Specific complications of sinus surgery are numerow.

Several can be catastrophic because of the proximity of

the paranasal sinuses to the omit and brain. All otolcu:yngologists
should be familiar with work of Harris P. Mosher
( 11 ), who described the ethmoid labyrinth in great detail
in his 1929 publication. Mosher described intranasal ethmoidectomy as "one of the easiest operations with
which to kill a patient. Most of the catastrophic complications
are related to ethmoidectomy and frontal
sinus surgery. Thble 44.2 lists the complications of sinus
surgery. May et al. (12) studied the complications of
sinus surgery among large populations of patients noting
CSF leak and blindness were the common major complications;
orbital hematoma the most common minor
complication.

Complications of inferior meatal antrostomy (IMA) include

bleeding due to injury to the greater palatine artery, injury
to Hasnervalve (Fig. 44.9) and the lacrimal apparatus, dental
injwy, and functional complications due to synechia, or
redn:ulation of infected mucus. Complications of the traditional Caldwell-Luc operation
are facial swelling, cheek discomfort, hemorrhage. facial
asymmetry, facial paresthesia, oroantral :fistula, gingivolabial
fistula. daayocystitis, devitalized teeth, recuiTent polyps,
and recurrent sinusitis. The most common immediate
complications are facial swelling and cheek discomfort.
which occur after almost 90% and 33% of procedures, respectively (13) and resolve within 1 to 2 weeks of the
procedure. The most common
complications were postoperative hypesthesia, devitalized
teeth, and postoperative ethmoiditis. Blindness can occur
with the Caldwell-Luc procedure if the orbit is entered, but
this is a rare complication. Intranasal ethmoidectomy can be performed with a headlight
microscope, or endoscope. As previously implied
through the work of H. P. Mash~ ethmoidectomy has
been described as perhaps the most dangerous of all
otolaryngologic operations. Catastrophic complications
such as blindness, permanent diplopia, CSF fistula with
meningitis, brain injury. and major vessel injuries have
been described. Complications of transantral ethmoidectomy and external
ethmoidectomy are the same as for intranasal ethmoidectomy.
However, because direct vision with or without a
microscope is used, fewer major complications are found.
Transantral ethmoidectomy necessitates a Caldwell-Luc
operation; therefore, the complications include those of a
Caldwell-Luc procedure (see earlier). lmost all patients
have ecchymosis from an injury to 1he angular vasels and
lid edema from 1he incision. Most complications are minor
orbital problems such as perio:rbital edema and forehead
anes1hesia,. which can occur via injwy to 1he supratrochlear
and suprao:rbital neurovascular bundles. 01her problems
include hemorrhage and wound infections that resolve
in the majority of cases. Injury to the lacrimal apparatus
can happen as well. Complications such as intracerebral
hemorrhage. pneumocephalus, and CSF fistula occurred
among 3.1% of patients (22). Minor complications such
as infrao:rbital nerve numbness and pain. atrophic rhinitis,
facial edema,. crusting, epistaxis, diplopia,. and epiphora
also were found. Infrao:rbital nerve injury with numbness
was the most common complication. CSF leaks can occur when a sphenoidotomy
is improperly performed, and these leab can be repaired
with a number of intrasphenoidal techniques. Injuries to
the cavernous sinus and/or carotid artery are rare but can
be fatal. Sphenoidotomy can
cause major complications, but these are rare. Minor complications
include bleeding from 1he septal branch of the
sphenopalatine artery, which is controlled with electrocautery,
as well as murus recirculation around a false ostium,
ostial stenosis, and late mucocele formation. Bleeding and numbness of the overlying skin are the most
common adverse outcomes of frontal sinus trephination; howeva;.
injury to the supratrochlear neurovascular bundle may
occur or even injury to the o:rbital trochlea.

Open suffer from all the usual complications

related to the approach: scar, bleeding, and paresthesias.