Endoscopic Sinus and Nasal Surgery

Endoscopic sinus and nasal surgery, also known as Functional Endoscopic Sinus Surgery (FESS), is a minimally invasive technique used to restore proper drainage and function of the paranasal sinuses. It has become the gold standard for treating chronic rhinosinusitis (CRS), nasal polyposis, and other sinonasal pathologies unresponsive to medical management.

This surgical advancement allows otolaryngologists to work through the nostrils without external incisions, using an endoscope to provide magnified visualization of the nasal cavity and sinus anatomy.

Anatomy of the Paranasal Sinuses

The paranasal sinuses are air-filled spaces within the bones of the face and skull. They include:

• Maxillary sinuses (cheek area)

• Frontal sinuses (forehead)

• Ethmoid sinuses (between the eyes)

• Sphenoid sinuses (behind the nose)

These sinuses are connected to the nasal cavity through narrow channels. Blockage of these passages can lead to infection, inflammation, and chronic sinusitis.

Indications for Surgery

Endoscopic sinus surgery is considered when conservative treatments fail, including:

• Chronic rhinosinusitis (with or without nasal polyps)

• Acute recurrent sinus infections

• Obstructive nasal polyposis

• Mucoceles

• Sinus fungal infections

• Deviated nasal septum obstructing sinus outflow

• Sinus tumors (benign or malignant)

• Cerebrospinal fluid (CSF) leaks

Preoperative Evaluation

A thorough assessment is crucial for optimal outcomes:

• History & Physical Examination: Including nasal endoscopy

• Imaging: High-resolution CT scan of the sinuses to evaluate extent of disease

• Medical therapy trial: At least 6–12 weeks of intranasal corticosteroids, nasal irrigation, and antibiotics (if indicated)

Surgical Technique

1. Anesthesia

• Typically performed under general anesthesia

• Local anesthesia may be used in select cases

2. Endoscopic Access

• A rigid endoscope (usually 4mm in diameter) is introduced through the nostril

• Nasal decongestants and local vasoconstrictors are used to reduce bleeding

3. Surgical Steps

• Removal of diseased mucosa, polyps, or bony partitions

• Widening of the natural sinus ostia

• Preservation of mucosa when possible

• Navigation assistance (image-guided surgery) may be used in complex anatomy

Advantages

• No external scars

• Improved sinus ventilation and drainage

• Faster recovery time

• Reduced hospital stay

• Better preservation of normal structures

Postoperative Care

• Nasal saline irrigations (several times daily)

• Topical or systemic corticosteroids

• Antibiotics if infection is suspected

• Avoidance of strenuous activity for 2 weeks

• Regular follow-up with debridement if necessary

Potential Complications

While generally safe, risks include:

• Bleeding (epistaxis)

• Orbital injury (rare)

• CSF leak

• Adhesions (synechiae)

• Altered sense of smell

• Recurrent polyps or sinusitis

Outcome & Prognosis

Endoscopic sinus surgery has a high success rate when performed on appropriate candidates. Most patients report significant improvement in quality of life, reduced infection rates, and improved nasal breathing. Long-term management may still require maintenance therapy, especially in patients with polyps or allergies.