Thursday, March 8, 2012

What can go wrong during a sinus surgery?

What can go wrong during a sinus surgery?

Several complications happen during a sinus surgery. For instance, bleeding, fat herniation, cerebrospinal fluid leak, retro-orbital hemorrhage, medial rectus damage or optic nerve lesion may require extra procedures and time. Minimizing these complications is however possible.

Proximity of the anterior ethmoidal and sphenopalatine arteries to the surgery site increases chances of cutting through these arteries, causing bleeding. The damaged anterior ethmoidal artery may retract into the orbit, increasing pressure in the rear part of the eye. If this condition is not treated, patient will loose eyesight. The bleeding and clotting disorder (coagulopathy) also triggers bleeding.  To minimize the bleeding, maximize medical treatment before the sinus surgery and use a shaver or through-cutting forceps for tissue removal.
CSF leak
The cerebrospinal fluid (CSF) may leak during the surgery because of proximity to thin skull base. The leak resembles to a stream flowing through a blood pool. The leak generally pulsates. Different types of grafts and an oxidized cellulose dressing are used to plug the leak. Prophylactic antibiotics are administered.
Correct positioning of surgical instruments help in avoiding the leak. Surgeon shall familiarize himself/herself with paranasal sinus area thoroughly before the surgery.  A CT scan aids in deciding the surgical area to be operated for aerating the sinuses. A “black halo” near the skull base on the scan ensures presence of normal cells that will protect the base. On the other hand, a “white-out” on the scan requires a very careful approach.
Fat hernia
Diplopia (An eye disorder in which single object appears as two different objects.) may or may not accompany the orbital fat hernia, sagging of the fat.
Medial rectus damage
Medial rectus, the eye muscle, controls eye movement.  Deep penetration into the eye area (orbit) damages the muscle. The damage causes diplopia and scarring. Surgeon shall avoid damaging the muscle.
Optic nerve lesion
If the surgeon penetrates into the orbit via the lamina papyracea, the optic nerve may damage. If the nerve is visible in the sphenoethmoid air cell, the nerve trauma may occur.
Retro-orbital hematoma
A supraorbital cell separates the frontal recess and the anterior ethmoid artery. The chances of damage to the cell increases with an increase in its penumatization. Some times the artery is dehiscent. If the artery is torn unknowingly during the surgery, the vessels retract to the orbit, causing retro-orbital hematoma (localized blood collection). A sizeable hematoma constricts the optic nerve and affects the vision.  

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