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Jay M. Dutton, MD
Rush-Presbyterian-St. Luke's Medical Center
Chicago, IL
Surgery on the nasal septum, turbinates, and sinuses is recommended only after it has been determined that medical management has been unsuccessful. While these procedures are generally very successful, patients must be aware of certain risks before electing to proceed. These risks include, but are not necessarily limited to, the following:
- Postoperative bleeding: Aspirin, ibuprofen and certain non-prescription supplements (vitamin E, garlic, etc.) can increase the propensity to bleed, so patients should consult with their physicians before using these agents before or after surgery. Intranasal packing is utilized by many sinus surgeons to help avoid this complication but occasionally postoperative bleeding is encountered despite all precautions.
- Anesthesia complications: Adverse reactions to local or general anesthesia may occur, including cardiac and pulmonary complications. Fortunately, these risks are quite rare in this era of modern anesthesia.
- Intracranial complications: The base of the skull forms the roof of the ethmoid and sphenoid sinuses.
 If this layer is violated, a leak of cerebrospinal fluid (the fluid that bathes the brain and spinal cord) may occur (Figure 1). This can usually be repaired at the time of the initial surgery, although in rare cases further complications such as meningitis may ensue.
- Intraorbital complications: The orbit is situated immediately adjacent to several of the paranasal sinuses but is separated by a layer of bone. Because of this close proximity, in rare cases bleeding may occur into the orbit requiring repair at the time of the initial surgery. Visual loss and blindness have been reported but are extremely rare.
- Smell: The sense of smell usually improves, although it may occasionally worsen, depending on the extent of infection, allergy or polyps.
- Voice changes: One of the functions of the sinuses is to affect resonance, so vocal professionals should be aware of potential changes in their voice after sinus surgery.
- Infection: The most common reason to undergo sinus surgery is a chronic infection that does not resolve with medications. The patient with sinusitis is therefore at risk of developing certain other infections in this area (abscesses, meningitis, etc.) regardless of whether they manage the sinusitis with or without surgery.
- Nasal obstruction: Much of the nasal septum is made of cartilage, which has "memory" - the propensity to move back to its original position. Despite certain measures performed by the surgeon at the time of septoplasty this may still occur and require a secondary procedure. Small scar bands may also occur in the nose and require removal by the surgeon at postoperative visits.
- Numbness: A transient numbness of the front upper teeth, lip or nose may occur after surgery but is usually self-limiting.
While surgery may entail these complications, it is also crucial to remember that the failure to intervene surgically may also place the patient at risk for certain complications. When left untreated, the infection may rarely spread to adjacent structures such as the eye or brain and lead to abscesses in these areas, meningitis, visual loss, or even death. Fortunately, the rare patient suffers from complications of the infection or sinus surgery.
Acknowledgments
Original diagram provided courtesy of AstraZeneca LP and modified by Jay M. Dutton, MD.
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