Functional Endoscopic Sinus Surgery (FESS)

  • What is functional endoscopic sinus surgery?

    Functional endoscopic sinus surgery is a reconstructive surgery to open and enlarge the connection between your child's sinuses and nose, allowing for proper drainage.

    FESS is used to treat:

    • Severe acute sinusitis
    • Chronic sinusitis
    • Recurrent bouts of sinusitis
  • About the surgery

    Endoscopic sinus surgery usually is done in the operating room with your child under general anesthesia. The procedure takes one to three hours and most older children are released home a few hours after surgery. Some younger children will need to be monitored longer and may spend a night in the hospital after surgery.

    FESS is an endoscopic procedure. Your child's surgeon will use an endoscope (a small tube with a light and a camera lens at the end) to view the inside of the nose. Small incisions or cuts are made inside your child's nose to allow the scope to pass.

    During the surgery, your child's surgeon may remove polyps, cysts or thickened mucus membranes.

    In some cases, FESS will be performed at the same time as another operation such as:

    • Septoplasty, surgery to fix a deviated septum
    • Tonsillectomy, surgery to remove the tonsils
    • Adenoidectomy, surgery to remove the adenoids
    • Tympanostomy tube insertion (surgical 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

    After the FESS, most children are fussy for a few hours. Your child will be given intravenous (IV) fluids while in the hospital until discharge. Clear liquids for your child to drink are available in the Post Anesthesia Care Unit (PACU), also called the recovery room.

    The head of your child's 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 your child's nose to prevent bleeding. This packing is usually dissolvable, but your child may be able to feel it. To minimize confusion and discomfort, your child should be told before surgery that when he wakes up, he may feel like there is something in his nose. If packing is not used, swelling may cause this feeling.

    If your child also had a septoplasty straightening of the bone and cartilage in the center of the nose) performed, splints may be placed inside the nose at the end of the operation. These will be removed at the physician's office one to two weeks post-operatively and may cause some discomfort while in place.

  • Discharge instructions

    Pain

    Headaches and facial pain are common for the first 1-2 days after surgery. Many children will also have eye puffiness and bruising across the bridge of the nose and under the eyes.

    You may give your child acetaminophen (Tylenol, Panadol, Tempra) as directed on the product label.

    If your child is in severe pain, we may give you a prescription for pain medicine. Do not give ibuprofen (Motrin, Advil) or aspirin products for two weeks after surgery.

    Nasal discharge

    For 1-2 days after surgery, your child may have blood discharge from the nose. To help soak up the drainage, you may use small rolls of gauze as a "mustache". The drainage will change from bright red to brownish streaked mucus. It will decrease over a two-week period. An antibiotic may be prescribed to prevent an infection.

    Nasal congestion

    Most children will complain of a stuffy nose for 7-10 days after surgery. Use an over-the-counter saline nasal spray and a cool mist humidifier to help moisturize your child's nose and clear nasal crusting.

    Discourage nose blowing. If your child must blow his nose, keep both sides open. Sniffling is better while your child is recovering from sinus surgery. Teach your child to sneeze with his mouth open; this will decrease pressure and discomfort.

    Activity level

    Your child may return to school and other play activities when he feels ready and when prescribed pain medicine is no longer needed. Many children return to school within several days after the surgery. 

    There are no activity restrictions after surgery, but your child may not swim in an ocean or lake for two weeks. Your child should also avoid any heavy lifting after surgery until a follow-up assessment by doctor.

  • 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 101.3° F or 38.5° C taken under the arm; greater than 102.2° 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
  • Follow-up care

    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.
     

    Review date: February 2009