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Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive surgical technique used to restore normal drainage and ventilation of the paranasal sinuses.

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https://youtu.be/kWBNkFpl-xM

https://youtu.be/qKTRyowwaLA

https://youtu.be/cIBnAWFr5yY

Indications


Category Examples
Chronic rhinosinusitis (CRS) With or without nasal polyps; refractory to medical therapy
Recurrent acute sinusitis ≥4 episodes/year despite treatment
Sinonasal polyposis Obstructing vision, airway, or causing anosmia
Mucoceles Particularly in ethmoid or frontal sinuses
Fungal sinusitis Allergic fungal rhinosinusitis, mycetoma
Sinonasal tumors Benign: inverted papilloma; Malignant: biopsy or resection aid
Orbital decompression For Graves’ orbitopathy or orbital cellulitis drainage
CSF rhinorrhea Localization and repair of leak site

Principles of FESS


Anatomy Crucial to FESS (CT Landmarks)


Structure Relevance
Ostiomeatal complex (OMC) Common drainage pathway for frontal, maxillary, and anterior ethmoid sinuses
Uncinate process Removal opens access to maxillary sinus
Ethmoid bulla Largest ethmoidal air cell; posterior border of OMC
Lamina papyracea Thin medial orbital wall; risk of orbital injury
Cribriform plate (fovea ethmoidalis) Roof of ethmoid sinus; injury risk → CSF leak
Sphenoid sinus ostium Near vital structures: optic nerve, internal carotid artery
Agger nasi cells Anterior to middle turbinate; key to frontal recess ventilation

Radiology


https://youtu.be/nTzjAdQj4Ho

Preoperative imaging