Functional endoscopic sinus surgery (FESS) is an effective and safe surgical technique, which revolutionized the surgical management of nasal cavity and paranasal sinus diseases. The intimate connection between paranasal sinuses and the orbit places the orbital content at a risk of injury during sinus surgery, especially that of ethmoid sinuses. The orbit, the optic nerve, extraocular muscles and the lacrimal drainage system could be damaged during FESS. The risk of injury correlates to anatomical variations, degree and severity of disease, previous procedure results, and surgical experience. Ophthalmic complications can vary in severity from minor ones, such as localized hematomas, to extremely dangerous, such as optic nerve injury, that could lead to complete blindness. In order to minimize the risk of such complications, it is necessary to consider probable anatomic variations of paranasal sinuses and orbit, which are to be detected by CT scan before surgery.
Septal deviations may obstruct nasal breathing at the deformation side and trigger the development of pathological process in the nasal cavity and paranasal sinuses. Therefore, it becomes necessary to perform a complex of surgical interventions on the nasal cavity structures to restore the lost functions and to eliminate the pathological process in the paranasal sinuses. We conducted a retrospective analysis of 370 case studies for the period of January 2016 through August 2017 in the Otorhinolaryngology Clinic of Pavlov First Saint Petersburg State Medical University to evaluate the incidence of endonasal endoscopic surgical interventions in the nasal septum deviation combined with the pathological state of the maxillary sinuses. The retrospective study revealed a large percentage of combined interventions in the nasal cavity. A major part of them was the combination of the nasal septum deviation with the chronic polyposis rhinosinusitis and the maxillary sinus cysts. The combined operation is especially necessary if there is a pathogenetic relation between the two surgical diseases. The disease may aggravate without the simultaneous surgical correction of the combined pathology in the postoperative period. In some cases, the need for such operations is stipulated by anatomical complications of access to other structures.
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