What Is FESS?
Functional endoscopic sinus surgery (FESS) is a minimally invasive procedure used to treat chronic sinus problems that don’t improve with medication or other non-surgical treatments. During FESS, a surgeon uses a thin, flexible endoscope with a camera to visualize the nasal passages and sinuses, enabling precise removal of blockages, such as inflamed tissue, polyps, or bone. By restoring normal sinus drainage and ventilation, FESS helps relieve symptoms like nasal congestion, facial pressure, and sinus infections.
FESS can be used to treat problems in all four of the major paranasal sinuses:
- Ethmoid sinus
- Frontal sinus
- Maxillary sinus
- Sphenoid sinus
History of Functional Endoscopic Sinus Surgery (FESS)
Functional endoscopic sinus surgery was first introduced in the 1980s as a minimally invasive technique for treating chronic sinusitis. Prior to FESS, traditional sinus surgery involved external incisions and more invasive procedures, often resulting in higher risks of complications and longer recovery times. I remember working with Dr. Wymueller at the University of Washington and making external incisions on the forehead to treat frontal sinusitis.
FESS was pioneered by Professors David Kennedy, Walter Messerklinger, and Heinz Stammberger in the United States and Austria. The development of endoscopes with light sources and cameras enabled surgeons to visualize and access the sinuses through the nasal passages, leading to the emergence of FESS as a safer, more effective alternative to open sinus surgery.
Benefits of Functional Endoscopic Sinus Surgery
1. Minimally Invasive
FESS is considered a minimally invasive procedure performed entirely through the nostrils, eliminating the need for external incisions. This results in reduced post-operative pain, faster recovery times, and less scarring compared to traditional open sinus surgery.
2. Improved Visualization
The use of endoscopes provides surgeons with a clear, magnified view of sinus anatomy, enabling precise, targeted surgical interventions. This leads to more effective treatment of sinus disease while minimizing damage to surrounding healthy tissue.
3. Preservation of Normal Anatomy
FESS aims to restore normal sinus function by opening blocked or inflamed sinus passages and preserving anatomical structures that support airflow and mucus drainage. This can lead to long-term improvements in symptoms, such as nasal congestion, facial pain, and recurrent infections.
4. Customized Treatment
FESS can be tailored to each patient’s specific sinus anatomy and disease severity. Surgeons can address individual sinus cavities and structures, ensuring a personalized treatment plan that addresses the underlying causes of sinus disease.
5. High Success Rates
Studies have shown that FESS, when properly performed, is highly effective in relieving symptoms of chronic sinusitis and other sinus disorders. Many of my patients experience significant improvements in these symptoms and reduced frequency of sinus infections after undergoing FESS.
6. Reduced Nasal Congestion
By using endoscopic surgery to precisely open blocked sinus passages, particularly in cases of chronic maxillary sinusitis, FESS restores normal airflow and drainage. This targeted approach not only relieves persistent nasal stuffiness but also helps prevent recurrent infections, allowing patients to breathe more easily and enjoy long-term sinus health.
General vs Local Anesthesia: Which Option Is Better for FESS
For FESS, both general and local anesthesia can be used, but general anesthesia is often preferred for endoscopic procedures. It ensures that patients remain completely still and comfortable during surgery, allowing the surgeon to work precisely within the delicate sinus passages. While local anesthesia with sedation may be an option for less extensive cases, general anesthesia provides optimal conditions for thorough and safe treatment, particularly when multiple sinus cavities need to be addressed.
Complications and Pitfalls of Functional Endoscopic Sinus Surgery
In some instances, FESS can be combined with endoscopic orbital decompression to relieve sinus pressure that threatens the optic nerve or contributes to an orbital hematoma. This approach allows surgeons to carefully access the orbital periosteum and surrounding structures, providing adequate drainage and decompression while minimizing trauma. When medical treatment alone is insufficient, this combined procedure can protect vision, reduce swelling, and promote faster healing of orbital complications.
FESS Recovery
Recovery after FESS is generally smooth because it is a minimally invasive surgery. FESS is usually performed as an outpatient procedure. Patients typically spend a short time in the recovery room before going home, with some postoperative discomfort expected, including mild pain and bloody discharge from the nose.
Pain medication can help manage any soreness, while nasal saline sprays and sinus irrigation are essential for keeping the nasal passages clean and promoting healing. Nasal steroids and nasal sprays may be prescribed to reduce inflammation, and patients are advised to avoid nose blowing during the initial healing period. In some cases, temporary nasal packing is used to control bleeding, but most patients experience gradual relief as the sinuses recover.
Texas Sinus & Snoring Offers Comprehensive FESS Procedures
I started Texas Sinus and Snoring because there is a link between snoring and nasal obstruction. One common finding in evaluating the nose for obstruction is chronic sinus inflammation. Although I often alleviate this inflammation with antibiotics or balloon sinuplasty, I am also an expert at functional endoscopic sinus surgery (FESS).
Functional endoscopic sinus surgery has revolutionized the treatment of chronic sinusitis and other sinus disorders, offering patients a minimally invasive and highly effective surgical option. By restoring normal sinus function and addressing the underlying causes of sinus disease, FESS can significantly improve symptoms and quality of life for many patients. However, it is essential for patients to be well-informed about the benefits, risks, and potential complications associated with FESS.
Our surgeons approach each case with meticulous care and attention to detail, ensuring the best possible outcomes for our patients. Through ongoing research, technological advancements, and continued refinement of surgical techniques, the field of functional endoscopic sinus surgery continues to evolve, offering hope of improved outcomes and quality of life for patients with chronic sinus disorders.
Combining FESS with Endoscopic Orbital Decompression (EOD) to Relieve Pressure on the Optic Nerve and Heal Orbital Hematoma
In some instances, FESS can be combined with endoscopic orbital decompression to relieve sinus pressure that threatens the optic nerve or contributes to an orbital hematoma. This approach allows surgeons to carefully access the orbital periosteum and surrounding structures, providing adequate drainage and decompression while minimizing trauma. When medical treatment alone is insufficient, this combined procedure can protect vision, reduce swelling, and promote faster healing of orbital complications.
Conclusion
Functional endoscopic sinus surgery has transformed the treatment of chronic sinus conditions, enabling surgeons to precisely remove diseased tissue and address conditions such as nasal polyposis while preserving critical structures, including the lateral nasal wall. With its minimally invasive approach, patients experience minimal discomfort and maintain a nose that stays moist and healthy throughout recovery. In more complex cases, FESS can be combined with endoscopic decompression to relieve pressure in sensitive areas.
While the procedure is generally safe, surgeons remain vigilant for rare and major complications, such as cerebrospinal fluid leaks and cavernous sinus thrombosis. Overall, FESS offers effective, long-term relief from sinus disease, improved breathing, and a significant enhancement in quality of life.
Ready to Breathe Freely Again?
By Dr. Ben Cilento, ENT
October 29, 2025
