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FESS (Functional Endoscopic Sinus Surgery)

Minimally invasive endoscopic surgical technique to restore natural sinus drainage pathways and ventilation in chronic rhinosinusitis, nasal polyposis, and refractory sinus disease.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our KBB (Kulak Burun Boğaz) department. Book Appointment →

What is FESS (Functional Endoscopic Sinus Surgery)?

FESS (Functional Endoscopic Sinus Surgery) is the gold-standard surgical treatment for chronic rhinosinusitis with or without nasal polyposis that has failed maximal medical therapy (intranasal steroids, saline irrigation, antibiotics, leukotriene inhibitors, biologics).

Surgery uses 0°, 30°, 45°, and 70° rigid endoscopes through the nostrils; the surgeon opens the natural drainage pathways of the maxillary, ethmoid, frontal, and sphenoid sinuses while preserving healthy mucosa. Image guidance (navigation) is used in revision or complex cases.

Goals are to restore mucociliary clearance, improve topical medication delivery, reduce polyp burden, and prevent serious complications. FESS may be combined with septoplasty, turbinate reduction, or treatment of nasal polyposis (Draf procedures, balloon sinuplasty for selected cases).

Symptoms

Chronic rhinosinusitis with persistent nasal obstruction, facial pressure, postnasal drip, hyposmia (>12 weeks)
Nasal polyposis with airway obstruction or anosmia
Recurrent acute sinusitis (>4 episodes per year)
Sinus mucocele or fungal sinusitis
Complications of sinusitis (orbital, intracranial)
Aspirin-exacerbated respiratory disease (Samter triad)
Failure of maximal medical therapy after 3-6 months

Risk Factors

Allergic rhinitis and atopy
Asthma and nasal polyposis
Cystic fibrosis and primary ciliary dyskinesia
Aspirin sensitivity (AERD/Samter triad)
Immunodeficiency (CVID, IgA deficiency)
Anatomic narrowing (septal deviation, concha bullosa)
Recurrent fungal sinusitis or environmental exposure

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Symptoms of chronic sinusitis lasting more than 12 weeks
  • Recurrent acute sinusitis (>4 episodes per year)
  • Loss of smell, severe facial pain, or eye involvement
  • Sinusitis complications (periorbital cellulitis, vision changes, severe headache)
  • Suspected nasal polyps or fungal sinusitis
  • Persistent symptoms despite optimal medical therapy
  • Pre-operative evaluation by ENT surgeon and CT imaging

Treatment Methods

01
Pre-operative CT scan of paranasal sinuses (Lund-Mackay scoring)
02
FESS under general anesthesia (60-180 minutes depending on extent)
03
Image-guided navigation in revision or skull base cases
04
Endoscopic uncinectomy, maxillary antrostomy, ethmoidectomy, frontal/sphenoid opening
05
Polyp removal with microdebrider in nasal polyposis
06
Postoperative saline irrigation, topical steroids, debridement at 1-2 weeks
07
Long-term medical therapy: nasal steroids, biologics (dupilumab, omalizumab) for refractory polyposis

Which Department to Visit?

You can visit our KBB (Kulak Burun Boğaz) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About KBB (Kulak Burun Boğaz) Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.