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Complications of sinus surgery

Minor complications of sinus surgery occur occasionally and many of them are not evident to the patient.  In fact, many minor complications clause problems at all for patients and aren't than a significant concern.  Other minor complications are a nuisance or may require revision surgery.  As I counsel patients before sinus surgery, I typically tell them that there can be complications in any area of the body near the site of surgery, that is near the sinuses.  Those concerning areas are the eye or the orbit (the bone around the eye) and the eye structures within the orbit itself.  This would include the muscles that move the eye, the nerves that supply the muscles, the optic nerve itself that carries the visual signals, the eyeball, the tear sac, or blood vessels in the orbit that supplies the eye  and other structures.  There is a very thin bone between the ethmoid sinuses and the orbit, called the lamina papyracea.  In a small percentage of cases, in his lamina or thin bone can be cracked, fractured, removed, traumatized, or penetrated by a surgical instrument.  A minor cracke or removal of a small amount of bone is usually of no consequence.   There may be a bit of bruising of the eyelid near the nasal bones or perhaps some bruising of the upper or lower eyelid.  This bruising usually resolves over a few days and has no other importance.  However, if there is trauma to the structures beyond the bone, there may be consequences, and some of these consequences can be significant.  Trauma beyond the bone can cause nerve injury or muscle injury.  Either these injuries can cause the limit the eye mobility.  This can cause double vision because the left eye and right eye will not track together.  The images will differ from one eye to the other in location, and will cause double vision.  If the nerve to the eye, the optic nerve, is damaged (or the blood supply to the nerve is damaged) a patient can lose vision.  This can happen quickly or may occasionally occur slowly over a period of several hours.  If it occurs slowly, the patient will notice a darkening of vision and a slow decrease in color vision, particularly with red colors.  This is an eye emergency.  Trauma to the eyeball or globe itself is rare.  Finally, there can be injury to the tissues in the eye that causes bleeding.  The bleeding can build up pressure behind the eye, push the eye Ford, and cause such pressure in the eye that the blood supply is constricted and the patient can lose vision.  The eye is pushed forward, the lives become discolored from bruising, and if untreated the patient can lose vision.  This is another eye emergency after sinus surgery.

There is a tear duct and tear sac that lies in the orbit, adjacent to the ethmoid sinuses.  Occasionally this is traumatized during sinus surgery, resulting in tearing from the eye or occasionally infections of the tear sac.  Infections in the tear sac can cause swelling around the corner of the eye closest to the nose.

Injury to the structures of brain or round the brain can occur during sinus surgery and generally occurs in less than 1% of cases.  The bone above the sinuses, that is between the sinuses and the brain, it is very thin and areas.  It's less than 1 mm thin in several areas.  This bone can be cracked during sinus surgery.  In some cases the bone is very thin and this can inadvertently happen.  You can be of no consequence.  However if the thick layer around the brain, the dura, is interrupted as well, the patient can have a leak of spinal fluid.  Spinal fluid is a liquid that surrounds the brain and cushions the brain during movement.  A leaked a spinal fluid may be detected during the surgery, because the clear fluid washes away the red blood and sometimes as noted in his way.  However, sometimes the clear fluid is noted after surgery, and in May recovery room or sometimes days after surgery.  This complication needs to be evaluated urgently because there is a chance that over time the patient can develop meningitis, or infection around the brain.  Meningitis can be life threatening condition or can have serious consequences for patients.  Repair of a spinal fluid leak, or cerebrospinal fluid leak, can be performed at the time it is noted during original sinus surgery, or the patient can return to the operating room if it is noted after sinus surgery.  Occasionally, small leaks will be observed because they will stop on their own after several days.

If the bone above the sinuses and the dura is interrupted, there can be trauma to the brain.  Small bits of brain can be inadvertently removed.  However a more serious concern is bleeding of the brain tissue, which can cause a stroke or other neurologic deficits.  Sometimes there are is forced through the whole in the skull, and air can be forced into and around the tissues of the brain.  This requires surgical intervention as well usually.

Sinus surgery can cause other problems as well that are not related to the brain or the eye.  Occasionally patients will have nosebleeds after sinus surgery.  Many of these are treated with packing.  Some require cautery in the operating room.  A small number will require a surgical clipping of the arteries that supply the nose that are bleeding.  Trauma to other nerves is rare.  However numbness of the cheek or eyebrow area has been reported.  Rarely, trauma to nervous around the sinuses will cause a pain syndrome.  The above complications encompass the vast majority of complications of sinus surgery