Author(s)
Hassan H. Ramadan, MD MSc
Mustafa G. Bulbul, MD MPH
Fatima Asad, MSc
Kareem Wasef, BS
Chadi A. Makary, MD
Affiliation(s)
West Virginia University;
Abstract:
Objective: To report our experience on the complications of pediatric endoscopic sinus surgery (ESS) and share lessons learned.
Methods: Retrospective cohort study of pediatric ESS performed from 1991 to 2016. Inclusion criteria was children (age <12-years-old) who underwent primary ESS with or without adenoidectomy for chronic rhinosinusitis (CRS). All patients underwent maxillary antrostomy +/- partial or total ethmoidectomy. Patients with complicated acute rhinosinusitis were excluded. Complications reviewed included: orbital injuries (blindness, orbital hemorrhage, periorbital swelling and bruising, fat exposure, & emphysema), skull base injury and CSF leak, and bleeding requiring intervention.
Results: A total of 352 patients underwent ESS between 1991-2016. There were no blindness or orbital hematoma reported, and no major nasal bleeding requiring intervention. The total number of complications was 31 (8.8%): 1 (0.3%) CSF leak, 3 (0.85%) orbital emphysema, 5 (1.4%) periorbital ecchymosis and 22 (6.3%) lamina papyracea violation with orbital fat exposure. Maxillary antrostomy technique was modified in 2002 to reduce the incidence of orbital injury. 158 ESS cases were performed from 1991-2001 compared to 194 ESS from 2002-2016. Prior to 2002, 12% of patients had lamina papyracea violation compared to 1.5% after 2002 (Fisher's exact p<0.0001).
Conclusion: Complications of pediatric ESS are rare, the most common being orbital injury. We describe a modified maxillary antrostomy technique to reduce that complication.