Endoscopic Sinus Surgical Preparation and Technique Surgical Risks

Surgical Risks Every decision for therapy involves a risk-benefit analysis and a discussion of potential risks is beneficial for parents in order to put treatment options into perspective. Children probably have lower overall complication rates with endoscopic sinus surgery than adults, perhaps because they usually undergo more limited procedures. For adults, the incidence of serious operative complications such as cerebral spinal fluid leak or eye injury is estimated to be .2 to 5% 6. The incidence of lesser complications such as periorbital bruising from injury to orbital fat, synechiae to the middle turbinate, or temporary epiphora is higher. The risk-benefit analysis is most difficult with otherwise healthy patients with chronic illness but no health impact. Concerns persist that sinus surgery at a young age may affect subsequent facial growth but most studies in children do date have failed to demonstrate noticeable effects on facial appearance 1,7. Animal studies have shown effects on facial growth 2,5 and a few case studies have described sinus hypoplasia after endoscopic sinus surgery in children 4. While endoscopic techniques have allowed for relatively safe surgery focused on the natural outflow tracts if the sinuses, reports in the literature indicate that the overall increased incidence of sinus surgery has led to an increase in iatrogenic cerebrospinal fluid leak and long-term frontal sinusitis complications 9,11. Given concerns for subsequent facial growth and concerns for inducing chronic obstruction through scarring, the pendulum in pediatric endoscopic sinus surgery appears to be swinging back towards more focused patient selection and surgical approaches. Imaging Assessment Coronal bone-window computed tomography is the usual “road-map” for endoscopic surgery. Axial views are also very helpful in cases of orbital or frontal disease. Newer imaging technologies such as the helical scanner, allow for excellent sagital reconstructions (especially valuable in frontal sinus disease). In addition to showing what sinuses need approaching, the CT can help the surgeon anticipate difficulties and thus avoid complications. Young children tend to have narrow anterior ethmoid cavities with relatively concave middle meati. Endoscopic Sinus Surgery in the Pediatric Age Group