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FESS Complications

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)

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FESS Complications

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  1. 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)

  2. SAMEER

  3. 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.

  4. FESS Complications • Sinus surgery is currently number one area of litigation in otolaryngology .

  5. Informed consent Each 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

  6. 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

  7. FESS Complications

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

  9. 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

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

  11. FESS Complications

  12. 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

  13. 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.

  14. 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

  15. 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)

  16. 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)

  17. Thank you Prof. Bafaqeeh

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