If you’ve been struggling with chronic sinus problems that don’t respond to medications, your doctor may have mentioned sinus surgery as a treatment option. But not all sinus surgeries are created equal. Functional Endoscopic Sinus Surgery (FESS) is a highly sophisticated type of surgery, which has revolutionized the surgical management of chronic sinus diseases. Understanding the differences between functional sinus surgery and traditional approaches can help you make an informed decision about your care.
What Is Functional Sinus Surgery?
Functional Endoscopic sinus surgery (FESS) is a minimally invasive surgical procedure that opens up the sinus air cells and the sinus ostia with an endoscope. The use of FESS as a sinus surgical method has now become widely accepted and the term functional is meant to distinguish this type of endoscopic surgery from the nonendoscopic more conventional sinus procedure.
The concept of FESS is the removal of tissue obstructing the Osteo Metal Complex (OMC) and the facilitation of drainage while conserving the normal non-obstructing anatomy and mucous membrane.
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 normal function.
The Science Behind Functional Sinus Surgery
The rationale behind FESS is that localized pathology in the osteomeatal complex blocks the ostia and leads to inflammation in the dependent sinuses. The surgical interventions of the procedure are designed to remove the osteomeatal blockage and restore normal sinus ventilation and mucociliary function.
The concept behind sinus surgery and functional ESS (FESS) in treating sinusitis are to enlarge sinus ostia, restore adequate aeration of sinuses, improve mucociliary transport, and provide a better route for topical therapies.
This approach differs significantly from older surgical methods that focused primarily on removing as much diseased tissue as possible, often at the expense of healthy structures.
How Traditional Sinus Surgery Compares
Traditional sinus surgery methods required more invasive approaches. Sinus surgery was once performed through external incisions (such as on the face and in the mouth), required extensive nasal packing, caused significant pain and discomfort, and often followed by a long recovery period. So called “traditional sinus surgery” is a term that might conjure dread and fear to those who are familiar or have undergone such past surgeries. Thankfully, endoscopic sinus surgery today is a vastly improved sinus surgery technique and experience. With recent advances in technology, including the nasal endoscope, sinus surgery is now commonly performed entirely through the nose, without face or mouth incisions.
Key Differences: FESS vs. Traditional Surgery
The main advantage of FESS compared with traditional techniques is that it is less invasive, resulting in minimal postoperative discomfort. Scars and damage to the nerve supply of the teeth are also avoided.
Functional endoscopic sinus surgery (FESS) is minimally invasive surgery for serious sinus conditions. It’s mostly used to treat chronic sinusitis and nasal polyps. Healthcare providers use nasal endoscopes to operate inside your nostrils, so there are no incisions in or around your nose.
| Feature | Traditional Surgery | Functional Sinus Surgery |
|---|---|---|
| Incisions | External (face/mouth) | Through nostrils only |
| Visualization | Limited | Direct endoscopic view |
| Tissue preservation | Less conservative | Preserves healthy tissue |
| Recovery time | Longer | Shorter |
| Postoperative pain | More significant | Minimal discomfort |
| Scarring | External scars possible | No visible scars |
Who Is a Candidate for Functional Sinus Surgery?
The initial and most common indication for FESS is chronic rhinosinusitis. Functional endoscopic sinus surgery should be reserved for use in patients in whom medical treatment has failed.
Chronic rhinosinusitis affects millions of Americans each year. Chronic rhinosinusitis (CRS) is a broad public health issue with a prevalence of 12.5%, a yearly estimated cost of $8.6 billion in the United States, and an adverse impact on quality of life that matches those of major chronic medical conditions.
According to CDC data, sinusitis affects an estimated 11% to 12% of adults in the United States, with over 30 million cases diagnosed annually.
Chronic sinusitis is chronic inflammation of the sinus or nasal passages occurring for more than 12 weeks at a time. Patients who experience persistent symptoms despite medications may benefit from surgical intervention.
Success Rates and Outcomes
The results of functional sinus surgery are impressive. The most suitable candidates for this procedure have recurrent acute or chronic infective sinusitis, and an improvement in symptoms of up to 90 percent may be expected following the procedure.
Functional endoscopic sinus surgery (FESS) has become a widely used and effective tool in treating chronic sinusitis refractory to medical therapy. Reported success rates, defined mainly on the basis of improvement of preoperative symptoms, have been encouraging and ranged between 71 and 93%.
Long-term studies also show durable results. Of patients responding to a question about overall symptoms, 98.4% reported improvement compared with before surgery. There was a trend toward continued subjective improvement in symptom scores with longer follow-up.
Excellent subjective results following FESS can be maintained in the long term with appropriate postoperative management. The study also validates the concept that patients in whom the cavity can be normalized following surgery are unlikely to require further surgery.
The Technology Behind Modern FESS
Since functional endoscopic sinus surgery was introduced, the indications for performing this procedure have been expanding. The advances in the endoscopes, the camera, instrumentation, and navigation have laid the groundwork for an ever-expanding world of endoscopic surgery.
Powered instrumentation and stereotactic image-guided surgery have improved efficiency and safety of this procedure.
In conventional Functional Endoscopic Sinus Surgery (FESS), surgeon mentally correlates the information of CT and MR with the direct sinuscopic view of operative field. In Computer-Assisted Functional Endoscopic Sinus Surgery (C-A FESS), computer provides image guidance for the surgeon.
What to Expect: The FESS Procedure
The procedure can be performed under general or local anesthesia on an outpatient basis, and patients usually experience minimal discomfort. The complication rate for this procedure is lower than that for conventional sinus surgery.
Most functional endoscopic sinus surgeries last about two to three hours if both sides are involved.
For patients with CRS, the 2 main intraoperative goals are to restore patency of the sinuses while preserving mucosa and to prevent injury to the surrounding structures.
Beyond Chronic Sinusitis: Expanding Applications
FESS has proven beneficial for conditions beyond sinusitis. Research shows it can help patients with related conditions like asthma. FESS is a viable option for improving the control of asthma. 21 patients reported overall significant improvement in the asthma. 6 patients were completely taken off from all sort of anti-asthmatic drugs.
Endoscopic sinus surgery targets sinus pathology and is the gold standard for treating chronic rhinosinusitis (CRS). The boundaries of ESS are continually expanding with technological advances. At this point, the indications of ESS have surpassed the field of rhinosinusitis. The application of this procedure marked its place in the management of sinus tumors and pathologies beyond the sinuses.
Comparing FESS to Balloon Sinuplasty
Another modern option is balloon sinuplasty. A recently developed alternative to functional endoscopic sinus surgery is balloon sinuplasty. This technique uses balloon catheters to dilate the maxillary, frontal, and sphenoid natural ostia without bone or soft-tissue removal. Reports show persistent patient symptom improvement and sinus ostia patency.
FESS can address more complex sinus issues and usually requires a longer recovery time than balloon sinuplasty. Endoscopic sinus surgery (ESS) is a more comprehensive surgical approach that can effectively address a wider range of sinus conditions. It is particularly useful for patients with nasal polyps, severe inflammation, or anatomical issues that contribute to chronic sinusitis.
Your surgeon will help determine which approach is best for your specific condition.
Recovery and Postoperative Care
A thorough understanding of the nasal and paranasal anatomy is the key to safe endoscopic sinus surgery. After surgery, proper follow-up care is essential for optimal results.
When FESS is performed for CRS, there is always a risk of recurrence or persistence. Failure to perform a proper maxillary antrostomy and widen the natural ostium can lead to mucus recirculation through the accessory ostium. Lateralization of the middle turbinates leads to obstruction of sinus drainage. Due to inadequate postoperative cleaning and management, Synechiae is another cause of nasal obstruction post-sinus surgery.
Following your surgeon’s postoperative instructions carefully—including nasal irrigations and follow-up appointments—maximizes your chances of long-term success.
Is Functional Sinus Surgery Right for You?
If you’ve been dealing with chronic sinus problems that haven’t responded to medications, nasal sprays, or other conservative treatments, functional endoscopic sinus surgery may offer the relief you need. This is the most common type of sinus surgery. This surgery widens the drainage passages between your nose and your sinuses, removing bone or infected tissue so mucus trapped in your sinuses can get out.
Take the Next Step
At Sinusitis in Seattle, our experienced team specializes in advanced sinus care, including functional endoscopic sinus surgery. We take a comprehensive approach to evaluate your condition and determine whether FESS or another treatment option is right for you.
Schedule a consultation today to discuss your symptoms and explore your treatment options with our expert team.
