Sinus Surgery In Children

WHAT IS FESS?

Functional endoscopic sinus surgery or FESS is done to treat severe sinus infections or compilations that arise from sinusitis. The ENT surgeon uses small instruments to go through the nose and open the sinuses. This procedure helps to restore normal drainage in the sinuses thereby minimizing future sinus infections. 

Figure 1. Diagrammatic representation of sinus anatomy in a child

WHAT ARE THE DANGERS ASSOCIATED WITH THE SURGERY? 

As the sinuses are located deep within the nasal cavity next to the eye and the brain, these major structures may be affected in less than 1% of the time. If this indeed happens, your child may require a second or subsequent operations to repair the injured structure. 

There is a very small risk of blindness or brain damage when this occurs. 

SURGERY

The operation will be done under general anesthesia and does not leave any visible scar. Your child may be admitted one night before the operation. 

After the surgery, there will be a surgical sponge inside your child’s nose for wound care. Your child will be instructed to breathe through his mouth for one to two days until the doctor removes the nasal pack. 

POST-SURGERY INFORMATION

Your child should rest at home for the first 24 hours after discharge. We will advise avoidance of school and group activities for another 2 weeks. This prevents the child from catching a viral infection. Catching a viral infection will increase the risk of post-surgery nose bleeding. We also advise against heavy exercises such as biking, running or swimming for 2 weeks. 

DIET

It is important to drink a lot of clear fluids for the first 3 days after surgery. Your child may return to a normal diet the day after the surgery. Avoid hot foods as this may cause nose bleeding. 

PAIN

Your child may have a stuffy nose or discomfort after the surgery. Paracetamol is usually sufficient to manage the pain. Please inform your doctor if the pain persists beyond a week or it is not relieved by paracetamol. 

BLEEDING

Your child may experience mild bleeding or mildly blood-stained mucus from the nose (mild spotting on tissue paper) for the first 3 days after surgery. Should the bleeding be persistent like a tap which cannot be turned off, please contact your doctor immediately. 

MEDICATIONS

An antibiotic will be prescribed to treat any residual sinus infection or prevent bacterial infection post-surgery. 

A saline nasal spray will be prescribed to promote healing of the internal nasal wounds. 

Your doctor may also prescribe an antihistamine medication to reduce mucus production. 

It is important to complete the medications as instructed.

WHEN SHOULD YOU GO TO THE EMERGENCY ROOM?

  • Heavy or persistent nose bleeding 
  • Heavy clear watery discharge from the nose
  • Pain not reduced with paracetamol
  • Eye or face swelling
  • Change in vision
  • Headache
  • Persistent fever over 38.5 degrees
  • Vomiting that lasts more than 6 hours after surgery
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