Functional Endoscopic Sinus Surgery (FESS)
A minimally invasive procedure performed through the nostrils to clear blocked sinus pathways and restore normal drainage
What is functional endoscopic sinus surgery (FESS)?
Functional endoscopic sinus surgery is done entirely through your nostrils. A thin rigid telescope carries light and a camera into the nose, and your surgeon works alongside it with fine instruments while watching a screen. There are no cuts on the face and no external scar.
The word functional describes the aim. The sinuses are air-filled spaces in the bones of the face, and each drains through a narrow natural opening into the nose. The operation enlarges those natural openings and removes the thin bony partitions and the swollen lining blocking them, so that the sinuses can clear themselves the way they are built to. Healthy lining is preserved wherever possible.
How much is done varies enormously between patients, from opening one sinus on one side to clearing all of them on both. Your surgeon plans it from a CT scan of your sinuses, which is essential beforehand and acts as a map during the operation. Some centres add image guidance, which tracks the instrument against that scan in real time.
What it involves
This is done under general anaesthetic with an overnight stay. You are admitted having not eaten for six hours, and you are fully asleep throughout.
A solution to shrink the lining and reduce bleeding is placed in the nose first. Your surgeon then works through each nostril in turn with the telescope, opening the drainage pathways and removing obstructing tissue, often with a microdebrider, which is a powered instrument that shaves and suctions at the same time.
The operation takes one to two hours. Dissolvable dressings are usually placed in the nose at the end, and non-dissolvable packing is used where bleeding needs controlling, in which case it is removed the following day.
You wake with a blocked nose, a gauze bolster taped under the nostrils, and a sore throat. Expect blood-stained fluid from the nose for the first day, which is normal. You stay the night, are reviewed the next morning, and go home with saline rinses, painkillers and often a course of nasal steroid.
Recovery
Your nose will be more blocked after the operation than before it for the first one to two weeks, as the raw surfaces swell and crust. Blood-tinged discharge for a week and a mild headache behind the eyes are usual.
Start saline rinses as soon as you are told to, usually within a day or two, and do them several times a day. This is the most important thing you will do: rinsing clears crusts and stops surfaces sticking together, and people who skip it heal with adhesions.
Do not blow your nose for a week, and open your mouth when you sneeze. Avoid heavy lifting, straining and gym work for two weeks, and swimming and flying for three to four.
Most people take one to two weeks off work. Your surgeon will see you at one to two weeks to clean the nose with a telescope in clinic, and often again after that. This is uncomfortable for a few minutes and it makes a real difference to the final result. Smell and breathing continue improving for two to three months.
Questions about functional endoscopic sinus surgery (FESS)
Will my nose be packed, and does removing it hurt?
Most surgeons now use dissolvable dressings that soften and wash away with saline rinses over a week or two, so nothing needs pulling out. Traditional non-dissolvable packing is still used where bleeding needs controlling, and it is removed the next morning; that is uncomfortable for about ten seconds and is over quickly. Either way your nose will feel completely blocked for the first days, and you will breathe through your mouth and wake with a dry throat. A gauze bolster under the nostrils catches blood-tinged fluid for the first day. Ask your surgeon which they plan to use.
Will the problem come back?
The operation opens the natural drainage pathways and it does not change the tendency of your nasal lining to swell, so symptoms can return. Most people get lasting relief, and the results are generally good and durable. Recurrence is more likely where the lining is inflamed throughout, where there is asthma or aspirin sensitivity, and where nasal treatment is stopped after surgery. Continuing your nasal steroid spray and saline rinses long term is the single largest factor within your control, and people who stop them are the ones who come back. Some patients need a second operation years later.
Will my sense of smell come back?
Often it improves, and the improvement builds over two to three months as the swelling settles, so do not judge it in the first fortnight. Smell returns best where it was blocked by swelling and obstruction, and returns less where the smell nerve endings themselves have been damaged by years of inflammation. A smaller number of people find smell reduced after surgery, and complete loss is uncommon. Saline rinses and your steroid spray both help by keeping the top of the nose open. If smell has not improved by three months, tell your surgeon, since smell training is worth trying.
Other ENT treatments
Management of recurrent or persistent tonsil problems, including medical treatment and surgery when indicated
Day CareTreatment for enlarged or chronically infected adenoids that may affect breathing, sleep or ear health
Day CareTalk to a care coordinator about functional endoscopic sinus surgery (FESS)
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one