Complications of primary pediatric endoscopic sinus surgery for chronic rhinosinusitis: A 25‐year single surgeon experience

Abstract

Objective To report our experience on the complications of primary pediatric endoscopic sinus surgery (ESS). Methods Case series of pediatric ESS performed from 1991 to 2016 on children who failed maximal medical therapy and/or adenoidectomy. Inclusion criteria were children (age <12 years old) who underwent primary ESS with or without adenoidectomy for chronic rhinosinusitis (CRS) after failed maximal medical therapy and/or adenoidectomy. All patients underwent maxillary antrostomy ± partial or total ethmoidectomy. Patients with complicated acute rhinosinusitis were excluded. Complications reviewed included: skull base injury and CSF leak, orbital injuries (blindness, orbital hemorrhage, emphysema, periorbital swelling and bruising, fat exposure), and bleeding requiring intervention. Results A total of 352 patients underwent ESS between 1991 and 2016. There were no blindness or orbital hematoma reported, and no major nasal bleeding requiring intervention. The total number of complications was 31 (8.8%): 1 (0.3%) CSF leak, 3 (0.85%) orbital emphysema, 5 (1.4%) periorbital ecchymosis, and 22 (6.3%) lamina papyracea violation with orbital fat exposure. Conclusions Complications of primary pediatric ESS can be rare dependent on surgeon's experience, the most common being orbital injury. Level of evidence: 4.

Comorbidities of chronic rhinosinusitis in children and adults

“…The procedure enhances sinus ventilation and drainage and enables comprehensive treatment access. Low complication rates reported in studies for both age groups might further support its common utilization 41,42 . Moreover, we showed that maxillary trephination (puncture) was the only operation that significantly differed between children and adults, with it being more commonly performed among children.…”

“…Low complication rates reported in studies for both age groups might further support its common utilization. 41,42 Moreover, we showed that maxillary trephination (puncture) was the only operation that significantly differed between children and adults, with it being more commonly performed among children. Maxillary sinus trephination could be preferred in children due to its less invasive nature for diagnostic or therapeutic purposes compared with antrostomy surgery.…”

Platelet‐rich plasma following endoscopic sinus surgery in patients with chronic sinusitis: A systematic review and meta‐analysis of randomised controlled trials

“…9 It is important to note that ESS, like any surgical procedure, carries potential risks and complications, including bleeding, infection, scarring, anosmia (loss of sense of smell) and rare but severe complications such as cerebrospinal fluid leak or orbital injury. [10][11][12] To assure the optimal selection of candidates for ESS, a comprehensive evaluation of the patient's medical history, physical examination and appropriate imaging studies should be performed.…”