Functional Endoscopic Sinus Surgery (FESS) with VTI (Computer Guidance)
Sinus surgery is indicated when medical therapy has failed to treat sinus problems/ infections. We are careful to evaluate each patient individually based on their symptoms and CT scan findings, to determine if surgery is necessary. If surgery is needed, it generally can be performed as an outpatient.
The procedure takes about 1 ½ -3 hours depending on the amount of surgery that is needed. It is performed under a general. We use small telescopes (similar to the size of a pen) that are passed through the nose to visualize the anatomic structures within the nose and sinuses. Small manual forceps and electric swiveling instruments are used along with suction devices to clean out the sinus cavities and enlarge their openings so that future sinus material can drain out more easily.
Generally, no external or visible incisions are necessary. The procedure does involve working close to the eye (orbit) and the brain; so potential for injuries to these areas is possible, but unlikely (less than 1% of the time). Following surgery, some pain can exist for 1-7 days, and sometimes packing may need to be removed from the nose following surgery (at the post operative visit). Occasionally, a second trip to the operating room may be needed about 2- 6 weeks following surgery to clean out the nasal/sinus cavities. The surgery is successful in improving sinus problems about 85 % of the time. Occasionally, revision sinus surgery is needed years later.
We often utilize technology called Image Guidance in the surgical suite. The Image Guidance system is like GPS for the sinuses. This device allows us to pinpoint the location of our instruments within that particular patient as we work during the surgical procedure. This allows the surgeon to have the greatest accuracy and location of anatomic structures during surgery. It has been a great advance in our field. Our practice was one of the first in the Midwest to start using this technology in about 1994.
TWO WEEKS BEFORE SURGERY: Do not take non-steroidal anti-inflammatory drugs (NSAIDs) for two weeks prior to surgery. Medications in this family include: aspirin, ibuprofen, Advil, Motrin, Aleve, naproxen, Celebrex and others. These medicines increase the risk of bleeding. Also, discontinue all homeopathic alternative medicines such as ginkgo biloba, garlic, fish oil, dong quai, feverfew or ginseng. These too may increase bleeding. Tylenol (acetaminophen) is not an NSAID, therefore, can be taken prior to surgery.
POST-OPERATIVE CARE AFTER FESS
1. You should anticipate a visit to our office during the first week after surgery. Additional visits will be arranged as determined by you and your surgeon.
2. Please avoid lifting more than 15 pounds. Also, do not bend over for a long period of time, or strain heavily for one to two weeks following surgery since this may promote bleeding. Avoid vigorous exercise and activity until healing is completed.
3. Do not resume aspirin containing products or NSAIDs for at least one week after surgery.
4. If you need to cough or sneeze, please do so with an open mouth since this will help prevent excessive postoperative bleeding. You may blow your nose gently beginning a few days after surgery.
5. Use a saline nasal spray (Ocean Nasal Spray, Simply Saline, etc.) frequently to help cleanse your nose and keep the crusting in the nose soft. In addition, bacitracin antibiotic ointment can be applied inside both nostrils with a Q-Tip two times a day for a week or two after surgery.
6. Keeping your head elevated while sleeping will help to reduce the swelling within your nose.