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Functional endoscopic sinus surgery (FESS) is a surgical treatment of sinusitis and nasal polyps, including bacterial, fungal, recurrent acute, and chronic sinus problems. FESS uses nasal endoscopes to restore drainage of the paranasal sinuses and ventilation of the nasal cavity. == History == FESS came into existence through the pioneering work of Drs. Messerklinger and Stamberger of the ENT department (Graz, Austria). Other surgeons have made contributions (first published in USA by Kennedy in 1985). By the early 1990s endoscopic sinus surgery became one of the most popular surgeries. In their 1990 publication. Dr. Stamberger mentioned of operating 4500 patients, roughly 450 patients annually. The surgical procedures include the operation of diseased ethmoid compartments (usually ethmoidal bulla), widening of stenotic clefts (uncinate process) and freeing of prechambers (agar nasi cells) to the frontal and maxillary sinuses from disease. They claimed classical trilogy of sinus infection as nasal congestion (can be caused by allergies also), discharge (unless it is purulent it is not a clear sign of infection), and headache (the majority of patients complaints and differential diagnosis for migraines were unclear or not discussed). A Cochrane review in 2006, based on three randomized control trials (Fairley 1993, Hartog 1997, and Ragab 2004) concluded that there was no significant difference in cure rates comparing FESS to other treatment methods. A meta-analysis of these three studies was not used as the studies did not have a single disease staging system, a single FESS procedure or uniform outcome measures. Fairley 1993 found no significant difference between FESS and inferior meatal antrostomy in regards to symptom score (weighted mean difference (WMD) 1.37, p=0.6). Hartog 1997 found no statistically significant difference in cure rates at 1 year when comparing FESS to nasal irrigation alone (odds ratio 1.63, P = 0.35). Ragab 2004 found no significant difference in total symptoms score at one year between FESS and medical treatment aloneWMD 1.20, P = 0.86). Hartog 1997 found a relapse rate of 2.4% in FESS and sinus irrigation group and 5.6% relapse rate in sinus irrigation only group (RRR=0.571, NNT = 32). The other studies did not mention relapse rate. FESS is solely based on establishing the drainage pathways - other factors such as pathogen virulence, immune response and allergies are ignored. Modern rhinologists will look for irreversible mucosal damage for endoscopic surgery indication instead of solely relying on patients headache, congestion and drainage symptomatology . Although most of Dr. Messerklinger's indications for surgery are abandoned, his 2 decades of work proved that endoscopes are the ideal instruments for sinus surgery, and safe and precise sinus surgery can only be performed by endoscopes. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Functional endoscopic sinus surgery」の詳細全文を読む スポンサード リンク
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