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Unless the orbital contents are supported, the insertion of nasal packing material during endoscopic endonasal surgery may cause serious intracranial complications such as cerebrospinal fluid leakage.
Methods:
Case report and literature review.
Results:
We report a patient with iatrogenic cerebrospinal fluid rhinorrhoea caused by intracranial entry of a Silastic sheet inserted into the nasal cavity. This skull defect and the surrounding skull base were successfully reconstructed in a multilayer fashion via an endoscopic endonasal approach.
Conclusion:
This case highlights the need for caution when inserting nasal packing material. During endoscopic endonasal reduction of blowout fractures, great care must be taken to support the orbital contents, in order to avoid serious intracranial complications such as cerebrospinal fluid leakage.
We present a 38-year-old man with a tension pneumo-orbit following medial orbital wall fracture, managed with endoscopic decompression.
Method:
A case report and a review of the world literature concerning the aetiology, clinical features and management of medial orbital wall fractures are presented.
Results:
Our patient presented with a post-traumatic tension pneumo-orbit exacerbated by air travel and nose-blowing. Computed tomography revealed a fracture of the ethmoid bone, and intra-orbital emphysema causing proptosis. Management with endoscopic, endonasal surgery produced excellent results, with decompression achieved and immediate and sustained improvement in visual acuity.
Conclusion:
A search of the world literature revealed no documented cases of tension pneumo-orbit as a complication of medial orbital wall fracture. Endoscopic sinus surgery is currently used in the management of nasal and sinus diseases and their orbital complications. We discuss this extended indication of endoscopic surgery, and its advantages over other surgical approaches.
Cutaneous meningiomas are extremely rare tumours and their diagnosis is difficult. We describe the case of a patient who developed a paranasal swelling after head trauma and associated fractures in the same region years before. Histopathological examination of an incisional biopsy revealed the diagnosis of cutaneous meningioma. After one and a half years’ follow up, surgical excision was performed because of progressive growth of the tumour and associated aesthetic problems. Extracranial meningiomas can develop probably secondary to trapping of meningeal tissue after trauma. If there is no intracranial connection surgical removal can be considered.
A fracture of the lamina papyracea as a result of nasal packing, though plausible is undocumented. A case is presented, with a cautionary note to avoid the use of excessive pressure in packs and balloons when attempting to control epistaxis in elderly patients.
A case is reported in which a patient presented, 18 months after initial injury, with a progressive proptosis of the left eye. X-rays did not reveal a foreign body but a fracture of the lateral orbital wall and an area of soft tissue density were seen on the CT scan. Exploration of the orbit revealed a 2 cm wooden fragment in the floor of the orbit.
The sagittal plane, computerized tomography (CT) scan has been proposed as the most important radiological view in the diagnosis of orbital floor blow-out fractures. This view however is impractical and unnecessary. Direct, coronal plane CT scan with careful attention paid to the shape of the inferior rectus muscle and antral roof will successfully diagnose this traumatic condition, as in our reported case in which no other radiological abnormalities were present.
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