Functional Endoscopic Sinus Surgery (FESS)
The purpose of Functional Endoscopic Sinus Surgery (FESS) is to open and enlarge the connection between the sinuses and the nose, allowing for proper drainage. It is called an endoscopic procedure because the physician uses an endoscope (a small tube with a light and a camera lens at the end) to view the inside of the nose. FESS may be used to treat severe acute sinusitis, chronic sinusitis or recurrent bouts of sinusitis.
Small incisions or cuts are made to allow the scope to pass. The cuts are made inside the nose. The physician may remove polyps, cysts or thickened mucus membranes.
Endoscopic sinus surgery
- Endoscopic sinus surgery usually takes between one and three hours and is done in the operating room with the child under general anesthesia.
- Some young children spend the night in the hospital, but most older children may stay for only a couple of hours after surgery.
- Depending on the surgeon's preference and the needs of the child, endoscopic sinus surgery may be performed at the same time as another operation such as septoplasty, tonsillectomy, adenoidectomy, or insertion of ear tubes.
- Your child may need a second procedure three to four weeks after initial FESS to remove crusts and remaining obstructing issue.
What to expect after surgery
- Your child will have intravenous (IV) fluids until the time of discharge. Clear liquids for your child to drink are available in the Post Anesthesia Care Unit (PACU), also called the recovery room.
- Your child may complain of a sore nose, not being able to breathe through the nose, and difficulty swallowing.
- A pain reliever may be given for pain. An antibiotic is prescribed to prevent infection.
- The head of the bed will be raised in the PACU to help with swelling, breathing and drainage. At home, you should have pillows or a recliner chair available to help your child stay comfortable with the head elevated above the level of the chest.
- There may be packing in the nose to prevent bleeding. This packing is usually dissolvable.
- If a septoplasty (straightening of the bone and cartilage in the center of the nose) is performed, splints may be placed inside the nose at the end of the operation. These will be removed at the physician's office in one to two weeks and may cause some discomfort while they are in place.
- If packing is used, your child may be able to feel it in the nose. Your child should be told before surgery that she or he may feel like there is something in the nose when waking up. If packing is not used, swelling may cause this feeling. Your child should not forcefully blow the nose for a week or two.
- At first, there may be some drainage from the nose. You may see a small piece of gauze taped under your child's nose. This is called a "drip pad" or "moustache dressing." This is usually only needed for the first day, if at all. The drainage from the nose will probably be tinged with blood. Your child may cough or spit up some pink or brown mucus.
- Most children are fussy the first few hours after this procedure.
- Your child may begin normal play after several days, but may need to stay home from school until the discomfort improves. Consult your child's physician for more specific recommendations.
- Your child's physician may recommend the use of nasal ointment, salt water spray, or nasal steroid spray after surgery. Follow instructions carefully.
Please review The Children's Hospital of Philadelphia discharge instructions for Functional Endoscopic Sinus Surgery (FESS).
When to call your child's physician
The following are some of the symptoms that may indicate a need for you to promptly contact your child's physician:
- Bright red bleeding from the nose or mouth
- Vomiting bright red blood or a coffee ground-like material
- Double or impaired vision
- A persistent leak of clear fluid from the nose
- Vomiting (or if the vomiting becomes severe)
- Signs of dehydration (a child can become dehydrated when he or she has prolonged or severe vomiting and is not able to drink enough fluid)
- A temperature greater than 101.30°F or 38.50°C taken under the arm; greater than 102.20°F or 39°C by mouth or rectum.
Signs of dehydration
- Dry mouth
- Sunken look around eyes
- Decreased amount of urine (i.e., fewer wet diapers than usual in an infant)
- No tears when crying
- Skin that, when pinched, forms and holds the shape of a tent
A visit with your child's physician is usually scheduled one to two weeks after surgery and then again several more times in the months after surgery to make sure that the nose is healing properly. Consult your child's physician if you have any questions.
Reviewed by: Steven D. Handler, MD, MBE
Date: February 2009