The sinuses are air-filled spaces in the bones of the face, connected to the nose by small openings. When those openings block, mucus is trapped, the lining swells and infection follows. Chronic sinusitis is sinusitis that lasts more than twelve weeks despite treatment: facial pressure, congestion, discharge down the throat, a lost sense of smell and a general feeling of never being quite well.
Functional endoscopic sinus surgery, known as FESS, restores the drainage. It is called functional because the aim is to reopen the natural pathways of the sinuses and leave the sinuses intact, so they can look after themselves again. It is called endoscopic because the whole operation is done through the nostrils with a thin telescope, watched on a screen, with nothing cut on the outside of the face.
When surgery is considered
Most sinusitis is treated with medication first: saline rinses, steroid sprays, courses of antibiotics or oral steroids. Dr. Teker recommends surgery when these have been given a fair trial and symptoms persist, when a CT scan shows fixed blockage or polyps, or when infections keep returning. Nasal polyps, soft growths of inflamed lining, are the most common reason; they block the nose and the sinuses and often take the sense of smell with them.
What happens in the operation
Guided by the CT scan, Dr. Teker widens the openings of the affected sinuses in turn: the maxillary sinuses in the cheeks, the ethmoid cells between the eyes, the frontal sinuses in the forehead and the sphenoid at the back. Polyps and diseased lining are removed with a microdebrider designed to spare healthy tissue. A deviated septum or enlarged turbinates are corrected at the same time if they contribute to the blockage. The operation takes one to two hours and most patients go home the same day.
After surgery
The first week is about keeping the nose clean: saline rinses several times a day, and a visit around day five to seven to remove crusts. Congestion usually clears over two to three weeks. A sense of smell lost to polyps or blockage often improves once the sinus disease is treated, though not in every patient and not always for good. Because the sinuses are now open, steroid sprays and rinses reach where they could not before, which is why rinses and sprays continue after surgery.
Sinuses and septum together
Sinus, septum and nose are one system, and Dr. Teker treats them as one. Patients who come for rhinoplasty and turn out to have sinus disease, or who come for sinusitis and have a deviated septum, are treated for both in a single operation whenever that is sensible.