Overview

Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive procedure to treat chronic sinusitis, nasal polyps, and other sinus disorders.

FESS is crucial for treating chronic sinusitis, nasal polyps, and improving nasal airflow and sinus drainage.

Learn more in our comprehensive RxDx ENT Course

Indications

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Chronic Sinusitis

Refractory to medical therapy

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Nasal Polyps

Obstructing polyps

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Sinus Obstruction

Anatomical obstruction

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Recurrent Acute Sinusitis

Multiple episodes

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Sinus Tumors

Benign sinus lesions

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Uncontrolled bleeding
✗ Severe coagulopathy

Relative Contraindications

✗ Active infection
✗ Recent surgery
✗ Poor general health

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient assessment, imaging review, equipment setup, and understanding contraindications.

Step-by-Step Procedure

Step 1: Patient Preparation

Position patient, administer anesthesia.

⚠️ Common Mistakes to Avoid:

  • Poor positioning
  • Inadequate anesthesia

💡 Pro Tip:

Use proper positioning.

Step 2: Nasal Preparation

Decongest and anesthetize nasal cavity.

⚠️ Common Mistakes to Avoid:

  • Inadequate preparation
  • Poor visualization

💡 Pro Tip:

Ensure proper preparation.

Step 3: Uncinectomy

Remove uncinate process.

⚠️ Common Mistakes to Avoid:

  • Incomplete removal
  • Orbital injury

💡 Pro Tip:

Use careful technique.

Step 4: Maxillary Antrostomy

Open maxillary sinus.

⚠️ Common Mistakes to Avoid:

  • Inadequate opening
  • Injury to structures

💡 Pro Tip:

Use proper technique.

Step 5: Ethmoidectomy

Remove ethmoid air cells.

⚠️ Common Mistakes to Avoid:

  • Incomplete removal
  • CSF leak

💡 Pro Tip:

Use careful technique.

Step 6: Closure

Pack nasal cavity and provide instructions.

⚠️ Common Mistakes to Avoid:

  • Inadequate packing
  • Poor instructions

💡 Pro Tip:

Use proper technique.

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Post-procedure Care

Post-procedure care involves nasal care, monitoring for complications, and long-term follow-up.

Complications & Management

Complication Incidence Signs Management Prevention
CSF leak 0.5-1% Clear rhinorrhea Immediate repair Careful technique
Orbital injury 0.1-0.5% Periorbital ecchymosis Immediate evaluation Careful technique
Bleeding 2-5% Active bleeding Packing, cautery Proper hemostasis
Infection 1-3% Fever, pain Antibiotics Sterile technique

Clinical Pearls

💡

Identify key landmarks.

🎯

Use image guidance when needed.

⚡

Ensure adequate sinus opening.

🔍

Check for complications.

📊

Document procedure details.

🎨

Provide clear post-op instructions.

⚠️

Monitor for complications.