Tension pneumocephalus: a case following otologic surgery

Asymptomatic pneumocephalus associated with cerebrospinal fluid drainage through a dural defect following extensive skull base surgery is not uncommon. Its occurrence following otologic surgery, however, is rare. Tension pneumocephalus, if not recognized, can rapidly lead to death due to increased intracranial pressure. A case of tension pneumocephalus is presented to demonstrate its clinical features and surgical management. The pathophysiology, diagnosis, and management of tension pneumocephalus are reviewed.     

Gossypiboma: an unusual intracranial complication of endoscopic sinus surgery

We report a case of a 52-year-old man who presented with iatrogenic bilateral nasoethmoidal meningoencephaloceles following endoscopic nasal surgery performed in a neighboring country 8 years ago. Imaging studies, including computed tomography and magnetic resonance imaging of the paranasal sinuses and anterior skull base, demonstrated bilateral meningoencephaloceles and a suspicious intracranial lesion. In view of the intracranial lesion and size of the skull base defect, an external approach via a bicoronal flap was used for exploration and repair. Intraoperative findings revealed the suspicious intracranial lesion to be a retained piece of gauze. The patient underwent a successful removal of the foreign body and repair of the skull base defect. Postoperative recovery was uneventful. To our knowledge, an iatrogenic intracranial foreign body following an endonasal endoscopic procedure has never been reported before.     

鼻内镜手术适应证及并发症

陈文文 （200081上海市第一人民医院分院耳鼻咽喉头颈外科）这次会议上，许庚教授有两点十分精辟的经验之谈，值得大家重视。第一点，他以自己为例：1995年12月，他用鼻内镜检查自己时，发现双侧都长了鼻息肉。CT影像显示上颌窦、筛窦密度增高，充满积液。当年，他利用在广州召开会议的机会，请韩德民教授为他手术。手术在局部麻醉下进行。当时员彭年教授、林尚泽教授在旁一边观看，     

Paraffinoma--a rare complication following endonasal surgery]

BACKGROUND: Paraffin is a mineral oil which was discovered by Reichenbach in 1830. Injection of paraffin into tissue causes a foreign body reaction that results in the formation of a paraffinoma. METHODS: We are reporting on two cases of paranasal paraffinomas, in a 30-year-old male three months after a septorhinoplasty in which paraffin nasal packing was used and in a 56-year-old female patient two months after sinus surgery. RESULTS: A paraffinoma is probably caused by penetration of paraffin through a mucous membrane defect into the adjacent soft tissue. Paraffinomas are usually treated by excision. Although recurrences are frequent, a complete removal should be attempted because of the potential carcinogenicity of paraffin. CONCLUSION: Paraffinomas must be considered in the differential diagnosis of periorbital or paranasal swellings that occur months after endonasal procedures where paraffin packing was used.     

Refractory torticollis: an uncommon complication of adenotonsillectomy

We report the case of an 8-year-old boy with refractory torticollis post-adenotonsillectomy who was later found to have Arnold-Chiari malformation. The differential diagnosis, roentgenographic findings and medical and surgical management of this disorder are discussed.     

A case of pneumocephalus and meningitis as a complication of silent otitis media

Silent otitis media is a progressive otogenic disease. Intracranial manifestations of this complication are limited; the most common is meningitis. We report a case of meningitis and pneumocephalus as a complication of silent otitis media. To the best of our knowledge, this is the first reported case of pneumocephalus as a complication of silent otitis media.     

The magnetic resonance imaging profile of occult intracranial violations as a result of sinus surgery

INTRODUCTION: Intracranial injury is a well-described complication of sinus surgery. Although such complications are typically associated with catastrophic morbidity, the neurological sequelae may be subtle and even unrecognized during the postoperative period. Magnetic resonance imaging (MRI), which can distinguish intracranial hemorrhage and injury, may provide a means for the accurate assessment of atypical presentations of occult intracranial complications. OBJECTIVE: To describe the MRI profile of occult intracranial complications that result from unrecognized skull base violation during sinus surgery. METHOD: Retrospective chart review. RESULTS: Two patients, who had endoscopic sinus surgery performed elsewhere, underwent postoperative MR for further evaluation of headache. The available medical records, as well as the patient's personal reports, suggested that no intraoperative cranial base compromise had occurred. Both MRIs showed abnormal signal intensity in the brain parenchyma adjacent to the floor of the anterior cranial fossa; these findings are consistent with traumatic injury presumably from the surgical procedure. Neither patient developed postoperative cerebrospinal fluid rhinorrhea, and neither patient experienced focal neurological deficits. CONCLUSION: New-onset and/or atypical headache after sinus surgery may be associated with occult intracranial injury. MRI may serve as the diagnostic means for this occult intracranial violation. Significant incongruity may exist between patient symptoms and the objective MR evidence that can suggest serious intracranial injury. MRI signal patterns can provide both temporal and anatomical cues about the specific injury.     

Virtual simulator as a training tool for endonasal surgery

BACKGROUND: Virtual simulation could be an important tool for medical and surgical training as well as education. The efficacy of a simulator for endoscopic nasal procedures in a training program was evaluated. METHODS: The simulator is a medical and scientific tool for visualizing and interacting with three-dimensional volumetric data. Twenty endonasal operations with chronic rhinosinusitis were simulated by two 3rd-year residents and proctored by the senior surgeon 1 day before the actual surgery was performed with an endoscope and computer-aided surgery. A questionnaire was established. RESULTS: The surgical simulator may provide a better understanding of the morphology of the paranasal sinuses with a minor impact on performance of endoscopy by junior residents. Disadvantages identified were time consumption, absence of force feedback, and subtle handling of the joysticks. CONCLUSION: The virtual simulator allows the nonendoscopically nasal trained surgeon to understand and practice endonasal surgery using real-patient data but failed to make an impact on operating room performance. Furthermore, the simulator's effectiveness was limited by the absence of force feedback, subtle handling of the joysticks, and considerable time consumption.     

Cerebrospinal fluid rhinorrhoea as a complication of endoscopic endonasal reduction of blowout fractures

Background: 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.     

Encephalocoele as a complication of intranasal surgery

Intranasal encephalocoele can be congenital or acquired as a consequence of injury to the floor of anterior cranial fossa disrupting dura resulting in herniation of brain tissue in the nasal cavity. Authors came across a case of encephalocoele as a complication of intranasal polypectoury. We are reporting this case due to its rareness.     

Cerebellar abscess as an intracranial complication of otogenic origin (author's transl)

Three cases of otogenic cerebellar abscesses, treated between 1976 and 1978, are reviewed. Early diagnosis is the most important factor in the successful management of these lesions. In localising subtentorial intracranial abscesses, computed axial tomography appears superior to other neuroradiological methods. Lumbar puncture is both inaccurate in diagnosis and dangerous to the patient, when increased intracranial pressure exists.     

Tracheocutaneous fistula as a complication of laryngotracheal separation surgery

To evaluate the relationship between the occurrence of tracheocutaneous fistula of the proximal tracheal stump regarding the indication (therapeutic or prophylactic) of laryngotracheal separation surgery (LTS) and regarding the presence of a current or previous tracheostomy when LTS was performed. Retrospective analysis of 66 patients submitted to LTS. The tracheocutaneous fistula occurred in 14 (21.2%) patients. Twelve (33.3%) of 36 patients whose indication was therapeutic and in two (6.7%) of 30 patients whose indication was prophylactic (p?=?0.019). It occurred in 8 (57.1%) of 14 patients who had undergone tracheostomy prior to completion of LTS, while occurred in 6 (11.5%) patients who had not previously undergone tracheostomy (n?=?52) (p?=?0.0009). The incidence of tracheocutaneous fistula as a postoperative complication of laryngotracheal separation is high and occurs mainly in patients whose indication is therapeutic and for those with a current or previous tracheostomy. Despite the significant incidence, most of them closed spontaneously through the adoption of conservative therapy.     

Glossal abscess as a complication of tongue-base suspension surgery

Approximately 60 cases of tongue abscess have been reported in the English-language literature over the past 30 years. We report what we believe is the first case of a glossal abscess that arose as a complication of tongue-base suspension surgery. The patient was a 31-year-old man who presented with a several-day history of odynophagia, tongue swelling, voice changes, and increased snoring. Two years earlier, he had undergone a tongue-base suspension procedure for the treatment of obstructive sleep apnea. Computed tomography (CT) revealed a tongue abscess. During peroral incision and drainage, a knotted 0 Prolene suture was discovered within the abscess cavity. The suture was removed, the area was thoroughly irrigated, the drain was placed in the abscess cavity, and the incision was loosely closed. On postoperative day 5, repeat CT revealed resolution of the abscess, and the patient was discharged on oral antibiotics. Although glossal abscess is very rare, physicians should consider it in the differential diagnosis of any patient who presents with lingual swelling following tongue-base suspension surgery.     

Tension pneumocephalus after endoscopic sinus surgery: case report of repair and management in absence of obvious skull base defect

Tension pneumocephalus is a rare complication of functional endoscopic sinus surgery that may lead to rapid neurologic deterioration. Patients typically display symptoms within hours after the operation, and computed tomography reveals the presence of a skull base defect. We report a unique case of subacute tension pneumocephalus with no obvious skull base defect, which was associated with a pupil-involving third-nerve palsy. We discuss management of this complication and preventive measures for avoiding pneumocephalus after functional endoscopic sinus surgery.     

Perforation of hypopharynx -- a uncommon complication of transesophageal endosonography

BACKGROUND: Today the endoscopical sonography of the oesophagus and heart is a useful diagnostic procedure. Perforations of the oesophagus or hypopharynx after this procedure are grave and life-threatening complications of this invasive diagnostic procedure. MATERIAL AND METHODS: In the past 8 years we observed 3 cases of hypopharyngeal perforation as complication of endosonographic procedure. These cases were evaluated retrospectively. RESULTS: In all 3 cases an increased resistance against insertion of the probe had been observed. In two cases the perforation was found in the right sinus piriformis. The third patient had a perforation of the posterior hypopharyngeal wall adjacent to the upper oesophageal sphincter. The former patients underwent an open transcervical revision, in the latter patient the perforation was clipped endoluminally to his impaired general condition. CONCLUSIONS: Perforations of the hypopharynx represent a rare but potentially life threatening complication of transoesophageal sonography. The endoscopically working physician should know and recognize the clinical signs for surgical treatment before further complications (e. g. mediastinitis) may occur.