Functional Endoscopic Sinus Surgery (FESS)


    Ενδοσκοπική Χειρουργική Ρινός - Παραρρινίων

    The paranasal sinuses are air-filled cavities located in the area of the face, around and behind the nose. These are maxillary sinuses which are located under the cheeks, the ethmoidswhich are located to the right and left of the nose between the eyes, the frontal sinuses,in the area of the forehead and the sphenoid sinuses which are located deeper. All these cavities communicate with the nose through small openings so as to facilitate the normal flow of air and mucus.

    When the paranasal sinuses do not function normally, inflammations are caused within them, commonly known as sinusitis or παραρρινοκολπίτιδεςIn general, such inflammation can be either acute or chronic.

    Η Acute sinusitis, in most cases, is treated with medication and the patient returns to normal after a few days.

    Στη In chronic sinusitis, however, things are different as the patient suffers from a series of symptoms which, despite any temporary remissions, persist over time και do not respond to medication.These symptoms include difficulty of breathing through the nose, a feeling of pain and pressure in the face, runny nose which in some cases also goes behind the nose causing an irritating cough, and partial or complete loss of smell. As a result of the above, there are often general symptoms such as fatigue, headaches and poor sleep quality. The nasal polyps that are present in many cases of chronic sinusitis can further aggravate the condition and worsen the patients' quality of life.

    The initial treatment of chronic sinusitis is usually medicinal with antibiotics, nasal washes, and sprays. However, in cases where the treatment does not work or the situation is deemed very serious from the outset, e.g., if there are large polyps,then the solution is provided by Functional Endoscopic Sinus Surgery (FESS)..

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    What diagnostic tests should be done before surgery?

    The diagnosis of chronic sinusitis is based on the patient's history as well as the endoscopy of the nose with a special video-endoscope in the doctor’s office. However, before proceeding with the surgery a Computed Tomography (CT) scan is necessary to και σε κάποιες περιπτώσεις και η Μαγνητική Τομογραφία accurately assess the extent of the problem and design our surgical plan accordingly.

    What is the procedure of the operation?

    H Functional Endoscopic Sinus Surgery is performed under general anesthesia. With the use of special endoscopes and without any external incision, the openings of the sinuses are dilated with special tools and the polyps and mucopurulent secretions inside them are removed. The extent of the operation, i.e., how many and which sinuses will be opened, depends on the severity of the problem. The average surgical time is 1 to 2 hours. In cases where greater precision is required in surgical manipulations, e.g., in cases of revision operations, , a special Navigator is used.Navigator)With this method, inflammation is treated in the most effective way and the normal circulation of air and mucus within the sinuses is restored.

    What happens after surgery?

    After surgery, the patient usually does not have any tamponade/gauzes that need to be removed.They can return to their home either on the same day or the day after the operation. There is no external scar, swelling or bruising.A slight difficulty in breathing through the nose is expected for the first few postoperative days due to the internal swelling of the nasal mucosa. A short antibiotic treatment can be given as a preventive measure, while frequent nasal washes are necessary for cleaning, healing and rapid restoration of the normal function of the nose. Nose blowing should be avoided for 1 week while vigorous physical activity is allowed 3-4 weeks after surgery. Afterwards, local treatment with nasal sprays and washes will contribute firmly to maintaining the result achieved with the surgery.

    Does the operation hurt?

    Functional Endoscopic Sinus-Paranasal Surgery is a painless operation. General anesthesia ensures the absence of pain during the procedure, while usually little or no painkillers are required afterwards.

    When can I go back to work?

    Usually, 3 to 5 days after the operation the patient can return to work as long as it does not require heavy physical activity. It is also recommended to avoid exercise and vigorous athletic activity for 15 to 20 days.

    With which other operations can Functional Endoscopic Sinus Surgery be combined?

    Sometimes, in addition to chronic sinusitis and the presence of nasal polyps, there may be deviation of the nasal septum and/or hypertrophy of the inferior nasal turbinates.In these cases, in addition to the removal of the polyps and the cleaning of the paranasal sinuses, an endoscopic septoplasty and/or and/or turbinoplasty is performed during the same operation..

    What other conditions can be treated with Functional Endoscopic Sinus–Paranasal Surgery?

    The use of endoscopes in combination with the special tools of endoscopic surgery offer exceptional possibilities nowadays. The reason is that, on the one hand, they provide us with images of the nose and sinuses with significant magnification and excellent resolution, and on the other hand, they allow us to operate on anatomical areas that were not accessible with classical methods. Thus, Endoscopic Surgery is an excellent option for treating a series of pathological conditions beyond chronic rhinosinusitis. Such are mainly tumors of the nose, either benign such as inverted papilloma,, το osteoma,, το cholesterol granuloma και το and juvenile angiofibroma, or malignant such as squamous cell carcinoma,, το adenocarcinoma,  και το and esthesioneuroblastoma (olfactory neuroblastoma).Finally, very good results are obtained by Endoscopic Dacryocystorhinostomy in cases of blockage of the lacrimal apparatus, and Endoscopic Transsphenoidal Access for the removal of pituitary tumors.

    Όταν η κυκλοφορία του αέρα εντός των παραρρίνιων κοιλοτήτων δε γίνεται φυσιολογικά, μπορεί να προκληθεί κάποια Sinusitis ή αλλιώς ρινοκολπίτιδα. Η συγκεκριμένη φλεγμονή μπορεί να είναι είτε οξεία είτε χρόνια.

    Τις περισσότερες φορές η οξεία ιγμορίτιδα αντιμετωπίζεται με φαρμακευτική αγωγή. Όταν όμως τα συμπτώματα δεν ανταποκρίνονται στην αντιβιοτική αγωγή και τα τοπικά σπρέυ και ρινοπλύσεις η κατάσταση αντιμετωπίζεται με την Ενδοσκοπική Χειρουργική των Παραρρινίων Κόλπων.


    Πριν την επέμβαση, ο ασθενής πρέπει να προβεί σε The ENT performs nasal endoscopy σε αξονική τομογραφία.

    Η Ενδοσκοπική Χειρουργική Ρινός- Παραρρινίων Κόλπων πραγματοποιείται υπό γενική αναισθησία. Κατά τη διάρκεια την επέμβασης, χρησιμοποιούνται ειδικά ενδοσκόπια, και χωρίς κάποια εξωτερική τομή, διανοίγονται τα στόμια των ιγμορείων και αφαιρούνται οι πολύποδες και οι βλεννοπυώδεις εκκρίσεις. Σε συγκεκριμένα μόνο περιστατικά χρησιμοποιείται και ειδικός πλοηγός (Navigator).

    Ο ασθενής επιστρέφει στο σπίτι του την ίδια ή την επόμενη ημέρα. Μετά την επέμβαση, συνήθως, δεν υπάρχουν γάζες που πρέπει να αφαιρεθούν, ούτε εξωτερικές ουλές ή πρήξιμο. Χορηγείται προληπτική αντιβιοτική αγωγή και δίνονται οδηγίες για ρινικές πλύσεις. Επίσης, για 2 εβδομάδες πρέπει να αποφεύγεται το φύσημα της μύτης και για 4-6 εβδομάδες η έντονη άσκηση.

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