Pre-vertebral surgical emphysema following functional endoscopic sinus surgery

Abstract

Functional endoscopic sinus surgery (FESS) is a widely practiced technique in the UK. This procedure has variable complication rates and can have some serious consequences. We present a case of surgical emphysema of the neck, face and the pre-vertebral space following FESS. Emphysema of the face and neck has been previously reported. However, to our knowledge, emphysema of the pre-vertebral space following FESS has not been documented. Pre-vertebral emphysema following FESS is an unusual and potentially serious complication.

Complications in endoscopic sinus surgery for chronic rhinosinusitis

“…A low‐lying skull base, Keros grade 3, was noted in 13%. That area of skull base medially extending back to the sphenoid sinus is much thinner than the lateral fovea ethmoidalis and much more prone to CSF leak 33. It is rare to puncture the cribriform plate medial to the middle turbinate during ESS because it is uncommon to remove disease medially except for nasal polyps.…”

Cervico-Facial Soft Tissue Emphysema with Pneumo-Mediastinum Following Endoscopic Sinus Surgery: A Dilemma of Related or Unrelated Complication

“…In our case too, facial, neck and chest emphysema developed 3 hours after the surgery initiated by severe bouts of coughing. Sanu and Jayanthi (2006) found no surgical violation of lamina papyracea or orbital periosteum and so in their case injury due to the nasal packing had been cited as the cause. In such a situation where there is no documented evidence of injury, it is difficult to build an effective medical audit based on ethical practice.…”

“…Various interventions have been blamed for this complication but the exact cause remains elusive. Sanu and Jayanthi et al (2006) [8] reported another case of prevertebral surgical emphysema following FESS wherein the exact cause of it could not be established because of absence of any perforation in the aerodigestive tract. They referred to another case of Bellamy and Berridge et al (1993) of cervico-facial emphysema which progressed rapidly to airway obstruction after stapedectomy operation under general anaesthesia where definitive pharyngeal tear and perforation was found.…”

Danger points, complications and medico-legal aspects in endoscopic sinus surgery

“…Healing though was without any complications [123]. In traumatological literature, case studies discuss that a certain valve mechanism with increasing accumulation of air in the soft tissue of the eye lid may lead to increasing deterioration of vision (“tension pneumo-orbit”) [124], [125].…”