Information on Ear, Nose and Throat Surgeries Sinus Surgery - FESS - Functional Endoscopic Sinus Surgery
Functional Endoscopic Sinus Surgery - FESS
Functional Endoscopic Sinus Surgery


Sinus surgery is one of the most commonly performed operations.  Using modern equipment called endoscopes, sinus surgery can almost always be performed through the nose and on an outpatient basis.  However, sinus surgery is used only as a last resort and most patients do not understand what sinus surgery does or even what sinuses are.  Sinuses are bony air cavities which surround the nose.  They lighten the head, resonate the sound of one's voice and may help protect the cranium against blunt trauma.  If the sinuses become blocked they can become infected producing discomfort.  However, most "sinus" problems seen in my patients are actually problems of the main nasal passages caused by smoking or allergies.  The perinasal sinuses are often normal even though the patient has symptoms of nasal drainage, pressure and airway obstruction.  The only sure way of diagnosing sinus disease is with sinus x-rays or CT scan. 

The below pictures show a patient who has multiple nasal polyps.  Polyps will often arise from the sinuses and block the sinus openings (ostium) into the nose.  The far right picture shows polyps next to the opening of the sphenoid sinus.  The middle picture shows a polyp in the middle meatus between the inferior turbinate (IT) and the middle turbinate (MT).  This polyp will block the drainage of both the maxillary sinus and ethmoid sinuses.  The picture on the left shows a nasal polyp between the middle turbinate (MT) and the nasal septum.    Click on Pictures to Enlarge
Functional Endoscopic Sinus Surgery for Nasal Polyps - Nasal PolyposisFESS for Nasal Polyps - Nasal PolyposisFunctional Endoscopic Sinus Surgery for Nasal Polyps - Nasal Polyposis

Before having sinus surgery a patient should almost always have tried and failed medical therapy.  Sinus surgery may have to be performed sooner in cases of severe acute sinusitis, massive sinus and nasal polyps, disease causing bone expansion or erosion, and in cases of suspected tumors.  Nasal polyps are often refractory to medical therapy.  Unfortunately, their presence has also been shown to predict a poorer surgical outcome. View Abstract  Dursun et al. also found that allergy and previous polypectomy (removal of nasal polyps) predicted a poor outcome from endoscopic sinus surgery. View Abstract   Soler et al. also found poor outcomes in patients with nasal (mucosal) eosinophilia (an indicator of nasal allergy).  View Abstract 

Revision rates for endoscopic sinus surgery "occurs at a high rate, especially in patients with asthma, Samter's triad, or frontal sinus disease" 
View Abstract

Simple nasal polypectomy without ethmoidectomy has been shown to have a similar reoperation rate and a lower complication rate.  Both procedures produced imporvement in symptoms but ethmoidectpmy patients experienced less congestion and pain.   View Abstract

In addition, headaches are usually not caused by sinus disease and thus may not respond to surgery.  View Abstract    If a patient smokes, it is unlikely that symptoms of nasal   drainage, airway obstruction and nasal pressure will respond to surgery.  Finally, if a patient's sinuses are not blocked on CT scan it is unlikely the patients symptoms will improve by draining the sinuses.

FLASH Animation: CT Scans of
Sinus Anatomy
Chronic Sinusitis and

Intraorbital Air


FESS Functional Endoscopic Sinus Surgery with Anterior Posterior Ethmoidectomy with Concha Bullosa Resection and Maxillary Sinus Osteotomy Video (10 mins)    
Drainage of Large Maxillary Mucocele Drainage Video (2.4 mins)  

Maxillary Sinus Osteotomy and Stent Placement (2.1 mins)
Nasal Endoscopy With Creation of an Antral Meatal Window and Drainage of the Maxillary Sinus and Removal of Necrotic Tissue - Video (4.5 mins)

Nasal Polyp Removal
(Polypectomy) Video

Nasal Polyp Removal
(Polypectomy) Video

Nasal Endoscopy With
Removal of a Nasal Papilloma


Functional Endoscopic Sinus
Surgery Flash Videos


Maxillary Sinus Osteotomy after Functional Endoscopic Sinus Surgery (FESS)Ethmoid and Maxillary Sinus StentThe operation is usually day surgery and the nose is packed for 1 to 3 days.  A small self retaining plastic stent may be left in the nose and removed 7 to 10 days later- see picture to the right.  At 7 to 14 days post-op
nasal endoscopy is performed in the office for removal of clots and cleansing of the surgical cavity.   The picture on the right shows the three week post-operative result.  Note that the sinus cavities are wide open and there is little scaring after stent removal. 

Click on Pictures to Enlarge

Maxillary and Ethmiod Sinuses after Functional Endoscopic Sinus SurgeryThe picture on the left shows a widely open
sinus cavities after endoscopic sinus surgery.  The middle turbinate
is small and may have been partially resected by the surgeon.  

Click on pictures to enlarge


Headaches are not often caused by
sinus disease and sinus treatments and surgery may not be effective.  Surgery for "sinus headaches" is debated and results cannot be guaranteed.  Shields has shown that there was no correlation between the severity of pain and the severity of sinus symptoms.  This brings into question whether sinus disease is causing the symptoms at all. One explanation is that most of this pain is caused by tension headaches and migraines.  The patients just assume the pain is from sinus disease because of the mass marketing of sinus medications they see on television.   View Article  

Smoking causes a severe and refractory nasal inflammation and symptoms to almost all types of medications and surgical interventions.  The lining of the inside of the nose is a single layer of highly specialized cells.  Theses cells secrete liquid to lubricate the nose and have cilia to clear the secretions and trapped debris.  Smoke damages this delicate lining.  If one smokes a half pack or 10 cigarettes  per day then one is blowing smoke about 200 times through the nose.  If you had burning watery eyes and were sticking your eyes in the smoke of a fire 200 times or even 10 times a day, do you think you would get better?  Do you think that medications or surgery would help the burning and watering?  Or would you stop exposing your eyes to smoke?  Thus, QUIT SMOKING !!!   Some nationally known sinus surgeons consider smoking a contraindication to performing sinus surgery.

Children:  In children who failed medical therapy, Ramadan (2004) found that they may benefit from surgery.  Following certain criteria, performance of an adenoidectomy alone improved 52% of children and performance of an adenoidectomy and endoscopic sinus surgery (ESS) improved 83% of children. 
View Abstract    Ramadan (2003) also found that ESS was not effective in the treatment of chronic sinusitis in children under the age of 3.  When performed for children under the age of 6, revision surgery at a later time may be required.  ESS was most beneficial in children older than 6 years of age and in all children, regardless of age, that developed a complication from sinusitis.   View Abstract 

It will sometimes be recommended that a second look ESS is performed 2 to 4 weeks after the first surgery.  This procedure is designed to clean the sinuses and remove excessive scar tissue.   However, the benefit to the patient has been questioned by several authors and probably should not routinely be performed.  
View Abstract   View Abstract

Complications of Sinus Surgery:   Review the CT scan, anatomy of the sinuses, to see the vital structures which are next to the sinuses that can be injured during surgery.  Go To Sinus CT Scans

  • Blindness - Prevention at the Time of Surgery.
  • Injury of the Nasolacrimal Duct with Tearing.
  • Leakage of Cerebral Spinal Fluid (Brain Fluid).
  • Bleeding, Infection.
  • Injury to the Carotid Artery which can cause massive
    Bleeding, Stroke and death.
  • Meningitis, Stroke, Death.
  • Chronic Pain.  Rarely, chronic facial pain has been reported to be associated with sinus surgery.



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Page Last Updated 08/24/2023  
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