What is Functional Endoscopic Sinus Surgery?
This surgery is indicated for moderate to severe sinus disease that is unresponsive to conservative medical management. This surgery involves the removal of bone or tissue that blocks the sinus cavities and prevents them from draining properly. Dr. Davis performs this procedure while the patient is under general anesthesia.
An endoscope (tube-like device used to enter open cavities in the body) with a light and camera is used to view the sinus cavities. The surgical plan will be based on your symptoms, your office endoscopic examination, and your CT scan.
Using a computer guided navigation system, Dr. Davis utilizes specialized sinus instruments to remove diseased tissue and/or small bony partitions throughout the sinus cavities to restore proper sinus ventilation and function. The procedure generally lasts 1-3 hours and is an outpatient procedure, meaning you can go home the same day. Nasal packing is rarely used in this type of procedure.
With chronic sinusitis, mucus becomes trapped in the compartments of the sinuses (left side). Functional endoscopic sinus surgery removes the small bony partitions, creating larger drainage pathways (right side).
Where exactly are my sinuses?
There are conceptually 5 major sinus areas on each side. The frontal and maxillary sinuses are large open cavities above and below each eye, respectively. Each opens into the nose through a narrow passage. Blockage of the frontal sinus often causes headaches in the forehead, while blockage of the maxillary sinuses causes cheek, face or tooth pain. The sphenoid sinuses are large cavities behind the eyes – almost between the ears. The optic nerve (which supplies vision from the retina), the internal carotid artery (which supplies blood to the brain) and the pituitary gland (which controls growth, the thyroid and the reproductive system) are all situated within or along the sphenoid sinus. Infections in the sphenoid can therefore become quite dangerous. Pain in this sinus can be described as coming from anywhere in the head, including the back of the head (occiput). The ethmoid sinus is more like a honeycomb than a cavity, and contains multiple small air pockets separated by paper thin bone. The ethmoids are directly between the eye sockets and extend up to the base of the frontal lobe of the brain. Surgeons divide the ethmoid cavity into an anterior portion, which drains in front of and beneath the middle turbinate, and a posterior portion, which drains behind the middle turbinate.
Will I have pain and nasal packing?
Sinus surgery causes surprisingly little pain in most patients. The bones dividing the ethmoid sinuses are as thin as a robin’s eggshell. Dr. Davis’s patients use prescription pain medication usually for less than 5 days. Typically we prescribe an oral narcotic pain reliever for a few days, depending on the extent of the surgery.
Nasal packing is dependent upon the severity of bleeding in surgery. With the vast majority of our surgeries, Dr. Davis is able to avoid nasal packing altogether. You should be prepared for the possibility that breathing through the nose may be worse for the first week after surgery.
What are the risks of sinus surgery?
Major complications from sinus surgery are exceedingly rare. However, sinus surgery involves the removal of bone and tissue very close to brain and in between the eyes. Injuries to the brain, spinal fluid leakage, meningitis, blindness, double vision and loss of smell have all been described after endoscopic sinus surgery. General anesthesia alone can cause serious complications, including stroke, heart attack, tooth injury, voice injury and death. Again, these risks are serious but rare – as are the risks of driving an automobile. More common, but less serious complications include nasal obstruction, bleeding, soreness, persistent infection, and need for reoperation. Select a surgeon who is certified by the American Board of Otolaryngology – Head and Neck Surgery and who has good training and experience with endoscopic sinus surgery.
What do I do after surgery?
After any general anesthetic, you should go home and rest for the day. Do not make any important decisions or drive a car for at least 24 hours after taking prescription pain relievers. Keep your head elevated to reduce swelling. Warm, moist air will be soothing.
After sinus surgery, crusts/blood clots will usually accumulate in the sinus cavities. These can cause residual infections and scarring that leads to further sinus trouble. Irrigating with sterile salt water (saline) will help you to keep your nose clean. You should not blow your nose for at least two weeks. Your surgeon will want to examine your nose in the office within a week after endoscopic sinus surgery, and may spend some time and effort cleaning your nose. Several such visits may be required, depending on the health of your nose at follow-up. Unlike most types of surgery, the professional fees for sinus surgery do not include postoperative endoscopy and cleaning. Depending on your insurance, you may need referrals for these visits and you should expect that they will be billed separately from the main surgery.
Remember the following after surgery:
- Do not blow your nose
- Continue allergy medications
- Irrigate with salt water
- Keep your appointments
DRESSING: Light red to clear drainage from the nose is normal for 3-5 days following surgery. The outside gauze dressing may be removed or changed when soiled or saturated. A 2×2 gauze pad folded under the nostrils and held in place with a strip of paper tape or folded surgical mask is sufficient.
MEDICATION: Headache, sinus or nasal discomfort is common after surgery. You should have pain medication for this. An antibiotic, steroids, and a nausea medication may also be prescribed.
SALINE IRRIGATIONS: You should flush out your nose with 8 ounces of saline solution at least 4-6 times daily to remove old blood and secretions, reduce crusting, keep sinus openings clear and stimulate the natural mucous flow in the nose. I recommend the Sinus Rinse squeeze bottle. Pre-made saline packets can be purchased at your pharmacy. Please use distilled or boiled water.
ACTIVITY: No strenuous activities or lifting should be attempted for at least 14 days after surgery as this might produce bleeding. Do not blow your nose for 2 weeks after sinus surgery.
EAT AND DRINK NORMALLY: Avoid alcoholic beverages and tobacco.
When to Call the Doctor
Call our offices if any of the following are noted:
- Excessive, bright red bleeding
- Double or blurred vision. Decreased ability to move or close eyes, or eye pain.
- Foul odor or fever over 101.0 F.
- Stiffness or pain in the neck or decreased alertness.
PROPEL is the first and only product in sinus surgery clinically proven with Level 1-A evidence to maintain surgical results.
PROPEL provides meaningful benefits to patients: PROPEL maintains the opening created during surgery by reducing post-operative scarring, inflammation, polyposis and middle turbinate lateralization. Reducing such scarring and inflammation is essential to improve long-term outcomes and reduce the need for revision surgery.
Propel eluting mometasone furoate into the sinus tissue
Healthy vs Diseased Sinus Anatomy
Propel being compressed
How It Works:
PROPEL Sinus Stent Procedure Animation
PROPEL® Contour sinus implant in action
Julia – PROPEL sinus stent patient testimonial
Safety & Efficacy – Evaluated in Three Prospective Multi-Center Clinical Trials totaling 205 patients
- A prospective, randomized, controlled, double-blind Pilot study4, recognized with the 2010 Maurice Cottle Research Award honoring best clinical or basic science by the American Rhinologic Society
- The ADVANCE single-cohort study assessed safety, endoscopic outcomes and demonstrated improved patient symptom scores out to six months
- The ADVANCE II randomized, controlled, double-blind clinical trial6, which included review by an independent panel of surgeons
All three trials assessed the safety and efficacy of controlled delivery of mometasone furoate to the ethmoid sinus mucosa via dissolvable implants in chronic rhinosinusitis (CRS) patients undergoing functional endoscopic sinus surgery (FESS). Safety Established in Clinical Studies:
- Ocular safety demonstrated: No clinically significant changes from baseline in intraocular pressure or lens opacities occurred
- Systemic safety demonstrated: No evidence of systemic steroid exposure or adrenal-pituitary axis suppression