Surgery Treatment

  • Home
  • Treatment
  • Surgery Treatment


Functional Endoscopic Sinus Surgery (FESS) permits the direct visualization and treatment of various parts of the nasal cavities and sinuses which are otherwise inaccessible surgically.


Dr Hirschmann (1903) is considered the father of endoscopy. Dr David Kennedy, MD, and Karl Storz, MD, of Johns Hopkins University developed instruments for use in endoscopic sinus surgery, and coined the term Functional Endoscopic Sinus Surgery. Prof. Stammberger from Austria is considered father of modern Functional Endoscopic Sinus Surgery.

  • Cases of sinusitis, anosmia, nasal obstruction.
  • Biopsy of nasal and nasopharyngeal tumors.
  • Evaluation of epistaxis of unknown origin.
  • Evaluation of cerebrospinal fluid rhinorrhea.
  • To evaluate the nasal cavity after surgery and surgical resections like radical maxillectomy, and other post-operative cases.

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

Minor complications Major complications
Septal or mucosal adhesions Blindness or loss of vision
Orbital emphysema CSF leak
Epiphora Meningitis
Bleeding Intracranial bleed
- Damage to the internal carotid artery
- Vasovagal collapse

Book Your Appointment