Sinus surgery is a common procedure for people who have chronic problems with sinusitis. Sinusitis is an inflammation of the sinuses caused by an infection or another problem.
It's important for patients and physicians to follow-up and keep a close eye on any problems that continue or develop after surgery, including watery drainage.
Sinusitis can be a risky condition
I think most people don’t get too concerned about sinusitis or sinus infections. When I hear about them, though, I think back to a lecture in my first year of medical school. The professor used the phrase “triangle of danger,” while making a triangle shape on his face, with the top point being the bridge of the nose and the bottom two points roughly at the top of the chin. He explained that infections in that area pose a particular risk of spreading to the brain because of a shared blood supply. That’s exactly what happened to a client of mine in a case—but that’s a different story.
Different types of sinus surgery
Back to sinus surgery. Ear, nose, and throat (ENT) doctors may offer sinus surgery as a treatment option when over-the-counter or prescription medications don’t reliably work to relieve the patient’s symptoms.
The most common type of sinus surgery involves the use of an endoscope, a piece of surgical equipment with a lighted camera. The ENT surgeon inserts the endoscope through the patient’s nostrils and it sends images back to a monitor and the operating room. With the endoscope in place, the surgeon uses micro-instruments to remove polyps or unwanted tissue and correct bony structures.
Some ENT surgeons use stereotactic or image-guided procedures to help protect the nearby eyes and brain. These operations begin with a CT scan of the sinuses. The images are uploaded into a computer system that helps guide the surgeon’s movement of the endoscope in real-time.
Another option for sinus surgery is balloon sinuplasty. As the name suggests, the surgeon uses an endoscope and catheter to place a small balloon in the exact location of a blocked sinus. Once positioned, the surgeon slowly inflates the balloon to open up the sinus and allow normal drainage.
ENT surgeons should be on the lookout for complications
Because of the close location of the sinuses to the brain, there is a risk of an accidental surgery-related injury or puncture of the protective coating of the brain called the dura mater. This may be described as an incidental durotomy and is considered an iatrogenic or hospital-acquired injury.
According to medical research, the most common locations of surgery-related injuries causing CSF leaks are the cribriform plate/fovea ethmoidalis, frontal sinus, and sphenoid sinus.
In most cases, when a surgeon accidentally causes this type of injury, it is considered a potential complication of the sinus surgery and not negligence. But the inquiry doesn’t end there.
By damaging the dura mater, it compromises the sealed protective layer of the brain and causes a cerebrospinal fluid (CSF) leak. Left unrecognized and untreated, it can place the patient at grave risk for developing an infection, like meningitis.
The textbook, telltale sign of a CSF leak is on-and-off clear, watery drainage out of one nostril. The drainage often depends on the position and may have a salty or sweet taste.
If a patient complains of this type of drainage after a sinus surgery, the standard of care requires the ENT to obtain a sample of the drainage and test it for spinal fluid. If the doctor downplays or ignores this important sign and doesn't do an appropriate workup, it's likely negligent and medical malpractice.
Treatment options for cerebrospinal fluid leak vary from medical management to surgical intervention. Medical management involves placing the patient on bed rest with detailed instructions on how to avoid increases in intracranial pressure (pressure within the cranium of the head). Some medical research suggests that most CSF leaks will close on their own with this type of treatment. If that doesn’t work, surgical options include placing a drain or other interventions to manage the intracranial pressure.
What if this happens to you?
If you or someone you care for has a sinus surgery, be on the lookout for a CSF leak. If you have clear nasal drainage and one nostril, it’s important to let your ENT doctor know immediately.
If the sinus surgery doesn’t go well or you end up with a cerebrospinal fluid leak, one of the best medical malpractice attorneys in Houston, Texas can help you investigate your potential case.
