections

  • Nasal polyps

  • Facial pain, pressure or headache related to sinus disease

  • Persistent nasal congestion and discharge

  • Post-nasal drip

  • Reduced or lost sense of smell

  • Sinus Barotrauma

  • Complications of sinus infection (e.g. orbital or intracranial spread)

Pre-operative Assessment

Before surgery, a full evaluation is essential:

  • Nasal endoscopy in clinic

  • CT scan of the sinuses

  • Review of prior medical treatment

  • Allergy assessment where appropriate

This allows precise surgical planning and ensures surgery is tailored to your individual anatomy and disease pattern.

What Happens During the Operation?

  • Performed under general anaesthesia

  • A rigid endoscope is introduced through the nostrils

  • High-precision instruments are used to:

    • Open blocked sinus pathways

    • Remove inflamed tissue or polyps

    • Clear trapped mucus and infection

  • Normal healthy mucosa is preserved wherever possible

  • There are no external cuts

  • Duration typically 60–180 minutes, depending on disease extent

In some patients, FESS may be combined with:

  • Septoplasty

  • Inferior turbinate reduction

This improves surgical access and long-term breathing results.

After Surgery – What to Expect

First 1–2 Weeks

 

  • Nasal blockage and crusting

  • Blood-stained discharge

  • Facial pressure or headache

  • Reduced smell (temporary)

These are normal and expected.

Post-operative Care

 

  • Saline nasal irrigations several times daily

  • Long term use of topical steroid sprays / steroid solution

  • Regular endoscopic Follow-ups in clinic

Most patients return to work in 10-20 days, depending on occupation.

Expected Benefits

  • Improved nasal breathing

  • Fewer sinus infections

  • Reduced facial pain and pressure

  • Improved smell

  • Better response to nasal sprays

  • Improved quality of life

FESS is not a cure for all sinus disease but is highly effective when combined with ongoing medical therapy.

Risks and Complications

FESS is a safe and established procedure when performed by an experienced surgeon. However, as with all surgery, risks exist:

Common

 

  • Bleeding

  • Crusting and scarring

  • Temporary nasal blockage

Rare but Serious

 

  • Cerebrospinal fluid leak

  • Eye injury or visual disturbance

  • Orbital bruising

  • Altered smell

  • Infection

All risks are discussed in detail prior to surgery.

Will I Need Surgery Again

Some patients with severe polyposis or inflammatory disease may require further surgery in the future.

However, FESS significantly reduces disease burden and improves long-term control when combined with medical therapy.

Summary

Functional Endoscopic Sinus Surgery is a precise, tissue-preserving procedure that restores sinus drainage and improves quality of life in patients with chronic sinus disease.

It is designed to work together with medical therapy, not replace it.