What is functional endoscopic sinus surgery?

Functional endoscopic sinus surgery (FESS) is procedure that involves enlarging the natural connections between your child's sinuses and nose in a minimally invasive manner using small telescopes. In addtion to improving drainage of the sinuses, FESS can be helpful by removing inflamed or infected tissue, such as polyps from the sinuses, and it also allows for better penetration of nasal sprays and rinses since the sinuses will be more open after surgery.

While most cases of sinusitis can be completely managed with medicines, FESS sometimes plays a role in treating:

• Severe acute sinusitis
• Chronic sinusitis
• Recurrent bouts of sinusitis

About the surgery

Endoscopic sinus surgery is performed in the operating room with your child under general anesthesia. The procedure can take several hours and most older children are released home a few hours after surgery. Some younger children will need to be monitored longer and may spend a night in the hospital after surgery.

FESS is an endoscopic procedure performed by passing telescopes into the nose through the nostrils. There are typically no external incsions or visible scars. During the surgery, the natural drainage passageways of the sinues are widened to allow drainage of mucus or infection and to provide a route for topical treatments, such as nasal sprays and rinses to more thoroughly reach the sinuses. If polyps are present, they are removed at the time of the procedure. 
In some cases, FESS will be performed at the same time as another operation such as:

• Septoplasty, surgery to fix a deviated septum
• Tonsillectomy, surgery to remove the tonsils
• Adenoidectomy, surgery to remove the adenoids
• Tympanostomy tube insertion (surgical insertion of ear tubes)

What to expect after surgery

After the FESS, most children are fussy or sleepy for a few hours. Your child will be given intravenous fluids while in the hospital until discharge. Clear liquids for your child to drink are available in the Post Anesthesia Care Unit (PACU), also called the recovery room.

The head of your child's bed will be raised in the PACU to help with swelling, breathing and drainage. At home, you should have pillows or a recliner chair available to help your child stay comfortable with the head elevated above the level of the chest.

There may be packing in your child's nose to prevent bleeding. This packing is usually dissolvable, but your child may be able to feel it. To minimize confusion and discomfort, your child should be told before surgery that when he wakes up, he may feel like there is something in his nose. If packing is not used, swelling may cause this feeling.

If your child also had a septoplasty straightening of the bone and cartilage in the center of the nose) performed, splints may be placed inside the nose at the end of the operation. These will be removed at the physician's office one to two weeks post-operatively and may cause some discomfort while in place.

Discharge instructions

Pain

Pain is usually mild and well tolerated after FESS. Mild headaches and facial pain are common for several days after surgery.

You may give your child acetaminophen (Tylenol, Panadol, Tempra) or ibuprofen (Motrin, Advis) as directed on the product label.

Nasal saline rinses

It is very important that your child use saline sprays or preferably higher volume nasal saline rinses during healing. Saline is critical for clearing away dried mucus and blood after surgery; it is essential for healthy healing post surgery. Your surgeon will provide detailed instructions regarding rinsing prior to surgery.  

Nasal discharge

For 1-2 days after surgery, your child may have bloody discharge from the nose. To help soak up the drainage, you may use small rolls of gauze as a "mustache". The drainage will change from bright red to brownish streaked mucus. It will decrease over a two-week period, especially if saline rinses are being used as described. Post surgery, an antibiotic may be prescribed to treat infection, if noted at the time of surgery.

Nasal congestion

Most children will complain of a stuffy nose for 7-10 days after surgery. Use saline rinses or spray to help moisturize your child's nose and clear nasal crusting.
Discourage nose blowing. If your child must blow their nose, it is best to do so gently and to keep both sides open while blowing. Saline sprays and rinses are preferred over blowing while your child is recovering from sinus surgery. If your child needs to sneeze during recovery, it is best to do so with the mouth widely open. Doing this will minimize the pressure of the sneeze within the nose.

Activity level

Your child may return to school and other play activities when he feels ready and when prescribed pain medicine is no longer needed. Many children return to school within several days after the surgery.

Patients should avoid contact sports, heavy lifting, bending or straining for two weeks post surgery. It is also best to avoid swimming in an ocean or lake during this healing window.

When to call your child's physician

The following are some of the symptoms that may indicate a need for you to promptly contact your child's physician:

• Bright red bleeding from the nose or mouth
• Vomiting bright red blood or a coffee ground-like material
• Double or impaired vision
• Severe pain
• Persistent drainage of thin, clear fluid from the nose
• Vomiting (or if the vomiting becomes severe)
• Signs of dehydration (a child can become dehydrated when he or she has prolonged or severe vomiting and is not able to drink enough fluid)
• A temperature greater than 101.3° F or 38.5° C taken under the arm; greater than 102.2° F or 39° C by mouth or rectum.

Signs of dehydration

• Dry mouth
• Sunken look around eyes
• Decreased amount of urine (i.e., fewer wet diapers than usual in an infant)
• No tears when crying
• Skin that, when pinched, forms and holds the shape of a tent

Follow-up care

A visit with your child's physician is usually scheduled one to two weeks after surgery and then again several more times in the months after surgery to make sure that the nose is healing properly.

Consult your child's physician if you have any questions.

Review date: March 2021