Head and Neck Imaging

Functional endoscopic sinus surgery

(FESS), nowadays the standard surgical treatment for sinusitis. FESS aims at restoring normal functioning of the sinuses, i.e. normalization of the ventilation and drainage by mucociliary transport, and restoring normal defence mechanisms against exogenous particles such as dust, viruses, bacteria and toxins. It aims at minimal trauma with maximal result. During FESS, the diseased mucosa is removed, as well as the bony lamellas bordering the different spaces and cells within the ethmoid. Enlargement of the maxillary sinus ostium is performed at its natural location in the middle nasal meatus, yielding not only restored ventilation but also active drainage of secretions.

Due to the proximity of several delicate structures, FESS is associated with some major complications (including orbital and intracranial injuries) if performed by unexperienced surgeons. Preoperative knowledge of the presence of anatomical variants is important (see also Keros classification, bony dehiscence, optic canal bony dehiscence).

With increasing experience and the development of specific instruments, the uses of FESS have expanded to other indications, such as orbital decompression, dacryocystorhinostomy, closure of cerebrospinal fluid leaks and benign nasosinusal tumours. Currently its use in the treatment of malignant tumours is controversial.

RH