GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery 2013, Vol. 12, ISSN 1865-1011

Danger points, complications and medico-legal aspects in endoscopic sinus surgery

Werner Hosemann, C. Draf

Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany

Table 1

Localization / Type of Injury

"Minor" Complication

"Major" Complication




optical nerve


optical muscle


nerves in orbita

4.1 Damage of the lamina papyracea 

orbital emphysema (Lufteintritt), 

preseptal bleeding beneath the skin of the eyelid





4.7 Nerve injuries - infraorbital nerve, alveolar nerve

5.1 Orbital haematoma

Retrobulbar hematoma


5.3 Reduced vision, visual field defects

5.4 Diplopia

5.5 enophthalmos (Zurückziehen des Augapfels)

5.6 Lacrimal duct injury complications in dacryocystorhinostomy


4.2 Uncomplicated bleeding of the mucosa



4.3 Uncomplicated liquorrhea (e.g. thru fistulae)

... can lead to major complications ->

5.7 Skull base injury, tension pneumocephalus, encephalocele (Nach-Außen-Wölben von Hirnteilen)

5.8 Meningitis, brain abscess, intracranial haemorrhage

5.9 Direct mechanical cerebral trauma, severe combined injuries

maxillary sinus

middle meatus

middle turbinate

olfactory mucosa

4.4 Synechiae [συν - εχειν], 

"missed ostium sequence", 

unstable middle turbinate with lateralisation





5.11 Anosmia

olfactory region

4.5 Hyposmia

4.6 Atrophic rhinits


5.2 Injury of

(*) anterior ethmoidal artery 

(*) posterior ethmoidal artery 

(*) sphenopalatine artery  

(*) internal carotid artery

Version: 5.1.2018

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