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Endoscopic Nose Surgery (FESS) - Chronic sinusitis


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FESS (Functional Endoscopic Sinus Surgery) or Functional endoscopic sinus surgery is surgery that is done for the treatment of chronic rhinosinusitis with or without nasal polyps

Chronic sinusitis (sinusitis, sfinoeiditis, ithmoeiditis, frontal sinusitis) caused by inflammation of the lining of the sinuses and nose that lasts more than three (3) months.

Chronic sinusitis is multifactorial disease. That means that many different causes can cause inflammation of the mucosa of the paranasal sinuses.

Patients suffering from chronic sinusitis complain:

  • for headache around the eyes, under the nose and around it,
  • for nasal obstruction,
  • for rhinorrhea, ie for secretions from the nose. The retronasal secretions can cause coughing, particularly when patient is supine.
  • For hyposmia.

In endoscopic control can be seen in the nose of the patient, the presence of polyps and secretions.


Depending on the extent and severity of the harm of the mucosa of the nose and paranasal sinuses affected, three types of surgeries can be applied.

  1. The small operation, is applied where there has no large-scale inflammation in any paranasal sinus. In this type of surgery we remove any polyps from the nose.
  2. The medium operation is applied where individual sinuses have intense inflammation. In this type of surgery we remove any polyps in the nose and push the nozzles of individual suffering sinuses .
  3. The big operation is applied when almost all paranasal sinuses are suffering. In this type of surgery we remove polyps of the nose and push the nozzles of almost all of the paranasal sinuses. In big surgery it is necessary to use a special navigation system - Navigator
  4. The navigation system - Navigator System: It should be noted that the paranasal sinuses are very close anatomical with the eye and brain.
  5. Lately we can use during surgery, a navigation system, which shows us, with a slight deviation, how close we are to the brain or the eye in any surgery carried out within the paranasal sinuses.The use of the Navigator - which combined with endoscopic surgery - is not essential to any surgery, but certainly provides extra safety, while in many cases it is considered necessary.Basically we can say that in several cases that previously we would have had many doubts to go to surgery, today we move safely.



Duration of surgery

The duration of the small operation can be from 30' to 40'. The duration of the medium operation can be from 60' to 90'. The duration of the big operation can be from 120' to 240'.

Stay in the clinic

Discharged the following morning


The improvement of the patient's symptoms will occur progressively.

Within a period of one month, the patient's breathing will be improved significantly, secretions will decrease, as also headaches will improve.

Combination with other operations

Many times it could be performed septoplasty (nasal septum straightening) and cauterisation of the nasal conchas, while in order to face breathing problems while sleeping and snoring it can be combined adenoidectomy, tonsillectomy, or Uvulo-Palato-Pharyngoplasty (UPPP) or simple Uvuloplasty

Instructions after surgery

  • Immediate mobilization of the patient after surgery
  • Removal of slight internal packing of the nose (slight internal splint) the day after
  • Special care for the internal of the nose by washing (with natural serum) and placement of ointments, 3 times a day for about a month
  • No painkillers required
  • Antibiotics given as precaution only for 4 days
  • The success of the surgery and thereby relieve the patient's symptoms depends largely on the patient. With sinuses surgeries we create the conditions for releasing the patient from his heavy symptoms, when he faithfully implement the local treatment that is given.
  • The surgery esentially multiplies the effectiveness of topical treatment. If the patient does not comply and implement faithfully the indicated treatment, then after some time the symptoms will reappear.



  • Chronic sinusitis
  • Chronic sinusitis
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  • Chronic sinusitis
  • Chronic sinusitis
  • Chronic sinusitis
  • Chronic sinusitis



What are the Paranasal sinuses?

The Paranasal sinuses are little gulfs (spaces) concluding air in the face area. Each one has two (2) maxillary sinuses (antrums), two (2) frontal sinuses, two (2) sphenoidal sinuses and a number of sinuses called ethmoidal sinuses or cells

When could we safely say that someone suffers from Chronic Paranasal Sinusitis?

When someone is complaining having the following symptoms for more than 12 weeks, it is very likely that he is suffering from Chronic Paranasal Sinusitis

  • Nose blockage (severe and constant)
  • Rhinorrhea. Nasal excretions could run out from the nose or be detected in the patient’s pharynx.
  • Sense of pressure or pain in front of the eye area, as also as in front of paranasal sinuses
  • Bad smell.

In order to safely say that someone suffers from Chronic Paranasal Sinusitis he should be complaining for at least two (2) of the these symptoms. Furthermore one out of the two symptoms should be for sure either nose blocking or rhinorrhea.

Simultaneously, signs of Chronic Paranasal Sinusitis should be found during endoscopic examination of the nose or in CT scanning.

What could cause Chronic Paranasal Sinusitis?

Chronic Paranasal Sinusitis could be caused by a variety of factors, meaning that a lot of different reasons could be responsible for it. The most significant of them are the following:

  • Inflammation caused by bacteria, proving to be extremely tolerant to antibiotics given for a long time to the patients. Some bacteria have the capacity to work with each other in order to produce some kind of film around them blocking this way the defensive system of an organism trying to neutralize them (Bio-films)
  • Inflammation of the closest tissues expanding to paranasal sinuses (e.g sinusitis caused from teeth problems)
  • Fungus infection (very rare)
  • Over-sensitive reaction to substances found in bacteria or funguses, developed in the nose area and the area of paranasal sinuses. Those organisms are not really dangerous (not pathogenic) but by mistake, some people’s organism considers them quite threatening and disastrous. For this reason an inflammation is being developed for the neutralization of those substances and micro-organisms which provide those “dangerous’’ substances to the body.

What are we trying to succeed with the recommended treatment to a patient suffering from Chronic Paranasal Sinusitis?

The aim of the treatment is:

  • To eliminate inflammation if it is caused by bacteria.
  • To reduce or moderate the tension or the inflammation if it is provoked by a false reaction of one’s organism to substances found in the mucus of the paranasal sinuses, which are as previously mentioned harmless for human body.

Is the treatment of Chronic Paranasal Sinusitis conservative or surgical?

The treatment of Chronic Paranasal Sinusitis is at first place conservative, consisted in proper medication either locally on the area of the nose or taken from the mouth, or even in very rare occasions by intravenous treatment.

When is surgical operation suggested to a patient?

If a patient in a regular basis doesn’t respond to conservative treatment then the operation could help him to cure or better control his disease.

What do we try to succeed with the operation?

To broaden the opening of the Paranasal Sinuses so as:

  • The suffering sinuses could be better ventilated
  • The excretions produced in the sinuses, which is a nutritious fluid for the bacteria, are not being kept in them, but be easily removed by the nose.
  • To remove that pathologic tissue from the Paranasal Sinuses which we are persuaded that could not turn into a healthy tissue again, despite the treatment provided with the use of nasal sprays and nose washing or medication taken by mouth.
  • Local treatment by sprays and nose washing should reach the most remote sinus and cure or settle down the Chronic Paranasal Sinusitis in a much more effective way comparing the same treatment provided before the surgery.

Which way do we follow so we can reach the paranasal sinuses during the operation?

During the past decade, with the help of endoscopes and other advanced technological equipment, the intervention is succeeded through the nose (intranasaly).

Finally, is the Chronic Paranasal Sinusitis being cured permanently after the operation?

As mentioned before in some cases the Chronic Paranasal Sinusitis can be cured with the surgical operation. In most of the cases with the operation we try to create those anatomical conditions in the paranasal Sinuses, so the local treatment provided to the patient before the surgery, can have multiple positive effects when given after the operation.

Practically speaking, this means that the same treatment that could help a patient before, it will act more effectively after the operation, meaning nose blockage, rhinorrhea, the sense of pressure in between the eyes and in front of the sinuses will be significantly reduced.

I have been suffering from Chronic Paranasal Sinusitis, which cannot be effectively controlled by the medication prescripted, and as a result I have been in big trouble for a very long time. But I am afraid to have a surgery. What would you suggest me to do?

The paranasal sinuses have a very close anatomical relationship with the eye and the brain. For this reason, it is sometimes imperative to use while performing an endoscopic operation a navigating system (navigator), which shows, with the slightest possibility of a mistake, how close we get to the brain or the eye. For that reason, we can nowadays say that in cases where the previous years we would be very reluctant to move to an operation like that, today we can safely do it. The navigating system (navigator) is not required in all the cases.

If I suffer from Chronic Paranasal Sinusitis and finally get operated without following the doctor’s instructions, meaning I don’t apply the treatment proposed, what will happen to me?

If the doctor suggests local therapy by the use of sprays or nose washing or for a short period of time some oral medication, if you ignore him then after a period of time, the excretions of the nose will increase, nose blocking will come back (swelling of the inner nose, polyps) plus the sense of pressure on the face and on the eye area will appear again.