1. Functional Endoscopic Sinus Surgery
P.G 661

2. Anatomy Frontal sinus Ethmoid sinus Maxillary sinus Sphenoid sinus
Ostia

3. Pathophysiology Sinus Disorders Anatomical Defects
Inflammatory conditions such as chronic sinusitis

4. Diagnostic
History and Physical
CT Scans

5. Surgical Intervention
The surgical intervention for FESS is to reestablish normal breathing and ability of mucus to be cleared from the sinuses. Due to inflammation, the mucus cannot be cleared from the sinus resulting in the formation of a mucocele and or a sinus infection

6. Special considerations
Although you are going in an orifice of the body you should still keep instruments as sterile as possible
Know how to change out lenses on the endoscope
Chance of orbital hematoma being treated if it one is located

7. Anesthesia
General
Local

8. Positioning
Supine with donut or foam headrest

9. Skin Prep Removal of facial hair is usually not necessary.
The prep goes from the upper lip and is extended to the hairlines beyond the chin.

10. Draping Turban-Style wrap to retain hair.
Three wound towels placed in a triangle, then a bar sheet placed across the forehead.
Split sheep or u drape encircling the face and covering the body.

11. Incision
Natural Orifice

12. Supplies, Equipment, and Instruments
Basic nasal set
Endoscopic instruments
Endoscopic video Equipment
Camera
Sinuscope light cord
Anti Fog lenses
Suction-irrigation system
Navigational system

13. Procedural Steps
The surgeon applies the topical anesthetic and injects the local anesthetic
The endoscope is introduced into the nose
The ostia of the sinus to be worked on is visualized and enlarged to facilitate drainage.
The diseased tissue is visualized and excised
Biopsy may be performed and polyps, if present, are excised.
An Ethmoidectomy may be performed to create on large sinus cavity to promote drainage

14. Procedural Steps
8he surgeon may perform a sphenoidectomy if diseased bone was identified on the CT scan
Endoscope is removed; antibiotic ointment is placed
Mustache Dressing is applied

15. Counts
Initial count
Final count

16. Dressing Material
Nose is packed with gauze. (may be dry of impregnated with vaseline)
A mustache dressing is also given to the patient and is taped on.

17. Specimen Care
Tissue Pathology

18. Prognosis
Discharge same day
Return to normal activities in 1 week

19. Complications
SSI
Hemorrhage
Death

20. Wound class
Class II: Clean- Contaminated