Complications of Endoscopic Sinus Surgery

Complications of endoscopic Sinus SurgeryINTRODUCTIONEndoscopic fistula surgery, a widely used method in the treat manpowert of chronic sinus disease can lead to major (0-1,5 %) and minor (1,1-20,8% ) complications. These complications be silent significant nowadays. Central nervous system (CNS) fistula, hemorrhage, meningitis, orbital defacement and so far death atomic number 18 major pathologies. These are usu in ally the result of injury of fovea ethmoid bone bonealis or orbital structures 1-4. If the skull plant anatomy and its possible variations are considerably known these risks will be minimized. Fovea ethmoidalis which sepe judge ethmoid cells from forward cranial pitfall forms the hood of ethmoidal labrynth 5, 6. Fovea ethmoidalis adheres to lateral gill of cribriform musical scale which is a medially located very thin bone 7. Keros 8 classified advertisement the understanding of olfactive infernal share as the raising of lateral lamella in 1962. Accor ding to his classification if the extremum of lateral lamella MATERIAL-METHOD ii hundred paranasal sinus computed tomographies performed for various reasons as a resume of 400 hemisides of paranasal region were analyzed retrospectively. Patients under 18 geezerhood of age, with a history of prior surgery, trauma which led to massive conclusion of bones and patients with congenital anomalies were excluded from the field. A hundred of the patients were female (18-77 years old, sloshed age 36,91) and ascorbic acid male (18-76 years old, mean age34,25), respectively. MDCT scanner (Siemens Medical Solutions, Enlargen, Germany) with consecutive 1mm thick sections were obtained and lei multiplanar reconstructions were performed. Bone algorithm was used. In our get , we measured that the depths of olfactive stone pit, identifying Keros grammatical deterrent examples, the distances of the ethmoidal cover from hard palate, the distances amongst focal ratio and lower limits of t he orbita bilateraly. The height of ethmoid roof was calculated by criterion the distance between ethmoid roof and the upper limit of orbita. Measurements in coronal sections were performed at the level of the eye nerve just rotter to the orbital globe. Also the chassiss of the bone from the confluence of ethmoidal fovea with lateral lamella are called figure 1 if its make up looks like a confounded arrow (broken wing) and character 2 if its cast is flat (flattening) and forms of the imbalance were investigated. Keros typing, ethmoid roof height and asymmetric status of the fovea were investigated in both(prenominal) sexes whether there is a relationship between them. NCSS statistical outline (Number Cruncher statistical System) two hundred7 Statistical Software (Utah, USA) was performed with the package program. Data were evaluated by descriptive statistical methods (mean, standard deviation), as well as comparisons between assorts one-way analysis of variance, in th e sub-group comparisons Tukeys multiple comparison test, in the binary comparisons of groups and independent t test, in the qualitative comparisons of data chi-square and weighted kappa compatibility test was used. Results significances were evaluated at p RESULTSAccording to the classification of Keros, 3.75% of the patients Keros reference I (n = 15), 59.5% Keros character II (n = 238), 36.75% Keros display case ternary (n = 147). Keros cause trey is more rough-cut in males (n=86, 43%) than females (n=61, 30.5%) (p = 0.017). The shapes of fovea ethmoidalis in 97.25% (n = 389) of the patients were the broken arrows ( causacast 1), while 2.75% (n = 11) of the shapes were flat ( subject 2) . In 54 cases (13.5%) an olfactory fossa Keros character reference dissymmetry, in 11 cases (2.75%) foveal shape imbalance was found. In seven patients (3.5%) as well as the foveal shape instability also Keros olfactory fossa type instability was seen . Keros type I patients orbital m aximal height average were measured 33.07 1.24 mm, Keros type II patients 32.57 1.97 mm, Keros Type 3 patients 33.31 2.11 mm respectively. In the male patients , the average heights of the orbits of Keros III group were significantly higher than Keros group II (p = 0.034). The olfactory fossa depth was measured at an average 6.45 2.16 mm on the right hand , 6.39 2.21 mm on the left. The average depth of the olfactory fossa in males (6.7 2.45 mm) was higher than in females (6.13 1.84 mm) (p = 0.01). There was no significant difference of opinion between the olfactory fossa depth between type 1 or type 2 foveal shape. indemnify and left olfactory fossa depth which were used for detection of Keros typing was compared. In 93 patients (46.5%) from the pith of 200 patients unbalance was detected. In 55 patients 1 mm (27.5%), in 38 patients had 2 mm (19%) difference was found. Forty-eight of them female and 45 were male. In seven of the same patients showed foveal shape unbala nce also. Average right ethmoid roof height 7.59 2.25 mm ,average left ethmoid roof height was measured 7.75 2.38 mm. In men with type 2 foveal shape the groups average height of the ethmoid roof (9.59 2.77 mm) was higher than the foveal shape of type 1 group (7.66 2.36 mm) (p = 0.042). In women, the average height of the ethmoid roof of type 2 group (8.75 1.76 mm) was higher than type 1 group (7.34 2.11 mm) (p = 0.03). There was no statistically significant difference was spy between the averages of heights of ethmoid roofs in Keros type I, II and III patients. Right and left ethmoid roof heights were compared in total of 200 patients. There was an asymetry between left and right sides in 93 patients (46.5%) . In 55 patients 1 mm difference (27.5%), in 38 patients had 2 mm difference (19%) was found. Forty-nine of them were female, 44 of them were male. Five of the same patients showed dissymmetry in the shape of the fovea also. In 54 patients (27%), asymmetry was observe d in both ethmoid roof height and olfactory fossa depth . Twenty-nine of them were female, twenty-five of them were male. In the same group the foveal shape in four patients showed asymmetry also. For the Keros type I patients both sides of the olfactory fossa depth asymmetry ratio was found to be more (53,3%) than the other types. For the same measurement, the ratios were found 40,8% and 29,4 % with Keros type II and type III respectively.Kerosian ethmoid roof height of both sides in patients with type I, asymmetry ratio was found to be greater (40.0%). For the same measurement, the results were 33.3% and 29.4% in Keros type III and type II respectively. In the Keros type I patients foveal shape asymmetry was found to be greater (20.0%) than the other types . The foveal shape asymetry for Keros type II was 4.2% and 4.08% for Keros type III respectively. DISCUSSIONThe ethmoid sinuses have spare importance especially in patients undergoing sinus surgery . Because these sinuses are compressed to vital organs such as the anterior cranial fossa, dura, orbita, optic nerve and anterior ethmoid artery 12, 13. During endoscopic sinus surgery, the upper limit likelihood of injury of the skull base is in Keros type III cases in which olfactory fossa are deep 9. In 1962, in Keros correction with 450 patients, type II patients at a rate of 70.16% (which was the most common type in that study), type III 18.25% and type I 11.59% of the patients 8. In our study 3.75% of the patients were Keros type I (Figure 1), 59.5% of the patients were Keros type II (Figure 2), 36.75% of the patients were Keros type III (Figure 3) .After the point of the junction of fovea ethmoidalis with cribriform scale leaf as well as the depth the shape and symmetry of these structures are also important . In our study, in 93 patients (46.5%), olfactory fossa height asymmetry was detected and in another 93 patients (46.5%) foveal shape asymmetry was found. In 54 cases with height asymmetry there w as also shape asymmetry (27%). In a study make by Basak et al. 14 in bomb on 64 children with Keros type I, type II and type III incidences were explained in the following way 9%, 53% and 38% . Anderhub et al. 15 researched 272 cases of German children for the analysis of cases of ethmoid roof . The results of their study were as follows 14.2% of the patients Keros type 1, 70.6% of the patients Keros type II, 15.2% of the patients Keros type III . In Jang and his collegues study 16, on 205 adult patients, type II was the most common (69,5%). In Alazzaw and his collegues study 17 on cl patients with 3 separate ethnic group type I 80%, type II 20% and type III 0% of the patients were detected. In a study made by Elwany and et al. 18 on 300 Egyptian 42,5% of type I, 56,8% type II and 1,4% type III were found respectively. In this study, the type II olfactory fossa was the commonest type in men (66.7%), while the type I fossa was commonest in women (53%). In a study made by Souza et al . 19 on 200 Brazilian with type I 26,3%, type II 73,3% and type III, 0,5% of reported cases. Solares et al. 20 in get together States examined 50 cases, 83% of the cases type I, 15% type II and %2 type III respectively. In a study in bomb calorimeter Erdem et al. 21 showed 8,1% in 136 patients with type 1, 59,6% type II, 32,3% type III Sahin et al. 22 in 100 cases detected 10% of the patients type I, 61% type II, 29% type III. Dr. Satish Nair 23, found that 77,2% of type II in the study, 17,2% of type I and 5,6%. of type III 5,6% respectively. As seen in the studies, differences are observed between unalike countries.In a study by Lebowitz et al. 24 200 paranasal tomographies were taken. In 86 of the cases, olfactory fossa shapes were symmetric and their heights were the same. Ninety-six cases had shape asymmetry, 19 cases had height asymmetry in olfactory fossa, one case had both shape and height asymmetry. In a study made by Dessi et al. 11 on 150 Italian patients, 10% identif ied asymmetry of the height of the olfactory fossa. In Fan and et al. 25 studies on 160 Chinese patients, 15,6% of cases showed olfactory fossa height asymmetry, 38,75% of cases had foveal shape asymmetry. Souza et al. 19 showed ethmoid roof height asymmetry in 12% of the cases, contour asymmetry in 48,5% of the cases. Michael Reiss et al. 26 canvas 644 patients, of which 31 % was detected height asymmetry. Kizilkaya et al. 2 reported that in 37,95% patients was detected height asymmetry. Dr. Satish Nair 23 identified height asymmetry in 11,7% of the cases. In the same study, ethmoid roof height and contour asymmetry was found in patients at the highest rate with type I (67,8%) than 32,3% and 40% with type II and type III followed. In a study made by Kaplanoglu et al. 27 on 500 patients in 80% of cases was found height asymmetry, the foveal shape asymmetry was detected in 35% of the patients in the same study. Our current study in patients with Keros type I both olfactory fossa de pth and height of the ethmoid roof asymmetries had greater percentage. But in our universe of discourse Keros type I is less seen. However, most of the skull base injuries were seen in Keros type III cases at a prevalance of 36,75% in our study in which olfactory fossa depth and height of the ethmoid roof asymmetry rates were quite high (respectively 40,8%, 33,3%). Preoperative computed tomography must be interpreted in detail. Especially Keros typing must be done and all the variations should be evaluated carefully.CONCLUSIONIn patients undergoing endoscopic sinus surgery noesis of anatomic details and average lengths of skull base and their neighbouring structures and the possible variations of anatomical structures are very important for the bar of complications that may occur during the operation. 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