Skip to main content
SpringerLink
Log in

Complications in endonasal sinus surgery: a 5-year retrospective study of 2,596 patients

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Recent developments should have aided to reduce postoperative complications of endoscopic sinonasal surgery: Computerised tomography (CT) and magnetic resonance imaging (MRI) allow a more precise preoperative view of the anatomic situation and possible variations. The Lund–MacKay-Index provides a tool to assess the extent of the disease, and by introducing microscopic-endonasal and computer-assisted sinunasal surgery (CAS) as well as providing the corresponding training technical progress has been made. We analysed the data of 2,596 patients with acute or chronic rhinosinusitis who underwent surgery between 2000 and 2005 using the procedure of Stammberger. We saw 3.1 % minor complications (minor bleedings, perforation of the lamina papyracea), 0.9 % major complications (severe bleedings, cerebrospinal fluid (CSF) leaks, lesion of the ductus lacrimalis), and one (0.04 %) serious complication (meningitis). When we compared these figures with those of reports from the late 90s by correlating opacification, type of operation, the surgeon’s experience and employing CAS with the outcome we did not find a distinct improvement in the rate of postoperative complications. Serious complications and those resulting in permanent harm such as carotid artery injury, cerebral deficit or death have, however, become very rare. A grading into I (minor), II (major) and III (serious) complications is proposed, to point out this critical grade-III proportion, which should not exceed 0.1 %.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Rudert H, Maune S, Mahnke CG (1997) Complications of endonasal surgery of the paranasal sinuses: incidence and strategies prevention. Laryngorhinootologie 4:200–215

    Article  Google Scholar 

  2. Levine HL (1990) Functional endoscopic sinus surgery: evaluation, surgery, and follow-up of 250 patients. Laryngoscope 100(1):79–84

    Article  PubMed  CAS  Google Scholar 

  3. Vleming M, Middelweerd RJ, de Vries N (1992) Complications of endoscopic sinus surgery. Arch Otolaryngol Head Neck Surg 118(6):617–623

    Article  PubMed  CAS  Google Scholar 

  4. Smith LF, Brindley PC (1993) Indications, evaluation, complications, and results of functional sinus surgery in 200 patients. Otolaryngol Head Neck Surg 108(6):688–696

    PubMed  CAS  Google Scholar 

  5. Kennedy DW, Shaman P, Han W, Selman H, Deems DA, Lanza DC (1994) Complications of ethmoidectomy: a survey of fellows of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg 111(5):589–599

    Article  PubMed  CAS  Google Scholar 

  6. May M, Levine HL, Mester SJ, Schaitkin B (1994) Complications of endoscopic sinus surgery: analysis of 2108 patients—incidence and prevention. Laryngoscope 104(9):1080–1083

    Article  PubMed  CAS  Google Scholar 

  7. Kinsella JB, Calhoun KH, Bradfield JJ, Hokanson JA, Bailey BJ (1995) Complications of endoscopic sinus surgery in a residency training program. Laryngoscope 105(10):1029–1032

    Article  PubMed  CAS  Google Scholar 

  8. Ramadan HH, Allen GC (1995) Complications of endoscopic sinus surgery in a residency training program. Laryngoscope 105(4 Pt 1):37

    Google Scholar 

  9. Gross RD, Sheridan MF, Burgess LP (1997) Endoscopic sinus surgery complications in residency. Laryngoscope 107(8):1080–1085

    Article  PubMed  CAS  Google Scholar 

  10. Weber R, Draf W, Keerl R, Schick B, Saha A (1997) Endonasal microendoscopic pansinusoperation in chronic sinusitis. II. Results and complications. Am J Otolaryngol 18(4):247–253

    Article  PubMed  CAS  Google Scholar 

  11. Schaefer SD (1998) An anatomic approach to endoscopic intranasal ethmoidectomy. Laryngoscope 108(11 Pt 1):1628–1634

    Article  PubMed  CAS  Google Scholar 

  12. Dursun E, Bayiz U, Korkmaz H, Akmansu H, Uygur K (1998) Follow-up results of 415 patients after endoscopic sinus surgery. Eur Arch Otorhinolaryngol 255(10):504–510

    Article  PubMed  CAS  Google Scholar 

  13. Moses RL, Cornetta A, Atkins JP Jr, Roth M, Rosen MR, Keane W (1998) Revision endoscopic surgery: the Thomas Jefferson University experience. Ear Nose Throat J 77(3):190–202

    PubMed  CAS  Google Scholar 

  14. Li Y, Xu G (1998) Complications of nasal endoscopic surgery. Zhonghua Er Bi Yan Hou Ke Za Zhi 33(3):142–145

    PubMed  CAS  Google Scholar 

  15. Keerl R, Stankiewicz J, Weber R, Hosemann W, Draf W (1999) Surgical experience and complications during endonasal sinus surgery. Laryngoscope 109(4):546–550

    Article  PubMed  CAS  Google Scholar 

  16. Sharp HR, Crutchfield L, Rowe-Jones JM, Mitchell DB (2001) Major complications and consent prior to endoscopic sinus surgery. Clin Otolaryngol Allied Sci 26(1):33–38

    Article  PubMed  CAS  Google Scholar 

  17. Wu C, Sun S, Yu B, Song W, Zhang Z (2002) Study on the factors in the complications of endonasal sinus surg. Lin Chuang Er Bi Yan Hou Ke Za Zhi 16(8):395–396

    PubMed  Google Scholar 

  18. Aletsee C, Deglmann M, Dieler R (2003) Paranasal sinus surgery in chronic sinus disease and benign tumors indications, concepts and complications at a teaching institution. Laryngorhinootologie 82(7):508–513

    Article  PubMed  CAS  Google Scholar 

  19. Bernal-Sprekelsen M, Sudhoff H, Dazert S (2004) Complications after endonasal surgery of the paranasal sinuses for inflammatory diseases. Laryngorhinootologie 83(1):23–28

    Article  PubMed  CAS  Google Scholar 

  20. Danielsen A, Olofsson J (2006) Endoscopic endonasal sinus surgery: a review of 18 years of practice and long-term follow-up. Eur Arch Otorhinolaryngol 263(12):1087–1098

    Article  PubMed  Google Scholar 

  21. Shi GG, Li XG, Wang ZD (2007) Severe complications in the treatment of chronic and nasal polyps with endoscopic sinus surgery. Zhonghua Er Bi Yan Hou Tou Jing Ke Za Zhi 42(1):19–22

    Google Scholar 

  22. Ecevit MC, Sutay S, Erdag TK (2008) The microdébrider ad its complications in endoscopic surgery for nasal polyposis. J Otolaryngol Head Neck Surg 37(2):160–164

    PubMed  Google Scholar 

  23. Oeken J, Törpel J (2008) The influence of navigation on endoscopic sinus surgery. HNO 56(2):151–157

    Article  PubMed  CAS  Google Scholar 

  24. Messerklinger W (1978) Endoscopy technique of the middle nasal meatus. Arch Otorhinolaryngol 221:297–305

    Article  PubMed  CAS  Google Scholar 

  25. Stammberger H (1991) Functional endoscopic sinus surgery. Decker, Philadelphia

    Google Scholar 

  26. Simmen D, Schuknecht B (1997) Computerized tomography of paranasal sinuses—a preoperative check list. Laryngorhinootologie 76(1):8–13

    Article  PubMed  CAS  Google Scholar 

  27. Lund VJ, MacKay IS (1994) Outcome assessment of endoscopic sinus surgery. J R Soc Med 87(2):70–72

    PubMed  CAS  Google Scholar 

  28. Draf W (1993) Endonasal micro-endoscopic pansinusoperation in chronic sinusitis. I. Indications and operation technique. Am J Otolaryngol 14(6):394–398

    Article  PubMed  CAS  Google Scholar 

  29. Bockmühl U, Kratzsch B, Benda K, Draf W (2006) Surgery for paranasal sinus mucocoeles: efficacy of endonasal micro-endoscopic management and long-term results of 185 patients. Rhinology 44(1):6

    Google Scholar 

  30. Graham MT, Nerad JA (2003) Orbital complications in sinus surgery using powered instrumentation. Laryngoscope 113(5):874–878

    Article  PubMed  Google Scholar 

  31. Bhatti MT, Schmalfuss IM, Mancuso AA (2005) Orbital complications of functional endoscopic sinus surgery: MR and CT findings. Clin Radiol 60:894–904

    Article  PubMed  CAS  Google Scholar 

  32. Oeken J, Bootz F (2004) Severe complications after endonasal nasal sinus surgery: an unresolved problem. HNO 52(6):549–553

    Article  PubMed  CAS  Google Scholar 

  33. Weber R, Keerl R, Hosemann W, Schauss F, Leuwer R, Draf W (1998) Complications with permanent damage in endonasal paranasal sinus operations—more frequent in experienced surgeons? Laryngorhinootologie 77(7):398–401

    Article  PubMed  CAS  Google Scholar 

  34. Thomaser EG, Tschopp K (2007) Does CT-navigation improve the outcome of functional endonasal sinus surgery? Laryngorhinootologie 86(8):584–587

    Article  PubMed  CAS  Google Scholar 

  35. Keerl R, Weber R, Drees G, Draf W (1996) Individual learning curves with reference to endonasal micro-endoscopic pan-sinus operation. Laryngorhinootologie 75(6):338–343

    Article  PubMed  CAS  Google Scholar 

  36. Ecke U, Klimek L, Müller W, Ziegler R, Mann W (1998) Virtual reality: preparation and execution of sinus surgery. Comput Aided Surg 3(1):45–50

    Article  PubMed  CAS  Google Scholar 

  37. Cumberworth VL, Sudderick RM, Mackay IS (1994) Major complications of functional endoscopic sinus surgery. Clin Otolaryngol Allied Sci 19(3):248–253

    Article  PubMed  CAS  Google Scholar 

  38. Wormald PJ, van Renen G, Perks J, Jones JA, Langton-Hewer CD (2005) The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery. Am J Rhinol 19(5):514–520

    PubMed  Google Scholar 

  39. Cincikas D, Ivaskevicius J (2003) Application of controlled arterial hypotension in endoscopic rhinosurgery. Medicina (Kaunas) 39(9):852–859

    Google Scholar 

  40. Leunig A (2006) Avoiding and dealing with bleeding during endoscopic sinus surgery. Laryngorhinootol 85(4):249–252

    Article  CAS  Google Scholar 

  41. Mortuaire G, Bahij J, Maetz B, Chevalier D (2008) Lund–MacKay score is predictive of bleeding in ethmoidectomy for nasal polyposis. Rhinology 46(4):285–288

    PubMed  CAS  Google Scholar 

  42. Bolger WE, Parsons DS, Mair EA, Kuhn FA (1992) Lacrimal drainage system injury in functional endoscopic sinus surgery: incidence, analysis, and prevention. Arch Otolaryngol Head Neck Surg 118(11):1179–1184

    Article  PubMed  CAS  Google Scholar 

  43. Jomain C, Kadraoui M, Margonari H, Menault P, Bolot G, Mercatello A (1997) Gas embolism during endonasal YAG laser surgery. Ann Fr Anesth Reanim 16(2):190–192

    Article  PubMed  CAS  Google Scholar 

  44. Osti D, Ferri E, Caggese G, Rinaldi S, Guberti A, Zoppellari R (2009) Probable case of vascular air embolism during endonasal CO2 laser surgery. Minerva Anestesiol 75(5):275–279

    PubMed  CAS  Google Scholar 

  45. Younis RT, Lazar RH (1996) Delayed toxic shock syndrome after functional endonasal sinus surgery. Arch Otolaryngol Head Neck Surg 122(1):83–85

    Article  PubMed  CAS  Google Scholar 

  46. Abram AC, Bellian KT, Giles WJ, Gross CW (1994) Toxic shock syndrome after functional endonasal sinus surgery: an all or none phenomenon? Laryngoscope 104:927–931

    Article  PubMed  CAS  Google Scholar 

  47. Vergnon L, Gotlib O (1979) Two cases of total ophthalmoplegia after section of the vidian nerve (author’s transl). Ann Otolaryngol Chir Cervicofac 96(6):407–410

    PubMed  CAS  Google Scholar 

  48. Park AH, Stankiewicz JA, Chow J, Azar-Kia B (1998) A protocol for management of a catastrophic complication of functional endoscopic sinus surgery: internal carotid artery injury. Am J Rhinol 12(3):153–158

    Article  PubMed  CAS  Google Scholar 

  49. Rombout J, de Vries N (2001) Complications in sinus surgery and new classification proposal. Am J Rhinol 15(6):363–370

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

There is no conflict of interest. The corresponding author has no connections with any company or organisation whose products are cited and the presentation is independent and neutral.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany

    Vanessa Siedek, E. Pilzweger, C. Betz, Alexander Berghaus & A. Leunig

Authors
  1. Vanessa Siedek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Pilzweger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Betz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander Berghaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Leunig
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vanessa Siedek.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Siedek, V., Pilzweger, E., Betz, C. et al. Complications in endonasal sinus surgery: a 5-year retrospective study of 2,596 patients. Eur Arch Otorhinolaryngol 270, 141–148 (2013). https://doi.org/10.1007/s00405-012-1973-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-012-1973-z

Keywords

Search

Navigation