Schwere Komplikationen nach endonasalen Nasennebenh�hlenoperationen?ein ungekl�rtes Problem

Abstract

Functional endoscopic sinus surgery is one of the most common procedures in our field. Despite modern techniques, major and even fatal complications may occur. We describe 3 cases of unilateral blindness due to retrobulbar hematoma and one case of an internal carotid artery injury with fatal outcome.

From chronic rhinitis to death: Fatal outcome of nasal polyposis treatment

“…Although majority of the patients suffering from chronic rhinosinusitis or NP recover well after the endoscopic surgery, and experience substantial relief of the symptoms [3,12], the possibility of undesirable outcome must not be ignored. Oeken and Bootz reported [13] about unilateral blindness and internal carotid artery injury after endonasal surgery. Similarly, Stankiewicz and Chow described several complications, including postoperative cerebrospinal fluid leak and brain hemorrhage, and a death following endoscopic sinus surgery [14].…”

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

“…A case report depicts a secondary orbital hematoma without significant proptosis, but with blindness [407]. A subperiosteal orbital hematoma with visual impairment should be equally rare – symptoms were reversible after an emergency hematoma decompression [408].…”

“…However, after covering and ‘gluing’ the artery, a pseudoaneurysm may develop within a period of a couple of days to months (in average after three weeks) This may result in secondary, massive hemorrhage or in thromboembolism; an arterial occlusion, caused by the expanding aneurysm itself, was merely reported in a case report. For this reason an angiography is indicated postoperatively [95], [97], [389], [392], [407], [424], [427], [428], [429]. In case of an aneurysm secondary neuroradiological treatment is performed.…”

Fehler und Gefahren: Eingriffe an den Nasennebenhöhlen und der Frontobasis unter Berücksichtigung mediko-legaler Aspekte

“…Die A. ethmoidalis posterior kann grundsätzlich bei Manipulationen im hinteren Siebbein oder bei der der Keilbeinhöhleneröff -nung verletzt werden [ 12 ] . Berichtet wurde kasuistisch über ein sekundäres Orbitahämatom ohne wesentliche Proptosis, jedoch mit Erblindung [ 408 ] . Ebenso selten dürfte ein subperiostales orbitales Hämatom mit Visus-Einschränkung sein -es war im Anschluss an eine notfallmäßige Hämatom-Entlastung rückbil-dungsfähig [ 409 ] .…”