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Postoperative Complications Following Functional Endoscopic

Sinus Surgery

By Edwin E. Breitenbach, M.D., J.D.

Sinus surgery has been carried out by otolaryngologists as a treatment for acute and chronic sinus disease for over a hundred years. As part of training in the residency specialty program of ear, nose, and throat, residents in the past have been taught how to perform these sinus procedures. Previously these procedures were performed under direct vision without the aid of magnification.

Approximately ten years ago, through the efforts of European and American surgeons, a major change in sinus surgery occurred with the advent of the sinus endoscope. With advancements in fiber optic technology, sinus endoscopes permitted sinus surgery to be carried out using fine instrumentation under direct visual magnification. This frequently resulted in much less radical surgery to affect the same curative ends.

Those surgeons who finished their residency training ten years ago or earlier had no formal training in this new field of endoscopic sinus surgery and had to educate themselves if they wished to incorporate this into their armamentarium of surgical procedures. Many workshops and training courses have arisen over the past ten years specifically designed to teach older practicing otolaryngologists the technical aspects of functional endoscopic sinus surgery. Although many of these courses are quite extensive and adequately provide surgeons with the technical skills necessary to carry out these highly technical procedures, some of the courses are quite abbreviated and leave the course participant with the false impression that he has been adequately trained to do this surgery.

In the past five years there has been a mushrooming in the incidence of serious complications following sinus surgery in general, and more specifically endoscopic sinus surgery. These complications include brain damage, central nervous system infection, intracranial hemorrhage, and injury to the eye with resulting visual impairment. Although certainly all of these complications can occur in a properly done endoscopic sinus procedure, in the absence of negligence, the sudden exponential increase in complications of this type would tend to suggest that many surgeons have been inadequately trained before embarking on surgery of this type. Thus, when confronted with a client who has sustained an injury of this type, an important part of the case evaluation will be to determine the degree of training and skill which the surgeon obtained prior to embarking upon surgery of this type. It is only through discovery information of this type that the attorney representing either the injured patient or the defendant doctor can adequately prepare for any litigation following the occurrence of the surgical complication.

About Edwin E. Breitenbach, M.D., J.D.