Functional Endoscopic Sinus Surgery (FESS) Lecture Review

Vocabulary-style flashcards covering the definition, history, anatomy, instruments, procedures, and complications of Functional Endoscopic Sinus Surgery (FESS).

FESS

Functional Endoscopic Sinus Surgery; a minimally invasive technique using nasal endoscopes to restore normal ventilation and drainage of paranasal sinuses.

Messerklinger

The researcher whose work on mucociliary clearance led to the development of FESS.

Stammberger and Kennedy

The individuals who popularized Functional Endoscopic Sinus Surgery.

Surgical Philosophy of FESS

To preserve normal mucosa, remove obstruction only, restore mucociliary function, and target the osteomeatal complex.

Osteomeatal Complex

The key area for drainage of the frontal, maxillary, and anterior ethmoid sinuses; obstruction here leads to chronic sinus disease.

Rigid Endoscopes

Instruments used in FESS available in $0^{\circ}, 30^{\circ}, 45^{\circ},$ and $70^{\circ}$ angles.

Through-cutting forceps

A specific type of instrument used during the FESS procedure.

Microdebrider

A powered instrument used for tissue removal during sinus surgery.

CT PNS

The gold standard imaging that defines anatomy, detects disease extent, and serves as a surgical roadmap.

Indications for FESS

Includes chronic rhinosinusitis refractory to medical therapy, nasal polyposis, recurrent acute sinusitis, fungal sinusitis, and mucocele.

Lignocaine with adrenaline

Local infiltration used to reduce bleeding and improve visualization during surgery.

Reverse Trendelenburg position

A patient position with the head elevated $15\text{--}30^{\circ}$ to reduce venous congestion.

Uncinectomy

The first major step in FESS involving the removal of the uncinate process to open access to the osteomeatal complex.

Middle Meatal Antrostomy

The enlargement of the natural maxillary ostium to improve drainage and ventilation.

Ethmoidectomy

The removal of diseased anterior and posterior ethmoid air cells.

Frontal Sinusotomy

The clearance of frontal recess obstruction to restore drainage to the frontal sinus.

Sphenoidotomy

The opening of the sphenoid sinus ostium, performed when sphenoid disease is present.

Endoscopic DCR

A technique that creates communication between the lacrimal sac and nasal cavity, avoiding an external scar.

Orbital Decompression

An advanced endoscopic technique used in thyroid eye disease to reduce orbital pressure.

Synechiae formation

A minor complication of FESS involving the formation of adhesions.

Major Complications

Includes orbital injury, diplopia, blindness (rare), CSF leak, and intracranial injury.

Post-operative Care

Involves nasal saline irrigation, endoscopic cleaning/debridement, antibiotics/steroids, and follow-up endoscopy.