FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS)

Rigid endoscopic examination of the paranasal sinuses is becoming increasingly useful in the management of a range of sinus pathology. The advent of endoscopes with angled viewing ports and the development of appropriate endoscopic surgical instruments have permitted a range of surgical procedures to be evolved which can be performed under endoscopic vision. Inferior meatal puncture and ‘Caldwell Luc’ pattern punctures afford access for antral assessment and surgery. Access to the higher level sinuses may require a middle meatal puncture. The maxillary sinus can be examined endoscopically in the surgery under local anaesthesia but, where nasal septal deviations are present or disease is suspected higher in the sinus system, general anaesthesia is required. Access is poor until septal deviations are corrected and frontoethmoidal surgery is kinder under full general anaesthetic.