Clinical pearls in endoscopic sinus surgery: Key steps in preventing and dealing with complications

Increasing prevalence of patients undergoing endoscopic sinus surgery (ESS) makes understanding methods to preventing complications important to otolaryngologists. This commentary details clinical pearls and perioperative strategies that may minimize complications and increase preparedness for appropriate decision making in the event of a complication. Preoperative preparation is an important factor in preventing adverse events in ESS. This includes ensuring the presence of objective radiographic findings before pursuing operative management, both for patients' safety as well as medicolegal reasons, and providing adequate preoperative patient education. Appreciating variants in skull base and orbital wall anatomy through preoperative imaging is crucial for avoidance of intracranial and orbital complications. The importance of optimal visualization intraoperatively and the appropriate role of CT-guided imaging are also discussed. Finally, strategies for dealing with postoperative sequelae of more common complications are noted. This article represents a brief review for introductory sinus surgeons and is not meant as an all encompassing review.