Endoscopic Sinus Surgery - Complications

Introduction

Sinus surgery involves the removal of diseased sinus and obstructive sinus tissue, which will help improve the drainage in the sinus by allowing the infected sinus material to drain from a pathway created during the surgery. When done endoscopically, it will help allow the surgeon to better visualize the internal structures without cutting open through incisions. Endoscopic surgery results in reduced swelling, discomfort, and bleeding, and the recovery is also quicker. However, this surgery also has a few complications and risks.

What Is Functional Endoscopic Sinus Surgery?

Functional endoscopic sinus surgery (FESS) is a new type of surgery in managing chronic sinus disease. In this procedure, a thin, flexible tube called an endoscope is attached with a light and camera to visualize the nasal and sinus cavities. The surgeon removes the disease and obstructive tissue, nasal polyps, cysts, and inflamed mucous membranes, which block the natural drainage pathway of the sinuses. The procedure's objective is to reinstate the natural drainage and normal ventilation of the sinuses, which will help provide symptomatic relief to the patient. This surgery will also help prevent recurring sinus infections. Ophthalmic complications such as optic nerve damage can occur in their procedure.

What Are the Indications for Endoscopic Sinus Surgery?

1. Chronic Sinusitis: It is a condition in which there is swelling and inflammation of the sinuses for an extended period of more than 12 weeks. It can cause persistent nasal congestion, facial pain, thick nasal discharge, reduces taste and smell sensation, chronic cough, and headache.

2. Sinus Cysts: Cysts are small fluid-filled sacs developing in the sinus.

3. Nasal Polyps: Nasal polyps are noncancerous growths that develop in the nasal passage lining of the sinuses. If polyps cause obstruction, endoscopic sinus surgery is recommended.

4. Sinus Tumors or Masses: Some benign and malignant tumors may require endoscopic sinus surgery for the purpose of debulking the tumor, complete resection, and also for studying under biopsy.

5. Sinus Mucoceles: Mucoceles are small cyst-like structures that will be formed due to blockage of the sinus, which can prevent normal drainage. This will result in mucus build-up in the sinuses. To remove these mucoceles, endoscopic sinus surgery is needed to create a drainage pathway.

6. Sinus or Nasal Structural Abnormalities: Structural abnormalities like enlarged turbinates (tiny structures inside the nose), deviated nasal septum, or concha bullosa (middle turbinate filled with air) can lead to chronic sinusitis and obstruction.

What Are the Prerequisites for Sinus Surgery?

Patients mostly undergo outpatient procedures, and there will not be a need for an overnight stay. An anesthesiologist review is important before surgery to approve the patient to be fit for surgery. Throughout the procedure, anesthesia will be monitored by the anesthetist. Patients who are on blood thinners like Aspirin should have to discontinue usage ten days prior to surgery. NSAIDs (non-steroidal anti-inflammatory drugs) such as Advil should be discontinued seven days before surgery. Acetaminophen is an approved painkiller medication to be used after surgery. Preoperative preparation includes NPO (nil per os) before eight hours of surgery, and the patients must take anything through the mouth.

What Should Be Done After the Procedure?

Patients are discharged on the same day after observing in the recovery room. Patients are advised to start saline irrigation after surgery. Saline rinses and sprays are suggested by the physician and can be used. Smoking should be discontinued after the surgery as it can lead to postoperative bleeding and coughing at times. Avoiding strenuous activities like weight lifting and bending over is important. Nasal irritants such as dusty environments and chemicals should be avoided as they can exacerbate nasal congestion and irritation. Maintaining a balanced diet and staying hydrated throughout the day is important to encourage healing.

What Are the Possible Complications and Side Effects After Sinus Surgery?

• Recurrence of sinus problems.

• Sinus infections are not resolving properly.

• Possible recurrence of sinus polyps.

• Bleeding under rare instances. It can be mild or severe and, at times, may need a blood transfusion. So it is mandatory to keep blood products and donor blood prepared in advance when the emergency need arises.

• Nasal blockage or adhesions may form within the nasal passage.

• Eye-related complications like double vision and visual disturbances.

• Crusting or dryness of the nose with chronic nasal drainage. It is also called empty nose syndrome.

• A neurologist's opinion may be necessary in certain cases.

• A failure to treat sinus headaches and nasal headaches.

• A second need for intense and aggressive sinus surgery.

• It cannot cure or treat allergies, and hence an allergy evaluation along with environmental control may be necessary.

• Failure to treat coexisting respiratory infections such as bronchitis, asthma, and cough.

• During surgery, damage can occur in the eye and its associated structures and skull base. Skull base damage can lead to brain abscess, meningitis, and spinal fluid leakage.

• The possible occurrence of secondary atrophic rhinitis.

• An indefinite palate, face, or upper teeth numbness.

• Failure to treat the infection can result in nasal obstruction.

• Permanent pain can occur, which can require hospitalization.

• Impaired healing.

• Worsening or impaired taste and smell sensation.

How to Prevent Surgical Complications After Endoscopic Sinus Surgery?

Keeping the head above the heart can help prevent swelling and edema formation. A noticeable swelling usually develops around the nose, cheeks, and upper lip, even after several days of surgery. An ice pack can be used to reduce postoperative pain and edema. Moderate amounts of bleeding can be controlled with the use of gauze. The gauze dressing will be changed periodically. Consumption of NSAIDs and Aspirin medications should be discontinued unless otherwise advised by the physician, as it can increase the risk of bleeding and delay clot formation. A soft and cool diet can be consumed by the patient as tolerated until complete recovery. Hot foods and hot liquids can be avoided for some days. The prescribed antibiotics should be completely taken by the patients. Full recovery from this surgery may take up to five days, and the patients are advised to rest during the healing period.

Conclusion

Endoscopic sinus surgery, like all other surgeries, has some complications that are inevitable. The potential risk can depend on the experience of the surgeon, surgical technique, instrumentation, and individual risk factors. The preventive measures to reduce complications differ as each person can react in a different way to the surgery. Seeking the help of a healthcare provider is important in case of severe complications after surgery.