Chronic sinusitis (CPP) is one of the most common ENT conditions. The increasing detection rate of this entity is due to the continuous improvement and dissemination of diagnostic methods, especially radiological imaging techniques. The primary treatment of sinusitis is pharmacotherapy. However, in some cases, medication does not work and surgery is required.
The diagnosis of chronic sinusitis requires that symptoms persist for more than 12 weeks. A completely different condition is acute sinusitis, which persists for a much shorter period of time and is a one-off process that usually ends without complications.
What is Functional Endoscopic Sinus Surgery?
FESS (Functional Endoscopic Sinus Surgery) procedures are a modern, state-of-the-art treatment for chronic sinusitis. The FESS procedure is extremely safe, especially for people who are burdened with various medical conditions, e.g. diabetes, hypertension, atherosclerosis, obesity, cardiovascular conditions. It is carried out through the anterior nostrils - commonly referred to as the 'holes' of the nose, under general anaesthesia. It is a minimally invasive method, which means that special micro-tools are used during the procedure to reach hard-to-reach areas of the nasal cavity. The entire procedure is carried out under the control of an endoscope - a device that is equipped with an optics system and a light source. During the operation, the surgeon controls the position of the instruments and is able to accurately assess inflammatory changes. During the procedure, the inflamed mucosa, polyps (hypertrophied mucosa) and elements such as hook-like processes are removed. FESS procedures are often combined with a correction of the nasal septum (septoplasty), correction of the nasal concha (conchoplasty), during which the hypertrophied nasal concha is removed, and correction of the external nasal framework (rhinoplasty).
What is the qualification and preparation for the procedure?
During a visit to an otolaryngologist (head and neck surgeon), the treatment options are presented. The doctor discusses with the patient the scope of the surgery, its course and possible postoperative complications. During the visit, an endoscopic examination is most often performed, which allows a thorough assessment of the inside of the nasal cavity, larynx and nasopharynx. Before surgery, a CT scan is necessary to help assess the condition of the sinuses. An anaesthesiologist also qualifies for the procedure, who takes a thorough history with the patient regarding past operations, ongoing medication and co-morbidities. It is important to stop smoking for several weeks before and after the procedure. FESS procedures are characterised by very few post-operative complications, thanks to the use of microsurgery. Most often, the patient leaves the same day and can return to work and other duties immediately after a few days. After the operation, discomfort in the nasal cavity area, swelling and minor bleeding are possible. Preoperative laboratory tests are necessary: blood count, determination of bleeding and clotting time, blood group, biochemical tests: sodium, potassium, glucose, creatinine, urea, CRP. Level of anti-Hbs and anti-HCV antibodies, ECG and chest X-ray.
Course of surgery:
- The procedure is carried out under the guidance of an endoscope which makes it possible to remove only those tissues affected by the disease process while keeping intact healthy structures, even those in close proximity. This method avoids the use of a scalpel and cuts on the skin of the face and inside the nasal cavity.
- During the procedure, the inflamed mucous membrane is removed and the sinus cavities are widened, allowing for proper ventilation of the sinuses.
- One of the steps is to flush out any inflammatory or purulent secretions from the sinuses.
- During the procedure, nasal polyps (overgrown mucous membrane) are removed.
- The use of angled endoscopes and appropriately curved instruments makes it possible to reach hard-to-reach h during classic sinus surgery.
Duration of procedure: 1-3 hours.
The FESS procedure is intended for people who suffer from chronic sinusitis with or without polyps. Particularly for all those for whom pharmacological treatment has not been successful. The procedures are performed by otolaryngologists following anaesthetic qualification. If chronic inflammation of the sinuses is a condition you have been battling for a long time, see an ENT or otolaryngologist. A referral from your general practitioner is necessary to see these specialists.
