Functional endoscopic sinus surgery: Current perspectives

Functional endoscopic sinus surgery (FESS) is a minimally invasive technique in which sinus air cells and ostia are opened under direct visualisation. The goal of this procedure is to restore sinus ventilation and normal function. The procedure is mainly indicated for patients with chronic rhinosinusitis who have failed optimal medical treatment. Lesser indications include recurrent acute sinusitis, mucoceles and treatment of orbital complications of rhinosinusitis. The recent advances in optical systems, powered instruments and image guidance systems have led to the extension of the role of FESS to include other indications. These include endoscopic dacryocystorhinostomy, endoscopic orbital and optic nerve decompression, repair of cerebrospinal fluid rhinorrhoea, and excision of benign and some malignant sino-nasal tumours. A number of studies have reported on favourable short-and long-term outcomes of FESS based on quality of life outcome measures. FESS is a safe technique when performed by trained surgeons. The reported incidence of major complications in the literature is very low. It is difficult to draw generalised conclusions on the efficacy of FESS due to a lack of a universal staging system for rhinosinusitis, because FESS is practiced differently by different surgeons and comparison with a sham operation is not ethical. FESS is best considered as an adjunct to medical treatment in patients with inflammatory sinus disease. Further randomised controlled trials comparing the long-term efficacy of FESS to medical treatments is required.