Sinus Surgery (FESS)

Sinus surgery (FESS) is a minimally invasive operation that widens the natural openings of the sinuses — the air-filled spaces behind your cheeks, forehead, and nose — so they can drain properly and allow air to flow through them freely.

During the procedure, a surgeon guides a thin, lighted tube called an endoscope through the nostrils. No cuts are made on the face. Using tiny instruments passed alongside the endoscope, the surgeon removes small amounts of bone, thickened tissue, or nasal polyps (grape-like growths inside the nose) that are blocking the sinus openings. Once the blockage is cleared, the sinuses can drain mucus on their own, reducing inflammation (swelling and irritation) and helping the lining of the sinuses return to health.

FESS is recommended when sinus problems have not improved after a full course of medical treatment — such as antibiotics, nasal sprays, or steroid (anti-inflammatory) medicines — and when imaging scans confirm that the sinus openings are physically blocked.

• Chronic sinusitis (long-term sinus infection or inflammation lasting more than twelve weeks despite treatment)
• Recurrent acute sinusitis (repeated short but severe sinus infections throughout the year)
• Nasal polyps (soft, non-cancerous growths that block airflow and drainage)
• A deviated septum (the wall between your nostrils sitting off-centre) when it contributes to sinus blockage
• Mucocele (a blocked mucus cyst that has grown inside a sinus)
• Fungal sinusitis (a sinus infection caused by fungus rather than bacteria)
• Repair of a cerebrospinal fluid (CSF) leak — a small hole between the skull and the nasal cavity — when the surgeon can access it through the nose
• Removal of certain benign (non-cancerous) tumours inside the nose or sinuses

FESS is generally not suitable in certain situations. Your doctor will weigh the risks carefully before recommending surgery in these cases:

• Very young children, where the sinuses have not yet fully developed
• Patients whose sinusitis is fully controlled with medication and who prefer to continue that approach
• Serious bleeding disorders that cannot be corrected before surgery
• Active, uncontrolled systemic (whole-body) illness that makes general anaesthesia unsafe

FESS is generally considered a safe procedure, but like all surgery it carries some recognised risks. Your surgical team will discuss these with you before you give consent.

• Bleeding during or after the operation — usually mild, but occasionally requiring treatment to stop it
• Infection of the surgical site or the sinuses themselves, sometimes requiring antibiotics
• Formation of scar tissue (adhesions) inside the nose, which can narrow the reopened passages over time
• Temporary or persistent crusting and dryness inside the nose
• Recurrence of nasal polyps or blocked sinuses, sometimes needing further treatment
• Damage to the eye socket or the structures around the eye, such as bruising or, very rarely, changes in vision
• Damage to the thin bone (the lamina papyracea) separating the sinuses from the eye socket, which in rare cases can allow air or fat to move between the two spaces
• Cerebrospinal fluid (CSF) leak — a small hole in the skull base that causes clear fluid to drip from the nose; rare but requires prompt repair
• Injury to the olfactory nerve (the nerve responsible for your sense of smell), causing a temporary or, rarely, permanent change in smell
• Reactions to anaesthesia, including nausea, sore throat, or, very rarely, more serious effects

Preparing well before FESS helps reduce the chance of complications and makes recovery smoother. Preparation usually takes place over the days or weeks before your surgery date and covers what you eat and drink, your medications, and your lifestyle habits.

Fasting and lifestyle: Your surgical team will give you specific instructions about when to stop eating and drinking before the operation — this is essential when general anaesthesia (being fully asleep) is used. Smoking narrows blood vessels and slows healing, so most teams ask patients to stop smoking for several weeks before and after surgery. Alcohol thins the blood and can interact with anaesthetic medicines, so it is usually stopped in the days before the procedure.

Medications: Tell your doctor about every medicine, supplement, or herbal remedy you take. Blood thinners (medicines that prevent clotting), certain anti-inflammatory painkillers, and some supplements such as fish oil or ginkgo can increase bleeding. Your doctor will usually advise pausing these for a period before surgery. Do not stop any prescribed medicine on your own without guidance.

Pre-operative tests: Before surgery, the team typically arranges several checks to make sure you are safe for anaesthesia and the procedure itself. Common tests include:

• CT scan (computed tomography) of the sinuses — this gives the surgeon a detailed map of your sinus anatomy before operating
• Blood tests to check your blood count, clotting ability, and general health
• A nasal endoscopy (a quick look inside the nose with a thin camera) to assess the extent of the blockage
• An ECG (electrocardiogram, a heart tracing) if you are older or have heart-related health issues
• A review of any allergies, especially to anaesthetic medicines or latex

What happens during the procedure: Steps can vary depending on how many sinuses are involved and whether additional work — such as straightening a deviated septum or removing polyps — is needed. The following is a general sequence used in most hospitals:

• 1. You are given anaesthesia — usually general anaesthesia so you are fully asleep, though local anaesthesia with sedation is sometimes used.
• 2. The surgeon inserts the endoscope through one nostril. No incisions are made on your face.
• 3. Using the endoscope's camera on a screen, the surgeon identifies the blocked sinus openings.
• 4. Tiny specialised instruments are used to remove obstructing tissue, small pieces of bone, polyps, or infected material.
• 5. The sinus openings are widened so that drainage can occur naturally.
• 6. If needed, a balloon sinuplasty (a small balloon is inflated to gently expand the opening) may be used instead of cutting tissue.
• 7. Soft packing or a dissolvable dressing may be placed inside the nose to control bleeding — not all surgeons use this.
• 8. You are moved to a recovery area where you are monitored as the anaesthesia wears off.

Recovery after FESS is different for every patient depending on how many sinuses were treated and whether extra work was done during the same operation. Most patients go home the same day or the day after surgery, but full healing of the sinus lining usually takes several weeks to a few months.

• Monitoring: After waking from anaesthesia you will be observed in a recovery area — usually for a few hours — until your breathing, blood pressure, and alertness are stable.
• Nasal care: The inside of the nose is tender and swollen after surgery. Saline (saltwater) rinses are almost always recommended to gently flush mucus, crusts, and old blood from the nose; your care team will show you how to do this correctly.
• Nasal packing: If packing was placed during surgery, it is usually removed in the clinic within a day or two. This can feel uncomfortable but is quick.
• Pain and swelling: Some facial pressure, tenderness, and mild bleeding or blood-tinged discharge in the first few days is normal. Your doctor will advise on suitable pain relief.
• Activity restrictions: Strenuous activity, heavy lifting, and nose-blowing are usually avoided for at least one to two weeks to reduce the risk of bleeding. Your doctor will advise when it is safe to return to exercise.
• Driving: You should not drive while you are still taking strong pain medicines or sedatives. Your team will tell you when driving is safe again.
• Work and daily life: Many patients with desk jobs return to light activity within about one to two weeks, but this varies. Physical jobs may require a longer break.
• Smoking and alcohol: Continuing to avoid both helps the sinus lining heal and reduces the risk of infection.
• Follow-up appointments: These are very important after FESS. The surgeon will examine the inside of the nose, remove crusts or scar tissue if needed, and check that the sinus openings are staying open. Missing follow-up visits can allow scar tissue to block the sinuses again.
• Ongoing medication: Nasal steroid sprays and saline rinses are usually continued for several months after surgery to keep inflammation under control and maintain good sinus function.
• When to seek urgent help: Seek medical attention promptly if you have heavy or non-stop bleeding, clear fluid dripping from the nose (which may indicate a CSF leak), sudden severe headache, high fever, vision changes, or swelling around the eyes.