Pitfalls in Sinus Surgery

Svider, Peter F.; Baredes, Soly; Eloy, Jean Anderson

doi:10.1016/j.otc.2015.05.002

Cited by 22 publications

(15 citation statements)

References 60 publications

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“…This is much higher than the acceptable 2 mm of accuracy needed to maintain the utility of intraoperative sinus navigation 14,29,30 . Greater imprecision has been associated with higher incidences of patient‐related complications 21 . While imprecision likely is a mediating factor for CSF leaks, given our study design we cannot definitively determine the causal relationship between imprecision of navigation and CSF leaks.…”

Section: Discussionmentioning

confidence: 88%

“…14,29,30 Greater imprecision has been associated with higher incidences of patient-related complications. 21 While imprecision likely is a mediating factor for CSF leaks, given our study design we cannot definitively determine the causal relationship between imprecision of navigation and CSF leaks. While IGS is not intended to supplant knowledge of surgical anatomy, these results suggest that surgeons may be overrelying on IGS during surgery.…”

Section: Discussionmentioning

confidence: 94%

“…Despite the safety and efficacy of ESS, patient complications are reported in 0.5% to 1.0% of ESS cases. 21 To improve the efficacy and safety of ESS, surgeons have implemented computed tomography navigation systems that track the position of tools inside the patient. Despite the increasing number of ESS cases that use navigation, little is known about the device-and patient-related complications associated with use of image-guided sinus navigation.…”

Section: Discussionmentioning

confidence: 99%

“…ESS is generally accepted as the standard of care for patients with sinonasal disease whose adequate medical treatment has failed. Despite the safety and efficacy of ESS, patient complications are reported in 0.5% to 1.0% of ESS cases 21 . To improve the efficacy and safety of ESS, surgeons have implemented computed tomography navigation systems that track the position of tools inside the patient.…”

Section: Discussionmentioning

confidence: 99%

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Adverse Events Associated With Image‐Guided Sinus Navigation in Endoscopic Sinus Surgery: A MAUDE Database Analysis

Orozco

Ulloa

Lin

et al. 2022

Otolaryngol.--head neck surg.

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Objective The utilization of image-guided navigation during endoscopic sinus surgery (ESS) has increased significantly since its introduction. However, the most common associated complications are still unknown. This study describes and analyzes adverse events related to image-guided ESS. Study Design Cross-sectional analysis. Setting The Food and Drug Administration’s 2018-2022 MAUDE database (Manufacturer and User Facility Device Experience). Methods The MAUDE database was searched for all reports on adverse events involving sinus navigation systems used in ESS from 2018 to 2022. Reported events were reviewed and categorized. Results During the study period, there were 1857 adverse events from 1565 reports, which were divided into device-related (n = 1834, 98.8%) and patient-related (n = 23, 1.2%) complications. The most common device-related complications were nonfunctionality of the system (n = 512, 27.9%), device imprecision (n = 427, 23.3%), and device sensing problems (n = 277, 15.1%). The most common patient-related complications were cerebrospinal fluid (CSF) leak (n = 14, 60.9%), intracranial injury (n = 4, 17.4%), and bleeding/hemorrhage (n = 3, 13.1%). Imprecision was associated with increased risk of navigation abortion by the surgeon (odds ratio, 1.50 [95% CI, 1.38-1.65]; P < .001) and increased risk of CSF leak (odds ratio, 16.5 [95% CI, 3.66-74.0]; P < .001) as compared with other device-related complications. Conclusions The most commonly reported device- and patient-related adverse events associated with image-guided sinus navigation systems were device nonfunction, imprecision, device sensing difficulties, and CSF leak. When imprecise navigation occurred, there was an increased likelihood of CSF leak and navigation abortion by the surgeon. Health care providers should be mindful of these possible complications when electing to use image-guided sinus navigation during ESS.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Adverse Events Associated With Image‐Guided Sinus Navigation in Endoscopic Sinus Surgery: A MAUDE Database Analysis

Orozco

Ulloa

Lin

et al. 2022

Otolaryngol.--head neck surg.

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“…1 Despite the safety and efficacy associated with ESS, major complications are reported in 0.5% to 1.0% of ESS cases. 2 Such complications include injury to critical vascular structures, injury to the skull base, and injury to the orbit. 2,3 Some of these complications can be reduced by a detailed understanding of the anatomy of the sinuses and their relation to vital structures.…”

Section: Introductionmentioning

confidence: 99%

Racial, Ethnic, and Gender Variations in Sinonasal Anatomy

Kulich

Long

Orozco

et al. 2022

Ann Otol Rhinol Laryngol

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Background: Complications during endoscopic sinus surgery often result from unfavorable anatomy. The prevalence rates of such anatomic findings vary tremendously in the literature, in part due to the small, homogenous populations previously studied. Objective: To characterize the prevalence of sinonasal anatomic variants among ethnic groups and genders seen at an academic medical center. Methods: This is a retrospective cross-sectional study of adult subjects who underwent CT imaging of the sinuses from January 2019 to November 2020 at a tertiary academic setting. CT scans were analyzed systematically by 3 trained study personnel for the presence of critical sinus anatomic variants that endoscopic sinus surgeons typically evaluate for preoperatively. Chi-squared tests and analyses of variance were conducted to detect differences in the prevalence of structural findings between genders and races/ethnicities. Results: A total of 489 subjects (57% female) were included: 44 Asian, 14 Black/African American, 101 Hispanic/Latino, 203 White, 127 Other. The prevalence of the following anatomical variants differed by race/ethnicity: Haller cells, Type 3 optic nerve, Onodi cells, maxillary septations, sphenoid lateral recess, anterior clinoid process pneumatization, and carotid artery dehiscence. Asian subjects had higher rates of Haller cells (48% vs 16%, P < .001) and Type 3 optic nerve (18% vs 4%, P = .022) compared to Hispanic subjects, as well as a higher prevalence of Onodi cells (39% vs 17%, P = .003) compared to White subjects. Males had a higher prevalence of mesenteric anterior ethmoid arteries (62% vs 45%, P < .001) and dehiscent carotid arteries (30% vs 21%, P = .024). Conclusion: Certain sinonasal anatomic variants, which have direct implications for complications during endoscopic sinus surgery, were found to be significantly more prevalent in some demographic groups. Surgeons should be aware of these differences in their review of preoperative imaging for safe surgical planning.

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Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: a systematic review and meta‐analysis

Patel

Thamboo

Rudmik³

et al. 2016

Int Forum Allergy Rhinol

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On meta-analysis, for CRS patients refractory to AMT, ESS significantly improves objective endoscopic scoring outcomes vs continued medical therapy alone. In patients with refractory CRS who have significant reductions in baseline QOL, ESS results in significant improvements. Continued medical therapy appears to maintain outcomes in patients with less severe baseline QOL. Unpooled analysis demonstrates improvement in health utility, olfaction, and cost-effectiveness following ESS compared to continued medical therapy alone, in medically refractory CRS.

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Pitfalls in Sinus Surgery

Cited by 22 publications

References 60 publications

Adverse Events Associated With Image‐Guided Sinus Navigation in Endoscopic Sinus Surgery: A MAUDE Database Analysis

Adverse Events Associated With Image‐Guided Sinus Navigation in Endoscopic Sinus Surgery: A MAUDE Database Analysis

Racial, Ethnic, and Gender Variations in Sinonasal Anatomy

Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: a systematic review and meta‐analysis

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