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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 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

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 metaanalysis 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