All surgeries will have risks and potential complications and Sinus Surgery is no different. Understanding the umbrella term “Sinus Surgery” is necessary because it can be used so widely. Included in what is thought of in this group includes:
- Maxillary Surgery
- Ethmoid Surgery
- Sphenoid Surgery
- Frontal Surgery
- Turbinate Reduction
- Nasal Polyp Removal
Normal recovery from sinus surgery has symptoms that are unpleasant but should improve beginning in the first week or two after surgery. These are normal and not considered to be complications including mild bleeding from the nose, congestion, moderate pain, fatigue, mild to moderate headaches, facial pressure. The following is a list of many of the complications of sinus surgery.
Risks and Complications of Sinus Surgery
Some blood from the nose is normal after sinus surgery. When you move or shift position you may have more bleeding. If the bleeding becomes severe such as continued coughing up of blood or constant draining from the nose then this is termed a hemorrhage. Hemorrhaging is a potentially life-threatening emergency and you should call your surgeon for advice. Packing the nose or surgery may be required to stop the bleeding and for severe bleeding, a transfusion may be required. If you can’t get in touch with your surgeon then you should go to your nearest emergency room. Stopping the bleeding can be life-saving in certain situations. There may be an underlying bleeding disorder requiring a work-up later with a hematologist as well.
Return of Nasal Polyps:
Polyps are formed from swelling of the tissue inside the sinuses. Removing most of the polyps still leaves some tissue that can cause recurrence of polyps. Removing all sinus tissue would cause severe drying and crusting inside the nose and is not recommended. Sometimes, allergy avoidance, allergy shots, steroids or other medications to decrease inflammation of the nasal tissue can slow polyp growth. In some cases, additional nasal polyp surgeries are needed.
Loss of Smell or Taste:
Sinus surgery may improve or restore the sense of smell but there can be no guarantees that this will occur. In addition, resection or damage to the delicate smell receptors in the nose can permanently reduce the sense of smell. Areas that are most likely to decrease smell include the upper septum, upper middle turbinate and midline area along the nasal septum. Failure to alleviate congestion in the areas responsible for smell or residual polyps in this area can also prevent the return of the smell sensation. The sensation of smell may have been lost due to a viral infection at some point in the past as well. Much of the sensation of taste is complemented by the sense of smell and food may not taste as good if you can’t smell what you are eating.
CSF or Cerebrospinal Fluid is the liquid that surrounds and cushions your brain. It provides nutrients to and takes away toxins from the cerebral tissue. Penetration of the protective bone coverage of the brain can cause this fluid to leak into the nose. You may experience a constant drip out of the front or back of your nose.
There is a risk of meningitis, brain abscess, brain damage, bleeding or air entering the skull which can be life-threatening. CSF leak repair involves the placement of tissue over the site of leakage which if recognized during surgery can be performed during the same surgery.
Empty Nose Syndrome (ENS):
This is a relatively new complication that is only now being described and studied in sinus and nasal surgery. It is the sensation that the nose has no resistance and it can make the patient feel like he or she is suffocating even though the nose is not obstructed. This is sometimes associated with dryness and crusting inside the nose. It is the sensation of “too open” when breathing. Removal of most of or the entire inferior turbinate, which is currently not recommended, may cause ENS. In some patients, just a slight increase in the width of the breathing area may make the nose feel “empty”. This is a serious condition with poorly understood mechanisms and treatments that will be further elucidated in the future. ENSIA is a non-profit society founded in 2014 dedicated to providing support and information regarding ENS.
Nasal Crusting or Dryness:
This can be variable and may last weeks to years. Changes in airflow inside the nose or removal of nasal tissue can cause areas to have crusts that may not resolve. Saline nasal rinses or nasal gels can improve symptoms. Sometimes, bacterial infections may be contributing to the crusts and an antibiotic ointment, mupirocin, can give dramatic improvement.
Damage to the eye:
The eyes are lateral to the left and right sinuses and sinus surgery may result in inadvertent entry into the orbit. Bleeding can cause the orbit to expand which can jeopardize vision. In rare cases or complex anatomy, the orbital nerve may be cut causing blindness in that eye. Eye muscles can be injured causing permanent double vision.
Return of polyps or swelling inside the nose can block breathing. The nasal septum “has memory” and may bend back to the same direction as before surgery. The inferior turbinates will grow over time and may require additional procedures to reduce their size. There can be a paradoxical sensation of obstruction if the nose feels “too open”.
Numbness of the Teeth or Palate:
The nerve that supplies the front upper 4 teeth and the area behind those teeth on the palate is the same nerve that supplies the front of the nasal septum. During surgery, the nerve can swell which can give a numbness or pain of the upper teeth for several weeks. This usually resolves but if there is permanent nerve damage the numbness or pain can remain permanently.
Damage to both sides of the tissue of the septum or a hole through the entire nasal septum may result in a hole in the septum after surgery. If the hole is recognized during surgery then it can be fixed by at least closing one side of the soft tissue covering.
An additional surgery may be needed to close the hole and sometimes the holes may become too large to be closed. Septal perforations can cause crusting, bleeding, whistling and obstruction. If blood collects in the septum after surgery then a septal hematoma may be formed which can become infected and cause a septal perforation.
Risks of Anesthesia:
Any type of anesthesia has risks. There is the risk of malignant hyperthermia, stroke and heart attack which may cause death. We feel that general anesthesia using a tube to protect the airway is the safest way to perform sinus surgery. If you or your family have a history of difficulty with anesthesia then you should let your surgeon and anesthesiologist know.
What should I do if I think I am having a serious complication of Sinus Surgery?
If you are having an emergency then you should contact your surgeon or report to a local emergency room. If it is less urgent then follow-up with your surgeon. You may need to see another physician depending on your symptoms with examples being a hematologist if you have bleeding problems or a neurologist for prolonged pain or numbness. Sinus surgery is relatively safe but knowledge of potential risks and complications can let you know if what you are experiencing is normal or if you should be concerned. Remember, always contact your surgeon if you are concerned.