Sphenoidotomy Periprocedural Care

Updated: Mar 19, 2015
  • Author: Thomas S Higgins, Jr, MD, MSPH; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Periprocedural Care

Patient Education & Consent

The risks, benefits, alternatives, and complications should be discussed with the patient before undergoing any procedure. The risks of endoscopic sphenoidotomy include, but are not limited to, the following: [3]

  • Bleeding
  • Infection
  • Anesthetic risks
  • Scarring
  • Recurrence of disease
  • Skull base injury, cerebrospinal fluid leak, and meningitis
  • Eye or vision loss and orbital nerve or optic chiasm injury
  • Carotid artery injury
  • Postoperative ostial stenosis
  • Mucocele formation
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Equipment

Equipment involved in sphenoidotomy includes the following:

  • Endoscope or microscope
  • Suction
  • Nasal curette
  • Nasal thru-cutting or grasping forceps
  • Sphenoid mushroom punch
  • Kerrison punch
  • Sickle knife
  • Microdebrider (judicious use only)
  • Image guidance probe
  • Drill (for severe osteitis or pituitary tumor approaches)
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Patient Preparation

Anesthesia

Sphenoidotomy, along with other components of a functional endoscopic sinus surgery, is usually performed under general anesthesia. There are rare occasions when a surgeon may elect to perform a sphenoidotomy under local anesthesia in the operating suite or office setting.

Positioning

The patient is positioned in the standard supine positioning for endoscopic sinus surgery. Each surgeon has preferences for positioning. Some head positions that may assist the surgeon include elevating the head or reverse Trendelenburg positioning and tilting the head toward the surgeon.

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Monitoring & Follow-up

The postoperative management of a endoscopic sphenoidotomy is similar to that of other procedures in functional endoscopic sinus surgery. Patients are often asked to perform nasal saline irrigations or lavages several times a day. Postoperative antibiotics and oral corticosteroids are given per surgeon preference.

Patients are usually seen in clinic for nasal endoscopy with debridement at about 1-2 weeks after surgery. The debridement of crusts and blood clots, as well as the early identification of scar tissue, helps limit postoperative adhesions.

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