Retrobulbar hematoma and orbital compartment syndrome requiring lateral canthotomy and cantholysis in patient with penetrating facial trauma

2021 ◽  
Vol 24 ◽  
pp. 101072
Author(s):  
Sharon Kam ◽  
Jesse O. Wrenn ◽  
Daniel A. Valenzuela
Keyword(s):  
Compartment Syndrome ◽  
Facial Trauma ◽  
Retrobulbar Hematoma ◽  
Lateral Canthotomy

scholarly journals Surgical Treatment of Orbital Blowout Fractures: Complications and Postoperative Care Patterns

2016 ◽  
Vol 9 (4) ◽  
pp. 299-304 ◽  
Author(s):  
Matthew Shew ◽  
Michael P. Carlisle ◽  
GuanningNina Lu ◽  
Clinton Humphrey ◽  
J.David Kriet
Keyword(s):  
Postoperative Complications ◽  
Vision Loss ◽  
Average Length ◽  
Case Reports ◽  
Postoperative Management ◽  
Facial Trauma ◽  
Outpatient Basis ◽  
Retrospective Assessment ◽  
Retrobulbar Hematoma ◽  
Orbital Blowout Fractures

Orbital fractures are a common result of facial trauma. Sequelae and indications for repair include enophthalmos and/or diplopia from extraocular muscle entrapment. Alloplastic implant placement with careful release of periorbital fat and extraocular muscles can effectively restore extraocular movements, orbital integrity, and anatomic volume. However, rare but devastating complications such as retrobulbar hematoma (RBH) can occur after repair, which pose a risk of permanent vision loss if not addressed emergently. For this reason, some surgeons take the precaution of admitting patients for 24-hour postoperative vision checks, while others do not. The incidence of postoperative RBH has not been previously reported and existing data are limited to case reports. Our aim was to examine national trends in postoperative management and to report the incidence of immediate postoperative complications at our institution following orbital repair. A retrospective assessment of orbital blowout fractures was undertaken to assess immediate postoperative complications including RBH. Only patients treated by a senior surgeon in the Department of Otolaryngology were included in the review. In addition, we surveyed AO North America (AONA) Craniomaxillofacial faculty to assess current trends in postoperative management. There were 80 patients treated surgically for orbital blowout fractures over a 9.5-year period. Nearly all patients were observed overnight (74%) or longer (25%) due to other trauma. Average length of stay was 17 hours for those observed overnight. There was one (1.3%) patient with RBH, who was treated and recovered without sequelae. Results of the survey indicated that a majority (64%) of responders observe postoperative patients overnight. Twenty-nine percent of responders indicated that they send patients home the same day of surgery. Performance of more than 20 orbital repairs annually significantly increased the likelihood that faculty would manage patients on an outpatient basis postoperatively ( p = 0.04). For orbital blowout fractures, the number of immediate postoperative complications at our institution is low. In addition, North American trends in postoperative management of orbital blowout fractures may suggest that selected patients can be managed on an outpatient basis, which would have a positive effect on conservation of diminishing healthcare resources.

Out-of-Hospital Lateral Canthotomy and Cantholysis: A Case Series and Screening Tool for Identification of Orbital Compartment Syndrome

2018 ◽  
Vol 37 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Robert Whitford ◽  
Sara Continenza ◽  
Jeremy Liebman ◽  
Jason Peng ◽  
Elizabeth K. Powell ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Screening Tool ◽  
Case Series ◽  
Lateral Canthotomy

scholarly journals Lateral Canthotomy and Cantholysis: Emergency Management of Orbital Compartment Syndrome

2015 ◽  
Vol 48 (3) ◽  
pp. 325-330 ◽  
Author(s):  
Adam D. Rowh ◽  
Jacob W. Ufberg ◽  
Theodore C. Chan ◽  
Gary M. Vilke ◽  
Richard A. Harrigan
Keyword(s):  
Emergency Management ◽  
Compartment Syndrome ◽  
Lateral Canthotomy

scholarly journals Emergency lateral canthotomy and cantholysis to relieve intraocular pressure following severe motor vehicle collision

2017 ◽  
Vol 86 (1) ◽  
pp. 49-51
Author(s):  
Jason L Elzinga ◽  
Herman Bami
Keyword(s):  
Medical Education ◽  
Intraocular Pressure ◽  
Compartment Syndrome ◽  
Motor Vehicle ◽  
Trauma Team ◽  
Motor Vehicle Collision ◽  
Telephone Consultation ◽  
Education Resources ◽  
Vehicle Collision ◽  
Lateral Canthotomy

A young woman displayed a dilated and fixed pupil following a motor vehicle collision with blunt force trauma to face. This was associated with drastically elevated intraocular pressure and proptosis. It was believed that a retrobulbar bleed was causing ocular compartment syndrome, an ischemic condition whereby elevated pressure within the orbit occludes blood flow to the retina and ocular nerves. This is a rare ocular emergency, and must be promptly treated to prevent permanent damage. Ophthalmology was consulted by telephone to confirm the diagnosis and direct treatment. A lateral canthotomy and cantholysis was performed under guidance from Ophthalmology and free open access medical education resources. The trauma team managed to save the eye, with visual acuity remaining near normal. In this report, the mechanism of orbital compartment syndrome is explained, and the lateral canthotomy and cantholysis procedure is outlined. This case highlights the importance of telephone consultation and easily accessible medical education resources in the acute care of rare conditions that may arise following trauma.

Bony Orbital Decompression Following Lateral Canthotomy and Cantholysis for Traumatic Orbital Compartment Syndrome

2019 ◽  
Vol 30 (1) ◽  
pp. 231-234 ◽  
Author(s):  
Yoshiyuki Kitaguchi ◽  
Yasuhiro Takahashi ◽  
Maria Suzanne Sabundayo ◽  
Hirohiko Kakizaki
Keyword(s):  
Compartment Syndrome ◽  
Orbital Decompression ◽  
Lateral Canthotomy

Management of acute retrobulbar haemorrhage: a survey of non-ophthalmic emergency department physicians

2019 ◽  
Vol 36 (4) ◽  
pp. 245-247 ◽  
Author(s):  
Matthew R Edmunds ◽  
Anjana S Haridas ◽  
Daniel S Morris ◽  
Kasyap Jamalapuram
Keyword(s):  
Compartment Syndrome ◽  
Visual Loss ◽  
Online Survey ◽  
Response Rate ◽  
Case Vignette ◽  
Multiple Choice Questions ◽  
Out Of Hours ◽  
The United Kingdom ◽  
Survey Response Rate ◽  
Lateral Canthotomy

IntroductionAcute retrobulbar haemorrhage (RBH) with orbital compartment syndrome is a sight-threatening ophthalmic emergency requiring treatment with lateral canthotomy and cantholysis (LC/C). However, such cases may present to non-ophthalmic emergency departments (ED) out-of-hours, when specialist intervention is not readily available. We completed a survey of ED physicians to explore experiences of RBH and confidence in undertaking LC/C.MethodsFrom February to April 2018, an online survey was sent to ED physicians of all training grades in seven UK locations. The survey comprised a case vignette of a patient presenting with clinical features of RBH with orbital compartment syndrome, with multiple choice questions on the diagnosis, management and onward referral of such cases. Additional questions explored the experience of RBH, LC/C and perspectives on current and future training of ED physicians in this area.Results190 ED doctors completed the survey (response rate 70%). While 82.8% correctly diagnosed RBH and 95.7% recognised irreversible visual loss as a consequence of untreated RBH with orbital compartment syndrome, 78.7% indicated that they would initially undertake CT imaging rather than performing LC/C. Only 38.9% had previously encountered a case of RBH and only 37.1% would perform LC/C themselves, with 91.4% indicating that this was due to lack of training. 92.2% felt that more training was required for ED physicians in RBH management and performing LC/C.ConclusionWhile cases of RBH with orbital compartment syndrome are infrequent, it is important that RBH management with the vital, sight-saving skill of LC/C is added to the United Kingdom Royal College of Emergency Medicine training curriculum. At present, though the majority of ED physicians can identify RBH, the minority are willing or able to undertake LC/C, potentially risking irreversible but avoidable visual loss.

scholarly journals Carotid-Cavernous Fistula as a Complication of Facial Trauma: A Case Report

2015 ◽  
Vol 8 (3) ◽  
pp. 239-245 ◽  
Author(s):  
Maria Lazaridou ◽  
Eleni Bourlidou ◽  
Konstantinos Kontos ◽  
Doxa Mangoudi
Keyword(s):  
Rare Complication ◽  
Facial Trauma ◽  
Trauma Symptoms ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Cavernous Sinus Syndrome ◽  
Retrobulbar Hematoma ◽  
Superior Orbital Fissure Syndrome ◽  
Craniomaxillofacial Trauma ◽  
Upper Lid

Posttraumatic carotid-cavernous fistula is a very rare complication that can occur in patients with craniomaxillofacial trauma. Symptoms involve headache, diplopia, ptosis of the upper lid, conjunctival chemosis, pulsating exophthalmos, and ophthalmoplegia. Diagnosis can be challenging because various pathologic entities can present with similar symptoms such as superior orbital fissure syndrome, orbital apex syndrome, retrobulbar hematoma, and cavernous sinus syndrome. However, accurate and early diagnosis is of utmost importance because treatment delay may lead to blindness or permanent neurologic deficits. In this article, a case of posttraumatic carotid-cavernous fistula that was twice misdiagnosed is presented.

scholarly journals Orbital Compartment Syndrome: Alternative Tools to Perform a Lateral Canthotomy and Cantholysis

2016 ◽  
Vol 27 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Kenneth V. Iserson ◽  
Zelda Luke-Blyden ◽  
Scott Clemans
Keyword(s):  
Compartment Syndrome ◽  
Lateral Canthotomy

scholarly journals Orbitakompartment-szindróma. Arcot ért trauma következtében leggyakrabban vakságot okozó állapot

2017 ◽  
Vol 158 (36) ◽  
pp. 1410-1420 ◽  
Author(s):  
Gusztáv Klenk ◽  
József Katona ◽  
Gábor Kenderfi ◽  
János Lestyán ◽  
Katalin Gombos ◽  
...  
Keyword(s):  
Foreign Body ◽  
Compartment Syndrome ◽  
Surgical Intervention ◽  
Rare Condition ◽  
Surgical Decompression ◽  
Facial Fractures ◽  
Common Cause ◽  
Short Period ◽  
Retinal Artery ◽  
Lateral Canthotomy

Abstract: Introduction: Although orbital compartment syndrome is a rare condition, it is still the most common cause of blindness following simple or complicated facial fractures. Its pathomechanism is similar to the compartment syndrome in the limb. Little extra fluid (blood, oedema, brain, foreign body) in a non-space yielding space results with increasingly higher pressures within a short period of time. Unless urgent surgical intervention is performed the blocked circulation of the central retinal artery will result irreversible ophthalmic nerve damage and blindness. Aim, material and method: A retrospective analysis of ten years, 2007–2017, in our hospital among those patients referred to us with facial-head trauma combined with blindness. Results: 571 patients had fractures involving the orbit. 23 patients become blind from different reasons. The most common cause was orbital compartment syndrome in 17 patients; all had retrobulbar haematomas as well. 6 patients with retrobulbar haematoma did not develop compartment syndrome. Compartment syndrome was found among patient with extensive and minimal fractures such as with large and minimal haematomas. Early lateral canthotomy and decompression saved 7 patients from blindness. Conclusion: We can not predict and do not know why some patients develop orbital compartment syndrome. Compartment syndrome seems independent from fracture mechanism, comminution, dislocation, amount of orbital bleeding. All patients are in potential risk with midface fractures. We have a high suspicion that orbital compartment syndrome has been somehow missed out in the recommended textbooks of our medical universities and in the postgraduate trainings. Thus compartment syndrome is not recognized. Teaching, training and early surgical decompression is the only solution to save the blind eye. Orv Hetil. 2017; 158(36): 1410–1420.

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