Complications Of Endoscopic Sinus Surgery Research Articles

Complications of ESS and Safe Surgery

Endoscopic Sinus Surgery (ESS) is generally accepted as a safe surgery, however, surgeons who have poor understanding of surgical anatomy and variation of paranasal sinus cause troubles such as injury lamina papyracea, blood vessel and ethmoid roof (CSF leak) during surgery. Orbital tissue injury is the most frequent among the problems of sinus surgery. When only orbital fat tissue is pulled out, the patient will have just edema and subcutaneous hemorrhage around the eye. However, if the orbital muscle, especially medial rectal muscle, is injured, disturbance of eye movement occurs. Severe bleeding during surgery generally causes these problems, because surgical field is not identified under endoscope. Therefore, the important things which prevent injury and perform safe surgery are as f of lows : 1. Full knowledge of surgical anatomy 2. Manipulation of forceps under clear observation 3. Control bleeding, pain and blood pressure by sufficient anesthesia 4. Selection of appropriate forceps and correct manipulation of forceps 5. Adequate and quick treatment for injuries.

부비동 내시경 수술 233례의 임상 고찰

Recently, endoscopic procedure is generalized in paranasal sinus surgery. We analysed the results of 233 endoscopic sinus surgery from August, 1992 through February, 1994 retrospectively. Nasal obstruction, rhinorrhea, posterior nasal drip, headache are common preoperative symptoms. About allergy, there was no significant difference between patients with nasal polyp and patients without polyp. The mean durations of symptoms were 17 days about headache, 24 days about rhinorrhea, 25 days about posterior nasal drip, 28 days about nasal obstruction. In children(< 15 years old), the means of postoperative symptomatic duration were significantly longer than those of adults(>15 years old)(p<0.05). Complications of endoscopic sinus surgery included postoperative pain, synechia, antrostomy closure, postoperative hyperthermia, in order. One hundred sixty nine patients(86.2% showed improved sinus state after operation, 27(13.8%) showed stationary or worsened state, and 37 were lost during postoperative period.

Scarring in Endoscopic Ethmoidectomy

The formation of postoperative adhesions is perhaps the most frequent complication of endoscopic sinus surgery: These incidents may vary from trivial, small strands of scar to serious obstructive situations that mandate further surgery. This study is a retrospective analysis of 970 endoscopic ethmoidectomies performed in 535 patients over a 5-year period and followed by a single surgeon. Postoperative follow-up ranged from 6 to 70 months. The overall incidence of postoperative adhesions of all types was 10.5% and involving 102 cases. Of these, 40 cases (4.1%) of the total required subsequent revision surgery due to obstructive scarring. Further analysis is presented, showing the effects of various surgical techniques on the development of adhesions. The incidence of postsurgical lateral adhesion of the middle turbinate was reduced in this series in procedures that incorporated partial middle turbinate resection.

Complications of endoscopic sinus surgery: Analysis of 2108 patients—incidence and prevention

The incidence of complications of endoscopic sinus surgery (ESS) in a combined experience with 2108 total patients is compared to complications in 11 other series of patients (2583 total) who underwent ESS and 6 series of patients (2110 total) who underwent traditional endonasal sinus surgery. The incidence of major perioperative complications was 0.85%, with cerebrospinal fluid (CSF) leak being the most common. The most common minor complications of ESS were those related to orbital penetration and middle turbinate adhesions; minor complications occurred in 6.9% of the 2108 patients. There were no statistically significant differences in the overall incidences of major complications between this series and the other two groups. Recommendations are made for the prevention of complications during ESS.

Complications of pediatric endoscopic sinus surgery: The diagnosis and management of cerebrospinal fluid rhinorrhea

Major complications of endoscopic sinus surgery may be classified into two broad categories: orbital and intracranial. Significant complications are usually the result of poor appreciation of anatomic relationships, poor visualization, or excessive bleeding. Cerebrospinal fluid (CSF) fistulas represent a life-threatening complication of endoscopic sinus surgery (ESS) and may result in meningitis or brain abscess. The incidence of CSF fistula is less than 1% following endoscopic sinus surgeryi-‘i (Table 1) and compares favorably with traditional transnasal ethmoidectomy. i2-16 The use of ESS in pediatric sinusitis has generated few reports of complications. In the pediatric population, the lack of reported CSF fistulas may be secondary to less extensive surgery, less developed sinuses (with thicker bone), or thicker dura. Thus, the management of potential complications must be based on the adult literature as well as experience with the pediatric trauma patient. The diagnosis and management of CSF fistulas secondary to ESS are reviewed and formulate the basis of our current recommendations.

COMPLICATIONS OF ENDOSCOPIC SINUS SURGERY: The Role of the Radiologist in Prevention

Intranasal surgery via the endoscope has become an extremely popular technique for refractory rhinosinusitis, but like all procedures it carries a risk of complications. Mosher in 1912 stated that intranasal ethmoidectomy is "the blindest and most dangerous (operation) in all surgery."15 Complications of a surgical procedure are among the most devastating problems in the practice of medicine. A thorough knowledge on the part of the radiologist of what the otolaryngologist is attempting to do can only enhance patient care. All screening CT scans should be approached as if they are preoperative examinations. It is not enough for the radiologist to merely describe air-fluid levels or mucoperiosteal thickening. Instead, the radiologist is an important member of the health care team, and an active role should be assumed to describe anatomic variants that may place the patient at increased surgical risk and to assist the surgeon in the appropriate evaluation of the patient who has a surgical complication.

Complications of endoscopic sinus surgery.

Endoscopic sinus surgery has become popular during recent years. We report the complications of endoscopic sinus surgery in 593 patients in whom 1235 sides were operated on. Forty-five patients had complications, in three of whom they were systemic. The remaining 42 patients had complications on 52 (4.2%) sides; these complications were mostly minor. In 0.3% of the sides operated on, potentially serious complications, such as orbital hematoma or cerebrospinal fluid leak, were seen. None of these patients developed loss of vision or meningitis. Absence of the middle turbinate is a risk factor for developing complications. We conclude that endoscopic sinus surgery is a safe procedure in experienced hands.

Fatal and other major complications of endoscopic sinus surgery : Maniglia AJ. Laryngoscope 101:349, 1991

Fatal and other major complications of endoscopic sinus surgery : Maniglia AJ. Laryngoscope 101:349, 1991

Studying whole-mounted sections of the paranasal sinuses to understand the complications of endoscopic sinus surgery : Rontal M, Rontal E. Laryngoscope 101:361, 1991

Studying whole-mounted sections of the paranasal sinuses to understand the complications of endoscopic sinus surgery : Rontal M, Rontal E. Laryngoscope 101:361, 1991

Avoiding orbital and lacrimal complications of sinus surgery

Orbital complications of endoscopic sinus surgery are avoidable, provided the endoscopic surgeon is constantly vigilant and uses available techniques to define pertinent anatomy. Almost all orbital complications are reversible, provided the surgeon recognizes early signs and symptoms of their occurrence and intervenes appropriately. As surgeons gain experience with this procedure, the risks of complications will decrease; nevertheless, the surgeon must always remain alert to possible variations in anatomy and to individual disease presentations. Orbital complications of endoscopic sinus surgery are avoidable, provided the endoscopic surgeon is constantly vigilant and uses available techniques to define pertinent anatomy. Almost all orbital complications are reversible, provided the surgeon recognizes early signs and symptoms of their occurrence and intervenes appropriately. As surgeons gain experience with this procedure, the risks of complications will decrease; nevertheless, the surgeon must always remain alert to possible variations in anatomy and to individual disease presentations.

Complications of endoscopic sinus surgery

Complications of endoscopic sinus surgery

Fatal and Other Major Complications of Endoscopic Sinus Surgery

Endoscopic sinus surgery has become an acceptable technique for the treatment of chronic sinus disease. This report analyzes five complications which came to my attention. Two cases were orbital:1 bilateral blindness due to damage of the optic nerves, and 1 damage of medial rectus muscle. The other 3 cases were intracranial:two cribriform plate damage with frontal lobe injury and hematoma, and 1 damage of the anterior cerebral artery, resulting in death. This rather novel technique, especially when used by less-experienced surgeons, has major complications similar to what has been reported with the traditional intranasal sphenoethmoidectomy. Knowledge of anatomy, good training, and meticulous surgical technique are very important. Endoscopic sinus surgery in patients with extensive pathology should be used with caution, especially if general anesthesia is selected or if excessive bleeding occurs. It would be beneficial to otolaryngologists to have previous experience in the traditional technique before adopting endoscopic sinus surgery to their armamentarium. Even then, major complications may occur in the hands of very experienced surgeons. Early recognition and proper management of these complications are of utmost importance in order to minimize disability or prevent death.

Fatal and Other Major Complications of Endoscopic Sinus Surgery

Fatal and Other Major Complications of Endoscopic Sinus Surgery

Studying Whole‐Mounted Sections of the Paranasal Sinuses to Understand the Complications of Endoscopic Sinus Surgery

Endoscopic techniques for paranasal sinus surgery have allowed detailed and complete removal of sinus disease while promising minimum distress to the patient. The telescopic view of the operative field shows detail of the sinus anatomy and its disease, not possible in earlier transnasal techniques. Several articles document the serious complications seen with the endoscopic surgery. To understand the paranasal sinuses and their relationships to the orbit and cribriform plate, blocks of cadaver heads that included the orbit and paranasal sinuses were whole sectioned. It has been possible to see areas of the cribriform and orbital wall that are at risk to produce cerebrospinal fluid rhinorrhea and orbital complications. At the same time, landmarks for avoiding these complications can be defined to guide the surgeon during this dissection as seen through the endoscope.

Studying Whole-Mounted Sections of the Paranasal Sinuses to Understand the Complications of Endoscopic Sinus Surgery

Studying Whole-Mounted Sections of the Paranasal Sinuses to Understand the Complications of Endoscopic Sinus Surgery

Complications of endoscopic sinus surgery

Complications of endoscopic sinus surgery

Complications of Endoscopic Sinus Surgery

Complication rates of intranasal sinus surgery range from 2 per cent to 17 per cent. This range identifies the difference between experienced and inexperienced sinus surgeons. Endoscopic sinus surgeons encounter the same risks as traditional intranasal or external sinus surgeons. New technology demands added training and increased vigilance so that complication rates remain as low as possible. Synechia formation, orbital hematoma, and antrostomy closure are the most common complications. CSF leak with meningitis, double vision, and blindness are the most devastating. Reduction of complication rates begin with prevention, which is achieved through diligent preparation. Careful surgical technique based on both old and new principles combined with compulsive postoperative care are the necessary ingredients needed for safe sinus surgery.

Indications for and Avoidance of Complications in Endoscopic Sinus Surgery

At the Spring Meeting of the American Rhinologic Society in Palm Beach, Fla, Vijay Anand, MD, New York, reviewed his indications and methods for avoidance of complications in endoscopic sinus surgery. His four indications are ethmoiditis, fungal sinusitis, recurrent sinusitis, and biopsy of tumor. Contrasted with this, he recommends not using the procedure for recurrent pansinusitis, tumor resections, and frontal sinus mucocele. To avoid complications, Dr Anand advocates a good preoperative evaluation with a careful diagnostic endoscopic examination. The preoperative planning includes a coronal computed tomographic scan that is reviewed with the radiologist. Special areas of concentration during surgery include local anesthesia and hemostasis. A knowledge of anatomy is absolutely essential. Immediately after the operation, vision and eye movements need to be evaluated. An ophthalmologic consultation is recommended for any eye dysfunction identified. Likewise, if a cerebrospinal fluid leak is suspected, neurosurgical consultation is essential.