Inferior Oblique Paresis, Mydriasis, and Accommodative Palsy as Temporary Complications of Sinus Surgery

Unilateral mydriasis after video-assisted thoracic thymectomy: case report and review of literature

The article reviews a clinical case of unilateral mydriasis after uncomplicated video-assisted thoracic thymectomy as well as results of literature data analysis of.

Challenging Management of Double Vision After Functional Endoscopic Sinus Surgery-A Series of 6 Cases

PURPOSE

To present 6 cases of orbital trauma, diplopia and strabismus after functional endoscopic sinus surgery (FESS).

DESIGN

Retrospective observational case series.

METHODS

The medical charts of suitable patients were reviewed for information on medical examination, imaging studies, the type of corrective surgery, and surgical outcomes.

STUDY POPULATION

All patients with diplopia and strabismus after undergoing FESS who were treated or consulted at our institution between 2008 and 2017 were included.

MAIN OUTCOME MEASURES

The presence and extent of strabismus and double vision at the end of follow-up.

RESULTS

Six patients complained of diplopia after FESS; all of them had proven orbital trauma. In Cases 1-5, patients suffered medial rectus (MR) muscle transection and subsequent exotropia. Their prognosis was guarded despite prompt surgical intervention, and ranged from large exotropia when direct recovery of the MR was attempted, to primary gaze orthotropia but with minimal adduction capacity, during which vertical recti transposition was attempted. Patient 6 sustained transient diplopia, although all of his extraocular muscles appeared intact on imaging. His eye position and movement were completely resolved with conservative measures only.

CONCLUSIONS

Our experience was that immediate recovery procedures to reattach the muscle in cases with proven transection of the MR muscle are futile, and that definitive corrective strabismus surgery (ie, vertical muscle transposition) has a better chance to achieve favorable results.

Simple ways to dissect ciliary ganglion for orbital anatomical education

In the case of anatomical dissection as part of medical education, it is difficult for medical students to find the ciliary ganglion (CG) since it is small and located deeply in the orbit between the optic nerve and the lateral rectus muscle and embedded in the orbital fat. Here, we would like to introduce simple ways to find the CG by 1): tracing the sensory and parasympathetic roots to find the CG from the superior direction above the orbit, 2): transecting and retracting the lateral rectus muscle to visualize the CG from the lateral direction of the orbit, and 3): taking out whole orbital structures first and dissecting to observe the CG. The advantages and disadvantages of these methods are discussed from the standpoint of decreased laboratory time and students as beginners at orbital anatomy.

Transient oblong anisocoria and orbital surgery

We present a rare case of transient oblong (segmental) anisocoria occurring at the time of limited orbital surgery. Observation of this previously undescribed phenomenon prompted us to review the relevant anatomy and physiology of the iris and the pharmacokinetics of lidocaine as it pertains to surgery in the region of the eyelids and the orbit.

Complications of vision loss and ophthalmoplegia during endoscopic sinus surgery

OBJECTIVE

To describe two rare cases of concurrent vision loss and external ophthalmoplegia following powered endoscopic sinus surgery (ESS).

DESIGN

Observational case report.

RESULTS

The records of two patients who underwent powered ESS and developed multiple concurrent ophthalmic complications were retrospectively reviewed for clinical history, neuro-ophthalmologic examination, and imaging findings. Patient 1 developed a retinal vascular occlusion and complete loss of adduction. Patient 2 developed an orbital hemorrhage, optic neuropathy, and a restrictive global ophthalmoplegia. Similar published case reports were also reviewed.

CONCLUSION

Despite advances in powered ESS technique and instrumentation, serious ophthalmic complications can still occur. Inadvertent entry into the medial orbital wall can result in a combination of blindness and ocular motility dysfunction. The variety of mechanisms responsible for these complications underscores the importance of thorough pre- and postoperative clinical examination and review of imaging studies.

Temporary adduction deficit after nasal septoplasty and radiofrequency ablation of the inferior turbinate

A 19-year-old boy developed an adduction deficit after bilateral radiofrequency ablation of the inferior turbinate and septoplasty. Postoperative imaging disclosed an intact medial orbital wall and high T2 signal and enlargement of the medial rectus. Within 3 months, the motility deficit had resolved. This manifestation is attributed to injury of the medial rectus from radiofrequency ablation and represents the first reported case.

Functional endoscopic sinus surgery: indications and complications in the ophthalmic field

Functional Endoscopic Sinus Surgery (FESS) is a highly sophisticated type of surgery, which has revolutionized the surgical management of chronic sinus diseases. In the ophthalmic field, FESS plays a crucial role in the management of a few conditions, but not without risks. Ophthalmic complications associated with FESS are well documented. They mainly occur due to the shared common anatomic areas between ophthalmology and otolaryngology. Ophthalmic complications can vary in severity from very trivial cases such as localized hematoma collection, which is not very problematic to very devastating cases, such as optic nerve damage, which can lead to complete blindness. In order to minimize such complications, safety measures need to be considered prio to the surgery, these include; precise knowledge of detailed anatomy, the operating surgeon's ability to interpret precisely the para nasal sinus CT scan and experienced procedural surgical skills.

Death related to nasal surgery: case report with review of therapy-related deaths

The investigation of deaths that are suspected to be related to medical therapy present several challenges for the forensic pathologist. In all such cases, it is important for the pathologist to understand the therapy/procedure that may have played a role in death. As such, review of medical records and possible consultation with various medical specialists before autopsy can provide valuable information to ensure proper evaluation in any given case.Herein, we describe a rare death occurring as a complication of septoplasty, nasal polypectomy, and intranasal endoscopic ethmoidectomy, which are common surgical procedures performed by otolaryngology/head and neck surgeons. An otherwise healthy 58-year-old woman underwent the elective surgical procedures for a deviated nasal septum, multiple nasal polyps, and chronic ethmoid sinusitis. Following surgery, the patient never awoke from general anesthesia, and further evaluation before death revealed a basilar subarachnoid hemorrhage. Autopsy disclosed basilar subarachnoid hemorrhage, a traumatic defect of the right cribiform plate, and associated anterior cerebral artery injury with frontal lobe damage. No vascular anomalies were present. The cause of death was attributed to complications related to nasal surgery, and the manner of death was ruled "accident."Following the presentation of this case, the authors discuss these common nasal surgical procedures, including a summary of their known complications. In addition, the authors address and review the topic of deaths related to medical therapy.

Neuro-ophthalmic complications of endoscopic sinus surgery

PURPOSE OF REVIEW

This review aims to provide an overview of powered endoscopic sinus surgery and raise awareness of the possible neuro-ophthalmic complications associated with the procedure.

RECENT FINDINGS

The neuro-ophthalmic complications of endoscopic sinus surgery can be categorized into five anatomic sites: eye, orbit, optic nerve, extraocular muscle, and lacrimal drainage system. Double vision may be caused by various ocular motility abnormalities. Visual loss may be the result of orbital hemorrhage or direct optic nerve trauma.

SUMMARY

A wide range of neuro-ophthalmic complications may occur during endoscopic sinus surgery. The use of powered cutting instruments has been a recent advance in endoscopic sinus surgery, but it has also been implicated in rapid, irreversible, and devasting complications. Multiple preoperative and intraoperative factors appear to be involved in the adverse events associated with endoscopic sinus surgery. Ophthalmologists may be asked to evaluate and manage ocular damage in patients who have undergone endoscopic sinus surgery, and in some cases emergent intervention may be required in an attempt to avoid permanent visual loss.

[Postoperative imaging of paranasal sinuses]

The radiological interpretation of postoperative changes of the paranasal sinuses requires knowledge of why and how the surgical intervention was performed and what the basic clinical findings were. It is important to know whether there was an inflammation, a reconstructive procedure, or a tumorous process. Multidetector computed tomography (MDCT) evaluated in a high-resolution bone window level setting represents the method of choice for imaging after nonfunctional and functional procedures after inflammatory changes as well as for imaging after reconstructive surgery because of facial trauma or before dental implantation. In the postoperative follow-up of tumor patients contrast-enhanced MDCT evaluated in a soft tissue window and bone window and especially magnetic resonance imaging (MRI) represent the standard. In many cases it is possible to differentiate tumor recurrence from inflammation with the help of contrast-enhanced multiplanar MRI and to detect bone marrow changes prior to CT.