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C O N S E L L E R I A D E Operation for ethmoidectomy and antrostomy S A N I T A T 1. Identification and description of the procedure Consist in emptying the ethmoidal cells, widely communicating them with the nasal cavity. It can also be associated to an opening in the maxillary sinus towards the nasal cavity also from the sphenoidal sinus. It can be unilateral or bilateral. It is performed with help from a microscope on endoscope through the nasal orifices. 2. Purpose of the procedure and benefits that are expected to be achieved It is usually performed for the extirpation of the nasal polyps or as a sinus treatment. In cases of nasal polyps the benefit a better disease control with resolution of the obstruction. In the rest of the cases a definitive cure when the operation has been successful. 3. Reasonable alternatives to this procedure If you decide to be operated you must continue a medical treatment and radiological controls to evaluate its progress. 4. Foreseeable consequences of its performance The foreseeable consequences of its performance are............................................................................................................. ...................................................................................................................................................................................................................... 5. Foreseeable consequences of its non performance Continue with the symptoms you are suffering from. The risks of not operating include ocular complications and endocranial complications. 6. Risks The vital risks are not very frequent, even though, as in any medical act and keeping in mind the necessity of general anaesthesia in all the cases, they can occur. These vital risks, both intra and well as postoperative are those of any major surgery and are closely related to age, the general state and the associated pathologies which the patient has. SPECIALITY IN OTORHINOLARYNGOLOGY The complications of this surgery include: Complications adherent to the anaesthesia act. Eye swelling. Haematoma or ocular abscess: that could require a new operation. Vision loss: It can be temporary, and even though it is extremely rare it can be persistent. Intracranial complications: Even though highly rare, meningitis or cerebral abscess could occur. Pain: the first days after surgery. Cerebralspinal liquid fistula: Haemorrhage: that could require blood transfusion. Nose dryness. The side effects that can be left after an ethmoidectomy with antrostomy are the following: Non-recuperation of the sense of smell. The previously mentioned vision loss. Epiphora or eye watering. After the intervention you will have the nose plugged up for at least one day. During a few weeks you will abundant scabs, hence you will have to perform nasal rinses. 7. Risks depending on the patient's clinical situation Other risks or complications that might appear, given your clinical situation and your personal circumstances, are ........................................................................................................................................................................................................... ...................................................................................................................................................................................................................... Operation for ethmoidectomy and antrostomy 8. Declaration of consent aged , with home address at , National Identity No. Mr./Mrs./Miss. Mr./Mrs./Miss. and SIP number aged , with home address at acting in the capacity of (the patient's legal representative, relative or close , with National Identity No. friend) HEREBY DECLARE: That the Doctor situation to perform In has explained to me that it is advisable/necessary in my on ,2 Signed: Mr./Mrs./Miss. With National Identity Card No Signed: Dr. With National Identity Card No Associate number 9. Revocation of the consent I hereby revoke the consent granted on the date of to carry on with the treatment that I hereby terminate on this date. In Associate number: and I do not wish ,2 Signed: The patient SPECIALITY IN OTORHINOLARYNGOLOGY Signed: The Doctor on ,2