Functional endoscopic sinus surgery (FESS)

23-06-2020
Endoskopija

Endoscopic sinus and paranasal cavities surgery-Fess, is available at Atlas Hospital.

The nasal cavity is the first section of the respiratory system. The nose is covered with skin on the outside, and on the inside, a bony-cartilaginous septum divides it into the left and right nostrils. The nostrils are lined with mucous membrane, the surface of which is enlarged with three gradually placed folds. The mucous membrane is covered with hairs and lashes that keep dust and microorganisms out of the air. During speech, the nasal cavity resonates.

A large number of diseases of the nose and paranasal cavities are successfully treated with drug therapy. First of all, acute inflammatory processes and allergic diseases. Chronic inflammatory processes, polyps of the nose and sinuses, cysts, mucocele, tumors, deviations of the nasal pyramid and nasal septum, etc. require surgical treatment. Surgical treatment is carried out after the drug treatment and appropriate diagnostic procedures have finished.

When antibiotics, antiallergic drugs, nasal drops, aerosols, inhalations no longer help, modern treatment of sinus diseases is focused on precise microsurgical procedures intended to resolve the pathology, which enables maximum recovery and return to daily activities.

Endoscopic operations of the nose and paranasal cavities (FESS – Functional endoscopic sinus surgery) are successfully performed by ENT surgery specialists at Atlas General Hospital. Our team consists of experienced experts in otorhinolaryngology and maxillofacial surgery who perform examinations and operations.

What is rhinoscopy?

Rhinoscopy stands for examination of the nasal cavity. There is anterior and posterior rhinoscopy. This procedure detects various diseases of the nose, sinuses and structures in the nasopharyngeal space (the space between the nose and throat). Anterior rhinoscopy is performed in an ambulatory conditions and lasts several minutes. Anterior and posterior endoscopic rhinoscopy are most often performed under short-term general anesthesia. The procedure takes 20 to 60 minutes.

Nasal polyps

Nasal polyps are soft growths of the nasal mucosa. They are usually located near the sinus opening. They can be caused by various problems, and the treatment is usually long-lasting.

Symptoms of nasal polyps:

  • Blocked or stuffy nose
  • Runny nose, sneezing, infection
  • Mucus dripping from the back of the nose into the throat
  • Itching around the eyes
  • Weakened sense of smell and taste
  • Feeling of fullness and pressure in the face or pain
  • Snoring

Nasal polyps

Sinusitis

The sinuses are cavities in the bones of the face, lined with mucous membranes whose main function is to create mucus or secretions.

Inflammation of the sinuses causes secretions to leak from the nose to the throat, with chronic throat irritation, sputum and irritating cough. Inflammation of the sinus mucosa occurs as a complication of an allergic reaction, respiratory infection caused by microorganisms, poor anatomical relations in the nose, and spread of bacterial infection from the tooth root, etc.

Inflammation of the sinuses prevents the proper circulation of air through the Eustachian tube and leads to inflammation of the ear with a feeling of pressure in the ear and deafness. Sinusitis is a common reason for otorhinolaryngologist visit.

Sleep is restless, snoring is often present, thus patients wake up tired and sleep deprived. After a cold, it takes a long time for the secretion of mucus in the nose to normalize, there is a long-lasting feeling of mucus flowing into the throat.

Symptoms of sinusitis:

  • Increased nasal secretion
  • Elevated temperature
  • General weakness and pain in the projection of the sinuses which intensifies if the head is tilted forward and downwards.

Treatment of rhinosinusitis can be conservative, with the administration of antibiotics per os or parenterally, topical administration of corticosteroids, analgesics, decongestants topically or per os. Another type of therapy is a combination of conservative and surgical – FESS.

Sinusitis and polyps must be treated, including sinus surgery in order to prevent complications that sinusitis can cause by spreading the disease to the eye and brain. In addition to nasal inflammation and sinusitis, tumors that require urgent diagnosis and treatment are also possible.

Sinusitis

Paranasal sinus cysts

Cysts in the paranasal sinuses, as well as elsewhere in the body, can be defined as benign growths filled with fluid. These are chronic, slow-growing formations, which can occur in any of the sinus cavities. In the middle of the cyst is a fluid that can be clear or thick and is usually lined with mucus that is made up of the same elements as the surrounding mucosa of the paranasal sinuses.

Two types of cysts that differ in origin are most often mentioned:

Retention cysts occur due to obstruction of the outflow tract of the gland that produces mucus and which is usually located inside the mucous membrane of the paranasal sinuses. As the gland continues to produce mucus and clogs the secretory duct, the resulting mucus accumulates and the gland expands until it acquires the characteristics of a true cyst.

Mucocele – they are preceded by sinus ostium obstruction, with accumulation of fluid in the sinus cavity. This liquid is usually thicker in consistency and sterile, but sometimes it can serve as a good food for bacteria, and then the liquid content can turn into pus. Such a formation is then called a mucopyocele. Sinus mucopyocele are chronic cysts of the paranasal cavities, surrounded by normal respiratory epithelium. Over the years, the production of contents in the cysts continues, gradually filling the affected sinus, which over time causes remodeling and erosion of the bones.

Symptoms

The symptoms that cause such cysts can be very different and range from very mild and nonspecific, to serious complications. They will largely depend on the sinus in which the cyst is located and its size, as well as on the proximity of important tissues and organs in the environment. Sometimes it is just a slight feeling of pressure in the front part of the head, real headaches, a feeling of nasal congestion, and less often there can be facial deformities, double vision, pushing the eyeball forward etc.

Unlike mucocele, which is more likely to cause symptoms, retention cysts are usually smaller, do not affect the entire sinus and usually lead to milder problems, and very often there are no issues. They are then detected as an accidental finding on X-ray, computed tomography (CT) or magnetic resonance imaging of the sinuses or head (MRI). Acute mucocele infection can cause fever, shivering, cellulitis (inflammation that spreads to surrounding soft tissues), rapid mucocele enlargement, or local infectious complications, including meningitis (inflammation of the meninges) or periorbital abscess (accumulation of pus inside the eye cavity).

FESS surgery of the sinuses and paranasal cavities

FESS is the common name for a large number of nose and sinus surgeries that address chronic inflammation, polyps, cysts, mucocele, chronic lacrimal gland inflammation, benign tumors and some malignant…

Advantages of endoscopic nasal surgery

This type of surgery has had the greatest progress in the ENT branch and has brought great relief to patients:

  • Minor operative trauma
  • Precise intraoperative process
  • Rapid postoperative recovery
  • No face cuts

Functional endoscopic sinus surgery (FESS)

Preoperative preparation for sinus surgery

Preoperative preparation is an important part of the operative procedure. Maximum drug treatment aims to create the best possible conditions for successful surgery. One of the important prerequisites is radiological diagnostics. MSCT or CBCT of the paranasal cavities in all three planes (axial, coronary and sagittal) is necessary. The images prepared in this way provide data on the relationship of the nasal cavity and sinuses with important surrounding structures, primarily the eye socket, the base of the skull and the endocranium.

The operation is performed under general anesthesia, which includes examination by an anesthesiologist, laboratory analysis, ECG and spirometry. The use of modern painkillers ensures the absence of pain after surgery.

Endoscopic sinus surgery

Surgical trauma is minimal, because the pathological process is completely removed while preserving the healthy structures of the nose and sinuses, which was not always possible with previous surgical techniques. The postoperative recovery is thus shortened, so the patient can return to daily activities after a few days. Recovery is accelerated and in a number of cases it is characterized by the absence of the need for nasal tamponade, which is inevitable after classic operations, and which is the greatest inconvenience for patients. Removing tampons (detamponade) is a particular inconvenience for most patients.

Atlas General Hospital has state-of-the-art equipment for performing FESS nose surgeries:

Endoscopes, HD cameras, high-resolution monitors, instruments and navigation devices that greatly facilitate the work of the surgeon and bring benefit to the patient.

Without previously made incisions on the skin of the face, which is common in classic sinus surgeries, with the help of the mentioned equipment, FESS enables insight into all sinuses (maxillaryfrontalsphenoid, and ethmoid), observation of the pathological process and its removal. All other, healthy structures of the nasal cavity and sinuses do not undergo surgery.

Recovery after FESS

As important as the role of the surgeon is during the operation itself, the postoperative care in which the patient has a decisive role is equally important. The doctor suggests drug therapy that the patient conducts after the operation. Persistence in its implementation is an important factor in the success of surgical treatment.

After the operation of the FESS sinus, in order to prevent bleeding, a nasal tamponade is placed, which is removed after 1-2 days or is resorbed spontaneously – it melts.

In the days after the operation, the nasal mucosa thickens and it is necessary to use nasal drops and emulsion to alleviate edema and speed up recovery. Return to daily activities is possible after seven days, and physical activity after 3 weeks.

There are no visible changes on the face such as swelling, bruising etc.

The price of FESS nose surgery is 217.000 rsd and the price includes preoperative preparation, surgery and one hospital day.