In cases where antibiotics, nasal drops, sprays and decongestants have failed to clear a sinus infection or problem (such as chronic sinusitis), it may be advisable to undergo surgery.
Functional endoscopic sinus surgery (FESS) is the procedure used to treat sinuses that have become physically obstructed and blocked. FESS can improve mucus drainage and restore the normal function of the sinuses. As with any surgical procedure, patients may question if there are any risks. Leading consultant rhinologist, nasal plastic and ENT surgeon Mr Joe Marais explains the likeliness of complications arising…
What complications can occur from sinus surgery?
Complications may occur in every single operation there is. This is no exception. The main risk of this operation itself is bleeding or haemorrhage. A small amount of spotting of blood on your hanky after the operation is normal but a severe nosebleed may occur up to 10 days post-operatively. This occurs in only 1-2% of cases but may be sufficiently severe to warrant re-admission to hospital, a drip and perhaps even a transfusion or a return to the operating theatre to arrest the bleeding.
Other structures which are in the vicinity of the surgery are theoretically at risk: namely the orbits (eye-sockets) and the meninges (membranous cover around the brain). Damage to these structures is extremely rare but must be mentioned. This is one reason why a CT scan is required: so that the surgeon is forewarned as to how near they are to the sinuses during the operation.
Dryness, crusting and further bouts of sinusitis may occur. Adhesions, (lining inside nose sticking together) can occur – especially if the nose is not adequately cleansed post-op by irrigating. Often the sense of smell improves after surgery but this cannot be guaranteed. There is a very small chance it may be worse after surgery, although this would probably be the end result of the disease itself, if untreated.
If a septoplasty is done for access there is a risk of septal perforation (a hole in the septum). This is permanent. It may not cause any trouble at all and be completely asymptomatic but it can cause crusting and bleeding.
You should not be alarmed by the possibility of these complications. They are extremely rare, but we have to mention them so that you can give your informed consent to the surgery.
Why are endoscopes used during sinus surgery?
These fibre optic instruments allow us to carry out much more precise surgery which addresses the individual problem, particular to that patient. We know which sinuses are diseased by looking at the CT scan, and so we can operate on those that are diseased and leave alone those that are not.
Why are CT Scans necessary?
The surgeon usually requires a CT scan to define where the surgery is needed, i.e. which sinuses are diseased and which are not. Also, anatomic relationships on the scan are important to help the surgeon avoid damaging surrounding structures – in other words, the scan acts like the surgeon’s roadmap.
How long will the operation take?
About 1 to 2 hours usually. This depends on the extent of the disease that must be treated. If, as in many cases, the disease is extensive, the surgery is also quite extensive – even though this may not be apparent from the outside (no facial incisions or bruising), but internally a lot of work has been done!