COMPLICATIONS

of Endoscopic
Sinus Surgery
 The most important innovation of the past
decades in rinosinusal surgery:

FESS (Functional Endoscopic Sinus Surgery)

FESS offers more advantages if compared
to the traditional surgery
as mini-invasiveness and efficacy…
Importance of multilevel dissection lab

High rate of complications at the

beginng and in the advanced phase

Stankiewicz
Stankiewicz JA.,
JA., 1999
1999
COMPLICATIONS!
COMPLICATIONS ?
MAJOR (0,75-8%)
MINOR (2-21%)
Stammberger H., 1985

INTRA-OPERATIVE
POST-OPERATIVE
Kaluskar SK., 1997
Nasal
Ophtalmic
Intracranial

he r
Ot
• Haemorrhage
• Intraorbital haematoma
• Optic nerve trauma
• Cerebro-spinal fluid leak
• Brian injuries
• Damage of the ICA
It is the most troublesome and a
common complication of FESS

Mucosal bleeding (often due to an inadequate

vasoconstriction)

Arterial bleeding (lesion of the anterior

ethmoidal artery or spheno-palatine artery)
 Arterial: lesion of the anterior ethmoidal
artery: sudden appearance
“severe pain on waking up after the surgical procedure”

Venous: lesion of the superior opthalmic

veins: slow growth
 Optic nerve trauma
Direct injury of the nerve
permanent blindness

intra-ocular pressure
blindness completely or partially
improves with time
Damage to the internal carotid artery: occurs at
the lateral wall of the sphenoid sinus, exceedingly
rare complication
Cerebro-spinal fluid (CSF) leak: occurs in
approximatlely 1% of cases. Preservation of the middle
turbinate as a landmark is of critical importance in
preventing these complications
Brain injury: intracranial hematoma, anterior
cranial fossa,hemorrage subarachnoid hemorrhage.
 “Cribriform plate, lateral lamella and fovea
etmoidales are the most common sites of CSF leak”

If detected during the endoscopic

procedure, it can be plugged with different
grafts (t.m Fascia, liodura, fat, middle
turbinate...).
If leak persists, neurosurgical assessment
and craniotomy may be needed
14 days after endoscopic repair
• Epiphora
• Subcutaneous orbital emphysema
• Diplopia
• Adhesions
• Others: Headache,atrophic
rhinitis, olfactory deficits, infections etc.
Typically due to an anatomical or functional
(edema) obstruction of the naso-lacrimal duct

The resection of the anterior fontanelle with

the backward-cutting forceps is the critical
step of the surgical procedure

If epiphora persists dacryocystorhinostomy

may be useful
Caused by the entry of air into the lamina
papyracea after a Valsalva manoeuvre
(vomiting, nose blowing, etc)

It is temporary and resolves within a

week
Typically due to direct or indirect injury to the
medial rectus muscle or its neurovascular
supply. It is temporary and rare.

If diplopia persists strabismus surgery may be

useful
 The most common complication of FESS
(strongly influenced by the) experience of the surgeon

Typically they develop 2-3 weeks after surgery

Only 20% of post-surgical adhesions have

clinical significance

If symptomatic, they often require a

corrective surgery
CP1113803-21
CP1113803-42
CP1113803-41
Massive pneumocefalus due to a fracture of the ethnmoidal roof
The lamina papyracea.

The anterior ethmoid artery and ethmoid roof.

The lateral lamella of the cribriform plate.

The posterior ethmoid roof and artery.

The area between posterior ethmoid and the

sphenoid sinus.
 HOW TO PREVENT
COMPLICATION
PRE-OPERATIVE
• Accurate anamnesis
• Accurate clinical evaluation
• Medical therapy
• Radiological case study
• Patients Counseling
• Anatomy knowledge
• Adequate surgical training INTRAOPERATIVE:
• Surgical technique • Accurate Tc valuation
• Anatomic variable identification
• Clear vision and adequate vasoconstriction
• Always look at anatomical landmarks
• Early complication detection
• Surgical navigation system
 Learn to use a new
technology

Could help us but don’ t

became a victim of it!!!