Introduction
Endoscopic sinus surgery (also known as Functional Endoscopic Sinus Surgery, or FESS) is a minimally invasive procedure used to treat chronic sinusitis, nasal polyps, and other conditions that cause blockages in the sinuses. The sinuses are hollow, air-filled cavities in the skull around the nose and eyes. When their drainage pathways become blocked due to inflammation, infection, or structural issues, mucus builds up, leading to chronic pain, pressure, congestion, and recurrent infections. Surgery is usually recommended when conservative treatments, such as antibiotics, nasal steroid sprays, and allergy management, have failed to provide relief. The goal of FESS is to widen the natural drainage pathways between the sinuses and the nose, allowing mucus to drain properly and air to circulate, thereby restoring the normal function of the sinuses.

Surgical Procedure
FESS is typically performed on an outpatient basis under general anesthesia and takes between 1 to 3 hours, depending on the extent of the disease.
The entire procedure is performed through the nostrils, so there are no external incisions or scars on the face. The surgeon inserts an endoscope—a thin, rigid tube equipped with a high-definition camera and a light—into the nasal passages. This provides a magnified, detailed view of the sinus anatomy on a monitor.
Using specialized micro-surgical instruments inserted alongside the endoscope, the surgeon precisely removes the tissues that are causing the blockage. This may include inflamed mucous membranes, nasal polyps, scar tissue, or thin pieces of bone. The surgeon effectively “opens up” the sinus cavities to create wider drainage pathways.
At the end of the procedure, dissolvable packing or temporary spacers may be placed in the nasal cavity to control bleeding and prevent the newly opened spaces from scarring shut during the healing process.

Surgical Risks
While FESS is a safe and highly effective procedure, the sinuses are located very close to critical structures, including the eyes and the brain, making precision essential. Standard risks of general anesthesia and bleeding apply.

General Complications
Common and expected side effects during the first few weeks of recovery include:
– Bloody nasal discharge: It is normal to have bloody drainage or ooze from the nose for several days after surgery.
– Nasal congestion and stuffiness: Your nose will feel very blocked, similar to a severe sinus infection, due to swelling, dried blood, and packing material.
– Mild to moderate facial pain and pressure.
– Fatigue for the first week or two.

Rare but Serious Complications
Severe complications are very rare but can include:
– Cerebrospinal fluid (CSF) leak: The roof of the sinus cavity is the floor of the brain. A breach can cause the fluid surrounding the brain to leak into the nose, requiring surgical repair and posing a risk of meningitis.
– Vision problems: The sinuses are adjacent to the eye sockets. Damage to the eye muscles or the optic nerve can cause double vision, bleeding into the eye, or, extremely rarely, blindness.
– Severe bleeding requiring a blood transfusion or emergency packing.
– Empty Nose Syndrome: A rare condition where the patient feels they cannot breathe well, despite the nasal passages being wide open.
– Recurrence of disease: Nasal polyps or chronic inflammation can return, sometimes requiring revision surgery years later.

Pre-operative Preparation
– Medical Evaluation: A CT scan of the sinuses is mandatory to provide a “roadmap” for the surgeon.
– Medication Adjustments: You must strictly avoid aspirin, ibuprofen, naproxen, and all other blood thinners, as well as certain herbal supplements (like ginkgo or ginseng), for at least two weeks before surgery to prevent severe bleeding.
– Fasting: You will need to fast (no food or drink) starting at midnight the night before the surgery.

Post-operative Care
You will go home the same day once you are fully awake. Pain medication and often a short course of antibiotics will be prescribed.

Wound Care
– Nasal Irrigations: This is the most critical part of post-operative care. You will be instructed to use a saline sinus rinse (like a NeilMed Sinus Rinse or neti pot) several times a day starting a day or two after surgery. This washes away dried blood, mucus, and crusts, and prevents infection and scarring.
– Do not blow your nose for at least a week. If you must sneeze, do it with your mouth open.
– Your doctor will perform nasal debridement during your follow-up visits (usually 1-2 weeks after surgery) to remove remaining crusts and packing, ensuring the sinuses stay open.

Diet
You can resume a normal diet, but avoid very hot liquids and spicy foods initially, as they can promote nasal bleeding.

Post-discharge Notes
It can take several weeks to feel the full benefits of the surgery, and complete healing can take a few months.
– Avoid strenuous exercise, heavy lifting, and bending over for at least two weeks to prevent bleeding.
– Sleep with your head elevated on 2-3 pillows to reduce swelling and congestion.
– Contact your doctor immediately if you experience a constant flow of clear, watery fluid from the nose (potential CSF leak), changes in vision, severe headache, stiff neck, high fever, or heavy, continuous nosebleeds.