Speak to our Gold Coast team about FESS
Functional endoscopic sinus surgery (FESS) is a procedure which is performed for treating rhinosinusitis which recalcitrant to medical therapy. The surgery has evolved dramatically over the last 10 years with significant improvement in patient outcomes. Historically FESS was a surgery with a limited success rate, with most patients not feeling the procedure made an appreciable difference to their symptoms. Dr Robinson focuses a lot of his practice on FESS and most of his patients have had a significant improvement in their symptoms following this procedure.
When do you need FESS?
FESS is indicated in situations where medical therapy for rhinosinusitis has not worked. There are other indications which are rarer but include:
- Barotrauma sinusitis (pain in face during descent in aircraft or descent whilst scuba diving)
- Sinusitis complications (infection/abscess formation around eye or brain which can’t wait for medical therapy to work)
Dr Robinson offers all patients a trial of medical therapy prior to performing FESS. This trial of medical therapy is tailored to the patient, but as a general rule includes:
- Saline irrigation to nose
- Steroid sprays
- Potential trial of oral steroids
- Potential trial of macrolide antibiotics
Following a trial of medical therapy Dr Robinson will arrange for a CT scan of your sinuses. If this demonstrates persistent sinusitis, then he will offer surgery. There are 3 main types of surgery which Dr Robinson offers:
- Full house FESS with image guidance
- Full house FESS with mega antrostomies with image guidance
Regardless of the operation the goal remains the same: to open up the diseased sinuses. Once they are open, this then allows for any washes and sprays to get where they need to go. Having an operation does not remove the requirement for sprays and Dr Robinson recommends to all patients that they use sprays in the note for at least 3 months and in some cases for the rest of your life.
Preoperative instructions from your surgeon
Dr Robinson will need you to cease any blood thinners in the week prior to the surgery. He may or may not ask you to take a dose of steroids or antibiotics prior to the surgery as well.
Full house FESS with image guidance
The goal of a standard FESS is to open up any cavities which have sinusitis. Dr Robinson performs this procedure for patients who have disease which does not involve the frontal nasal cavity. The sinuses that Dr Robinson will open include:
- Anterior ethmoid
- Posterior ethmoids
At the same time, Dr Robinson will also perform a turbinoplasty (decrease the inferior turbinates which are on both sides of the nose) to facilitate an improvement in your breathing. This may also be performed in conjunction with a septoplasty (straight the cartilage in the middle of the nose).
The procedure takes approximately one and a half hours and can be performed as a day surgery procedure. Most people are able to do office work the next day or two days after the operation.
Full house FESS with mega antrostomies with image guidance
Dr Robinson performs a Full House FESS with image guidance when you have sinusitis which involves your frontal nasal cavity or have severe sinusitis that requires a complete clearance of any disease which may be adjacent to your skull base.
Image guidance refers to using a machine which monitors the tip of the instrument which is being used to perform a CT Scan of the patient. This allows Dr Robinson to know within one millimetre where the tip of the instrument is during the procedure. Dr Robinson utilises this because of the following advantages:
- Increased safety of procedure
- Increased success of operation due to complete clearance of disease
When Dr Robinson performs a Full House FESS he takes the time required to open up all of the involved sinuses. If required Dr Robinson will take up to 3 hours to completely open every single sinus which has disease in it. Historically in FESS a significant proportion of the sinuses weren’t opened because the procedure would take a significant amount of time and some of these sinuses may be very difficult to open without an image guidance machine.
The sinuses which Dr Robinson opens during this procedure include:
- Anterior ethmoids
- Posterior ethmoids
Dr Robinson will also perform a turbinoplasty (reduction of inferior turbinates) during the procedure to facilitate an improvement in the breathing through your nose. Dr Robinson may also perform a septoplasty (straighten the cartilage in the middle of your nose) if it is required.
A Full House FESS with image guidance can take up to 3 hours. A lot of people choose to stay overnight after this operation. Most people feel like they have a cold after the operation, but are able to do office work 2 days post operatively.
Success rate of FESS for sinus obstruction
Dr Robinson collects research data on all patients he performs FESS on. This allows Dr Robinson to compare his results with other colleagues as well as look at his own results.
Dr Robinson has a very high degree of success with this procedure, with over 98% of patients having an improvement in their symptoms post operatively. He attributes this success rate to a meticulous approach, never rushing an operation and taking the required amount of time to open all of the diseased sinuses.
Research in FESS
Dr Robinson is actively involved in research in FESS. He has been an active participant in a trial looking at the utilisation of spacers and dressings in the nose. He has run a prospective study looking at the safety of topical steroids in the nose. He is also involved in a laboratory based research project looking at mucocilary flow in rhinosinusitis.