FESS Complications  Since its intruduction in USA in 1985 functional endoscopic sinus surgery has been the treatment of choice for medically refractory rhinosinusitis (American J.Rhinology,1999)  Among all procdures performed in otolaryngology,sinus surgery stands out as perhaps the most problamtic (Otolaryngologic clinics of north amerca,1989)

SAMEER

FESS Complications  Proper surgical preparation,conducting several courses and planning is the key for safe sinus surgery  Stankiewicz,(1987) reported an initial 5% major complication rate for his initial 90 endoscopic procedures which reduced to 0.5% for the subsequent 90.

FESS Complications  Sinus surgery is currently number one area of litigation in otolaryngology.

Informed consent Each patient should be informed of the risks which include:  hemorrahge  blindness  CSF leak  double vision  loss of smell  Anaesthesia problems  Need of revision Otol.clinic of north american,1989

FESS Complications  In experienced hands,major complications associated with FESS may include ICH,CSF leak,blindenss,diplopia and severe hemrrahge Otolaryngology,head and neck surgery,1993

FESS Complications

 Wright A.(1995) has suggested that puplication of standard list of recognized complications for properly performed procedures would be beneficial

 Patient appreciate this candor.despite what surgeons think,patient are not lost to suregry because of aggressive informed consent handled in an appropriate manner Otol.clinic of north american,1989  It is generally accepted that consent for specific complication is necessary if a complication rate of > 1% is expected Clin.otolaryngol.2001

FESS Complications  It is the responsibility of the doctor to warn of serious consequences of procedures even if happen only rarely.

FESS Complications

 Mosher famously described intranasal ethmoidectomy as the easiest way to kill a patient Clin.otolaryngol.2001  The major complication rates for FESS have been shown to be comparable to or lower than rate for intranasal ethmoidectomy Laryngoscope,1989

FESS Complications  May et al,(1994) performed meta- analysis which included 2108 patient underwent FESS,they found 0.85% incidence of major complications in their series.

FESS Complications  The last nationwide estimate of major complication rates in UK in 1993 was 0.23%.  Since that survey an average of one patient a year has suffered permanent blindness Clin.Otolaryngol,1994 

FESS Complications  The availability of image-guided surgical navigation is welcomed technology in tertiary care hospital setting  The navigation protocol is a major concern in patients with The potential for major complications or incompletely performed revision surgery. (american J.Rhinology,1999)

FESS Complications  The benefit of intraoperative identification of surgical landmarks and three-plane CT image confirmation is intuitive.  The immediate feedback between endscopic and CT is an excellent anatomic teaching tool in a residency trainig program. (American J.Rhinology,1999)

Thank you Prof. Bafaqeeh