Fehler und Gefahren: Eingriffe an den Nasennebenhöhlen und der Frontobasis unter Berücksichtigung mediko-legaler Aspekte

Zusammenfassung

In der endoskopischen Nasennebenhöhlenchirurgie haben sich in den letzten 2 Jahrzehnten technische und praktische Standards herausgebildet. Entsprechende Eingriffe sind international weit verbreitet. Bei routinemäßigen endoskopischen Nebenhöhleneingriffen muss man dessen ungeachtet in 5% mit leichten und in 0,5–1% mit gravierenden Komplikationen rechnen. Im Rahmen einer umfassenden Literaturübersicht wird eine systematische Aufstellung mit Erörterung der Pathogenese, des klinischen Bildes und der speziellen Therapie aller wesentlicher Komplikationen der endonasalen Nasennebenhöhlenchirurgie vorgenommen. In Detail erfolgt auch eine Wertung der Vorgänge in mediko-legaler Hinsicht und eine Erörterung der Konsequenzen für eine optimierte Struktur- und Prozessqualität der HNO-Fachabteilungen und der fachärztlichen Ausbildung.

Abstract

Comprehensive Review on Danger Points, Complications and Medico-Legal Aspects in Endoscopic Sinus Surgery

Endoscopic endonasal sinus surgery represents the overall accepted type of surgical treatment for chronic rhinosinusitis. Notwithstanding raised and still evolving quality standards, surgeons performing routine endoscopic interventions are faced with minor complications in 5% and major complications in 0.5–1%.

A comprehensive review on all minor and major complications of endoscopic surgery of the paranasal sinuses and also on the anterior skull base is presented listing the actual scientific literature. The pathogenesis, signs and symptoms of each complication are reviewed and therapeutic regimens are discussed in detail relating to actual publication references. Potential medico-legal aspects are explicated and recent algorithms of avoidance are mentioned taking into account options in surgical training and education.

Schlüsselwörter

endonasale Nasennebenhöhlenchirurgie - FESS - endoskopische Nebenhöhlenchirurgie - Komplikationen - mediko-legale Aspekte

Key words

endoscopis sinus surgery - FESS - skull base surgery - complications - review - medico-legal aspects

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