Complications of Endoscopic Sinus Surgery

Abstract

Endoscopic endonasal surgery of the nasal cavity and paranasal sinuses is usually effective and relatively common procedures. Primarily, endoscopic sinus surgery (ESS) is appropriate to treat infectious and inflammatory paranasal sinus diseases which fail to improve after medical treatment and tumors of the sinuses and skull base require surgical removal. Complications of ESS can classify according to localization as like intranasal, intraorbital, and intracranial complications or according to severity as like as minor complications which are usually managed conservatively or major complications which may be not treatable. The rates of major surgical complications (skull base, orbital, and hemorrhagic) following ESS is reported in 0.3-3% of patients. The current rate of major complications associated with ESS is lower than earlier reports. The most common complications are hemorrhage, orbital complications, and CSF leak. The rate of major complications following revision ESS is reported to be similar to primary cases. On the other hand, certain types of instrumentation such as powered instrumentation, insurance status, medications, and extent of surgery were found to be associated with an increased risk of major complications following ESS. Also, personal factors of patient include age, anatomic variation, and overall health are related with complication rate. Hemorrhage is the most common intranasal complication. Intraorbital complications may range mild orbital emphysema to direct optic nerve injury. Intracranial complications include cerebrospinal fluid rhinorrhea, traumatic neurovascular injuries, and infections. The use of image guidance or surgical experience is not eliminate complications from occurring. The key to prevention is knowledge of anatomy, preparation, anticipation, and experience. Even then, complications can occur in the most experienced hands.