This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.
Overview of Procedure
Functional endoscopic sinus surgery (FESS) is a minimally invasive approach to operating on the paranasal sinuses. Under general anaesthesia, a rigid endoscope is passed into the nasal cavity, with a variety of specifically designed instruments available to manipulate and remove tissue.
The most common indication for FESS is medically refractory chronic rhinosinusitis (CRS), with or without nasal polyps. The primary aim is to create space for the drainage pathways of the paranasal sinuses and reduce symptoms such as nasal obstruction, recurrent infection, pain, or nasal congestion.
Many patients with CRS may require multiple operations during their lifetime.
Complication
Intra-Operative
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Haemorrhage | Nasal mucosa is highly vascular and prone to bleeding | Prepare the nasal cavity with topical adrenaline or phenylephrine and use intra-operatively as needed, and use of dissolvable packing at the end of the procedure |
| Skull base injury | The cribriform plate at the superior aspect of the nasal cavity forms part of the anterior skull base; whilst rare, damage here can lead to CSF leak, pneumocephalus, or meningitis | |
| Visual Disturbance | The orbit is lateral to the thin lamina papyracea of the ethmoid bone, and any orbital breach or laceration to the anterior ethmoidal artery can results in diplopia, retrobulbar haematoma or blindness; visual complications occur in around 1:500 | Leave the eyes exposed intra-operatively so they can be examined at interval periods |
| Anaesthetic Risk | Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications | Forms a part of the anaesthetist assessment before the operation |
Early
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Bleeding | May occur when the nasal packing dissolves, but it usually resolves without intervention | Appropriate safety-netting should be provided to the patient |
| Pain | Pain usually present during the initial recovery stage and will resolve with time | Use of regular analgesia post-operatively |
| Cerebrospinal fluid leak | Injury to the cribriform plate may result in CSF leak, presenting as clear rhinorrhoea and occurs in around 1:1000 cases; rarely this can lead to meningitis or intracranial abscess | |
| Altered sense of smell and taste | A temporary complication due to oedema of the nasal mucosa postoperatively, usually resolves spontaneously |
Late
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Recurrence | Disease recurrence after complete treatment is not uncommon and further procedures are often required | Ensure all potential triggers of CRS, such as allergy, are addressed and all appropriate medical therapy, such as nasal douche and nasal steroids, are used regularly |