Complications in Endoscopic Sinus Surgery: Diagnosis, Prevention and Management

by SK Kaluskar, Sanjay Sachdeva

Among many aphorisms of Hippocrates (460 BC) perhaps the most important one is “Do no harm to the patient”. Endoscopic sinus surgery is now a well established modality all over the world for common inflammatory diseases of the paranasal sinuses. The clinical effectiveness of the technique is well demonstrated in the literature. Unfortunately complications of any surgical procedure are a reality in life. As the endoscopic techniques have become more popular, both major and minor complications have been reported in the literature leading to the severe detriment to the patient. When it comes to endoscopic sinus surgery, one has to remember that the surgeon is dealing with a benign common disease and not a life threatening “killer” disease such as malignancies. Therefore the surgeon owe to the patient that whenever he/she operates a patient for sinus surgery the complications should be absolute minimum or non existent. The main problem for the endoscopic surgeon is that the sinuses are surrounded by most vital structures of the human body, the brain and the eye. Authors believe from their vast experience in treating thousands of patients that Endoscopic sinus surgery complications can be made to absolute minimum by scrupulous diagnosis by comprehensive history taking, nasal endoscopy with careful methodical examination and interpretation of CT scans of the sinuses. There should be a good clinico pathological correlation to make sure that the patient is suffering from recurrent rhino sinusitis due to obstruction of their natural ostia and lack of ventilation. There has been a spate of books on endoscopic sinus surgery in recent years. In spite of newer technology in this field in terms of instruments, microdebriders, lasers, image guided systems, the incidence of complications have not changed significantly. It is precisely with this in mind that the authors have canned the concept of writing this book. It aims at filling a major hiatus in this field for the endoscopic sinus surgeon and for the novice who wishes to embark upon this technique. This book probably first on the subject is written with painstaking efforts to weave the texts around profuse material obtained from cadaver both hard and soft parts, patients, and CT scans. This is complemented by easy to understand schematic diagrams where necessary in various chapters. The contents of the book are distilled to present complications in endoscopic sinus surgery during and after the episode. More importantly greater emphasis is placed on how to avoid the complications prior to the operation when the patient is first seen in the clinic. The book takes the reader on a guided tour of understanding why and how complications occur and if, and when they occur and how to diagnose them and manage them. Fungal infections and some rare cases that an endoscopic surgeon may encounter are also described with special precautions and tips to prevent complications. Throughout, the book is profusely illustrated by colour photographs of exceptional quality pertaining to cadavers, CT scans, intra operative procedures and post operative follow up.

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