Functional Endoscopic Sinus Surgery

Functional Endoscopic Sinus Surgery (FESS) is a surgical modality for some diseases of the nose and paranasal sinuses. It is a relatively recent surgical procedure that uses the help of nasal endoscopes (which make use of Hopkins rod lens telescopes): these are endoscopes which have diameters of 4mm and 2.7mm and come in varying angles of vision from 0 degrees to 30, 70, 90, and 120 degrees. These provide good illumination and can be introduced into the nose after anesthetising.

It has now become the main-stay in the surgical treatment of sinusitis and nasal polyposis including fungal sinusitis: this technique of functional endoscopic sinus surgery came into existence because of pioneering work of Messerklinger and Stamberger (Graz, Austria.) Other surgeons have made additional contributions (first published in USA by Kennedy in 1985) [1].

The surgical technique usually adopted is the Messerklinger technique.

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Technique

There are four sinuses dealt with by means of this surgery: The frontal sinus with frontal recess dissection, the maxillary by uncinectomy and antrostomy, the anterior and posterior ethmoids which require careful dissection to the skullbase and orbital lamina, and finally the sphenoid sinus which is managed via a sphenoidotomy.

Extended Approaches

More recently, the paranasal sinuses have been found to be a relatively low-morbidity approach to selected tumors of the anterior and posterior cranial fossa.

Endoscopic access to pituitary tumors has been found to be quite useful as well. Using endoscopes for hypophysectomy allows excellent visualization within the sella and more complete tumor removal than would be available via microsurgical technique.

Word of Caution

Extreme care is required with this surgery due to the paranasal sinus' proximity to the orbits, brain, internal carotid arteries, and optic nerves. However, even with these possible serious risks, there are many benefits to be reaped by a patient with appropriate indications from a well-performed ESS. As the degree of difficulty increases with these surgeries, a surgeon with appropriate experience must be present to manage the procedure. This is especially true in approaches to neurosurgical procedures.

Definitions

Planum Sphenoidale marks the posterior limit of the anterior skull base. This bony structure is the plane created by the medial confluence of the lesser wing of the sphenoid bone.