FESS is not over once you leave the operating room. FESS has brought with its development three major advances in the treatment of sinus disease. The first advance is that it has allowed physicians to diagnose sinus disease more accurately. Second, the technique used in the operating room is less invasive and yields greater results. But I believe that the greatest advance that occurred with the development of the endoscope is in the ability to provide immediate postoperative care of the cavity and furthermore provide long-term care of chronic sinus disease. In fact, the postoperative care is almost as important to your overall health as the surgery. I like to think about postoperative care as the care rendered in the first 30-45 days after surgery.
I usually ask my patients to return to my office within the first 3 days after surgery for their first debridement. A debridement is a procedure by which the surgeon removes any crusts, infection, scabs, clots, scar, and residual diseased mucous membranes and/or bone fragments left in the surgical cavity. When my patients come to the office, I first spray their nose with a decongestant and a topical anesthetic. I then use an endoscope and various other instruments to clean out all of the sinuses. It is important to remove as much of the infection, crusting, scabbing and scar/diseased tissue as possible.
The debridement procedure is a little uncomfortable. I usually recommend taking a mild pain reliever or at least a Tylenol about a hour before the procedure is performed. When it is over, you will be able to breathe much better. This procedure is then repeated about once a week for the first month after surgery. The second month usually requires only two
debridement treatments, and another one is performed about a month later. For patients with bad chronic disease, long-term periodic debridement treatments with significant medical management may be required.
It takes about 3 months for the sinus membranes to heal to the point at which they are starting to work well and the membranes start to look normal. Debridement may or may not be performed by your physician and some physicians perform more while others perform less. This depends on the severity of your disease, your physician’s philosophy, and the type of chronic inflammation that makes you suffer. I believe that patients do best with optimal debridement. The better you control any new infections after sinus surgery by debridement (removal of infected bone and soft tissue and recurrent polyp and scar formation), the better the cavity will heal, the less scarring will occur, and the better you will feel.
On a microscopic level, healing takes much longer. With good care, you should see further progress and greater improvement in your symptoms over the course of the next full year. My patients are usually surprised when they see that the healing phase is not as fast as they thought. Most will continue to see more positive changes occurring over the next 2 years. Overall, it takes about 3 full years to experience the best this surgery has to offer. And it is important that you maintain good health by taking care of your sinuses. Very often, children will not be able to tolerate the debridement cleanings. If your child has had sinus surgery, occasionally your surgeon may recommend that he or she return to the operating room to remove scar tissue/recurrent polyps and debris under either local or general anesthesia.