Functional endoscopic sinus surgery

The first recorded instance of endoscopy being used to visualize the nasal passage took place in Berlin in 1901. Alfred Hirschmann, a designer and maker of medical instruments, modified a cystoscope for use in the nasal cavity. In October 1903, Hirschmann published "Endoscopy of the nose and its accessory sinuses." In 1910, M. Reichart performed the first endoscopic sinus surgery using a 7 mm endoscope. In 1925, Maxwell Maltz created the term "sinuscopy," referring to the endoscopic method of visualizing the sinuses. Maltz also encouraged the use of endoscopes as a diagnostic tool for nasal and sinus abnormalities. In 1978, Messerklinger published the book titled "Endoscopy of the Nose" on his findings, and his proposed methods to utilize nasal endoscopy for diagnosis. Heinz Stammberger, a head and neck surgeon and chair of otolaryngology at the University of Graz where he worked with Messerklinger, was interested by the technique and its implications for pathophysiology and treatment of sinus disease. He adopted the technique, becoming identified with it, and traveled the world to advocate for it. After meeting David Kennedy, a physician at Johns Hopkins University, he worked with him and the surgical instrument maker Karl Storz to develop instruments for use in endoscopic sinus surgery, and coined the term Functional Endoscopic Sinus Surgery. == Medical applications ==

Functional endoscopic sinus surgery is most commonly used to treat chronic rhinosinusitis (CRS), only after all non-surgical treatment options such as antibiotics, topical nasal corticosteroids, and nasal lavage with saline solutions have been exhausted. CRS is an inflammatory condition in which the nose and at least one sinus become swollen and interfere with mucus drainage. CRS is a common condition in children and young adults. The purpose of FESS in treatment of CRS is to remove any anatomical obstructions that prevent proper mucosal drainage. A standard FESS includes removal of the uncinate process, and opening of the ethmoid air cells and Haller cells as well as the maxillary ostium, if necessary. If any nasal polyps obstructing ventilation or drainage are present, they are also removed. In the thyroid disorder known as Graves' ophthalmopathy, inflammation and fat accumulation in the orbitonasal region cause severe proptosis. In cases that have not responded to corticosteroid treatment, FESS can be used to decompress the orbital region by removing the ethmoid air cells and lamina papyracea. Bones of the orbital cavity or portions of the orbital floor may also be removed. == Outcomes and complications ==

Functional Endoscopic Sinus Surgery is considered a success if most of the symptoms, including nasal obstruction, sleep quality, olfaction and facial pain, are resolved after a 1–2 month postoperative healing period. Reviews of FESS as a method for treating chronic rhinosinusitis have shown that a majority of patients report increased quality of life after undergoing surgery. and the success rate in treating children with CRS has been reported as 86–97%. The medial rectus muscle may be damaged. Blindness is the single most serious complication of FESS, and results from damage to the optic nerve during surgery. Serious complications such as blindness occur in only 0.44% of cases, as determined by a study performed in the United Kingdom. Another Cochrane review looked at postoperative care of patients after FESS using debridement (removal of blood clots, crusts, and secretions from the nasal and sinus cavities under local anaesthetic), but the evidence from the available clinical trials was uncertain. The debridement procedure after FESS may make little or no difference to health‐related quality of life or disease severity. There may be a lower risk of adhesions but whether this has any impact on long‐term outcomes is unknown. Functional sinus surgery had been grossly overutilized as a way of treating headache based on an assumption of a sinus etiology of the different types of primary headache. Many patients, primary care providers, and even specialists confuse any frontal migraine for sinus disease. Multiple attempts at further definition of primary headache and or sinus headache has been suggested by the International Headache Society and the American Academy of Otolaryngology–Head and Neck Surgery. It has been suggested early on that such a confusion might be a cause of failure of functional endoscopic sinus surgery. == References ==