Complications Of Endoscopic Sinus Surgery Research Articles

Examination of ethmoidal roof regarding Keros and Yenigun classifications in a Turkish population: a computerized tomography study.

Understanding ethmoid roof morphology is crucial to prevent complications in endoscopic sinus surgery. This study aimed to evaluate the morphological properties of the ethmoidal roof regarding gender and age differences using Keros and Yenigun classifications on high-resolution computed tomography images. We retrospectively analyzed 891 high-resolution computed tomography paranasal sinus study images and measured the depth of the cribriform plate in coronal sections and the anterior-posterior length in axial planes. The study retrospectively examined CT images of paranasal sinuses of patients living in the eastern Anatolian region of Turkey. In both Keros and Yenigun Classifications, the most common class was type 2, and the least common class was type 3. According to Keros et al.'s method, no significant difference was observed between men and women (p = 0.698). However, according to Yenigun et al., the average values of women in terms of the anterior-posterior distance of the ethmoid roof were significantly higher than men (p = 0.001). When examined according to age, a very low, negative correlation was revealed regarding Keros and Yenigun classifications (p = 0.047 and p < 0.001 retrospectively). According to Keros and Yenigun's classification, there was no significant difference between the left and right sides (p = 0.488 and p = 0.919, respectively). The morphological properties of the ethmoidal roof have importance to be considered for preoperative planning. Studying larger patient groups and meta-analyses that gather various research results about this subject might help better understand the ethmoidal roof morphology among populations.

Recovery From Visual Loss After Endoscopic Endonasal Decompression of Iatrogenic Orbital Abscess.

Orbital complications are the second most common complications of endoscopic sinus surgery (ESS), and orbital hematoma is the most frequent orbital complication. An orbital abscess is usually associated with rhinosinusitis, and a few cases of orbital abscesses occurring after orbital trauma have been reported. However, orbital abscess occurring after ESS is rare. Herein, we present a case of a right orbital abscess that developed after bilateral ESS, performed at an outside facility, and decreased vision in the right eye to light perception only. The visual loss persisted for 3 days, after which the patient was referred to our hospital for urgent management. The cause of abscess formation might have been an infected stagnant orbital venous hematoma that occurred as a complication of ESS. A defect in the right lamina papyracea and emphysema were confirmed on computed tomography. Orbital symptoms started immediately after ESS, and vision deteriorated to light perception only and lasted for 3 days, which was considered a high-grade risk factor for irreversible blindness by the ophthalmology team. Urgent endoscopic endonasal orbital decompression was performed to drain the orbital abscess, and maximal medical treatment was initiated, which included intravenous corticosteroids, intravenous broad-spectrum antibiotics, topical intranasal corticosteroids, irrigation, and topical antibiotic eye drops. Close follow-up assessments were performed by the infectious diseases team, and the ophthalmology team performed frequent orbital assessments. The patient recovered from blindness, which was an unexpected outcome.

A Study of Skull Base According to Gera Classification in a Korean Population

Background and Objectives The leakage of cerebrospinal fluid due to damage to the ethmoid roof and cribriform plate (CP) is one of the most serious complications of endoscopic sinus surgery (ESS). For the risk of skull base injury during ESS, the Keros classification has been widely used, but recently the Gera classification has been introduced as a tool for risk assessment. This study evaluated the risk of skull base damage using the Gera classification in Koreans.Subjects and Method We analyzed 592 left and right sides of 296 paranasal sinus CTs, and measure the angle between the lateral lamella of CP and the lateral extension of the horizontal plane passing through CP, namely the Gera angle. The angles were classified into three categories: the type I (&gt;80°, low risk), type II (45° to 80°, medium risk), and type III (&lt;45°, high risk).Results The type III, which is vulnerable to skull base damage, accounted for 11.7% of the study subjects. The Gera angle in females (64.0°±12.3°) was greater than that in males (61.3°± 14.0°), showing a significant gender difference (p=0.015). Although there was no difference between the left and the right side of the Gera angle (p=0.155), there was a significant difference between the left and the right side in the Gera classification (p&lt;0.001). Age and the Gera angle showed a negative correlation (r=-0.116, p=0.005).Conclusion The type III of the Gera classification was observed in 11.7% of the total study group. For the type III, extra care is required during ESS.

Complications of endoscopic sinus surgery for chronic rhinosinusitis in a tertiary care teaching hospital in Saudi Arabia

To aimed to determine the incidence of complications of endoscopic sinus surgery (ESS) and to investigate the factors associated with the occurrence of complications.In this retrospective study, we reviewed the medical records of all patients who had undergone ESS at King Saud University Medical City (KSUMC) between January 2015 and March 2022. Patients who underwent ESS for complicated acute sinusitis, sinonasal malignancy, and cerebrospinal fluid leak repair, and those who underwent extended ESS for indications other than chronic rhinosinusitis were excluded. This study was approved by the KSUMC Institutional Review Board.We included 1395 patients, 3 of whom had major complications and 28 had minor complications, resulting in an overall major complication rate of 0.2% and a minor complication rate of 2%. The most common major complication was orbital hematoma, and the most common minor complication was synechia. Moreover, the duration of surgery and laterality increased the risk of complications, whereas the use of image guidance had no effect.The ESS is a safe procedure. The operative start time and laterality were associated with an increased risk of complications and warrant further investigation.

Association of accessory sphenoidal septum with protrusions of sphenoid sinus.

Accessory sphenoidal septum (ASS) is a septal variation that exists in addition to the primary septum of the sphenoid sinus and can be found in or near anatomically essential structures. This study aimed to investigate the relationships between protrusions of vital structures around the sphenoid sinus and the ASSs. This cross-sectional retrospective study is based on the analysis of CBCT scans of 314 patients in axial, coronal, and sagittal planes with 0.2-0.3 slice thicknesses. Optic nerve (ON), internal carotid artery (ICA), both ON and ICA, maxillary nerve (MN), vidian canal (VN) and ASSs were detected, and the relationship between protrusions of these vital anatomical structures and ASS was evaluated. Statistically significant relationship was observed between the right Type 1 ON protrusion (p < 0.05) and left Type 1 ON protrusion (p = 0.001); left Type 3 ON protrusion (p < 0.05); right Type 4 ON protrusion (p < 0.05) and ASS. Statistically significant relationship was also observed between the right ICA protrusion and ASS (p < 0.05). The right Type 1 VN protrusion (p = 0.001); left Type 2 VN protrusion (p < 0.001); right and left Type 3 VN protrusions (p < 0.001) were found to be significantly associated with the ASS. ASSs have significant associations with some protrusions, and they tend to cause potentially severe complications in endoscopic sinus surgery. This variability requires a comprehensive understanding of regional sphenoid sinus anatomy with detailed three-dimensional tomographic imaging.

Endoscopic sinus surgery for removal of maxillary sinus fungal ball: a case report

&lt;p&gt;The incidence of fungal rhinosinusitis (FRS) has been increasing over the past decade. FRS is categorized into invasive and non-invasive based on the histopathological evidence of tissue invasion by fungi. According to Hardik Shah, among FRS, 48% were non-invasive, and 52% were invasive. Fungal ball is the most frequent cause of non-invasive FRS, and the most commonly involved sinus is the maxillary sinus, and most cases are unilateral. Nowadays, Endoscopic sinus surgery (ESS) has become the gold standard in treatment of non-invasive FRS, due to its low morbidity and the easy access to the affected paranasal sinus. However, removal of maxillary sinus fungal ball (MSFB) may be long and difficult. Therefore, it is important to keep a sufficient field of view in order to remove the fungal debris completely. Good handling of endoscopic is needed, and furthermore, although the risk of complication of ESS for FRS is low, it is important to understand the potential complications.&lt;/p&gt;

Infraorbitary artery epistaxis

Epistaxis is a common complication of endoscopic sinus surgery. Bleeding occurs more frequently due to injury of the sphenopalatine artery branches. Pathologies of the maxillary sinus that produce bone resorption and descent from the orbital floor into the sinus, expose the orbital fat and the infraorbital artery (IOA) to an injury that can cause severe epistaxis which is difficult to treat. Two cases of epistaxis due to an injury of the infraorbital artery in the maxillary sinus are described in our study.

Complications of Endoscopic Sinus Surgery: A Case Series Study from Mosul City

Background: Patients undergoing endoscopic sinus surgery may develop complications because of the sinuses’ proximity to the orbit and skull base. Endoscopic sinus surgery is done for patients with chronic rhinosinusitis with polyps (CRSwNP), chronic rhinosinusitis without polyps (CRSsNP) not responding to the medical treatment, and antrochoanal polyps. Objectives: The present study aims to evaluate the complications of functional endoscopic sinus surgery (FESS) in Mosul city. Methods: A case series study of 70 patients of different age groups who underwent functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis with polyps (CRSwNP), chronic rhinosinusitis without polyps (CRSsNP), and antrochoanal polyps at Al-Jamhoory Teaching Hospital, Mosul, Iraq, for the period from October 2011 to August 2012. Results: The age of patients ranged from 11 to 65 years, with a mean of 33.1 years. Thirty-four patients (48.57%) were male, and 36 patients were female (51.43%). Minor complications were observed in 25.71% of our patients. No major complications occurred. Conclusion: Although functional endoscopic sinus surgery (FESS) is an effective and minimally invasive technique, intraoperative and postoperative complications can still arise. Fortunately, complications are mostly minor, but patients should be informed about these complications. We recommend further studies on complications of endoscopic sinus surgery with more patients and a longer follow-up period.

Ophthalmic complications of endoscopic sinus surgery

Endoscopic surgery of the accessory nasal sinuses (ANA) is widely used as the main treatment method for ANA diseases. It is a well-proven, safe and effective method. However, occasionally certain complications may occur. Ophthalmic complications are rare but can lead to irreversible changes. Anatomical organization of the orbit and paranasal sinuses contributes to the risk of damaging the eye ball and its appendages. During endoscopic sinus surgeries, lamina papyracea of the ethmoid bone, extraocular muscles, the optic nerve and the lacrimal passages can be damaged. Ophthalmic complications are classified as non-significant, significant and severe. Studying the data obtained with multi-slice computed and/or magnetic resonance tomography and the patient's medical history during the preoperative stage is necessary in order to minimize the risk of such complications, as well as monitoring the clinical data during all stages of treatment.

Odor Disorders and Rare Neurological Complications in Endoscopic Sinus Surgery. Clinical studies

Odor Disorders and Rare Neurological Complications in Endoscopic Sinus Surgery. Clinical studies

Comparison Of Outcome Between Simple Polypectomy Versus Endoscopic Sinus Surgery

Objective: Nasal polyps are smooth, soft tissue, pale or yellow shining bulges that can block nasal cavity, sinuses and brings persistent state of rhino sinusitis influencing quality of life. The objective of this study was to compare outcomes of simple intranasal polypectomy versus Endoscopic sinus surgery after removing nasal polyps.&#x0D; Methodology: This comparative cross-sectional study was conducted at Department of ENT in Civil Hospital, Hyderabad from April 2020 to June 2020. After ethical approval, 60 adult patients of either gender ranging from 14 to 40 years, with Sino nasal Polyposis were randomly selected. The collected data was analyzed using SPSS version 17. Categorical variables like all complications were presented as frequency and percentage.&#x0D; Result: Out of 60 patients, 37(61.6%) males and 23 (38.4%) female, and mean age 28.87 ± 7.69 years, the post-operative complications like bleeding was observed in 6.7%, crusting 10%, Synechiae formation 10% of patients after 6 weeks, recurrence in 13.3% after 3 months, while intraorbital complications i.e. orbital swelling in 13.3% patients following simple intranasal polypectomy. In contrast, bleeding 10%, crusting 16.7% with orbital swelling 3.3% was reported up to 2 weeks following surgery. Synechiae formation 16.7% up to 3 months was observed following Endoscopic sinus surgery.&#x0D; Conclusion: Post-operative complications of endoscopic sinus surgery have been quite lesser as compared to simple nasal polypectomy along with low recurrence rate. Fortunately, intra cranial complications were not observed, only intra orbital swelling was seen in both types of surgeries.

EXPERIENCE OF DOING ENDOSCOPIC SINUS SURGERY FOR CHRONIC MAXILLARY SINUSITIS WITHOUT PRE-OPERATIVE CT-SCAN IN A PERIPHERAL HOSPITAL

Objective: To determine frequency of our complications of endoscopic sinus surgery without pre-operative CT-Scan and to compare this frequency with other similar studies done with the help of pre-operative CT-Scans.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: ENT Department, Combined Military Hospital Skardu Pakistan, from Jun 2017 to Jun 2019.&#x0D; Methodology: Total 69 patients (116 Sides) were operated under general anesthesia by using 0 and 30 degree endoscopes to address the Maxillary sinusitis. Frequency of complications was compared to other studies by applying chi-square test for goodness of fit. The complications were also correlated to ages of patients by applying Spearman correlation analysis.&#x0D; Results: Mean age was 29.75 ± 10.9 years (range 15-75). Overall complications rate was 4.3% (5 out of 116 sides, 95% confidence interval 4.23-4.4). Peri-orbital ecchymosis and peri-orbital emphysema were most commonly occurring complications (4.3%). This complication rate was compared to few other studies, which proved that difference was not statistically significant. Correlation of occurrences of orbital complications with the age proved that there was no statistically significant correlation (Correlation coefficient r=-0.085, p-value 0.276).&#x0D; Conclusion: Isolated chronic maxillary sinusitis refractory to medical treatment can be treated by endoscopic sinus surgery without pre-operative CT-Scan.

Endoscopic intranasal control of hemorrhage from unexpected ethmoidal hemangioma during conchoplasty: A case report.

Introduction and importanceHemangiomas of paranasal sinuses are rare. Unexpected hemangiomas of this region can bleed profusely leading to operative morbidity and mortality. Hemangiomas of paranasal sinuses may be associated with concha bullosa.Case presentationWe report a case of 41-year-old female who presented with difficulty in nose breathing and headache since two years. She was diagnosed with concha bullosa with deviated nasal septum and was planned for endoscopic septoplasty and conchoplasty. During the procedure, profuse, unexpected hemorrhage resulted from the undiagnosed hemangioma which was managed by endoscopic intranasal cauterization of anterior ethmoidal artery.DiscussionHemangiomas of paranasal sinuses such as ethmoidal sinus are rare. These are slow growing tumors and may be radiologically silent. Due to high vascularity of these lesions, it may be very difficult to manage associated bleeding. A sound knowledge of vascular anatomy of this area is important in managing intraoperative complications. Until now, only a few cases of ethmoidal hemangiomas have been reported in association with concha bullosa. Screening for these lesions may be important in patients with concha bullosa.ConclusionSound knowledge of surgical anatomy forms the basis of managing intraoperative complications in endoscopic sinus surgery. Further research should be carried out to find out the association between concha bullosa and ethmoidal hemangioma and patients with concha bullosa should be screened with advanced imaging techniques for such vascular lesions where feasible.

Safety of Endoscopic Sinus Surgery in the Elderly-Are Octogenarian Patients at a Higher Risk?

Surgeons are often faced with concerns regarding the risks versus benefits of endoscopic sinus surgery (ESS) in elderly patients. To analyze the risk for complications of ESS in the elderly (age ≥70 years) compared to younger patients, with emphasis on octogenarians. Retrospective review of medical charts of adult patients who underwent ESS at a tertiary referral center during the years 2014 to 2018. We compared 128 elderly patients with 276 matched younger patients. In the elderly group mean age was 76 years (range, 70-91 years ). Thirty-one elderly patients were 80 years or older. Surgical complications in the elderly patients were 3.9%. Minor complications were 2.3% and major complications were 1.7%. The surgical complications rate was similar in the younger group (8%, P value: .127). Medical complications were observed in 2.3% comparing to 0.7% in younger patients. Interestingly, age, revision surgery, extent and duration of surgery, and modality of anesthesia were not identified as risk factors. Only ischemic heart disease (IHD) was identified as a risk factor for complications in a multivariate analysis in elderly patients. Comparison of elderly patients younger than 80 years with octogenarians revealed no difference in complication rate between these groups. Overall, ESS was found to be a safe procedure in elderly patients compared to younger patients. Octogenarian patients should not be denied upfront surgery. IHD is a risk factor for complications in elderly patients.

Olfactory Fossa Evaluation as a Maxillary Sinus Development Using Cone Beam Computed Tomography.

In our study, we aimed to evaluate the risk of skull base perforation during endoscopic sinus surgery in individuals with hypoplasic maxillary sinuses using Cone Beam Computed Tomography (CBCT). We included 52 patients with bilateral maxillary sinus hypoplasia and 52 patients with normal maxillary sinus in the study. Reviewing paranasal CBCT scans, we noted the olfactory fossa depths and lateral lamella lengths of all the groups and compared between the hypoplasia groups and the control group. Compared the maxillary hypoplasia sinus individuals with the control group, both the olfactory fossa depths and the lateral lamina length were different in the maxillary hypoplasic individuals. In individuals with hypoplasic maxillary sinus, the olfactory fossa depth and the lateral lamina length values are higher, which increases the risk of complications in endoscopic sinus surgery.

Delayed Tension Pneumocephalus Following Intraoperative Cerebrospinal Fluid Leakage Repair

Tension pneumocephalus is a rare complication of endoscopic sinus surgery (ESS) that may lead to rapid neurologic deterioration. Symptoms typically develop within the first postoperative week after enough air has entered the intracranial cavity to create pressure on the dura. Furthermore, there may be a rapid onset of symptoms after a positive pressure event. However, there may be a more insidious onset of symptoms in the absence of a positive pressure event. We report a rare case of delayed tension pneumocephalus following an intraoperative cerebrospinal fluid leak repair. We discuss here the mechanisms of this complication and the diagnosis and treatment strategies of tension pneumocephalus after an ESS.

A Case Report of Blepharotosis as a Complication of Endoscopic Sinus Surgery

Endoscopic sinus surgery (ESS) is a common procedure performed in patients with chronic sinusitis. Although most of them result in excellent outcomes, some complications due to injury of nearby structures, such as the orbit or brain, may have serious consequences. Ophthalmic complications, occurring in less than 1% of all ESS cases, include orbital hematoma, diplopia, injury to the nasolacrimal duct, and in severe cases, even blindness. Here, we present a rare case in which a 49-year old female developed unilateral blepharoptosis after undergoing revision ESS.

Gender as a Predictor of Complications in Endoscopic Sinus Surgery.

Understanding patient-specific risk factors for complications of functional endoscopic sinus surgery (ESS) is critical. Previous work has investigated such risk factors, but a population-based analysis has not been performed to date. This study analyzes the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patient-specific risk factors associated with complications following ESS. A retrospective cohort study of patients who underwent ESS was conducted using the NSQIP database from 2011 to 2017. Patients were identified using CPT-codes for ESS procedures. The primary outcome analyzed was any postoperative complication. Simultaneous procedures with ESS were controlled for with regression analysis. Post-operative complications and 30-day readmission were evaluated using multivariate logistic regression controlling for age, gender, race, comorbidities (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, congestive heart failure, renal failure, steroid use, and cancer history), smoking history, and intraoperative factors. A total of 1279 patients who underwent ESS were identified. The average age of patients was 46.1 (SD = 16.8). Most patients (58.2%) had no major comorbidities. 594 (46.4%) patients had a tonsillectomy, adenoidectomy, or uvulopharyngoplasty at the same time as ESS. 101 (7.9%) patients experienced a complication post-operatively. 46 (3.6%) patients experienced a readmission postoperatively. The most common complication was reoperation (N = 40, 3.1%). Regression analysis revealed that gender was the only demographic factor associated with risk of post-operative complications, with women having a significantly lower risk than men (OR = 0.61, 95% CI 0.37-0.99, P = .046). ESS is typically performed on a relatively young and healthy population. Women have a significantly lower risk of complications after controlling for comorbidities. Further analysis of gender-specific differences in surgical outcomes should be evaluated to understand this phenomenon.

Cholesterol Granuloma as a Late Complication of Endoscopic Sinus Surgery

Introduction: To date there are five reports referring to cholesterol granuloma of the sphenoid sinus. This is the first case where cholesterol granuloma is presented as a late complication after successful removal of a mucocele through functional endoscopic sinus surgery (FESS) and associated with convergence insufficiency. Case Report: A 67-year-old carpenter presented with binocular diplopia and frontal headache. A mucocele of the left sphenoid sinus was removed endoscopically leading to the resolution of his symptoms. Eight months later he presented with similar symptoms and findings. Following a revision FESS, cholesterol granuloma was diagnosed. Discussion: Haemorrhage within the sphenoid sinus, obstruction in the sinus ostium and fibrous tissue formation may explain the postoperative formation of cholesterol granuloma. Convergence insufficiency could be attributed to mechanical failure or denervation of eye muscles. Conclusion: Cholesterol granuloma should be included in the differential diagnosis, when recurrence of a sphenoid sinus mucocele is suspected.

A case of cavernous carotid aneurysm diagnosed when diplopia developed after endoscopic sinus surgery

Background: Visual complications of endoscopic sinus surgery usually occur during or immediately after the surgery. We report a case of cavernous carotid aneurysm which developed and gradually worsened after endoscopic sinus surgery was performed. Case presentation: A 63-year-old woman with chronic rhinosinusitis resistant to conservative treatment underwent endoscopic sinus surgery. Despite the surgery being successful and without complications, diplopia developed 2 weeks later. Intracranial ima- ging revealed a giant cavernous carotid aneurysm as a likely cause of the diplopia. The patient underwent endovascular stenting treatment, and the diplopia was consequently reduced. Conclusions: We experienced a rare case of cavernous carotid aneurysm which started to develop 2 weeks after endoscopic sinus surgery. Possible causes of the aneurysm in this patient are an indirect effect of surgery, such as perioperative hypertension, and bacterial sinusitis.