Functional Endoscopic Sinus Surgery P.G 661

Anatomy Frontal sinus Ethmoid sinus Maxillary sinus Sphenoid sinus Ostia

Pathophysiology Sinus Disorders Anatomical Defects Inflammatory conditions such as chronic sinusitis

Diagnostic History and Physical CT Scans

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

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

Anesthesia General Local

Positioning Supine with donut or foam headrest

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.

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.

Incision Natural Orifice

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

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

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

Counts Initial count Final count

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.

Specimen Care Tissue Pathology

Prognosis Discharge same day Return to normal activities in 1 week

Complications SSI Hemorrhage Death

Wound class Class II: Clean- Contaminated