In 1985, Dr. David Kennedy brought a minimally invasive approach to surgery for sinusitis called functional endoscopic sinus surgery (FESS) from Europe to the Johns Hopkins School of Medicine in Baltimore. FESS represented a significant advance compared to the sinus procedures performed prior to the development of FESS. FESS allows the surgeon to reestablish normal sinus drainage pathways by removing or correcting key areas of sinus obstruction. Small rigid telescopes called nasal endoscopes are inserted into the nose and the surgery is performed using a variety of delicate micro-instruments to open the sinuses. This allows for a much less traumatic and far more delicate procedure.
What is functional endoscopic sinus surgery (FESS)?
Dr. Kennedy taught the procedure to the resident surgeons at Johns Hopkins, including Dr. Wyatt, and to other surgeons throughout the United States. The techniques used in FESS have continued to evolve, with the development of multiple technologies over the years that make the procedure even safer, more effective, and easier to recover from.
There are several advantages to FESS over the sinus procedures performed before FESS was developed. To begin with, the ability to see within the nose and sinuses is much improved. This allows for more precise technique and better control of bleeding. In the past, lots of nasal packing and splinting was usually needed with sinus surgery. At the Dallas Sinus Center, these are used very infrequently. With FESS, there are usually no visible signs that surgery has been performed since the surgery is almost always done completely through the nostrils. Recovery is faster and there is less postoperative pain and bleeding.
What are the advantages of FESS?
When patients with sinusitis do not improve or continue to relapse after repeated courses of antibiotics and reasonable trials of the other medications used to treat sinusitis, FESS is often very beneficial. We may also recommend FESS based on your physical examination, nasal endoscopy and CT scan findings. At the Dallas Sinus Center, the decision to perform surgery is made only after carefully considering the risks and benefits to the patient.
Who will or will not benefit from FESS?
Patient preferences also play a role in the decision. The decision to have sinus surgery is usually made by the patient when the impact of their sinus problems on their quality of life is so significant that a successful surgery can improve their ability to function in daily life.
In some cases we may recommend FESS that includes “surgical navigation” – usually with a special type of CT or MRI scanner – in order to diminish the chance of complications and improve results. This is most often done in patients where the sinus disease is severe and in patients who have had prior surgery.