In response to Complications in endoscopic sinus surgery for chronic rhinosinusitis: A 25‐year experience

It is a pleasure to respond to the letter to the editor by Dr. Edward Wladis. I am in total agreement with the excellent points described in his letter. It is unfortunate but true that despite thousands of cadaver courses teaching the principles and surgical techniques of endoscopic sinus surgery since 1985 in the United States, the teaching of how to perform a lateral canthotomy with or without cantholysis to save a patient’s vision from orbital hematoma is rarely taught. In addition, external sinus procedures that could serve as an alternative to a lateral canthotomy/cantholysis are also now rarely taught due to the popularity of endoscopic sinus surgery. Although endoscopic orbital decompression is a procedure that is sometimes taught in dissection courses, it is seldom used in practice outside of academic institutions. Unfortunately, short of these dissection courses, we have no similar eye-related procedures that allow teaching of canthotomy/cantholysis. The problem is that orbital hematoma with potential for blindness is still a fact of life for endoscopic sinus surgeons. It happens even as we speak. Vision is lost in most of these cases when adequate decompression is not performed. Residency programs in otolaryngology–head and neck surgery and perhaps the American Board of Otolaryngology need to understand that the teaching of procedures such as canthotomy (cantholysis) to treat complications of the primary procedures we perform is as important as the teaching of the primary procedures themselves. Complications of surgery can be devastating to a patient’s quality of life and sometimes to life itself. Anything we can do as teachers of surgical practice to limit complications and prevent permanent injury is appropriate and should be done. Every endoscopic sinus surgery cadaver course should include in the dissection how to perform canthotomy/cantholysis, orbital decompression, external ethmoidectomy, and cerebrospinal fluid leak repair. Waiting for an ophthalmologist to assist us in the treatment of an orbital complication is often not feasible or practical. We need to act for the patient’s sake emergently by performing vision-saving or lifesaving procedures we are familiar with so they are performed correctly.