Sinusitis is a very common condition, affecting 31 million Americans each year; 30% of the United States population have sinusitis at some point in their lives. The average adult has three to four upper respiratory infections a year; 1% of these infections are complicated by sinusitis, accounting for 16 million visits to the doctor each year.
After inducing adequate vasoconstriction with cocaine or ephedrine, the surgeon locates the middle turbinate, the most important landmark for the FESS procedure. On the side of the nose at the level of the middle turbinate lies the uncinate process, which the surgeon removes. The surgeon opens the back ethmoid air cells, to allow better ventilation, but leaves the bone covered with the mucous membrane. Following this step, the ostium located near the jaw is checked for obstruction and, if necessary, opened with a middle meatal antrostomy. This surgical procedure often greatly improves the function of the osteomeatal complex and provides better ventilation of the sinuses.
FESS offers several advantages:
It is a minimally invasive procedure.
It does not disturb healthy tissue.
It is performed in less time with better results.
It minimizes bleeding and scarring.
As with many diseases, the history of a patient with sinusitis represents a key part of the preoperative evaluation. Before considering FESS, the ear, nose and throat (ENT) specialist will proceed with a thorough diagnostic examination. The development of such diagnostic tools as the fiberoptic endoscope and CT scanning has greatly improved the treatment of sinus disease. The fiberoptic endoscope is used to examine the nose and all its recesses thoroughly. The specific features the physician must examine and evaluate are the middle turbinate and the middle meatus, any anatomic obstruction, and the presence of pus and nasal polyps.
CT scanning can also be used to identify the diseased areas, a process that is required for planning the surgery. It shows the extent of the affected sinuses, as well as any abnormalities that may make a patient more susceptible to sinusitis.
FESS is usually performed under local anesthesia with intravenous sedation on an outpatient basis with patients going home one to two hours after surgery. It usually does not cause facial swelling or bruising, and does not generally require nasal packing.
Monique Laberge Ph.D., The Gale Group Inc., Gale, Detroit,