State Consumer Disputes Redressal Commission
Sawecha Kothari vs Geetaanjali Medical on 8 October, 2021
Page 1 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 jktLFkku jkT; miHkksDrk fookn izfrrks"k vk;ksx] lfdZV cSap mn;iqj ¼jkt0½ ifjokn la[;k %& 02@2011 1- Kumari Swechha Kothari D/o Shri Arun Kothari, 200-A Block Hiran Magri, Sector 14, Udaipur (Raj.) 2- Shri Arun Kothari S/o Late Shri Mohan Lal Kothari, 200-A Block Hiran Magri, Sector 14, Udaipur (Raj.) &ifjoknhx.k cuke~ 1- Geetanjali Medical College and Hospital, Hiran Magari Extension, Eklingpura Chauraha, Udaipur (Raj.) Through Chairman and Managing Director.
2- Dr. A.K. Gupta, ENT Specialist, Geetanjali Medical College and Hospital, Hiran Magari Extension, Eklingpura Chauraha, Udaipur (Raj.) 3- The Oriental Insurance Corp. Ltd.
DO 3 Nyay Marg, Out side Delhi gate, Udaipur (Raj.) 313001 &foi{khx.k le{k % eku~uh; Jh ,l-ds-tSu] lnL; ¼U;kf;d½ eku~uh; Jh jkeQwy xqtZj] lnL;
mifLFkr %& 01- Jh ts-ih-'kekZ] vf/koDrk ifjoknhx.k dh vksj ls A 02- Jh jkgqy esgrk] vf/koDrk] foi{kh la01 o 2 dh vksj ls A 03- Jh ds-,e- lsBh] vf/koDrk] foi{kh la03 dh vksj ls A Page 2 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 fu.kZ; fnukad 08 vDVwcj] 2021 jkT; miHkksDrk vk;ksx]lfdZV cSap mn;iqj] }kjk Jh ,l0ds0tSu] lnL; ¼U;kf;d½ 01- ifjoknhx.k us foi{khx.k ds fo#) ;g ifjokn i= bl vk;ksx esa fnukad 03-05-2010 dks bu rF;ksa ds lkFk izLrqr fd;k fd ifjoknh la[;k&2 dh iq=h ifjokfn;k la[;k&1 vBkjg o"kZ dh uo;qorh gS] ftlus fnukad 10-04-2008 dks foi{kh la[;k&1 vLirky esa foi{kh la[;k&2 MkW0 ,-ds-xqIrk dks viuh ukd fn[kk;h Fkh] D;ksfa d mldh ukd ls yhdst gksrk Fkk] rc MkW0 ,-ds-xqIrk us VkWpZ ls ukd dks ns[kk ,oa nwljs fnu fnukad 11-04-2008 dks lhVh Ldsu] ,Dljs djk;s fcuk Nasal Polyp vkWijs'ku dj fn;k A vkWijs'ku ds ckn ifjokfn;k la[;k&1 ds 'kjhj esa xEHkhj flj nnZ dh f'kdk;r gq;h] rc foi{kh la[;k&2 us Vovran batsD'ku ns fn;k rFkk fnukad 12-04-2008 dks lhVh Ldsu djk;h ,oa mlh fnu CT enjoy Hkh djk;h] rc ;g ik;k x;k fd ifjokfn;k la[;k&1 ds flj esa Undisplaced Fracture Fkk A bl izdkj foi{kh la[;k&2 ukd] dku] xyk fo'ks"kK us fcuk lhVh Ldsu ds ykijokghiwoZd vkWijs'ku dj fn;k] ftlls ifjokfn;k la[;k&1 ds flj esa gsejst gks x;k A ifjoknhx.k us fMLpktZ djus ds fy, dgk] fdUrq foi{kh la[;k&1 rFkk 2 us ifjokfn;k la[;k&1 dks vLirky ls fMLpktZ ugha fd;k A fnukad 16-04-2008] 18-04-2008 rFkk fnukad 21-04-2008 dks lhVh Ldsu djk;s x;s ,oa bZykt pkyw j[kk x;k] fdUrq ifjokfn;k la[;k&1 dh fLFkfr esa dksbZ lq/kkj ugha gqvk ,oa gkyr fcxM+rh pyh x;h A fnukad 23-04-2008 dks jktdh; vLirky ds U;wjksfQftf'k;u fpfdRld MkW0 ,-,-'kSQh dks ifjoknh la[;k&2 us ifjokfn;k la[;k&1 ds bZykt ls lEcfU/kr nLrkostkr fn[kk;s] rc mUgksaus ,e-vkj-vkbZ- djok;h] rc ifjokfn;k la[;k&1 ds Subarachnoid hemorrhage (SAH) ik;k x;k] rc fnukad 24-04- 2008 dks ifjokfn;k la[;k&1 dks fMLpktZ fd;k x;k A mlds ckn ifjokfn;k la[;k&1 dks vgenkckn esa MkW0 nhid iVsy dks fn[kk;k x;k] ftUgksua s fnukad 26-04-2008 dks ifjokfn;k la[;k&1 ds czsu dk vkWijs'ku fd;k ,oa vxys rhu o"kksZa rd yxkrkj bZykt pyus dh ckr crk;h x;h A MkW0 nhid iVsy us ;g Hkh crk;k fd ifjokfn;k la[;k&1 okgu ugha pyk ldsxh] vkx o ikuh ds ikl ugha tk,xh] ÅapkbZ ij ugha p<+ ik;sxh A bl izdkj ifjoknhx.k ds vuqlkj foi{kh la[;k&1 o 2 us fcuk lhVh Ldsu djk;s Nasal Polyp vkWijs'ku dj fn;k] ftlds dkj.k Subarachnoid hemorrhage (SAH) gks x;k A foi{khx.k Page 3 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 us ifjokfn;k la[;k&1 dks fcuk fdlh dkj.k ds 14 fnuksa rd vius vLirky esa jde ,aBus ds mn~ns'; ls HkrhZ j[kk rFkk blh dkj.k ls ifjoknhx.k ds ifjokn i= esa crk;s vuqlkj 1]84]284@&#i;s bZykt esa [kpZ gks x;s A ifjoknhx.k us ifjokn i= izLrqr dj ;g vuqrks"k pkgk gS fd bZykt esa [kpZ gq;h jkf'k] vxys rhu o"kZ ds bZykt ds fy, [kpZ jkf'k rhu yk[k #i;s] ekufld o 'kkjhfjd larki isVs nl yk[k #i;s] lkekU; thou thus ls oafpr jgus ds fy, lkr yk[k #i;s] ikSf"Vd vkgkj vkfn ds fy, rhu o"kZ ds rhu yk[k #i;s] rhu o"kksZa rd vgenkckn tkdj bZykt djkus ds isVs rhu yk[k #i;s dqy 27]50]000@&#i;s fnyk;s tkus dk fuosnu fd;k gS A ifjoknhx.k us izkjEHk esa foi{kh la[;k&1 rFkk 2 dks gh i{kdkj cuk;k Fkk] fdUrq ckn esa foi{kh la[;k&3 chek dEiuh dks Hkh i{kdkj cuk;k x;k gS A 02- foi{kh la[;k&1 rFkk 2 us tcko ifjokn i= izLrqr dj ifjokn i= ds rF;ksa ls bUdkj djrs gq, ;g fy[kk fd bl ekeys esa foLr`r lk{; dh vko';drk gksus ds dkj.k bl vk;ksx }kjk fu.kZ; ugha fd;k tkuk pkfg,] cfYd flfoy U;k;ky; }kjk fu.kZ; fd;k tk ldrk gS A ;g Hkh fy[kk fd jksVsjh Dyc ds lg;ksx ls foi{kh la[;k&1 vLirky }kjk fu%'kqYd dSEi yxk;k x;k Fkk] tgkW ifjokfn;k la[;k&1 dks fn[kk;k x;k Fkk rFkk vkWijs'ku Hkh fu%'kqYd fd;k x;k Fkk A ;g Hkh fy[kk gS fd foi{kh la[;k&2 vuqHkoh] ;ksX;] fMxzh/kkjh ukd] dku] xyk fo'ks"kK gS A ifjokfn;k la[;k&1 us blds igys Hkh MkW0 jktho lDlsuk ukd] dku xyk fo'ks"kK dks fnukad 15-03-2008 dks fn[kk j[kk Fkk A mUgksua s Hkh Nasal Polyp chekjh gh crk;h Fkh A ;g Hkh fy[kk fd foi{kh la[;k&2 us lhVh Ldsu djkus dh lykg nh Fkh] fdUrq ifjoknh ds }kjk lhVh Ldsu djkus ls euk dj fn;k x;k Fkk A ;g Hkh fy[kk fd ifjokfn;k la[;k&1 ds Dyhfudy ijh{k.k ls Nasal Polyp gksuk gh ik;k x;k] ftldk vkWijs'ku lHkh lko/kkuh cjrrs gq, Endosclopy ds ek/;e ls fd;k x;k A ;g vkWijs'ku ifjokfn;k la[;k&1 ds ifjtuksa dh lgefr ls fd;k x;k Fkk A vkWijs'ku ls gksus okys dkWEiyhds'kUl ifjoknh la[;k&2 dks crk fn;s x;s Fks A bl izdkj mUgksaus foi{kh la[;k&2 fpfdRld dh ykijokgh gksus ls bUdkj fd;k gS A muds vuqlkj ifjokfn;k la[;k&1 ds czsu vFkok Cribriform Plate esa dksbZ pksV ugha igqWph gS A ;g Hkh fy[kk fd fpfdRld us ukd dh cka;h lkbZM esa vkWijs'ku fd;k Fkk] tcfd ifjokfn;k la[;k&1 ds flj esa nkfguh rjQ QzsDpj ik;k x;k gS A ;g Hkh fy[kk gS fd muds }kjk vkWijs'ku ds ckn yxkrkj lhVh Page 4 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 Ldsu djk;h x;h gS rFkk fnukad 23-04-2008 ds lhVh Ldsu esa Subarachnoid hemorrhage (SAH) dh iw.kZ fjdojh vk;h gS A bl izdkj muds vuqlkj muds vLirky esa Subarachnoid hemorrhage (SAH) dk bZykt Hkh fd;k x;k gS A ;g Hkh fy[kk x;k gS fd ,e-vkj-vkbZ- fjiksVZ ls ifjokfn;k la[;k&1 ds dksbZ CSF Leakage ugha ik;k x;k gS] ftldk ;gh vFkZ fudyrk gS fd foi{kh la[;k&2 }kjk lgh <ax ls vkWijs'ku fd;k x;k gS A ;g Hkh fy[kk x;k gS fd 12 fnuksa dk bZykt dk [kpZ foi{kh la[;k&1 vLirky esa ek= 14]400@&#i;s] MkW0 foftV ,oa tkWpksa dk [kpZ 24]230@&#i;s vk;k Fkk] ftlesa ls Hkh 30 izfr'kr NwV nsdj 15]500@&#i;s dk gh fcy fn;k x;k FkkA mUgksua s ;g Hkh fy[kk gS fd ifjoknh la[;k&2 us jktLFkku esfMdy dkmfUly esa Hkh f'kdk;r dh Fkh] rc foi{kh la[;k&1 esfMdy dkWyst ds }kjk tkWp desVh cuk;h x;h Fkh] ftUgksaus foi{kh la[;k&2 dh dksbZ ykijokgh ugha ekuh gS rFkk jktLFkku esfMdy dkmfUly ds }kjk Hkh lkjs ekeys dks ns[kk x;k] rc Hkh dksbZ ykijokgh ugha ekuh x;h A bl izdkj mUgksua s ifjokn i= [kkfjt fd;s tkus dk fuosnu fd;k gS A 03- foi{kh la[;k&3 chek dEiuh dh vksj ls tcko ifjokn i= izLrqr dj foi{kh la[;k&2 ds fy, ikap yk[k #i;s rd dk chek djuk Lohdkj fd;k gSA chek dEiuh us vius tcko ifjokn i= esa yxHkx ogha rF; nksgjk;s gSa] tks foi{kh la[;k&1 o 2 us vius tcko ifjokn i= esa fy[ks gSa A bl izdkj mUgksaus ifjokn i= [kkfjt fd;s tkus dk fuosnu fd;k gS A 04- mHk; i{k ds }kjk 'kiFk i= ,oa fofHkUu nLrkostkr izLrqr fd;s x;s gSa] ftudk vko';drk vuqlkj vkxs foospu fd;k tk,xk A 05- mHk; i{k ds fo}ku~ vf/koDrkx.k dh cgl lquh x;h ,oa i=koyh dk voyksdu fd;k x;k A 06- gLrxr izdj.k esa ;g rF; fufoZokfnr gS fd foi{kh la[;k&1 vLirky ds fpfdRld foi{kh la[;k&2 us ifjokfn;k la[;k&1 dk Nasal Polyp vkWijs'ku Endoscopy ls fnukad 11-04-2008 dks fd;k gS A ml le; rd lhVh Ldsu ugha djk;h x;h Fkh A vkWijs'ku ds ckn ifjokfn;k la[;k&1 dks xEHkhj flj nnZ dh f'kdk;r gksus ij fnukad 12-04-2008 dks foi{kh la[;k&2 ds }kjk gh lhVh Ldsu djok;h x;h gS] ftlesa Subarachnoid hemorrhage (SAH) vk;k gS A foi{kh la[;k&1 vLirky esa ifjokfn;k la[;k&1 dks fnukad 24-04-2008 Page 5 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 rd HkrhZ j[kk x;k gS A fnukad 23-04-2008 dks ,e-vkj-vkbZ- djk;h x;h gS] ftlesa fuEufyf[kr rF; izdV gq;s gSa %& "MR imaging reveals:- A bony defect at the base of the anterior cranial fossa on the left side of the midline with herniation of the cerebral parenchyma through it into the superior aspect of the left side of the nasal cavity suggestive of an encephalocele. No evidence of CSF leakage at present. subarachnoid haemorrhage along the anterior interhemispheric fissure. A small bony defect at the roof of the right orbit."
fnukad 26-04-2008 dks vgenkckn esa MkW0 nhid iVsy }kjk ifjokfn;k la[;k&1 ds czsu dk vkWijs'ku Hkh fd;k x;k gS A 07- esfMdy fyVjspj ds vuqlkj Nasal Polyp ds ckjs esa fuEukuqlkj crk;k x;k gS %& A nasal polyp is a benign (noncancerous) tumor that grows from the lining of the nose or sinuses. These polyps usually occur in both the right and left nasal passages and obstruct the flow of air. They can make your nose feel stuffy, and can decrease your sense of smell. Not all growths in the nose are polyps.
Nasal polyps may result from chronic (long-lasting) inflammation of the lining of the nose, although they often occur for no apparent reason. People with chronic hay fever (allergic rhinitis) are more likely than others to develop nasal polyps. In addition, nasal polyps commonly develop in children with cystic fibrosis.
People with nasal polyps and asthma often are allergic to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. They may experience a sudden, severe shortness of breath if they take one of these drugs.
If you have nasal polyps and asthma, avoid medications containing aspirin or other NSAID. Remember that aspirin and other NSAIDs are present in many over-the-counter pain pills and cold and flu remedies. They also are present in some skin creams.
Page 6 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq jifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 Symptoms The key symptoms of nasal polyps are:
Difficulty breathing through your nose Constant draining from your nose Persistent stuffiness and facial discomfort Frequent sinus infections Loss of smell Diagnosis Your doctor will ask about your medical history. He or she probably will ask if you have a history of hay fever, allergic rhinitis, asthma or an allergy to aspirin.
The doctor, most commonly an otolaryngologist (ear nose and throat specialist) will examine your nose and look for translucent grapelike masses colored yellow to gray. He or she usually can detect polyps by examining your nasal passages with a special instrument called a nasal endoscope, a small, flexible tube connected to a camera. Sometimes, a computed tomography (CT) scan may be used to determine the location and size of the polyps. CT scanning also will tell if the polyps are coming from the nose or from the sinuses.
Nasal polyps almost always occur on both sides. If a polyp is seen only on one side, a CT scan should be done to make sure that the growth is not something more serious. The scan also can accurately show the size of the growth.
In addition to examining your nasal passages, your doctor will ask about your medical history. He or she probably will ask if you have a history of hay fever or allergic rhinitis, asthma or an allergy to aspirin.
Treatment Page 7 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 If the nasal polyps are small, your doctor may prescribe a nasal spray containing corticosteroids, perhaps along with corticosteroid pills. This medication will shrink the polyps slowly and prevent them from returning. Large polyps that do not respond to medical therapy usually require surgery. In most cases the surgery is an outpatient procedure. The surgeon may use a small tube called an endoscope to do the surgery. This avoids the need to make an external incision on the face. The surgeon will send some of the polyp tissue to a lab for closer examination. In rare cases, what appeared to be a polyp may turn out to be something else.
For unilateral polyps, a biopsy usually should be done or they should be removed to make sure they are benign.
08- esfMdy fyVjspj ds vuqlkj Subarachnoid hemorrhage (SAH) ds ckjs esa fuEu izdkj ls crk;k x;k gS %& What is a subarachnoid hemorrhage ?
Subarachnoid hemorrhage (SAH) refers to bleeding within the subarachnoid space, which is the area between the brain and the tissues that cover the brain.
The subarachnoid space is the space where the cerebrospinal fluid circulates, and it's responsible for protecting your brain from injury by serving as a cushion. A hemorrhage in this space can cause a coma, paralysis and even death.
This condition can occur quickly, and is often the result of head trauma. The key to survival is immediate medical intervention. Call a doctor or 911 as soon as possible if you or someone you know has the symptoms of SAH.
This life-threatening condition is also rare. According to the Brain Aneurysm Foundation, SAH accounts for between 0.01 and 0.08 percent of visits to the emergency room.Page 8 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j
ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 09- esfMdy fyVjspj ds vuqlkj Nasal Polyp ltZjh ds fuEufyf[kr Complications gks ldrs gSa %& Major complications include the following ; 1- Central nevous System - Surgery - related cerebrospinal fluid leak, meningitis, intracranial hemorrhage, brain abscess, brain herniation 2- Orbit - Blindness, optic nerve injury, orbital hematoma, eye muscle injury leading to diplopia, nasolacrimal duct injury leading to epiphora 3- Vascular - Vascular injury leading to severe hemorrhage 4- Death 10- gLrxr izdj.k esa rF;kRed fLFkfr ;g Li"V gq;h gS fd foi{kh la[;k&2 fpfdRld us foi{kh la[;k&1 vLirky esa fcuk lhVh Ldsu djk;s ifjokfn;k la[;k&1 dh Nasal Polyp ltZjh fnukad 11-04-2008 dks dh gS A blds ckjs esa ;|fi foi{khx.k us ;g crkus dk iz;kl fd;k gS fd mUgksua s vkWijs'ku djus ds igys lhVh Ldsu rFkk ih-,u-,l- djkus dh lykg nh Fkh] fdUrq ifjoknh la[;k&2 us euk dj fn;k Fkk A bl ckjs esa mUgksua s Routine investigations :
(Available) 'kh"kZd okyk nLrkost izLrqr fd;k gS] ftlesa fnukad 10-04-2008 dks tkWpksa dh tks lykg nh x;h Fkh] mudk fooj.k gS rFkk vLirky esa HkrhZ djus dh lykg nh x;h Fkh A blesa fpfdRld us ,Dljs ih,u,l] CyM VsLV rFkk ;wfju VsLV fy[ks gSa] vFkkZr~ lhVh Ldsu djkus dh lykg ugha nh gS] cfYd vLirky esa HkrhZ djds ejht dks nwljs fnu 9-30 cts vkWijs'ku fFk;sVj esa Hksts tkus ds fy, fy[kk gS A bl nLrkost esa vyx gs.M jkbZfVax rFkk vyx L;kgh ls fuEufyf[kr ykbZu tksM+h x;h gS %& "CT Scan PNS advised but pt. refused."
mijksDr ykbZu vyx gs.M jkbZfVax esa rFkk vyx L;kgh ls fy[kh x;h gS] ftldk ;gh vFkZ fudyrk gS fd foi{kh la[;k&1 o 2 us vius cpko esa ;g ykbZu fy[kh gS A bl izdkj foi{khx.k dk ;g dFku ekU; ugha gS fd mUgksua s vkWijs'ku ds igys lhVh Ldsu djkuk pkgk gks] ftls ifjoknh la[;k&2 us euk dj fn;k gks A ;fn rdZ ds rkSj ij ;g eku Hkh fy;k tkos fd ifjoknh Page 9 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 la[;k&2 us viuh vkfFkZd fLFkfr ds dkj.k lhVh Ldsu djkus ls euk dj fn;k Fkk] rc Hkh foi{kh la[;k&2 dks vko';d #i ls lhVh Ldsu djkuh pkfg, Fkh] rHkh Nasal Polyp ltZjh djuh pkfg, Fkh] D;ksfa d esfMdy fyVjspj ds vuqlkj Nasal Polyp ltZjh ¿Fuctional endoscopic sinus surgery (FESS)À djus ds igys lhVh Ldsu djk;k tkuk vko';d crk;k x;k gS] ftls esfMdy fyVjspj esa fuEu izdkj ls crk;k x;k gS %& Computed tomography scans of paranasal sinuses before functional endoscopic sinus surgery Abstract This review aims to familiarize the radiologist with the common types of sinus surgery including their indications and techniques. We also illustrate how surgeons interpret 3D sinus anatomy when evaluating computed tomography (CT) studies. Preoperative evaluation by CT is mandatory for all patients undergoing functional endoscopic sinus surgery (FESS). In the past decade in particular, CT of the paranasal sinuses has become a roadmap for FESS. The radiologist's goal is to report on five key points: the extent of sinus opacification, opacification of sinus drainage pathways, anatomical variants, critical variants, and condition of surrounding soft tissues of the neck, brain and orbits. We present a systematic approach to the use of coronal, axial, and sagittal images in CT evaluation before FESS.
11- esfMdy fyVjspj ds vuqlkj Fuctional endoscopic sinus surgery (FESS) ds ckjs esa fuEu izdkj crk;k x;k gS %& Functional endoscopic sinus surgery (FESS) is a type of paranasal sinus surgery performed intranasally using a rigid endoscope. Its primary objective is to restore physiological ventilation and mucociliary transport.Page 10 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j
ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 Paranasal sinus imaging is crucial in preoperative planning and is also increasingly being used intraoperatively (image-guided surgical navigation) to help prevent complications and guide the surgeon.
Indications Indications for endoscopic sinus surgery include:
chronic or recurrent sinusits despite appropriate medical treatment or previous surgical treatment sinonasal polyposis and antrochoanal polyps paransal sinus mucoceles cerebrospinal fluid (CSF) leak closure choanal atresia repair foreign body removal epistaxis controle Certain ophthalmic procedures can also be carried out via endoscopic approach, including:
orbital decompression (e. g. thyroid - associated orbitopathy) optic nerve decompression dacryocystorhinostomy Contraindications Endoscopy cannot satisfactorily correct certain conditions; in such cases, an open technique is used. These include:
orbital abscess Pott puffy tumor certain sinonasal diseases and conditions, after failed endoscopic attempts Page 11 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 Radiographic features CT CT is the modality of choice for sinonasal surgery planning. A presurgical CT scan is now mandatory before every endoscopic sinus operation, in the interest of minimizing potential complications (see below).
An axial CT scan (1.5 mm slices or thinner) with coronal and sagittal reformation (3 mm slices or thinner) is performed for delineating both sinonasal anatomy and disease extent.
Anatomy Particular attention should be given to the following structures and anatomic variants, as failure to do so may result in serious complications.
ethmoid roof /cribriform plate dehiscence and asymmetry,
skull base angle
lamina papyracea dehiscence
carotid canal dehiscence
relationship of the optic nerve to air cells
position of the anterior ethmoidal artery
uncinate process attachments and relationships
middle turbinate variants and attachments
presence of infraorbital (Haller) and sphenoethmoidal (Onodi)
air cells
frontal recess configuration
Major complications
The rate of major complications is less than 0.5%. These include 10:
Page 12 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq jifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 internal carotid artery (ICA) injury skull base penetration with resultant intracranial hemorrhage, skull base fracture or cerebrospinal fluid leak blindness, either due to optic nerve injury or failure to promptly treat orbital hematoma massive epistaxis meningitis Minor complications adhesions (synechiae) minor epistaxis nasolacrimal duct obstruction; treated with dacryocystorhinostomy anosmia or hyposmia; virtually all cases resolve Failed FESS Failed FESS consists of recurring symptoms following the procedure. It is most often due to recurrent disease, anatomical variants or incomplete surgery.
middle turbinate lateralization: seen in ~30-78% of failed FESS incomplete surgery, including:
o anterior or posterior ethmoidectomy (~31-74% of failed FESS) o uncinectomy (~37% of failed FESS) o retained agger nasi cell (~13-49% of failed FESS) o Onodi cell misidentified as the sphenoid sinus recurring sinusitis: most often involve the frontal sinus and due to persisting obstruction or postoperative scarring of the frontal sinus outflow tract Page 13 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 12- mijksDr esfMdy fyVjspj ds vk/kkj ij ;g fu"d"kZ fudyrk gS fd Nasal Polyp ltZjh djus ls igys vko';d #i ls lhVh Ldsu djk;k tkuk Fkk] D;ksfa d ukd ds ikl gh vkWa[k rFkk czsu fLFkr gS] ftuesa {kfr gksus dh iw.kZ laHkkouk gS A lhVh Ldsu djk ysus ls Nasal Polyp ltZjh djus okys fpfdRld dks ;g irk py tk,xk fd mls dgkW rd ltZjh djuh gS] vFkkZr~ ukd esa tks ekal c<+k gqvk gS] og okLrfod #i ls dgkW rd fLFkr gS] tcfd gLrxr izdj.k esa foi{kh la[;k&2 us dsoy ek= VkWpZ ls fDyfudyh ns[kdj Nasal Polyp gksuk crk fn;k gS rFkk nwljs fnu dsoy ek= CyM ,oa ;wfju ds VsLV djkdj Nasal Polyp ltZjh dj nh gS] ftlds dkj.k ifjokfn;k la[;k&1 ds Subarachnoid hemorrhage (SAH) gks x;k gS rFkk ifjokfn;k la[;k&1 dks czsu dk vkWijs'ku djkuk iM+k] ftlds dkj.k ifjokfn;k la[;k&1 yEcs le; rd bZyktjr jgh rFkk lkekU; thou thus ls oafpr jgsxh A 13- foi{khx.k dk ;g rdZ jgk gS fd esfMdy cksMZ us foi{kh la[;k&2 fpfdRld dh ykijokgh ugha ekuh gS A bl ckjs esa i=koyh ij miyC/k nLrkostkr ds voyksdu ls ;g Li"V gS fd ftl esfMdy cksMZ us foi{kh la[;k&2 dh ykijokgh ugha ekuh gS] ml esfMdy cksMZ ds leLr lnL; foi{kh la[;k&1 esfMdy dkWyst esa inLFkkfir fpfdRld gSa] fdUrq bl tkWp desVh us Hkh viuh fjiksVZ ds fu"d"kZ esa ;g ekuk gS fd Nasal Polyp ltZjh ds ckn Complications gksus ds dkj.k ifjokfn;k la[;k&1 dks Subarachnoid hemorrhage (SAH) gqvk gS A bl tkWp desVh us ;|fi Subarachnoid hemorrhage (SAH) ds ckjs esa ekuk gS fd Nasal Polyp ltZjh ds ckn ,slk gks tkuk LokHkkfod gS rFkk bls Bhd fd;k tk ldrk gS] fdUrq mlds i'pkr~ jktLFkku esfMdy dkmfUly ds }kjk lkr fpfdRldksa ds iSuy us bl bZykt ls lEcfU/kr leLr nLrkostkr dks ns[kdj tks fu"d"kZ fudkyk gS] mlesa Li"V #i ls foi{kh la[;k&2 MkW0 ,-ds-xqIrk dks nks"kh ekudj psrkouh nh x;h gS A bu lkr fpfdRldksa ds iSuy dh jk; fuEu izdkj gS %& "The Council is of the view that warning be issued to Dr. A.K. Gupta to be more vigilent while doing surgery.
Dr. A.K. Gupta is hereby warned to be more vigilant in future while doing surgery."Page 14 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j
ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 bl izdkj mijksDr psrkouh dk Hkh ;gh vFkZ fudyrk gS fd bu lkr fpfdRldksa ds iSuy us Hkh foi{kh la[;k&2 dks blh dkj.k psrkouh nh gS fd mUgksua s fcuk lhVh Ldsu djk;s Nasal Polyp ltZjh dj nh] ftlds Complications QyLo#i ifjokfn;k la[;k&1 dks Subarachnoid hemorrhage (SAH) gks x;k A foi{khx.k dk ;g rdZ Hkh ekU; ugha gS fd mUgksua s ifjokfn;k la[;k&1 dh ukd ds cka;h rjQ dh ltZjh dh Fkh] tcfd ifjokfn;k la[;k&1 ds flj esa nkfguh rjQ QzsDpj gqvk gS] blfy, ;g ugha ekuk tkos fd Nasal Polyp ltZjh ds dkj.k Subarachnoid hemorrhage (SAH) gqvk gS] D;ksfa d ,e-vkj-vkbZ- tkWp fjiksVZ ds ifj.kke dks Åij fy[kk tk pqdk gS A mlds vuqlkj eq[; #i ls cka;h lkbZM esa gh cksuh fMQsDV vk;k gS ] ;|fi nkfguh rjQ Hkh Leky cksuh fMQsDV vk;k gS A 14- foi{khx.k dh vksj ls fuEufyf[kr U;k; n`"VkUr~ izLrqr fd;s x;s gSa %& 1- 1 (2008) CPJ 238 (NC) Ajay Kumar Gupta (Dr.) Vs Indira Gandhi Institute of Medical Sciences & Anr.
2- 2014 NCJ 481 (NC) Vijay Dutt Vs Dr. R.D.Nagpal 3- 2015(1) CPR 411 (NC) Dr. A.K. Handa (Consultant Surgeon and Urologist) & Anr. Vs Ram Kali (Since Deceased), Through LRs & Ors.
4- 2014(1) CPR 522 (NC) Parveen Sharma Vs Anne Heart and Medical Centre, Chandigarh 5- 2015(1) CPR 541 (NC) Arun K. Engineer Vs Dr. Milind Karmarkar 6- 2009 ACJ 1695 Martin F. D'Souza Vs Mohd.Ishfaq 7- 2010 ACJ 1444 Kusum Sharma and ors. Vs Batra Hospital & Medical Research Centre & ors.
8- 4(2014) CPJ 162 (NC) Varghese Silvester Vs Dr. Archana Dhawan 9- 4(2014) CPJ 165 (NC) Subash Prasad Vs Dr.(Mrs) Vidya @ Vidya Rani Singh Page 15 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 10- 2013 NCJ 782 (NC) Rajiv Navath Vs Dr. shajahan Yoosaf Sahib 11- 2013 NCJ 361 (NC) Orthonova Institute of Advanced Surgery & Research T.C.M.L. House Vs Nripendra Kumar Thakur 12- 2013 NCJ 297 (NC) Mohd. Abdul Masood Vs Dr. O. Muralidhar 13- jkT; miHkksDrk vk;ksx lfdZV cSap mn;iqj dh vihy la[;k 99@11 lqHkk"kpan cuke~ MkW0fnyhi lh-'kkg o vU; esa ikfjr fu.kZ; fnukad 20-03-2014 mijksDr U;k; n`"VkUrksa dk geus vknj lfgr voyksdu fd;k gS A bu lHkh U;kf;d n`"VkUrksa esa eq[; #i ls ;gh crk;k x;k gS fd ;fn fpfdRld iw.kZ #i ls vuqHkoh] ;ksX;rk/kkjh gks rFkk mlds }kjk vius drZO;ksa dk fuoZgu i;kZIr lko/kkuh cjrrs gq, fd;k x;k gks] rc mls fpfdRlh; ykijokgh ds fy, nks"kh ugha ekuk tk,xk] Hkys gh bZykt dk ifj.kke foijhr fudyk gks A mDr lHkh U;k; n`"VkUr gLrxr izdj.k ij blfy, ykxw ugha gksrs gSa] D;ksafd gLrxr izdj.k esa foi{kh la[;k&2 ukd] dku] xyk fo'ks"kK us ifjokfn;k la[;k&1 dh Nasal Polyp ltZjh djus ds igys vko';d tkWp lhVh Ldsu ugha djk;h gS rFkk blh dkj.k ls ifjokfn;k la[;k&1 dks Subarachnoid hemorrhage (SAH) gqvk gS] ftldk ;gh vFkZ fudyrk gS fd foi{kh la[;k&2 us vius drZO;ksa dk fuoZgu i;kZIr lko/kkuh cjrrs gq, ugha fd;k gS A vr% mijksDr U;k; n`"VkUrksa ls gLrxr ekeys esa foi{khx.k dks dksbZ ykHk ugha feyrk gS A 15- mijksDr foospukuqlkj i=koyh ij miyC/k nLrkostkr ,oa mijksDr of.kZr esfMdy fyVjspj ds vk/kkj ij ;g fu"d"kZ fudyrk gS fd foi{kh la[;k&2 ukd] dku] xyk fo'ks"kK MkW0 ,-ds-xqIrk ds }kjk foi{kh la[;k&1 vLirky esa ifjokfn;k la[;k&1 dk fnukad 11-04-2008 dks tks Nasal Polyp ltZjh dh x;h gS] og fcuk lhVh Ldsu djk;s dj nh x;h gS] ftlds dkj.k Subarachnoid hemorrhage (SAH) gqvk gS] ftlds ifj.kkeLo#i ifjokfn;k la[;k&1 dks vgenkckn tkdj czsu dk vkWijs'ku djkuk iM+k gS rFkk vgenkckn ds fpfdRld MkW0 nhid iVsy us okgu ugha pykus] vkx ds ikl ugha tkus] B.Ms ikuh ds ikl ugha tkus rFkk ÅapkbZ ij ugha tkus vkfn fgnk;rsa nh gSa] ftlds dkj.k ifjokfn;k la[;k&1 viuk lkekU; thou ugha th ldrh gS] D;ksfa d fujUrj mls bu lHkh lko/kkfu;ksa dks /;ku esa j[kuk gksxk A foi{kh Page 16 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 la[;k&2 fpfdRld ds }kjk fcuk lhVh Ldsu Nasal Polyp ltZjh dj fn;s tkus ds dkj.k gh ifjokfn;k la[;k&1 dks Subarachnoid hemorrhage (SAH) gqvk gS A bl izdkj ;g lkfcr gks tkrk gS fd foi{kh la[;k&2 ukd] dku] xyk fo'ks"kK MkW0 ,-ds-xqIrk us foi{kh la[;k&1 vLirky esa ykijokghiwoZd vkWijs'ku djds fpfdRlh; lsok nks"k fd;k gS A vkWijs'ku ds ckn fnukad 12-04- 2008 dks lhVh Ldsu djkus ij Subarachnoid hemorrhage (SAH) dh tkudkjh gksus ij Hkh ifjokfn;k la[;k&1 dks vius vLirky esa HkrhZ j[kk gS] bl dkj.k ls foi{kh la[;k&2 ds lkFk&lkFk foi{kh la[;k&1 vLirky dh Hkh fpfdRlh; ykijokgh jgh gS A blds vykok Hkh foi{kh la[;k&1] foi{kh la[;k&2 dh fpfdRlh; ykijokgh ds fy, Vicarious rkSj ij fpfdRlh; ykijokgh ds fy, mRrjnk;h gS A 16- vc ge ;g ns[krs gSa fd ifjoknhx.k dks fdruh jkf'k fnyk;h tkos A ifjoknhx.k us vius ifjokn i= esa foi{kh la[;k&1 vLirky esa rFkk vgenkckn vLirky es]a vgenkckn vkus&tkus ds [kpZ bR;kfn esa [kqyklk fooj.k nsrs gq, 1]84]284@&#i;s dh jkf'k ekaxh gS] tks fnyk;s tkus ;ksX; gS A vgenkckn ds fpfdRld MkW0 nhid iVsy us vkxkeh rhu o"kksZa rd bZykt ysus dh lykg nh gS rFkk ifjoknhx.k us mDr vkWijs'ku ds ckn Hkh vgenkckn tkdj bZykt ysus lEcfU/kr nLrkostkr izLrqr fd;s gSa] blfy, vkxkeh rhu o"kksZa ds bZykt dk [kpZ Hkh fnyk;k tkuk U;k;ksfpr gS A bu rhu o"kksZa esa ifjokfn;k la[;k&1 ds ikSf"Vd vkgkj vkfn ij Hkh [kpZ gqvk gS rFkk vgenkckn vkus&tkus dk [kpZ Hkh gqvk gS A vr% vgenkckn esa vkWijs'ku gksus ds ckn vkxkeh rhu o"kksZa ds bu leLr [kpksZa ds fy, ;|fi ifjoknhx.k us dqy ukS yk[k #i;s dh ekax dh gS] fdUrq ge 3]00]000@&#i;s dh jkf'k fnyk;h tkuk mfpr le>rs gSa A tSlk fd Åij foospu fd;k x;k gS fd foi{kh la[;k&1 o 2 dh ykijokgh ds dkj.k ifjoknhx.k dks ekufld ,oa 'kkjhfjd larki gqvk gS A ifjokfn;k la[;k&1 viuk lkekU; thou thus ls oafpr gq;h gS A ifjoknhx.k us ekufld o 'kkjhfjd larki isVs nl yk[k #i;s rFkk lkekU; thou thus ls oafpr jgus ds isVs lkr yk[k #i;s dqy l=g yk[k #i;s dh ekax ifjokn i= esa dh gS] fdUrq ge 12]00]000@&#i;s dh jkf'k fnyk;h tkuk mfpr le>rs gSa A ifjoknhx.k us vf/koDrk Qhl ,oa ifjokn O;; isVs Ms< yk[k #i;s dh ekax dh gS] fdUrq ge 50]000@&#i;s dh jkf'k fnyk;h tkuk mfpr le>rs gSa A bl izdkj gekjh jk; esa gLrxr izdj.k esa Page 17 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 foi{kh la[;k&1 rFkk 2 ls ifjoknhx.k 184284$300000$1200000$50000 ¾ dqy 17]34]284@&#i;s ¼v{kjs l=g yk[k pkSarhl gtkj nks lkS pkSjklh #i;s½ {kfriwfrZ jkf'k izkIr djus ds vf/kdkjh ik;s tkrs gSa A 17- foi{kh la[;k&2 MkW0 ,-ds-xqIrk us foi{kh la[;k&3 chek dEiuh ls fpfdRlh; ykijokgh ds fy, ikap yk[k #i;s rd dh jkf'k dk chek djk j[kk gS] blfy, ikap yk[k #i;s rd dh jkf'k ds fy, foi{kh la[;k&2 rFkk 3 la;qDrr% ,oa i`Fkd~r% mRrjnk;h gksx a s A vr% ifjoknhx.k dk ifjokn i= foi{kh la[;k&1 yxk;r 3 ds fo#) blh izdkj Lohdkj fd;s tkus ;ksX; gS A vkns'k ifjoknhx.k ds }kjk foi{khx.k ds fo#) izLrqr ifjokn i= Lohdkj fd;k tkrk gS rFkk fuEu izdkj {kfriwfrZ vkns'k ikfjr fd;k gS %& 1- foi{kh la01 rFkk 2] ifjoknhx.k dks mn;iqj rFkk vgenkckn esa gq;s bZykt rFkk vgenkckn vkus&tkus ds [kpksZ lfgr 1]84]284@&#i;s ¼v{kjs ,d yk[k pkSjklh gtkj nks lkS pkSjklh #i;s½ vnk djsx a sA 2- foi{kh la01 rFkk 2] ifjoknhx.k dks ekufld ,oa 'kkjhfjd larki isVs rFkk ifjokfn;k la[;k&1 ds lkekU; thou thus ls oafpr jgus ds isVs 12]00]000@&#i;s ¼v{kjs ckjg yk[k #i;s½ {kfriwfrZ jkf'k vnk djsaxs A 3- foi{kh la0 1 rFkk 2] ifjoknhx.k dks vkWijs'ku ds ckn vkxkeh rhu o"kksZ ds bZykt [kpZ] ikSf"Vd vkgkj isVs rFkk vgenkckn vkus&tkus ds [kpZ vkfn ds isVs dqy 3]00]000@&#i;s ¼v{kjs rhu yk[k #i;s½ dh jkf'k vnk djsaxs A 4- foi{kh la01 o 2] ifjoknhx.k dks vf/koDrk Qhl ,oa ifjokn O;; isVs 50]000@&#i;s ¼v{kjs ipkl gtkj #i;s½ vnk djsx a sA 5- mijksDrkuqlkj ifjoknhx.k dks foi{kh la[;k&1 o 2 la;qDrr% ,oa i`Fkd~r% dqy 17]34]284@&#i;s ¼v{kjs l=g yk[k pkSarhl gtkj nks lkS pkSjklh #i;s½ vnk djsaxs] ftlesa ls ikap yk[k #i;s dh jkf'k ds fy, foi{kh la[;k&2 rFkk foi{kh la[;k&3 chek dEiuh la;qDrr% ,oa i`Fkd~r% ifjoknhx.k dks vnk djus ds fy, mRrjnk;h gksx a sA Page 18 of 18 jkt0jkT; vk;ks x lfdZ V cS a p ]mn;iq j ifjokn la [ ;k 02@2011 fu.kZ ; fnuka d 08 vDVw c j] 2021 6- ifjoknhx.k mijksDr leLr jkf'k 17]34]284@&#i;s ¼v{kjs l=g yk[k pkSarhl gtkj nks lkS pkSjklh #i;s½ ij ifjokn i= izLrqr djus dh fnukad 03-05-2010 ls rk olwyh 9 ¼ukS½ izfr'kr okf"kZd nj ls C;kt Hkh izkIr djus ds vf/kdkjh gksx a sA ¼jkeQwy xqtZj½ ¼,l0ds0tSu½ lnL; lnL; ¼U;kf;d½