COMPLICATIONS WITH PERSISTENT DEFICITS IN ENDONASAL SINUS SURGERY - DO THEY OCCUR MORE OFTEN WITH EXPERIENCED SURGEONS

Background: The rate of serious complications in endonasal sinus surge ry has not gone down although optical aids are widely used nowadays. A re serious complications caused more often by unexperienced or experie nced surgeons using a microscope and/or endoscope? Methods: We defined serious complications as follows: death, persistent neurological defi cits or permanent loss of vision, and injury to the internal carotid a rtery. Two different studies were made: the first consecutive 300 inte rventions of 6 sinus surgeons were evaluated. Sixteen malpractice case s were analysed regarding the experience of the surgeon. Results: In 9 out of 16 malpractice cases serious complications were attributable t o experienced surgeons, five to moderately experienced surgeons, and o nly two to an inexperienced surgeon (although he had extensive experie nce in external sinus surgery). There were 6 deaths, 6 neurologic defe cts, 2 visual disorders, and 2 injuries to the internal carotid artery without any sequelae. In 9 cases the serious complications were relat ed to injury of the internal carotid artery, in five cases to perforat ion of the skull base. Twice the orbital wall was penetrated. In 1800 procedures performed by 6 surgeons, no serious complications were enco untered. There were only lesions of the periorbit (n = 33) or CSF leak s (n = 8) without any permanent damage to the patient. Conclusions: Ev en an experienced surgeon must always keep in mind that serious compli cations can occur in sinus surgery. One must constantly be alert to th e possibility of anatomical variants or specific pathologic findings.