FESS

Introduction:

FESS is the acronym for Functional Endoscopic Sinus Surgery. This procedure has revolutionized the management of sinus infections to such an extent the hitherto commonly performed antral lavage has been relegated to history.

Middle meatus area: This is a crucial area for the drainage of anterior group of sinuses. Any pathology in this area could effectively compromise this rather critical drainage process. The success of FESS depends on how effectively this area is cleared.

Stamberger's hypothesis:

Stamberger proved that drainage from the maxillary sinuses always occurred through the natural ostium. He also demonstrated that the cilia of the epithelium covering the maxillary sinus cavity always beat towards the natural ostium propelling the mucous and secretions through the ostium. He also demonstrated that a more dependent inferior meatal antral opening had no role in this clearance because the cilia always pushed the secretions towards the natural ostium. So he found there is no logic in performing inferior meatal antrostomy to clear the pent up secretions.

Pathology affecting middle meatus:

1. Gross deviated nasal septum

2. Concha bullosa of middle turbinate obstructing the middle meatus

3. Infections involving the anterior ethmoidal air cells

Aim of FESS:

1. Disease clearance

2. Improvement of drainage

Instruments:

1. Nasal endoscope

2. Camera (endo)

3. Monitor

4. Surgical instruments

Procedure: Could be performed both under local / G.A.

1. Uncinectomy

2. Bullectomy

3. Identification of natural ostium

4. Widening the natural ostium