Functional Endoscopic Sinus Surgery (FESS)

Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive procedure to treat chronic sinus diseases, restore normal sinus drainage, and improve nasal function. FESS is effective for chronic rhinosinusitis, nasal polyps, recurrent sinus infections, and related conditions, providing faster recovery, less discomfort, and better long-term outcomes than traditional open sinus surgery.

History of FESS Surgery

FESS emerged in the 1980s with Drs. David Kennedy and Heinz Stammberger, introducing endoscopic sinus surgery based on a functional, mucosa-sparing philosophy. The approach emphasizes restoring ventilation and drainage rather than wide tissue removal. Advances in endoscopic equipment, high-definition imaging, and microdebriders over the last four decades have improved precision, safety, and outcomes.

FESS Surgery in India

Chronic sinusitis and nasal polyposis are increasingly diagnosed in India due to pollution, allergens, and lifestyle factors. Indian tertiary care centres report high volumes of FESS surgeries with excellent outcomes: improved sinus ventilation, reduced infections, symptom relief, and high patient satisfaction.

Indications for FESS Surgery

Chronic Rhinosinusitis (CRS): Persistent sinus inflammation lasting >12 weeks despite medical therapy.
Nasal Polyps: Obstruction, anosmia, or recurrent sinus infections caused by benign growths.
Recurrent Acute Sinusitis: Frequent infections not responding to medical management.
Fungal Sinusitis: Allergic or invasive fungal disease requiring clearance.
Anatomical Blockages: Deviated septum, concha bullosa, or other variations causing obstruction.
Mucocoeles: Cystic sinus lesions requiring surgical drainage.

Pre-Operative Evaluation for FESS

ENT Examination: Physical and endoscopic evaluation of the nasal cavity for polyps, swelling, or pus.
Sinus Imaging: High-resolution CT scan for surgical planning and assessment of anatomy.
Allergy Testing: Skin prick or IgE testing to identify allergic triggers.
Medical Optimization: Control of active infections, allergies, or asthma before surgery.
Blood Tests & Anesthesia Assessment: Standard pre-operative labs and evaluation to minimize risk.

Types of FESS Procedures & Recent Advances

Endoscopic Maxillary Antrostomy: Opening blocked maxillary sinus ostium.
Endoscopic Ethmoidectomy: Removal of diseased anterior/posterior ethmoid cells.
Sphenoidotomy: Opening the sphenoid sinus when involved.
Frontal Sinusotomy: Restoring drainage of the frontal sinus.
High-Definition & 4K Endoscopy: Improved visualization for precise tissue removal.
Image-Guided Navigation Systems (IGS): Real-time instrument tracking using CT data.
Powered Instrumentation (Microdebriders): Controlled removal of polyps with minimal trauma.
Balloon Sinuplasty: Less invasive dilation of sinus ostia in selected patients.
Steroid-Eluting Stents: Maintain sinus openings while delivering anti-inflammatory medication.
Combined Approaches: FESS with septoplasty or turbinate reduction for optimal results.

Potential Side Effects and Risks

Nasal Pain & Congestion: Mild to moderate post-operative discomfort.
Bleeding (Epistaxis): Usually minor; significant bleeding is rare.
Infection: Post-operative sinus infection managed with antibiotics.
Crusting & Scarring: Mild adhesions that typically resolve with saline irrigation and debridement.
Rare Complications: Orbit or skull base injury, CSF leak, or meningitis, minimized with careful planning.
Loss of Smell (Hyposmia): Temporary or permanent reduction may occur in a small percentage.

Results & Outcomes After FESS

High Symptom Improvement: Relief from nasal blockage, facial pressure, postnasal drip, and chronic infections.
Improved Quality of Life: Significant improvement in SNOT-22 scores post-surgery.
Reduced Medication Dependency: Less reliance on long-term antibiotics or steroid sprays.
Lower Recurrence & Revision Rates: Targeting anatomical obstruction reduces recurrence and need for repeat surgery.
Indian Clinical Evidence: High success rates, improved drainage, symptom resolution, and long-term satisfaction consistent with global outcomes.

Conclusion

FESS is the standard of care for patients with chronic sinusitis, nasal polyps, and recurrent sinus infections unresponsive to medical therapy. Modern advances, including high-definition endoscopy, image guidance, balloon-assisted techniques, steroid-eluting stents, and powered instruments, have improved surgical precision, safety, and patient outcomes. Proper pre-operative evaluation and experienced surgical care ensure excellent results, symptom relief, and long-term success, making FESS a powerful treatment option in India and worldwide.

Fess Surgery