Functional Endoscopic Sinus Surgery For Rhinosinusitis

What you should know

  • 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.

Getting Ready

The week before your surgery:

  • Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.

  • Ask your caregiver if you need to stop using any of your present medicines. These may include aspirin, ibuprofen, or blood thinners.

  • Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.

  • You may need to have a computed tomography (CT) scan, chest or paranasal sinus x-rays, and blood tests. Other tests may also be needed, such as a nasal endoscopy or an anterior rhinoscopy. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

  • Your caregiver may give you steroids and other medicines to use. These medicines help prevent infections or swelling. Ask your caregiver for more information about these medicines.

The night before your surgery:

  • Ask caregivers about directions for eating and drinking.

  • Your bowel may need to be emptied and cleaned out before the surgery. Caregivers may give you a liquid medicine called an enema. This will be put into your rectum (rear end) to help empty your bowel. Your caregiver will teach you how to do this.

  • You may be given a pill to help you sleep.

The day of your surgery:

  • Write down the correct date, time, and location of your surgery.

  • Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.

  • Do not wear contact lenses on the day of your surgery. You may wear glasses. Wear socks to help you stay warm.

  • If you are staying in the hospital after your surgery, bring your personal belongings with you. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers.

  • Caregivers will insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.

  • An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your surgery.

  • You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

  • You may be given medicine to help you relax or make you drowsy. You will be taken on a cart to the operating room and then moved into a special bed. 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. Your head may be rested on a small pillow. Caregivers may give a general or local anesthesia to make you sleep during surgery. An endotracheal tube connected to a breathing machine may be put into your mouth. This will go down the windpipe to keep your airway open and help you breathe during your surgery.

  • During your surgery, no incisions will be made on your face. Stereotaxy may be used to search for the location of your affected sinuses. Your caregiver will pass an endoscope and other small tools through your nostrils. While watching the images on a monitor, your caregiver will remove small bones, tissues, or other materials blocking the openings. A small rotating burr that may widen your sinuses or scrape away tissue may also be used. After removing the blockages in your sinuses, samples of the tissues may be sent to the lab for tests. Your caregiver controls any bleeding by 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 packings.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

  • You cannot make it to your appointment on time.

  • You have a fever.

  • You have swelling over the forehead, eyes, side of the nose, or cheeks.

  • You have questions or concerns about your surgery.

Seek Care Immediately if

  • You have a fever, stiff neck, or an eye pain especially when looking directly at the lights.

  • You have a sudden severe headache.

  • You have blood or foul-smelling discharge coming from your nose.

  • You have trouble breathing, seeing, or smelling.

© 2014 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.

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