Hematoma orbitario secundario a cirugía endoscópica nasosinusal / Orbital hematoma secondary to endoscopic sinus surgery

Resumen Durante la cirugía endoscópica nasosinusal, la sección inadvertida y retracción hacia la órbita de la arteria etmoidal anterior (AEA) es el mecanismo habitual del hematoma orbitario (HO); éste se manifiesta con proptosis, dolor y déficit visual potencialmente irreversible. El déficit visual es secundario a isquemia del nervio óptico por aumento de la presión intraocular, siendo suficientes treinta minutos para que ocurra daño visual permanente. Por sus secuelas el tratamiento del HO debe ser rápido y agresivo. Presentamos el caso de un varón de 72 años con diagnóstico de rinosinusitis crónica con pólipos nasales refractaria a tratamiento médico que se sometió a cirugía endoscópica nasal y que desarrolló en el posoperatorio inmediato con un HO. Se manejó precozmente con cantotomía-cantolisis, descompresión orbitaria medial endoscópica y control vascular de la AEA. El paciente evoluciona favorablemente, sin déficit visual. En este artículo se discutirán el diagnóstico y manejo oportunos del hematoma orbitario iatrogénico.

Abstract During endoscopic sinonasal surgery, inadvertent section of the anterior ethmoidal artery (AEA) with retraction into the orbit is the usual mechanism of orbital hematoma (OH), leading to proptosis, pain, and potentially irreversible visual loss. Thirty minutes is sufficient for retinal ischemia and permanent visual loss. The explanation for blindness is due to increased intraorbital pressure. The treatment of iatrogenic HO must be quick and aggressive, because if it is not managed in time, it can cause a permanent visual deficit. We present the case of a 72-year-old man with a diagnosis of chronic rhinosinusitis with nasal polyps refractory to medical treatment who underwent nasal endoscopic surgery, evolving in the immediate postoperative period with an HO, requiring canthotomy - cantolysis and early surgical reintervention for endoscopic medial orbital decompression and vascular control of AEA. The patient evolves favorably, without visual deficit. This article will discuss the timely diagnosis and management of iatrogenic orbital hematoma.

A Case of Subperiosteal Orbital Hematoma Associated with von Willebrand Disease

PURPOSE: Subperiosteal orbital hematoma is rare, and most cases occur in children or young adults after direct facial or orbital trauma. Nontraumatic subperiosteal hemorrhage has been reported in association with systemic disease associated with leukemia, scurvy, sudden elevation of cranial venous pressure or venous congestion, and paranasal sinusitis. To our best knowledge, this is the first case of subperiosteal orbital hematoma associated with von Willebrand disease in Korea. METHODS: A 30-year-old woman experienced a sudden onset of proptosis, diplopia and decreased visual acuity. Clinical features, orbital CT and MRI established the diagnosis of subperiosteal hematoma of the orbit. The patient was treated with superior orbitotomy with hematoma evacuation. RESULTS: After the surgery, the patient's visual acuity completely recovered and proptosis disappeared. During follow-up periods, she was diagnosed to have von Willebrand disease.

A Case of Subperiosteal Orbital Hematoma in Patient with Ethmoid and Maxillary Sinusitis

Subperiosteal hematoma of the orbit is uncommon and mostly caused by trauma or some general diseases such as leukemia, hemophilia, and scurvy. Subperiosteal yhematoma associated with sinusitis which is not related to trauma and general diseases, however, is extremely rare. The authors report a case of subperiosteal hematoma of the orbit in 22-year-old man without a history of trauma and general diseases. He had proptosis, and sudden decreased visual acuity. Clinical features, and computerized tomography established the diagnosis of subperiosteal orbital hematoma secondary to ethmoid and maxillary sinusities. We could make definitive diagnosis by needle aspiration of blood using 18-gauge needle with a 10ml syringe at our OPD. To avoid complications such as compressive neuropathy, central retinal occlusion, and recurrence of hematoma, we managed it successfully by evacuation of blood and thermal cauterization to bleeding areas of periosteum, or bone.