Deviation in the Standard of Care During Endoscopic Sinus Surgery

Evaluate breaches in the standard of care when exploring a Deviation in the Standard of Care During Endoscopic Sinus Surgery

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following indications for endoscopic sinus surgery did the patient present? (Choose all that apply)
    History of recurrent acute sinusitis
    History of chronic sinusitis
    Presence of nasal polyposis
    Presence of fungal sinusitis
    Presence of mucocele
    Presence of orbital decompression
    Drainage of subperiosteal abscess
    History of dacryocystorhinostomy
    Presence of cerebrospinal fluid leaks or encephalocele
    History of pituitary surgery
    Resection of Sinonasal neoplasms
    None of the above
    Answer unknown
    Why is this important?
    Sinus surgery is performed to treat lesions that block the sinuses. The lesions could vary from polyps to chronic lesions.
    (2004) 24 EIACNA 1 119-134

  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Many conditions predispose a patient to developing chronic sinusitis. The clinician needs to recognize these predisposing factors.
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  • Was a thorough physical examination performed? Why is this important?
    Answer this question
    Prominent symptoms of acute sinusitis include nasal congestion, purulent rhinorrhea, facial-dental pain, postnasal drainage, headache, and cough. Chronic sinusitis symptoms are similar but might be even more subtle. Pain is much less a feature of chronic sinusitis.
    (2005) 116 JAACIM S6 S13-S47

  • Were pre-operative laboratory studies performed? Why is this important?
    Answer this question
    Laboratory tests will provide additional diagnostic information.
    (2005) 116 JAACIM S6 S13-S47

  • Were pre-operative imaging studies performed? Why is this important?
    Answer this question
    Imaging techniques can provide confirmatory evidence of sinusitis when symptoms are vague, physical findings are equivocal, or clinical disease persists despite optimal medical therapy.
    (2012) 24 EOMSCA 2 275-283

  • Which of the following contraindications did the patient have? Why is this important?
    Answer this question
    Some patients may have medical issues that are significant enough to warrant postponing the surgical procedure and preclude significant sedation or general anesthesia.
    (2006) 17 EOTOHN1 58-65

  • Was an informed consent obtained? Why is this important?
    Answer this question
    The clinician has a legal and ethical responsibility to provide information to the patient regarding the diagnosis, treatment options available, risks associated with those treatments and the risks associated with not proceeding with the treatment.
    (2007) 66 GAINEN 2 213-218

  • Was a pre-operative evaluation performed? Why is this important?
    Answer this question
    Each patient must be thoroughly evaluated prior to surgery to ensure that they are stable enough for the procedure.
    (2004) 37 EOTCNA 2 453-472

  • Were prophylactic antibiotics administered prior to the surgery? Why is this important?
    Answer this question
    Antibiotic prophylaxis is always indicated in microsurgical operations.
    (2012) 65 EJPRAS 5 601-609

  • Were there any intra-operative complications? Why is this important?
    Answer this question
    Endoscopic sinus surgery has an impressive and continually improving safety record. Increasing surgical experience and improved techniques and equipment make this procedure fundamentally safe. Anatomic variations, extensive disease, and the tight confines that the sinuses occupy between the skull base and orbits, however, do allow the possibility of untoward events.
    (2004) 37 EOTCNA 2 453-472

  • Was the biopsied specimen sent for further investigations? Why is this important?
    Answer this question
    Biopsy is usually done during the procedure, and sent for analysis, to determine, the pathology of the lesion.
    (2012) 24 EOMSCA 2 175-189

  • Were post-operative imaging studies performed? Why is this important?
    Answer this question
    CT or MRI performed after endoscopic sinus surgery will demonstrate postsurgical changes, verify the success of the procedure, and alert the clinician of any complications.
    (2012) 24 EOMSCA 2 175-189

  • Was the patient given discharge instructions? Why is this important?
    Answer this question
    Patient education needs to be conducted while the patient is still hospitalized.
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  • Were there any post-operative complications? Why is this important?
    Answer this question
    Every patient must be made aware of the possible intra-cranial complications. A thorough discussion of the technique and risks and benefits is necessary. The incidence of complications in nasal and sinus surgery is low, therefore, on balance, the potential benefits far outweigh the risks.
    (2004) 37 EOTCNA 2 453-472

  • Were periodic follow-up visits recommended? Why is this important?
    Answer this question
    Follow up evaluations need to be performed frequently and regularly once the patient is discharged from the hospital.
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  • Were the intra-operative complications managed appropriately? Why is this important?
    Answer this question
    An accidental injury may include bone perforation, blood vessel injury or nerve injury. Any injury must be detected, assessed and managed immediately.
    (2004) 37 EOTCNA2 453-472