Therapeutic:

• Chronic sinusitis.
• Antrochoanal and Ethmoidal polyposis.
• Cauterization of bleeders in epistaxis.
• Closure of CSF rhinorrhea leaks.
• Optic nerve de-compression.
• Rhinolith and foreign body removal.
• Intranasal Dacryocystorhinostomy (DCR).
• Removal of nasal masses such as Rhinosporidiosis, Angiofibroma, Inverted papilloma.
• Choanal atresia.
• Turbinoplasty.
• As an approach for Trans-Sphenoidal Pituitary tumors and Anterior skull base tumors.

Contraindications:

• Inexperience and lack of proper instrumentation.
• Disease inaccessible by endoscopic procedures, e.g. very lateral frontal sinus and disease encasing the Internal carotid system.
• Osteomyelitis.
• Threatened intracranial or intraorbital complications.

Aim of Functional Endoscopic Sinus Surgery (FESS):

• Remove the diseased mucosa to relieve obstruction.
• Restoration of nasal patency, without excessive exposure. Excessive nasal patency is reportedly associated with a syndrome of ‘empty nose’ characterized by dryness, crusting, subjective obstruction and sometimes pain.

• Improved delivery of medications and washes.
• Improved exposure to olfactory stimuli.
• Clearance of inflammatory foci (opacified cells and sinuses).
• Maintenance and restoration of natural mucociliary pathways.

Anesthesia:

• General anesthesia is preferred by most of the surgeons.
• Local anesthesia with intravenous sedation can be used in adults when surgery is limited and cooperative patients.

Position:

• Patient lies flat in supine position with head resting on a ring or head rest and raised it by 15 degree (reverse Trendelenberg position).

Techniques:

• Two surgical techniques are followed:
• Anterior to posterior (Stammberger’s technique)- In this technique surgery proceeds from uncinate process backward to sphenoid sinus. Advantage of this technique is to tailor the extent of surgery to the extent of disease.
• Posterior to anterior (Wigand’s technique)- Surgery starts at the sphenoid sinus and proceeds anteriorly along the base of skull and medial orbital wall. This is mostly done in extensive polyposis or in revisional sinus surgery.