Functional Endoscopic Sinus Surgery

Functional Endoscopic sinus surgery [FESS] refers to operating through the nostrils to open up the sinuses. This procedure has undergone significant evolution over the last 10 years. Recent advances in imaging, better intra operative techniques, better instrumentation, improvements in anaesthetic, increased post operative surveillance and disease understanding have led to very significant improvements in outcomes for patients undergoing sinus surgery. Our surgeons have had extensive training in endoscopic sinus surgery and pride themselves on being meticulous in their approach to these cases.

Patients who are appropriate for endoscopic sinus surgery have usually had a trial of medical therapy for their condition and then proceed to an operation.

Operative approaches in endoscopic sinus surgery have changed significantly over the last decade with a focus now being on creating a functional sinus cavity and opening of all diseased sinuses. Gone are the days of what used to be referred to as a sinus scrape which would often not make the patient much better. The focus of surgery now is on opening the diseased sinuses and allowing them to be appropriately washed post operatively and monitored in the rooms. To further facilitate these goals, patients may require intraoperative image guidance to facilitate complete clearance of any inflammatory disease.

Post operatively patients usually do not have their nose packed . Removal of nasal packs was one of the causes for significant discomfort in years gone past associated with this procedure. Recent advances in anaesthetic as well as operative technique has meant that it is rare for patients to have any significant bleeding either intraoperatively or post operatively. Consequently, patients can be discharged the same day of surgery or alternatively stay overnight if appropriate.

Post operatively it is recommended that patients use a low pressure, high volume saline wash in their nose 4 times per day for at least 3 months. Follow up is meticulous with several post operative visits required to visualize their sinuses and remove any debri which has not been washed out by the saline. For further information on what to expect post endoscopic sinus surgery refer to our post operative handouts.

To further discuss endoscopic sinus surgery make an appointment with one of our surgeons at ENT Clinics.

Functional Endoscopic Sinus Surgery post operative instructions

What to expect

Immediately post op – You will wake up with some gauze under your nose. Your breathing through your nose is usually reasonable good immediately after the procedure. The pain is usually not significant because there is a lot of local anaesthetic in the nose.

Day 1 – Overnight some blood will ooze out of your nose. This is normal. It does not represent active bleeding. It is an ooze of blood and serous fluid which is a normal reaction to having an operation. Your nose is normally more blocked than it was immediately after the operation because of this ooze of blood. You will also notice that there are 2 clear splints inside your nose which are stitched in. Change the gauze under your nose if it becomes full.

The nurses will give you a wash bottle to use in your nose. Start this today. Using the wash bottle is as important as the surgery. After you have filled the wash bottle with water that has been boiled then allowed to cool add the solvent then insert the bottle into your nostril and apply pressure to the bottle. Do this with your head over the sink. A lot of the wash will come out of your nostril which is normal. Use half of the bottle on one side of the nose and half on the other side. Do this at least 4 times per day for a total of 3 months.

At night – Take some pain relief when you are about to go to sleep on the first night. This will ensure that you have a comfortable sleep.

When you go to bed lie on 2 pillows with a towel over the pillows and put the gauze or nasal bolster under your nose. The function of the gauze is to catch any fluid coming out of your nose which can be very irritating to your upper lip.

Day 2 – 7 – You will feel like you have a cold during this period. You may also notice some numbness over the tip of you nose and upper lip, both of which are normal.

Day 8 – 10– At the first follow up with our surgeons they will take the splints out of your nose if present. You will notice an immediate improvement in your breathing and the feeling of congestion will abate.

 

If you have any concerns or change in how you feel don’t hesitate to contact the office and we will see you in a timely manner. The staff are here to help and are more than happy to see you in the post operative period.

Pain relief?

A FESS is not an overly painful operation. Most people have a feeling of fullness post operatively but don’t feel they are in significant pain.

Take regular pain relief for the first 24 hours post operatively and then as needed after that.

Panadeine forte – Take this regularly for the first 24 hours regardless of whether you are in pain or not

Ibuprofen [Nurofen] – You can take nurofen if the panadeine forte is not effective pain relief for you and provided you are not allergic to it or have asthma. We recommend you take the nurofen no more than 3 times a day and to take it during a meal as it can cause significant stomach upset.

Endone – Take this pain relief only if you are in significant pain and the other medication is not working adequately

Antibiotics

Take a 7 day course of antibiotics after having a FESS

What should I eat?

You can eat and drink anything you like provided it does not cause a rush of steam up your nose. Anything that causes steam to go up your nose may precipitate bleeding

What are the activities I shouldn’t do?

  • No heavy lifting – 3 weeks
  • No strenuous exercise – 3 weeks
  • No blood thinning medication – 2 weeks
  • No very hot showers or baths – 2 weeks

How much time do I need off work?

As a general rule most people have one week off work. 

How important is the wash bottle?

Using the wash bottle is absolutely essential after this surgery. The wash bottle is essential to ensuring that the lining of your nose recovers from the operation. You must use it at least 4 times per day and if you want using it up 20 times per day can have additional benefits. You will not do any harm by using the wash bottle more than 4 times per day

What do I do if I get bleeding?

Use a wash in your nose if you have bleeding. Sit with you head forward, mouth open applying pressure to the sides of your nose down at the tip for a total of 10 minutes. If this is unsuccessful after 10 minutes then give yourself another wash and if the bleeding continues then make your way to the Gold Coast public hospital where there is an ENT surgeon on call 24 hours per day.

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