FROM CHRONIC SINUSITIS TO SINONASAL TUMORS: THE EXPANDING ROLE OF FESS IN MODERN SURGERY
Abstract
Objective: The objective of this study was to explore the evolving role of Functional Endoscopic Sinus Surgery (FESS) - the gold standard in the treatment of chronic rhinosinusitis and other sinus diseases. Advances in diagnostic imaging, surgical instruments, and navigation systems have significantly improved the safety and efficacy of this technique. This study provides an overview of the FESS technique, and its expanding indications - application in the treatment of selected sinus tumors, such as inverted papilloma, juvenile nasopharyngeal angiofibroma (JNA), and osteomas.
Methods: A narrative review of the literature was conducted, focusing on the development of FESS, its surgical technique, safety profile, and clinical outcomes. Special attention was given to its comparison with traditional open approaches in both inflammatory and neoplastic conditions of the sinonasal tract.
Key Findings: The analysis revealed that technological progress - particularly in diagnostic imaging, surgical instruments, and intraoperative navigation - has significantly improved the precision and safety of FESS. Clinical evidence demonstrates that endoscopic resection of sinonasal tumors often achieves recurrence rates equal to or lower than those associated with open surgery, while minimizing morbidity, hospitalization time, and facial disfigurement. Successful outcomes depend on appropriate patient selection, meticulous preoperative planning, and the surgeon’s expertise.
Conclusions: Functional Endoscopic Sinus Surgery is a safe and effective modality for treating a wide range of sinonasal diseases, including chronic rhinosinusitis and selected benign tumors. With proper patient selection, preoperative planning, and surgical expertise, FESS offers substantial benefits over traditional open approaches, including reduced morbidity and improved recovery. Continued technological advancements and long-term outcome studies will further refine its role in comprehensive sinonasal care.
References
Altaf, J., Ashfaq, A. H., Riaz, N., Arshad, M., Ayub, N., Rehman, A., & Maqbool, S. (2025). Effect of hot saline irrigation on the operative field during endoscopic sinus surgery: A randomized controlled trial. European Archives of Oto-Rhino-Laryngology, 282(1), 235–240. https://doi.org/10.1007/s00405-024-09005-0
Banhiran, W., & Casiano, R. R. (2005). Endoscopic sinus surgery for benign and malignant nasal and sinus neoplasm: Current Opinion in Otolaryngology & Head and Neck Surgery, 13(1), 50–54. https://doi.org/10.1097/00020840-200502000-00012
Bera, S. P., & Rao, L. (1997). Nasal endoscopy in chronic/recurring sinusitis. Auris Nasus Larynx, 24(2), 171–177. https://doi.org/10.1016/S0385-8146(96)00027-2
Buyuklu, F., Akdogan, M.V., Ozer, C. and Cakmak, O. (2011). Growth Characteristics and Clinical Manifestations of the Paranasal Sinus Osteomas. Otolaryngology–Head and Neck Surgery - Wiley Online Library. https://doi.org/10.1177/0194599811403380
Castelnuovo, P., Dallan, I., Locatelli, D., Battaglia, P., Farneti, P., Tomazic, P. V., Seccia, V., Karligktios, A., Pasquini, E., & Stammberger, H. (2012). Endoscopic transnasal intraorbital surgery: Our experience with 16 cases. European Archives of Oto-Rhino-Laryngology, 269(8), 1929–1935. https://doi.org/10.1007/s00405-011-1917-z
Cheng, K.-J., Wang, S.-Q., & Lin, L. (2013). Giant osteomas of the ethmoid and frontal sinuses: Clinical characteristics and review of the literature. Oncology Letters, 5(5), 1724–1730. https://doi.org/10.3892/ol.2013.1239
Cokkeser, Y., Bayarogullari, H., & Kahraman, S. S. (2013). Our experience with the surgical management of paranasal sinus osteomas. European Archives of Oto-Rhino-Laryngology, 270(1), 123–128. https://doi.org/10.1007/s00405-012-1981-z
Eller, R., & Sillers, M. (2006). Common Fibro-osseous Lesions of the Paranasal Sinuses. Otolaryngologic Clinics of North America, 39(3), 585–600. https://doi.org/10.1016/j.otc.2006.01.013
Eloy, P., Andrews, P., & Poirrier, A.-L. (2017). Postoperative care in endoscopic sinus surgery: A critical review. Current Opinion in Otolaryngology & Head & Neck Surgery, 25(1), 35–42. https://doi.org/10.1097/MOO.0000000000000332
Fanos, L. (2024). Functional Endoscopic Sinus Surgery (FESS): Techniques and Outcomes. Otolaryngology Online Journal, 14(2). https://doi.org/10.35841/2250-0359.14.2.372
Fyrmpas, G., Konstantinidis, I., & Constantinidis, J. (2012). Endoscopic treatment of juvenile nasopharyngeal angiofibromas: Our experience and review of the literature. European Archives of Oto-Rhino-Laryngology, 269(2), 523–529. https://doi.org/10.1007/s00405-011-1708-6
Govindaraj, S., Adappa, N. D., & Kennedy, D. W. (2010). Endoscopic sinus surgery: Evolution and technical innovations. The Journal of Laryngology & Otology, 124(3), 242–250. https://doi.org/10.1017/S0022215109991368
Homsi, M. T., & Gaffey, M. M. (2025). Sinus Endoscopic Surgery. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK563202/
Hosemann, W., & Draf, C. (2013). Danger points, complications and medico-legal aspects in endoscopic sinus surgery. GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery, 12, Doc06. https://doi.org/10.3205/cto000098
Jankowski, R., Auque, J., Simon, C., Marchal, J. C., Hepner, H., & Wayoff, M. (1992). How i do it: Head and neck and plastic surgery: Endoscopic pituitary tumor surgery. The Laryngoscope, 102(2), 198–202. https://doi.org/10.1288/00005537-199202000-00016
Jho, H.-D., & Carrau, R. L. (1996). Endoscopy assisted transsphenoidal surgery for pituitary adenoma: Technical note. Acta Neurochirurgica, 138(12), 1416–1425. https://doi.org/10.1007/BF01411120
Jiang, S., Fan, R., Zhang, H., Jiang, W., & Xie, Z. (2022). Outcomes of endoscopic and open resection of sinonasal malignancies: A systematic review and meta-analysis. Brazilian Journal of Otorhinolaryngology, 88, S19–S31. https://doi.org/10.1016/j.bjorl.2021.06.004
Kar, M., Bayar Muluk, N., Alqunaee, M., Manole, F., & Cingi, C. (2024). Functional Endoscopic Sinus Surgery: Key Points for Safer Surgery. Ear, Nose & Throat Journal, 103(3_suppl), 5S-14S. https://doi.org/10.1177/01455613241287280
Karpishchenko, S. A., & Bolozneva, E. V. (2015). Case report: Endoscopic endonasal removal of large osteoma in the ethmoid sinus. B-ENT, 11(4), 319–323.
Kennedy, D. W. (1985). Functional endoscopic sinus surgery. Technique. Archives of Otolaryngology (Chicago, Ill.: 1960), 111(10), 643–649. https://doi.org/10.1001/archotol.1985.00800120037003
Kennedy, D. W. (2006). Technical innovations and the evolution of endoscopic sinus surgery. The Annals of Otology, Rhinology & Laryngology. Supplement, 196, 3–12. https://doi.org/10.1177/00034894061150s902
Khademi, S., Kazemi, A., Divanbeigi, R., & Afzalzadeh, M. (2022). A review of the revisions and complications management procedure in sinus surgery. Journal of Family Medicine and Primary Care, 11(3), 887–895. https://doi.org/10.4103/jfmpc.jfmpc_897_21
Kopeć, T., Borucki, Ł., & Szyfter, W. (2014). Fully endoscopic resection of juvenile nasopharyngeal angiofibroma – Own experience and clinical outcomes. International Journal of Pediatric Otorhinolaryngology, 78(7), 1015–1018. https://doi.org/10.1016/j.ijporl.2014.03.027
Korkmaz, H., & Korkmaz, M. (2022). Endoscopic Sinus Surgery- Surgical Steps with Implications in Intraoperative Complications. Middle Black Sea Journal of Health Science, 8(2), 320–331. https://doi.org/10.19127/mbsjohs.1071048
Lawson, W., Kaufman, M. R., & Biller, H. F. (2003). Treatment Outcomes in the Management of Inverted Papilloma: An Analysis of 160 Cases. The Laryngoscope, 113(9), 1548–1556. https://doi.org/10.1097/00005537-200309000-00026
Ledderose, G. J., Betz, C. S., Stelter, K., & Leunig, A. (2011). Surgical management of osteomas of the frontal recess and sinus: Extending the limits of the endoscopic approach. European Archives of Oto-Rhino-Laryngology, 268(4), 525–532. https://doi.org/10.1007/s00405-010-1384-y
López, F., Shah, J. P., Beitler, J. J., Snyderman, C. H., Lund, V., Piazza, C., Mäkitie, A. A., Guntinas-Lichius, O., Rodrigo, J. P., Kowalski, L. P., Quer, M., Shaha, A., Homma, A., Sanabria, A., Ferrarotto, R., Lee, A. W. M., Lee, V. H. F., Rinaldo, A., & Ferlito, A. (2022). The Selective Role of Open and Endoscopic Approaches for Sinonasal Malignant Tumours. Advances in Therapy, 39(6), 2379–2397. https://doi.org/10.1007/s12325-022-02080-x
López, F., Triantafyllou, A., Snyderman, C. H., Hunt, J. L., Suárez, C., Lund, V. J., Strojan, P., Saba, N. F., Nixon, I. J., Devaney, K. O., Alobid, I., Bernal–Sprekelsen, M., Hanna, E. Y., Rinaldo, A., & Ferlito, A. (2017). Nasal juvenile angiofibroma: Current perspectives with emphasis on management. Head & Neck, 39(5), 1033–1045. https://doi.org/10.1002/hed.24696
McMains, K. C. (2008). Safety in endoscopic sinus surgery. Current Opinion in Otolaryngology & Head & Neck Surgery, 16(3), 247–251. https://doi.org/10.1097/MOO.0b013e3282fdccad
Moshaver, A., Lin, D., Pinto, R., & Witterick, I. J. (2009). The Hemostatic and Hemodynamic Effects of Epinephrine During Endoscopic Sinus Surgery: A Randomized Clinical Trial. Archives of Otolaryngology–Head & Neck Surgery, 135(10), 1005–1009. https://doi.org/10.1001/archoto.2009.144
Nicolai, P., Battaglia, P., Bignami, M., Villaret, A. B., Delù, G., Khrais, T., Lombardi, D., & Castelnuovo, P. (2008). Endoscopic Surgery for Malignant Tumors of the Sinonasal Tract and Adjacent Skull Base: A 10-year Experience. American Journal of Rhinology, 22(3), 308–316. https://doi.org/10.2500/ajr.2008.22.3170
Nicolai, P., Berlucchi, M., Tomenzoli, D., Cappiello, J., Trimarchi, M., Maroldi, R., Battaglia, G., & Antonelli, A. R. (2003). Endoscopic Surgery for Juvenile Angiofibroma: When and How. The Laryngoscope, 113(5), 775–782. https://doi.org/10.1097/00005537-200305000-00003
Nivean, P. D., Nivean, M., Duraisamy, R., & Mohammed Sayee, T. S. (2022). Ossifying fibroma and its differential diagnosis. Indian Journal of Ophthalmology - Case Reports, 2(3), 775. https://doi.org/10.4103/ijo.IJO_462_22
Önerci, T. M., Yücel, Ö. T., & Öğretmenoğlu, O. (2003). Endoscopic surgery in treatment of juvenile nasopharyngeal angiofibroma. International Journal of Pediatric Otorhinolaryngology, 67(11), 1219–1225. https://doi.org/10.1016/j.ijporl.2003.07.013
Pasquini, E., Sciarretta, V., Farneti, G., Modugno, G. C., & Ceroni, A. R. (2004). Inverted papilloma: Report of 89 cases. American Journal of Otolaryngology, 25(3), 178–185. https://doi.org/10.1016/j.amjoto.2004.01.004
Patrick M. Spielmann, Richard Adamson, Kenneth Cheng, Robert J. Sanderson. (2008). Juvenile Nasopharyngeal Angiofibroma: Spontaneous Resolution. Ear, Nose & Throat Journal, 87(9):521-523. https://doi.org/10.1177/014556130808700911
Rampinelli, V., Ferrari, M., Dohin, I., Vinciguerra, A., Mattavelli, D., Saccardo, T., Testa, G., Conti, C., Frigerio, C., Verillaud, B., Ajasllari, G., Gaudioso, P., Cazzador, D., Aga, A., Taboni, S., Arioso, A. D., Neri, L., Borsetto, D., Wolf, A., … Herman, P. (2025). Advanced paranasal sinuses osteomas: A retrospective multicentric analysis on surgical management outcomes and intra- and postsurgical complications. Rhinology Journal, 0(0), 0–0. https://doi.org/10.4193/Rhin24.165
Roger, G., Tran Ba Huy, P., Froehlich, P., Van Den Abbeele, T., Klossek, J.-M., Serrano, E., Garabedian, E.-N., & Herman, P. (2002). Exclusively Endoscopic Removal of Juvenile Nasopharyngeal Angiofibroma: Trends and Limits. Archives of Otolaryngology–Head & Neck Surgery, 128(8), 928–935. https://doi.org/10.1001/archotol.128.8.928
Schick, B., & Steigerwald, C. (2001). The role of endonasal surgery in the management of frontoethmoidal osteomas. Rhinology, 39, 66-70.
Stammberger, H. (n.d.). Anatomy of the paranasal sinuses.
Tajudeen, B. A., & Kennedy, D. W. (2017). Thirty years of endoscopic sinus surgery: What have we learned? World Journal of Otorhinolaryngology - Head and Neck Surgery, 3(2), 115–121. https://doi.org/10.1016/j.wjorl.2016.12.001
Turri-Zanoni, M., Dallan, I., Terranova, P., Battaglia, P., Karligkiotis, A., Bignami, M., & Castelnuovo, P. (2012). Frontoethmoidal and Intraorbital Osteomas: Exploring the Limits of the Endoscopic Approach. Archives of Otolaryngology–Head & Neck Surgery, 138(5), 498–504. https://doi.org/10.1001/archoto.2012.644
Upadhya, I. B., & Rao, K. (2022). Sinonasal Inverted Papilloma: A Narrative Review. Indian Journal of Otolaryngology and Head & Neck Surgery, 74(Suppl 2), 1017–1022. https://doi.org/10.1007/s12070-020-02089-0
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