Endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS)

Encompasses a variety of procedures performed to encourage sinus drainage and prevent infection. These are performed endoscopically and often include a septal procedure to improve access. A pre-operative CT is mandatory.

 

Indications

 

Usually acute or chronic sinusitis that fails medical treatment, advanced indications all exist

 

Risks

 

Risks of hospital admission, anaesthesia, failure of the surgery/ recurrence of symptoms, bleeding, nasal discharge, dryness and crusting, cerebrospinal fluid leak (with potential for meningitis) (<0.5%), periorbital/orbital haematoma (<0.5%), loss of vision.

The image opposite shows a schematic of the difference pre FESS (right side) to post op FESS (left side). All ostia have been opened and drainage from the paranasal sinuses have been improved.

Submucosal resection (SMR) /septoplasty

 

This surgery is performed to correct a bent nasal septum. It is also performed as part of FESS to allow access to the middle meatus. The terms SMR and septoplasty are often used interchangeably but strictly speaking in an SMR bent septum is removed whereas a septoplasty aims for more conservative correction of the abnormality with minimal cartilage removal.

 

Indications

 

Nasal obstruction, FESS, occasionally performed for snoring and epistaxis

 

Risks

 

Risks of hospital admission, anaesthesia, failure to improve symptoms, bleeding, septal haematoma/abscess, loss of sense of smell/taste, teeth numbness, septal perforation, late cosmetic change (nasal saddling) (0.5%).

 

Turbinate reduction surgery

 

Removal of most of the inferior turbinate or the entire turbinate. 

 

Indications

 

Turbinate enlargement that has failed medical treatment (may be performed as part of other nasal procedures), and usually other surgical treatments too.

See the images below (left pre turbinate resection. Right image shows the improved sinus drainage into the middle meatus post removal of middle turbinate).

 

Nasal polypectomy

 

This is the surgical removal of nasal polyps. This may be performed manually or with an automatic debrider and rigid nasendoscope.

 

Indications

 

Nasal polyposis resistant to medical treatment

 

Risks

 

Risks of hospital admission, anaesthesia, failure of the surgery/ recurrence of symptoms with only temporary relief, bleeding, nasal discharge, dryness and crusting.

The images below show a series of clinical images taken intraoperatively during a nasal polypectomy

 

The first image shows a view into the left nasal cavity. We can see a large nasal polyp blocking our view of the middle meatus and turbinates.

The primary symptom in this patient is treatment resistant nasal obstruction

 

Image 2 shows mid polypectomy. The polyp is removed to clear the nasal cavity.

 

The final image shows a clear nasal passage with a good view under the middle turbinate. Air flow through the cavity will now be dramatically improved

 

The removed polyp. Note its smooth fleshy appearance.