Samuel S. Becker, MD, Guest Editors

Alexander G. Chiu, MD

Every surgical procedure involving the paranasal sinuses and skull base carries the risk of complication. Complications can occur despite surgery that has been technically well performed; however, at every step of the surgical pathway there are opportunities to minimize complications.

Medical management, including oral steroids, is often used in the diagnostic and preoperative setting. Steroids and other commonly used medications have the potential for significant side effects, and prescribing physicians should be well versed in their mechanisms of action and potential complications.

Once a decision to operate has been made, the informed consent process is critical to ensure that patients have a reasonable understanding of the potential risks, benefits, and complications involved. Before surgery, the CT scan should be evaluated by the surgeon to help plot a surgical plan and to identify anatomic “danger zones.” Intraoperatively, attention to patient positioning and anesthetic techniques has been shown to help improve outcomes and limit complications. During surgery on the nose, sinuses, and skull base, complications may involve any of the 4 sinuses—maxillary, ethmoid, sphenoid, and frontal. Surrounding structures, such as the lacrimal duct, orbit, skull base, and surrounding vasculature, may also be damaged during intranasal surgery. After surgery, proper postoperative care is important to the healing process to avoid scarring and an eventual unfavorable outcome.

When complications occur, physicians should be prepared to appropriately manage the situation. Once the situation is stabilized, a surgeon must be prepared to discuss what has occurred with appropriate members of the patient’s family.

In this issue of Otolaryngologic Clinics of North America , expert rhinologists and endoscopic skull base surgeons address the prevention and management of complications in sinus and skull base surgery. We would like to thank the authors for their contributions, the editor for her guidance, the publisher for their support, and the readers for their attention.