Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon
Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

Information is supplied only upon the condition that the viewer will make their own determination as to the suitability of the information for its purposes prior to use.  There will be no responsibility for information that is misused or misinterpreted and the information should not be used as a substitute for consultation with a health care professional.  It is not possible to answer questions regarding individual cases or to enter into individual correspondence.

ENT Surgical Complications

General postoperative complications (applying to all procedures):

  • Anaesthetic complications
  • Failure to improve
  • Requirement for future medical treatment or revision surgery
  • Local trauma from surgery
  • Post-operative discomfort
  • Infection
  • Bleeding – primary (within first 48 hours) or secondary (typically around 7-10 days)
  • Scarring from any skin incision
  • Transfusion of blood products
  • DVT/Pulmonary embolus
  • Time off work post-operatively – ask surgeon

Additional specific complications for procedures as indicated:

Ear (Otology)

Grommet (Ventilation tube) insertion

General postoperative complications above plus

  • Infection with discharge from grommet (otorrhoea), possible requiring (topical) ear drops or (systemic) oral medication
  • Discomfort (otalgia)
  • Early extrusion of grommet, earlier than 6 – 18 months for standard grommet, 6 months for mini-grommet
  • Elective removal of grommet under anaesthesia (general or local)
  • Recurrence of middle ear effusion (fluid or “glue”)
  • Future reinsertion of grommet
  • Persistent tympanic perforation (hole) – typically 1% or less –  requiring observation or future surgery with graft (myringoplasty)
  • Persistent hearing loss

 Myringoplasty

(operation to repair hole in tympanic membrane – the “eardrum”) or Tympanoplasty (repair of tympanic membrane and middle ear reconstruction, attempting to also improve hearing if possible): general postoperative complications above plus

  • Shave of hair around ear
  • Incision in front of or behind ear, which may produce scarring
  • Postoperative head bandage, dressing in and around ear and skin sutures
  • Graft failure, leaving persistence of tympanic perforation (10 – 50%), with possible persistence of recurrent ear infections and discharge from ear
  • Failure of hearing to improve and – very rarely – worsening of hearing
  • Numbness of lateral border of tongue/ possible impairment or change of taste
  • Facial palsy (weakness of movement of side of face of surgery) – rare
  • Dizzyness/ vertigo
  • Tinnitus
  • Protuberance of pinna “bat ear”

Stapedectomy

General postoperative complications above plus Myringoplasty/Tympanoplasty  plus:

  • Facial palsy (weakness of movement of side of face of surgery): 1%
  • Dead Ear – complete loss of hearing 1%

Mastoid exploration

(operation for Cholesteatoma or Mucosal disease of middle ear/ mastoid): general postoperative complications above plus Myringoplasty/Tympanoplasty  plus:

  • Facial palsy (weakness of movement of side of face of surgery): 1 – 3%
  • Recurrence of disease requiring revision surgery
  • Elective (planned) 2nd or 3rd look operation to exclude recurrence of disease
  • Long-term regular review of mastoid cavity
  • Chronic discharge from ear
  • Swimming may be contraindicated, depending on mastoid cavity and outcome

Nose (Rhinology)

MUA (Manipulation under anaesthesia) fractured nose

general postoperative complications above plus:

  • Nasal packing
  • External splint or dressing
  • Bruising/Facial swelling
  • Persistence/recurrence of deformity requiring future surgery such as Septorhinoplasty

Septoplasty

(including SMR) and Turbinate surgery (including outfracture, reduction, SMD, cautery and trimming): general postoperative complications above plus:

  • Possible need for postoperative nasal packs/dressings/splints
  • Headache and local discomfort
  • Septal perforation (hole in internal partition of nose)
  • Loss of sense of smell (Anosmia)
  • Loss of sense of taste (Ageusia) or impairment of taste (Hypogeusia)
  • Numbness of upper incisor teeth
  • Change in shape of nose; even collapse producing “saddle nose”
  • Crusting, dryness, unpleasant smell in nose (Atrophic rhinitis/Ozaena)
  • Adhesions forming between medial and lateral nasal walls, compromising airway and requiring future surgery to divide them

Endoscopic Sinus Surgery (FESS/ESS)

General postoperative complications above plus Septoplasty/Turbinate surgery plus:

  • Failure to improve or recover sense of smell
  • Persisting, or future recurrence of, nasal blockage
  • CSF leak (leakage of cerebrospinal fluid) (0.5%)
  • Orbital/ocular complications affecting eye, possible impairment or loss of vision (extremely rare) or double vision (diplopia) or impairment of movement of eye (also extremely rare)

Rhinoplasty/Septorhinoplasty:

  • General postoperative complications above plus MUA plus Septoplasty/Turbinate surgery plus:
  • Failure to improve or worsening of nasal shape, requiring future corrective surgery – 10% may require revision surgery to some degree
  • Facial swelling, bruising, “black eyes”, settling over 2-3 weeks
  • External dressing, usually Plaster of Paris splint for 1 week

Head and Neck

Excision of skin lesions

general postoperative complications above plus:

  • Insertion of drains through skin post-operatively
  • Re-exploration of wound to evacuate haematoma
  • Numbness of skin around incision
  • Scarring
  • Keloid formation (very prominent, hypertrophic, scar)
  • Recurrence of original lesion
  • Need for revision/future surgery

Thyroid and Parathyroid surgery

General postoperative complications above plus excision of skin lesions plus:

  • Trauma to recurrent laryngeal nerve causing weakness/loss of voice or breathing problems
  • Future need for thyroid or calcium supplementation

Submandibular gland excision

General postoperative complications above plus excision of skin lesions plus:

Salivary collection/Fistula/Ranula

Trauma to local nerves:

  • Marginal mandibular nerve causing lower facial weakness, especially around angle of mouth
  • Lingual nerve causing loss of sensation and taste to part of tongue
  • Hypoglossal nerve causing deviation of tongue

Parotid gland surgery

General postoperative complications above plus excision of skin lesions plus:

  • Salivary collection/Fistula
  • Frey’s syndrome, involving “gustatory sweating”, with perspiration over neck when eating, producing wetness and soreness
  • Facial palsy, with weakness affecting whole side of face including eye

Endoscopy, including Microlaryngoscopy, Pharyngoscopy, Oesophagoscopy and “Panendoscopy”:

General postoperative complications above plus:

  • Trauma to teeth/lips/gums/displacement of dental crowns or fillings
  • Alteration of voice
  • Cervical (Neck) discomfort due to tear or Surgical Emphysema (gas in tissues) requiring further surgical exploration

Tonsil and Adenoid surgery

General postoperative complications above plus:

  • Trauma to teeth/lips/gums/displacement of dental crowns or fillings
  • Significant post-operative discomfort
  • Bleeding: may include “primary” bleed within first 48 hours post-op (1%) or “secondary” at around 7 to 10 days post-op (up to 8%), any of which may require emergency attendance to hospital, local treatment/readmission/return to theatre
  • Time off school or work for up to 2 weeks for tonsil surgery, up to 1 week for adenoid surgery, as advised by surgeon and nursing staff

Neck Dissection

General postoperative complications above plus excision of skin lesions plus:

  • Transfusion of blood products
  • Extensive numbness around incisions
  • Breakdown of wound
  • Trauma to Accessory nerve producing stiffness/weakness of shoulder movement
  • Lymphatic leak or fistula requiring further surgery
  • Trauma to local nerves:
  • Marginal mandibular nerve causing lower facial weakness, especially around angle of mouth
  • Lingual nerve causing loss of sensation and taste to part of tongue
  • Hypoglossal nerve causing deviation of tongue
  • Change, or difficulty, with voice or swallowing
  • Cosmetic change to area
  • Post-operative chest or urinary infection, especially if catheter required
  • Possible future surgery involving flap or Tracheostomy
  • Horner’s Syndrome, involving – on that side – ptosis (weakness and drooping of eyelid), meiosis (small pupil), anhidrosis (loss of local sweating), enophthalmos (recession of eyeball) if any trauma to T1 sympathetic nerves
  • Time off work for at least 3 weeks, as advised by surgeon

Laryngectomy

General postoperative complications above plus excision of skin lesions plus:

  • Transfusion of blood products
  • Extensive numbness around incisions
  • Breakdown of wound
  • Loss of normal voice; possible future assistance from use of valve, recycled air or external device with help from Speech Therapy; possible failure to achieve any voice
  • Alteration of swallowing
  • Need for tube in neck to maintain airway
  • Future surgery/x-ray treatment/chemotherapy depending on clinical situation
  • Fistula/leak from oesophagus (gullet)
  • Time off work for at least 3 weeks, as advised by surgeon