Functional Endoscopic Sphenoethmoidectomy

  • Tolgar Lütfi Kumral
  • Yavuz Uyar
  • Emmanuel P. Prokopakis


Functional endoscopic sinus surgery (FESS) basically refers to provide adequate drainage of the diseased sinuses for the treatment of the chronic rhinosinusitis and nasal polyps. The extent of surgery varies according to the extent of the disease. A popular hypothesis for the development of chronic rhinosinusitis is that environmental factors, such as allergens, viruses, or air pollutants, stimulate the epithelium to induce local inflammation of the sinus mucosa. FESS targets to reverse the pathophysiology of the disease. FESS for chronic rhinosinusitis was introduced in the 1980s and is now one of the most commonly performed otorhinolaryngological procedures. FESS was elaborated by Messerklinger together with his assistant Stammberger and Wigand in Europe and has become the standard surgical treatment for chronic rhinosinusitis. Messerklinger described that even minimal inflammation localized in the critical region can be the etiology of generalized paranasal sinus pathology. Mucosal inflammation results to deterioration of the mucociliary clearance and lead to the stasis of the secretions and bacterial proliferation. Chronic sinusitis is a persisting inflammatory condition of one or more sinuses lasting beyond 12 weeks. Medical therapy should always be prior to surgery and when medical therapy fails, FESS should be considered. In this chapter, functional endoscopic sphenoethmoidectomy is reviewed.


Functional endoscopic sphenoethmoidectomy Functional endoscopic sinus surgery Chronic rhinosinusitis Nasal polyps Treatment 


  1. 1.
    Nilssen EL, Wardrop P, El-Hakim H, White PS, Gardiner Q, Ogston S. A randomized control trial of post-operative care following endoscopic sinus surgery: debridement versus no debridement. J Laryngol Otol. 2002;116:108–11.CrossRefGoogle Scholar
  2. 2.
    Messerklinger W. Endoscopy technique of the middle nasal meatus. Arch Otorhinolaryngol. 1978;221(4):297–305.CrossRefGoogle Scholar
  3. 3.
    Wigand ME, Steiner W, Jaumann MP. Endonasal sinus surgery with endoscopical control: from radical operation to rehabilitation of the mucosa. Endoscopy. 1978;10(4):255–60.CrossRefGoogle Scholar
  4. 4.
    Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, Cohen N, Cervin A, Douglas R, Gevaert P, Georgalas C, Goossens H, Harvey R, Hellings P, Hopkins C, Jones N, Joos G, Kalogjera L, Kern B, Kowalski M, Price D, Riechelmann H, Schlosser R, Senior B, Thomas M, Toskala E, Voegels R, de Wang Y, Wormald PJ. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;23:3 p preceding table of contents, pp. 1–298.Google Scholar
  5. 5.
    Damm M, Quante G, Jungehuelsing M, Stennert E. Impact of functional endoscopic sinus surgery on symptoms and quality of life in chronic rhinosinusitis. Laryngoscope. 2002;112(2):310–5.CrossRefGoogle Scholar
  6. 6.
    Friedman M, et al. Functional endoscopic dilation of the sinuses: patient satisfaction, post-operative pain, and cost. Am J Rhinol. 2008;22(2):204–9.CrossRefGoogle Scholar
  7. 7.
    Kennedy DW. Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope. 1992;102(12 Pt 2 Suppl 57):1–18.PubMedGoogle Scholar
  8. 8.
    Senior BA, Kennedy DW, Tanabodee J, et al. Long-term results of functional endoscopic sinus surgery. Laryngoscope. 1998;108(2):151–7.CrossRefGoogle Scholar
  9. 9.
    Jain R, Stow N, Douglas R. Comparison of anatomical abnormalities in patients with limited and diffuse chronic rhinosinusitis. Int Forum Allergy Rhinol. 2013;3(6):493–6.CrossRefGoogle Scholar
  10. 10.
    Ramakrishnan VR, Orlandi RR, Citardi MJ, et al. The use of image-guided surgery in endoscopic sinus surgery: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2013;3:236–41.CrossRefGoogle Scholar
  11. 11.
    Khalil HS, Nunez DA. Functional endoscopic sinus surgery for chronic rhinosinusitis. Cochrane Database Syst Rev. 2006;3:CD004458. Review.Google Scholar
  12. 12.
    Ragab SM, Lund VJ, Scadding G. Evaluation of the medical and surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial. Laryngoscope. 2004;114(5):923–30.CrossRefGoogle Scholar
  13. 13.
    Kennedy DW. Technical innovations and the evolution of endoscopic sinus surgery. Ann Otol Rhinol Laryngol Suppl. 2006;196:3–12.CrossRefGoogle Scholar
  14. 14.
    Cohen-Kerem R, Brown S, Villasenor LV, et al. Epinephrine/lidocaine injection vs. saline during endoscopic sinus surgery. Laryngoscope. 2008;118(7):1275–81.CrossRefGoogle Scholar
  15. 15.
    Bolger WE, Keyes AS, Lanza DC. Use of the superior meatus and superior turbinate in the endoscopic approach to the sphenoid sinus. Otolaryngol Head Neck Surg. 1999;120:308–13.CrossRefGoogle Scholar
  16. 16.
    Siedek V, Pilzweger E, Betz C, Berghaus A, Leunig A. Complications in endonasal sinus surgery: a 5-year retrospective study of 2,596 patients. Eur Arch Otorhinolaryngol. 2013;270:141–8.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Tolgar Lütfi Kumral
    • 1
  • Yavuz Uyar
    • 1
  • Emmanuel P. Prokopakis
    • 2
  1. 1.Department of OtorhinolaryngologyUniversity of Health Sciences, Okmeydanı Training and Research HospitalİstanbulTurkey
  2. 2.Department of OtorhinolaryngologyUniversity of Crete School of MedicineHeraklionGreece

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