Find out more about our Academic Medical Centre and efforts in Academic Medicine
Academic Medicine Executive Committee (AM EXCO)
Find out more about what JOAM do to support AM initiatives
Find out more about the Office of Duke-NUS Affairs and Study Trip to Duke Durham
Guidelines, forms, and templates for Academic Medicine.
Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive surgery used to treat recurrent or persistent sinus infections, abnormal growth of tissues in the nose (nasal polyps) and to remove tumours. In this procedure, an endoscope is used to operate on the sinuses through the nostrils. There are no external scars.
This procedure is done under general anaesthesia. Once the patient is asleep, an endoscope and various instruments are introduced into the nose. Surgery is then carried out using the endoscope to clear sinus disease.
Nasal packs may be left inside your nose for 24 – 48 hours following the surgery to stop bleeding from the operative site. These may be absorbable or non-absorbable. The nasal packs will prevent you from breathing through your nose and may cause tearing.
As with all surgical procedures, complications can occur. These complications can occur during or after the surgery. Some of these risks and complications are inherent in any operative procedure, especially when general anaesthesia is administered. You should ask your doctor about these risks. In addition, some of the possible complications specifically following a FESS are:
The risk of this occurring is less than1%. The brain is separated from the nasal sinuses by a thin layer of bone. This layer of bone may be breached especially if the surgeon does not have a clear view of the area due to reasons such as a badly infected sinus. Such a breach may cause some leakage of fluid surrounding the brain. Further surgery may be required to repair the breach.
The eyes lie next to the nasal sinuses. Removal of bone between the nose and eye socket is usually relatively harmless but may cause visual disturbances if important structures in the eye socket are damaged. This is uncommon. Blindness or double vision as a result of FESS is extremely rare but has been reported.
Some degree of bleeding during surgery is common. However, uncontrolled bleeding due to damage to blood vessels that run in or around the nose is rare but may occur (2%).
As part of the mucosal lining and bone in the nose will be removed during surgery, there will be some bleeding from the operative site. At times a nasal pack or sponge may be used to stop the bleeding. The nasal pack is usually left in the nose for 24 - 48 hours to stop the bleeding. After the packs are removed, some blood-stained mucus discharge from the nose can be expected and occasionally there may also be some clots. This is normal and to be expected.
The nose packs may block the opening of the tear duct draining tears from the eye into the nose. As a result, you may experience tearing. This will resolve when the packs are removed.
Your nose will still feel obstructed immediately after surgery as there is packing material in the nose. This will improve with nasal rinse, and after the packing is toileted during outpatient follow up.
Approximately: 2-3 hours
Average: 1-3 days
After surgery, your nose may be packed with sponges to prevent bleeding. If there is packing in your nose, you would not be able to breathe through your nose and will have to breathe through your mouth instead. You may also experience tearing due to blockage of the duct linking the eyes and nose. The packs are usually removed within 24-48 hours of the surgery and the symptoms should go away after the packs are removed. You may expect some blood-stained discharge from the nose in small quantities within the first week after surgery and a gauze dressing can be worn under the nostrils to capture these secretions.
In certain cases, it may also be necessary to regularly rinse the nose with a nasal douche as prescribed by the doctor. Crust formed in nose cavity after surgery can irritate the nasal mucosa and cause inflammation. The nasal rinse can help to remove the crust and minimize clots forming in nose cavities after nose surgery.
