FESS

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Functional endoscopic sinus surgery (FESS) is the mainstay in the surgical treatment of sinusitis and nasal polyps, including bacterial, fungal, recurrent acute, and chronic sinus problems. Ample research supports its record of safety and success.

FESS is a relatively recent surgical procedure that uses nasal endoscopes (using Hopkins rod lens technology) through the nostrils to avoid cutting the skin. These endoscopes have diameters of 4mm (adult use) and 2.7mm (pediatric use) and come in varying angles of view from 0 degrees to 30, 45, 70, 90, and 120 degrees. They provide good illumination of the inside of the nasal cavity and sinuses.

Here are four sinuses dealt with by means of this surgery: The frontal sinuses located in the forehead, the maxillary sinuses in the cheeks, the ethmoid sinuses between the eyes, and finally the sphenoid sinuses located in the back of the nasal cavity at the base of the skull.

Maxillary sinus

One of the most accepted means of functionally enlarging the maxillary ostium is to perform an uncinectomy via the "swing door" technique. This initially removes the vertical process of the uncinate via backbiter inferiorly and sickle knife superiorly. The uncinate is swung medially and then severed at its lateral attachment. This is followed by a submucosal removal of the horizontal process of the uncinate and subsequent trimming of the mucosa to fully visualize the maxillary ostium.

Controversy exists as to whether or not the maxillary ostium should be enlarged or not depending on the disease status of the maxillary sinus. However, the medical literature would support a wide antrostomy and complete clearance down to healthy mucosa if fungal mucin is present within the sinus. In this circumstance, the ostium is enlarged superiorly to orbital floor and posteriorly to posterior fontanelle to allow wide access for clearance.

A patient's maxillary ostium can be patent several years after undergoing a FESS

Complete maxillary debridement can be accomplished via either trans-ostial clearance which can be quite tedious.

Extended approaches

More recently, the para-nasal 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 micro-surgical technique.

This can be divided into:

    approaches to the anterior cranial fossa
    approaches to the mid cranial fossa
    approaches to the posterior cranial fossa
    access to the infra temporal fossa (incl. pterygopalatine fissure)
    access to the sella turcica
    orbital access
    optic nerve access