Functional Endoscopic Sinus Surgery

Functional Endoscopic Sinus Surgery

Functional Endoscopic Sinus Surgery (FESS) is a kind of surgery for the paranasal sinus performed intranasally with an endoscope rigid. The primary goal is to restore normal ventilation and mucociliary flow. 1..

Paranasal sinus imaging is vital in the preoperative planning process and is increasingly employed intraoperatively (image-guided surgery navigation) to avoid surgical complications and help guide the surgeon.

Indications

Endoscopic sinus surgery is a procedure that can be performed for various reasons. are:

• chronic or recurring sinusitis persistent sinusitis, despite medical or surgery

• Sinonasal Polyposis and anthropoidal polyps

• paranasal sinus mucoceles

• cerebrospinal fluid (CSF) leak closure

• the choanal atresia repair

• foreign body removal

• epistaxis control

Specific ophthalmic procedures may also be performed using an endoscopic technique, for example:

• orbital decompression (e.g., thyroid-associated orbitopathy)

• optic nerve decompression

• dacryocystorhinostomy

Contraindications

The endoscopy technique isn't able to completely rectify specific issues; in those situations, an open procedure is employed. This includes:

• orbital abscess

• Pott lumpy tumor

• certain sinonasal conditions and diseases that are caused by endoscopic failure (see e.g., Caldwell-Luc operation)

Radiographic content

CT

CT is the preferred method that is used for sinonasal surgery planning. A preoperative CT scanner is required before every endoscopic sinus surgery to ensure decreasing the chance of risks (see further below).

The axial CT scan (1.5-millimeter slices or smaller) with the sagittal and coronal reformations (3-millimeter slices or less) is used to define the sinonasal anatomy and disease extent.

Anatomy

Particular attention must be paid to the following anatomic structures and variants if you fail to do so could cause serious problems 3-4:

• ethmoid roof dehiscence of the cribriform plates and Asymmetry, skull base angle

• lamina papyracea dehiscence

• carotid canal dehiscence

• the connection between optic nerve optic nerve to air cells

• location on the anterior ethmoidal arterial

• the uncinate procedure attachments and connections

• Middle Turbinate versions and attachments

• The presence of infraorbital (Haller) and the presence of sphenoethmoidal (Onodi) Air cells

• the frontal recess configuration

Pathology

The Lund-Mackay score of 6. is used extensively for the radiologic evaluation of chronic rhinosinusitis.

Note that CT cannot discern between desiccated fluids as well as allergy fungal sinusitis (AFS) since both are hyperattenuating.

Technique

The endoscopic sinus surgery technique is based on the anterior-to-posterior approach of Messerklinger 9 and the posterior-to-anterior approach of Wigand for ethmoidectomy completion. In practice, the majority of surgeons employ a mixture of both.

In short, the process comprises seven actions 7 to be followed by the anatomy of the patient as well as the degree and severity of the illness:

• The patient is in a position, with their head towards the left and the examiner to the right side of the patient.

• The procedure is used to diagnose nasal endoscopy using rigid nasal endoscopes that are 30deg 8

  • Three-pass techniques are employed to advance the telescope across the nasal floor, towards the nasal nasopharynx, and in between the superior as well as the superior nasal conchae.

• Anesthetics that are injected into the skin; general anesthesia is recommended to treat the anxiety or pediatric patient and procedures that last for a long time.

• Medicalisation of the concha middle, exposing the ostiomeatal complex

• bunionectomy is performed using an endoscope that is 0deg

• maxillary antrostomy

• Removal of the bulla ethmoid

• Removal of the inferomedial portion of the concha's vertical lamella basal to make it easier to enter to the posterior the ethmoidal sinus

• Ethmoidectomy is crucial to remain low so as not to break the skull base.

• Identification of the sphenoid face as well as the posterior skull base

• skull base clearance posterior-to-anterior, with ethmoidal partition removal

• Sinusoid sinusotomy or sphenoidotomy

• Frontal sinusotomy. Frontal work is reserved for the last moment so that no bleeding from frontal interventions obscure the anatomy of the sinonasal sinus.

• Medicalisation of the middle nasal concha and middle meatal spacer position

Complications

The general outcomes for patients are excellent 2. and complications rates are meager, mainly when performed by skilled surgeons.

Major issues

The incidence of significant issues is below 0.5 percent. They include the following 10:

• internal carotid artery (ICA) injury

• Skull base penetration, resulting in intracranial hemorrhage, skull base fracture, or cerebrospinal fluid leak.

• blindness caused by injury to the optic nerve or the failure to properly remove the orbital hematoma

• massive epistaxis

• meningitis

Minor problems

• adhesions (synechiae)

• minor epistaxis

• nasolacrimal duct obstruction; treated with dacryocystorhinostomy

• hyposmia or anosmia The majority of cases can be resolved

FESS failed

FESS that fails results from repeated symptoms that occur after the procedure. This is usually caused by chronic illness, anatomical variations, or even incomplete surgical procedures. 12,13

• Middle turbinate lateralization is found in 30-78 percent of unsuccessful FESS patients.

• Incomplete surgery, for example:

  • Anterior or posterior ethmoidectomy (~31-74 percent of FESS that fails)

  • Uncanniectomy (~37 percent of FESS that failed)

  • retained Agger Nasi Cell (~13-49 percent of FESS that failed)

  • Onodi cell is misidentified as the sphenoid sinus.

• Recurrent sinusitis occurs in the frontal sinus. This is caused by persistent obstruction or postoperative scarring of the frontal sinus's outflow tract.