FESS Complications

Since its intruduction in USA in 1985 functional endoscopic sinus surgery has been the treatment of choice for medically refractory rhinosinusitis

(American J.Rhinology,1999)

Among all procdures performed in otolaryngology ,sinus surgery stands out as perhaps the most problamtic

(Otolaryngologic clinics of north amerca,1989)

SAMEER

FESS Complications

Proper surgical preparation,conducting several courses and planning is the key for safe sinus surgery

Stankiewicz,(1987) reported an initial 5% major complication rate for his initial 90 endoscopic procedures which reduced to 0.5% for the subsequent 90.

FESS Complications

Sinus surgery is currently number one area of litigation in otolaryngology .

Informed consentEach patient should be informed of the risks which include:

hemorrahge

blindness

CSF leak

double vision

loss of smell

Anaesthesia problems

Need of revision

Otol.clinic of north american,1989

FESS Complications

In experienced hands ,major complications associated with FESS may include ICH,CSF leak,blindenss,diplopia and severe hemrrahge

Otolaryngology ,head and neck surgery,1993

FESS Complications

FESS Complications

Wright A.(1995) has suggested that puplication of standard list of recognized complications for properly performed procedures would be beneficial

Patient appreciate this candor.despite what surgeons think ,patient are not lost to suregry because of aggressive informed consent handled in an appropriate manner

Otol.clinic of north american,1989

It is generally accepted that consent for specific complication is necessary if a complication rate of > 1% is expected

Clin.otolaryngol.2001

FESS Complications

It is the responsibility of the doctor to warn of serious consequences of procedures even if happen only rarely .

FESS Complications

FESS Complications Mosher famously described intranasal

ethmoidectomy as the easiest way to kill a patient

Clin.otolaryngol.2001

The major complication rates for FESS have been shown to be comparable to or lower than rate for intranasal ethmoidectomy

Laryngoscope,1989

FESS Complications

May et al,(1994) performed meta-analysis which included 2108 patient underwent FESS,they found 0.85% incidence of major complications in their series.

FESS Complications

The last nationwide estimate of major complication rates in UK in 1993 was 0.23%.

Since that survey an average of one patient a year has suffered permanent blindness

Clin.Otolaryngol,1994

FESS Complications

The availability of image-guided surgical navigation is welcomed technology in tertiary care hospital setting

The navigation protocol is a major concern in patients with The potential for major complications or incompletely performed revision surgery .

(american

J.Rhinology,1999)

FESS Complications

The benefit of intraoperative identification of surgical landmarks and three-plane CT image confirmation is intuitive.

The immediate feedback between endscopic and CT is an excellent anatomic teaching tool in a residency trainig program.

(American J.Rhinology,1999)

Thank you

Prof. Bafaqeeh