[Severe complications after endonasal nasal sinus surgery. An unresolved problem]

Area of Science:

• Otolaryngology
• Neurosurgery
• Ophthalmology

Background:

• Functional endoscopic sinus surgery (FESS) is a common otolaryngologic procedure.
• Despite advancements, significant complications can arise during FESS.
• Patient safety remains a critical concern in sinus surgery.

Observation:

• This report presents four severe complication cases during FESS.
• Three cases involved unilateral blindness secondary to retrobulbar hematoma.
• One case resulted in a fatal internal carotid artery injury.

Findings:

• Retrobulbar hematoma is a rare but devastating complication of FESS, potentially causing permanent vision loss.
• Internal carotid artery injury during FESS, though exceedingly rare, carries a high risk of mortality.
• These cases underscore the importance of meticulous surgical technique and awareness of potential vascular and orbital risks.

Implications:

• Enhanced vigilance and advanced surgical training are crucial to mitigate severe FESS complications.
• Improved intraoperative monitoring and anatomical knowledge can help prevent catastrophic outcomes.
• Further research into risk factors and preventative strategies for FESS-related injuries is warranted.