Endoscopic Sinus Surgery Health Article

Definition

Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical procedure that opens up sinus air cells and sinus ostia (openings) with an endoscope.

The use of FESS as a sinus surgical method has now become widely accepted; and the term "functional" is meant to distinguish this type of endoscopic surgery from nonendoscopic, more conventional sinus surgery procedures.

Purpose

The purpose of FESS is to restore normal drainage of the sinuses. Normal function of the sinuses requires ventilation through the ostia (mouth-like opening) and is facilitated by a mucociliary transport process that maintains a constant flow of mucus out of the sinuses. All sinuses need ventilation to prevent infection and inflammation, a condition known as sinusitis. In healthy individuals, sinus ventilation occurs through the ostia into the nose. The sinuses open into the middle meatus (curved passage in each nasal cavity) under the middle turbinate (thin, bony process that is the lower portion of the ethmoid bone in each nasal cavity), which together are known as the osteomeatal complex, the key area of the nose. The hair-like cilia direct the flow of mucus toward the ostia.

Sinusitis develops when there is a problem in the area where the maxillary and frontal sinuses meet near the nose or, occasionally, by dental infection. When sinusitis occurs, the cilia work less efficiently, preventing the flow of mucus. The mucous membranes of the sinuses become engorged, resulting in ostia closure. Poor ventilation and accumulation of mucus then produce the conditions required for bacterial infection.

Demographics

Sinusitis is a very common condition, affecting 31 million Americans each year; 30% of the United States population have sinusitis at some point in their lives. The average adult has three to four upper respiratory infections a year; 1% of these infections are complicated by sinusitis, accounting for 16 million visits to the doctor each year.