12. What are the risks associated with sinus surgery?
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Berrylin J. Ferguson, M.D. Pittsburgh, PA
The most common risks associated with sinus surgery are bleeding and infection. If there is bleeding the surgeon may place a nasal pack within the sinus cavity. Rarely patients may have decreased or loss of smell following surgery. Complications that occur less than one percent of the time include brain fluid leak (cerebrospinal fluid leak) and eye injury. If the brain fluid leak is not recognized and fixed, the patient may develop the brain infection called meningitis. Injury to the orbit or eye is very rare. There have been cases of double vision and blindness caused by sinus surgery. Sinus surgery in which the maxillary sinus (the sinus in the cheek) is opened by making an incision under the lip frequently causes discomfort or numbness of the cheek.
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Todd Kingdom, M.D. Denver, CO
Many potential risks are associated with sinus surgery. A careful review of these risks must be discussed with all patients considering sinus surgery. Surgeons typically group complications into two groups: 1) minor and 2) major. Minor complications typically do not lead to significant problems, are managed successfully, and are more common. The most common minor complications include bleeding from the nose and scar formation after surgery. Of course additional risk of sinus surgery is the potential failure to correct the symptoms or problems that the patient is experiencing. Symptoms or problems may require minor interventions to correct such as placement of packing materials in the nose to stop bleeding or minor office procedures to release scar formation. In some situations, post operative scar formation may lead to further surgeries to fully correct the problem. Sinus surgery can be associated with several major and even catastrophic complications. The proximity of the orbit (eye) and brain to the sinus cavities places these structures at risk during any surgical procedure of the sinuses. Visual change, visual loss, and brain injury have been described after sinus surgery. Cerebrospinal fluid leakage (trauma to the tissue layers surrounding the brain) may result from injury to the bone that separates the brain from the sinuses. If detected, this can be successfully repaired in 90-95% of cases. Overall, these major complications occur in less than 1% of all cases. Sinus surgery can be associated with several devastating complications; however, sound surgical technique and experience, advances in surgical equipment, and careful patient preparation make these events very rare.
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Becky L McGraw-Wall, M.D. Houston, TX
Although sinus surgery is a fairly common, safe surgical procedure, it is not without surgical risk. The most frequent complications include the potential for postoperative bleeding and infection and the possibility of recurrent sinusitis. The other serious risks are rare, and are related to the sinus anatomy and its close proximity to the eyes and skull base. Injury to the eyes, the eye muscles which move the eye, and the optic nerve can occur. Bleeding into the back of the eye can occur, which can affect vision if not treated promptly. A spinal fluid leak can result if the bony skull base that separates the sinuses from the cranial cavity is fractured or opened during sinus surgery. In addition, it is possible to have an injury to the sensory nerve of the cheek when operating on the maxillary sinus.
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Peter Hwang, M.D.
Associate Professor and Director
Stanford Sinus Center Stanford, CA
Because of the intricate anatomy of the sinuses, sinus surgery does carry a small risk of injury to adjacent structures. This includes possible injury to the eyes and to the lining of the brain, called the dura. A tear of the dura may cause brain fluid to leak into the nose, requiring additional surgery to correct it. There is also a small risk of bleeding after surgery, as well as associated risks of anesthesia. Fortunately, complications from sinus surgery are rare. You should discuss the risks of sinus surgery completely with your surgeon before you decide to proceed.
