Functional Endoscopic Sinus Surgery for Sinusitis

Gary D. Josephson, MD, University of Miami, and Charles W. Gross, MD, University of Virginia Medical Center


Medscape General Medicine. 1999;1(2) 

In This Article

Abstract and Introduction


Approximately 31 million individuals are afflicted with sinus disease annually. Most cases respond to medical therapy, but if no improvement in symptoms is achieved, patients are referred to the otolaryngologist for further medical and surgical intervention. Functional endoscopic sinus surgery (FESS) was introduced to the US in 1984. FESS advocates a systematic approach to the surgical treatment of diseases of the nose and paranasal sinuses. By implementing a systematic approach to nasal endoscopic examination, physicians can give special attention to the anatomic and pathologic detail of the anterior ethmoid, middle meatus, and middle turbinate region (collectively called the osteomeatal complex). Surgical correction of these structures restores the normal anatomic boundaries and reestablishes normal patterns of sinus drainage. Investigators have reported success rates of 86% or more with this approach in patients carefully screened and selected for surgical management. This success rate will increase as newer instrumentation continues to be developed and improves the surgeons' ability to safely and accurately treat sinus disease. Major complications, although rare, can occur during sinus surgery and include hemorrhage, intracranial injury, and visual disturbances. Minor complications include periorbital hematoma and cellulitis, subcutaneous orbital emphysema, epiphora, synechiae, and natural ostia closure.

Introduction -- Refractory Sinusitis Referred to ORL

Approximately 31 million individuals are afflicted with sinus disease annually.[1] Most of these patients are first examined by their primary care physician or a specialist in allergy and immunology. Medical therapy is the initial approach to treatment, including antibiotics and several adjunctive therapies. If medical therapy is ineffective, the patient may be referred to a specialist in otorhinolaryngology (ORT). The otorhinolaryngologist records a detailed history and performs a physical examination that includes the direct inspection of the patient's nasal anatomy with nasal endoscopes. Targeted medical therapy based upon the endoscopic findings can then be offered. The response to therapy is visually monitored with subsequent endoscopic examination. For those cases unresponsive to medical therapy, surgical intervention is considered and discussed with the patient. Endoscopy is used intraoperatively for direct visualization and removal of only the diseased tissue. This technique permits rapid tissue healing and quicker response to therapy.