Functional Endoscopic Sinus Surgery For Rhinosinusitis

WHAT YOU SHOULD KNOW:

Functional Endoscopic Sinus Surgery For Rhinosinusitis (Inpatient Care) Care Guide

  • Functional endoscopic (EN-do-skop-ik) sinus surgery, also called FESS, is surgery to treat rhinosinusitis. Rhinosinusitis is a condition where the mucous membranes in the nose and sinuses become infected, swollen, and blocked. The sinuses are air-filled spaces in the bones of the face and head. They are located between the eyes, behind the forehead, and in the cheeks. The sinuses drain mucus through small openings that are connected to the inside of the nose. They play an important role in how we breathe and make mucous secretions.

  • During your surgery, an endoscope and other small tools will be passed through your nostrils. An endoscope is a metal tube with a light and tiny video camera on the end. This allows your caregiver to remove small amounts of bone or other materials blocking the sinus openings. These openings where sinuses naturally drain are used to insert the endoscope without destroying important mucous membrane lining. Your caregiver may also do stereotaxy, where scanned images of your head will show pictures in three-dimensional (3-D) views. This will help him clearly see the nasal passages and sinuses while watching the images in a monitor. Stereotaxy will enable your caregiver to find the sinuses with blockages and other problems more accurately. With FESS, symptoms of rhinosinusitis may be relieved and your quality of life improved.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Problems may happen during FESS for your rhinosinusitis that may lead to more surgery. Your brain and its coverings, eyes, blood vessels, or nerves may get injured while having the surgery. You could also have trouble breathing, an infection, or too much bleeding after surgery. Even after a having surgery, there is still a chance that your rhinosinusitis may come back. Without treatment, you may have long-term infections and nasal polyps (small mass or sac-like growths). This may lead to further problems with breathing and smelling. Ask your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

  • Anesthesia:

    • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

    • Local anesthesia is medicine used to numb an area of your body that will have surgery or a procedure. The medicine may be given in an injection, cream, gel, or patch.

  • Endotracheal (ET) tube: An endotracheal tube may be put into your mouth or nose. It goes down into your windpipe to help keep your airway open and help you breathe. It may be hooked to a ventilator (breathing machine), and you may get extra oxygen through your ET tube. You will not be able to talk while the ET tube is in place.

During your surgery:

  • You will lie down on a special bed with your head rested on a small pillow. Antiseptics will be used to clean the inside of your nose and other parts of your face. Sheets will be put over you to keep the surgery area clean.

  • During your surgery, no incisions will be made on your face. Stereotaxy may be used to search for the exact location of your sinuses. Your caregiver passes an endoscope and other small tools through your nostrils. While watching the images on a monitor, your caregiver removes small bones, tissues, or other materials blocking the openings. A small rotating burr is inserted to widen your sinuses and scrape away excess tissue. After removing the blockages in your sinuses, samples of the tissues are sent to the lab for tests. Your caregiver controls the bleeding using a special device to seal blood vessels. Nasal packings are placed in your nostrils to prevent infection and control further bleeding.

After your surgery:

You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. You may need to breathe through your mouth until the nasal packings are removed by your caregiver. A caregiver may remove the nasal packings to check the inside of your nose. Ask your caregiver for more information about ways to prevent bleeding and take care of your nasal packing.

  • Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Medicines: You may need any of the following:

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

    • Anti-itching: This medicine is also known as antihistamine. Your caregivers may give you antihistamine to relieve symptoms of colds or allergy.

    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.

    • Decongestants: These medicines are used to treat a stuffy or clogged nose.

    • Immunoglobulin shots: These shots may be given to help relieve your symptoms. Immunoglobulin shots make your immune system stronger to help fight infections and other diseases.

    • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

      • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

      • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

    • Steroids: This medicine may be given to decrease inflammation.

  • Monitoring: Caregivers may check for your pulses on your arms or wrists. This helps caregivers learn if you have problems with blood flow after your surgery. You may also have any of the following:

    • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

    • Neurologic exam: This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.

  • Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

  • Oxygen and a ventilator: You may need extra oxygen when waking up and for a day or two after surgery. Caregivers may leave an endotracheal tube (ET tube) in your throat. Oxygen can be given through the ET tube by a breathing machine called a ventilator. After the ET tube is taken out, you may still need oxygen. The oxygen may be given through a plastic mask over your mouth and nose. Oxygen may also be given through nasal prongs (short, thin tubes in your nose).

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Hide
(web4)