Functional Endoscopic Sinus Surgery (FESS)

Functional Endoscopic Sinus Surgery (FESS)
FESS procedures that are performed in conjunction with navigation solutions offered by Medtronic are highly effective treatment strategies for complicated acute sinusitis and chronic sinusitis.
The primary advantages to using our navigation solutions for FESS include:

• Procedures are much less invasive than open surgical operations that were once standard
• Precision is greater, resulting in lower risk to the patient
• Patient discomfort is minimal
• Procedure recovery time is shorter

A minimally-invasive approach to surgery for sinusitis called functional endoscopic sinus surgery (FESS) evolved. FESS represents a significant advance compared to the open sinus procedures performed prior to the development of FESS. The goal of FESS is to reestablish physiologically normal sinus drainage pathways by removing or correcting diseased pieces of tissues in key areas of sinus obstruction. Small rigid telescopes, also called endoscopes, are inserted into the nose and the surgery is performed using fine instruments to open the sinuses.

There are several advantages to FESS over the open sinus procedures that preceded it. To begin with, the ability to see within the nose and sinuses is much improved. Open sinus procedures often required facial incisions with resulting visible scars and lots of nasal packing. With FESS, there are usually no visible signs that surgery has been performed since the surgery is usually done completely through the nostrils. Recovery is usually faster and there is usually less postoperative pain and bleeding. Nasal packing is used infrequently in FESS.

When patients with sinusitis do not improve after repeated courses of antibiotics and reasonable trials of the other medications used to treat sinusitis, the otolaryngologist may recommend undergoing FESS. The recommendation will be based upon the physical examination, nasal endoscopy and CT scan findings. The decision to perform surgery should be made only after carefully considering the risks and benefits.

Patient preferences also play a role in the decision. The decision to have sinus surgery is made by the patient when the impact of the sinusitis on their quality-of-life is so significant that a successful surgery can improve their ability to function in daily life.

Image Guided Endoscopic Sinus Surgery
One of the most recent advances is the development of computer-guided sinus surgery. Via a computer workstation in the operating room, surgeons can now access 3-dimensional CT scan images of a patient's sinuses during surgery. This interactive surgical device allows identification of critical anatomic structures and treatment of diseased areas for the patient with complex sinus disease.
Robert E. Johnson, M.D. uses the new "STEALTH" technology that guides surgical instruments for potentially more accurate and effective sinus surgery. Because the new procedure is done through an endoscope inserted into the nose, an open incision is rarely necessary.
The new technology, image-guided surgery, is used during surgery for severe forms of chronic sinusitis, in cases when previous sinus surgery has altered anatomical landmarks, or where a patient's sinus anatomy is very unusual, making typical surgery difficult. Tumors and cerebrospinal fluid leaks involving the nose and sinuses may also be approached using this technology.