Functional Endoscopic Sinus Surgery (FESS)
The tasks of the paranasal sinuses?
The sinuses are part of the nasal system, which produces normal secretion (mucus). Normally, the nose and sinuses secrete approximately half a liter of mucus per day. The mucus produced acts on the nasal cover (mucosa), removing bacteria, airborne particles and dust particles. This mucus then drains back into the throat and is swallowed. Particles and bacteria in it are broken down by stomach acid. Many people are unaware of this because it is a normal body function.
What does the discharge mean behind the nose?
Inside the nose; It produces too much mucus than normal when irritated by air pollution, allergy-causing substances, smoke, or viruses. This is a secretion like clear water, produced in large quantities to wash and remove the allergic substance in the nasal membranes. A water-like secretion occurs towards the back of the nose. This is the most important cause of back discharge. Another type is mucus sticky and thick. This occurs when the airways are too dry and the membranes do not produce enough fluid. Sticky and viscous mucus is also observed in infections caused by bacteria, and the color of the mucus may be yellow or green due to pus.
What are sinus and sinusitis?
The suffix "-it" refers to infection or inflammation in medicine. Therefore, sinusitis is an infection or inflammation of the sinuses. A typical case of acute sinusitis occurs with a large amount of mucus secretion as a result of a cold or an allergic attack. The membranes can swell so much that the small openings of the sinuses are blocked. If air and mucus cannot move easily between the nose and sinuses, mucus accumulates in the sinuses and causes an increase in pressure. Depending on which sinus is affected, pain occurs between the eyes or behind the eyes, cheeks and upper teeth, which is caused by pressing on the face or forehead. A sealed and mucus-filled sinus is a very suitable environment for bacteria to grow. If the cold lasts longer than usual and the color of the mucus turns green-yellow or a strange taste develops, a possible bacterial infection has developed. Pain in the face and forehead can be very bad in cases of acute sinusitis. Chronic sinusitis develops when the sinus outlet is blocked for a long time. Headaches are rare, but discharge and bad odor persist. As a result of excessive inflammation, formations called polyps develop. Some cases of sinusitis occur as a result of the infection in the upper tooth passing into the sinus.
What is sinusitis headache?
The headache that occurs in the face, cheeks, forehead, or around the eyes during a cold or when the nasal cover is swollen and the nose is running, or when the nose is full of mucus is probably sinusitis pain. Sinus infection causes this. Another type of sinus headache occurs when the plane descends to land. This is especially evident if you have a cold or active allergy (this is called "Vacuum Headache"). Unfortunately, there are many other causes that can be confused with sinus headaches. For example, migraine and other vascular-induced headaches or tension headaches can be confused with sinusitis because they cause pain around the forehead and eyes and also cause nasal discharge. However, these types of headaches come and go in a short time without doctor's intervention. They are different from sinusitis that lasts long without a doctor's intervention and can only be corrected with antibiotic treatment. However, the occasional headache that causes nausea and vomiting is rather a migraine headache. For the diagnosis of severe, frequent and prolonged headaches, a doctor should be consulted.
Who will encounter sinus problems?
In reality, anyone can get a sinus infection, but some groups are more susceptible. Those with allergies: An allergy attack causes swelling of the mucosa like a cold, closure of the sinus channels, obstruction of mucus flow and bacterial infection. Those who have structural nasal disorders that will prevent good breathing and mucus flow: For example, a broken nose or septum deviation (septum is a cartilaginous structure that divides the nose into two as right and left. Its tilting to one side is called deviation.) It is frequently exposed to infection. remainder: School teachers and medical staff are sensitive. Smokers: Tobacco smoke and nicotine disrupt the natural resistance mechanism.
Sinusitis is a disease that normally heals within 6-8 weeks at the latest. If the symptoms persist for more than 12 weeks and progress as acute attacks, it can be defined as a chronic sinusitis. Since there is an immune problem, it should be investigated and eliminated until many other systemic diseases. For example, a foreign body (piece of toy, food item, bead, etc.) in the nose may cause foul-smelling discharge and sinusitis, especially in children. It is extremely important to investigate these thoroughly and arrange the treatment accordingly. Especially in sinusitis in children, antibiotics and other supportive treatments are applied if necessary, depending on the condition of the infection, but if there is an obstruction that causes nasal obstruction such as nasal flesh, extremely large tonsils, nasal polyp, it may be necessary to open the respiratory tract by surgical method.
Minimally invasive methods have begun to be developed in the treatment of chronic sinusitis. In the past, sinus surgery was done in the face and mouth. Nowadays, endoscopic sinus surgery allows the
During the operation, the patient who has been scheduled for Functional Endoscopic Sinus Surgery (FESS) appears to have a thick purulent secretion, which drains into the left nasal cavity.
In 2012, I shared the following video titled "Right maxillary sinus retention cyst that drains into the nose":
Similar links >> Sinusitis - Definition, Symptoms, Causes, Complications and Treatment / Functional Endoscopic Sinus Surgery (FESS)
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
What is endoscopic sinus surgery?
Endoscopic Sinus Surgery (ESS) or Functional Endoscopic Sinus Surgery (FESS) is a surgical method that can be successfully applied in cases of inflammation of the cavities in the nasal and facial bones called paranasal sinus, flesh growths called polyps, cerebral fluid leaks that may be caused by trauma or without a cause.
Endoscopic sinus surgery was defined in the 1970s and became widespread in a short time. This surgical method has been very effective because it is suitable for physiology and has completely changed the treatment approach of chronic sinusitis. For this reason, almost all of the old surgical methods used in the treatment of sinusitis have been abandoned in a short time. The basic logic in this surgical approach is to expand the obstructed natural openings of the sinuses by imaging the inside of the nose with tiny camera tips, and to protect the mucosa covering the bone structures as much as possible while removing the osteitic tissue. Since the sinus mucous membranes are protected, mucus transport starts again over time and a normal phiological cycle can be achieved. Chronic sinusitis problem, especially due to anatomical disorders can thus be completely eliminated.
Endoscopic sinus surgery is described as surgical interventions in the sinuses in the nose with the help of an endoscope. Endoscope is a device that contains materials such as light and optical lens and is frequently used by many branches. During the endoscopic sinus surgery process, there are dark areas in the nose that cannot be easily seen. With the help of the endoscope, hard-to-reach places are easily reached and a clear image is taken from that area, thus enabling endoscopic sinus surgery to be performed easily. Since the images are also transferred to the computer, facilities such as zooming can be provided in high resolution, and the recording of the images will also be beneficial in the continuation of the process.
Endoscopic surgery for the nose is primarily defined for the treatment of chronic sinusitis. However, with the development of radiological and digital imaging over time and the increase of experience, tumor surgery of the sinuses and skull base, encephalocele excision, nasal repair of cerebrospinal fluid leaks, tear duct obstruction treatment, endoscopic surgical treatment of some eye diseases, opening choanal atresia. spread over the area.
Due to the complex structure of the sinuses and its close proximity to vital organs such as the eye and brain, it is a procedure that should be done carefully and with experience.
Who can have endoscopic sinus surgery?
Chronic sinusitis patients, nasal polyposis patients, patients with antrochoanal polyps, patients with inverted papilloma, patients with disease spread to the eye due to sinusitis, masses of the nasal cavity or sinuses, those with traumatic cerebrospinal fluid leaks, unstoppable nose bleeding for many diseases related to the nose and sinuses. can be applied successfully.
When is endoscopic sinus surgery performed?
There are many conditions in which endoscopic sinus surgery is applied. It is used in diagnosis, treatment and surgical operations in many diseases related to the conditions that develop around them, especially the nose and sinus. Recurrent sinusitis, nasal polyp, antrochoanal polyp, bloodshot reduction, sinus mucocele, nasal and nerve tumors, cerebrospinal fluid leakage, orbital decompression, orbital decompression , optic nerve decompression, such as the relief of the optic nerve from pressure, opening of the blocked tear duct, improvement of choanal atresia, removal of foreign bodies detected in the nose, nose bleeding control, pituitary gland tumors, skull base surgery, septal crest, endoscopic septoplasty and eustachian tube problems. Numerous conditions are undergoing diagnosis and treatment under endoscopic sinus surgery.
How is Functional Endoscopic Sinus Surgery (FESS) performed?
Inflammation and polyps in the nose and sinuses are cleaned by entering through the nostril with high resolution cameras.
Although the duration of surgery varies according to the extent of the disease, it varies between half an hour and 2 hours on average. During this surgery, nasal cartilage bone curvatures can be corrected, aesthetically pleasing, and nasal contours can be intervened. The operation is performed painlessly under general anesthesia. It is done completely through the nose, with the help of endoscopic systems and angled special tools, and there is no visible scar or deformity. The duration of surgery varies according to the extent of the pathology and whether there are additional interventions such as correction of intranasal curvature, aesthetic nose surgery, nasal concha reduction, correction of anatomical variations. While the intervention to a single sinus takes around 20-30 minutes, it may take two hours to clear the pathology involving all sinuses and to correct additional pathologies.
If the middle bone of the nose is not intervened after the surgery, the use of tampons is generally not required, but in cases where curvature is corrected, a tampon can be placed in the nose.
In endoscopic sinus surgery, many of the problems listed above may enter the diagnosis and treatment process, but each may have different protocols. The operation can be performed under general anesthesia or under local anesthesia. Depending on the procedure, it can be performed only with sedative drugs, that is, sedation that does not provide complete sleep. For this reason, before endoscopic sinus surgery, the patient's current disease history and the medications used, if any, should be known in detail by the endoscopic sinus surgery team. In the light of this information, preparation for all possible complications will be provided and clinical environments suitable for the health of the person will be created.
Anesthesia may vary as well as the procedure to be operated. If there is a problem over polyps or tumors, local anesthesia is preferred with simpler procedures such as foreign body while performing general anesthesia. Before the operation, sinus tomography should be taken and the surgeon should always be with him in a way that he can check.
In endoscopic sinus surgery, it is entered through the nose with an endoscope, and the process begins with highly sensitive surgical equipment specially developed for these processes.
Chronic sinusitis is one of the most common interventions within the scope of endoscopic sinus surgery. For example, the procedure performed in chronic sinusitis is the opening of the sinus canals that are already blocked. At the same time, the healthy tissues are protected and the diseased ones are cleaned. In nasal polyps disease, all polyps in the nose and nerves are cleaned without damaging healthy structures. In a sensitive subject tumors, the area where the tumor is located is removed with the surrounding part.
How about the postoperative period for endoscopic sinus surgery?
It is normal to experience nasal congestion up to 48 hours after surgery. A packing can be placed in the nose, it will be removed by the doctor within 3-7 days (this time varies depending on the surgical procedure and the nature of the nasal tampon used). Drugs should be used in the direction of the doctor and, if recommended, the inside of the nose should be cleaned. If not allowed, actions such as sucking water into the nose and blowing the nose should be avoided. It is normal to see dryness or crusting in the nose, but if the discomfort is severe, a doctor should be consulted. Depending on the content of the surgery, the healing process can take from a few weeks to 5-6 weeks, it is recommended not to disrupt dressings and controls during this process.
The use of antibiotics after surgery, the use of serum water that moisturizes the nasal cavity and reduces crusting, and the use of cortisone-containing sprays and drops after surgery in patients with allergies and polyps may be recommended.
After endoscopic sinus surgeries, the nasal cavities can be dressed in the office environment at repetitive one-week intervals until recovery is achieved.
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Fax: +90 212 542 74 47
