Acute Vision Loss Following Endoscopic Sinus Surgery

A 41-year-old female with a history of uterine cancer and Celiac and Raynaud’s Disease presented to our institution with frequent migraines and nasal congestion. She underwent functional endoscopic sinus surgery (FESS) and experienced acute unilateral vision loss postoperatively. Rapid recognition of the etiology and effective treatment are paramount given the permanent and irreversible vision loss that can result. Arterial vasospasm following FESS is rare. Patients with autoimmune diseases have perhaps an increased risk for vasospasm secondary to an increased vasoreactive profile. We present the first documented case of nitroglycerin sublingual therapy to successfully treat ophthalmic artery vasospasm following FESS. Nitroglycerin sublingual therapy is a promising treatment for ophthalmic vasospasm secondary to its ability to cross the blood-ocular barrier, its rapid onset of action, and its ability to promote relaxation of vascular smooth muscle.

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Rapid-onset clozapine-induced hyperglycaemia: pathways of glycaemic dysregulation

BMJ Case Reports ◽

10.1136/bcr-2021-243938 ◽

2021 ◽

Vol 14 (9) ◽

pp. e243938

Author(s):

Mariana Barbosa ◽

Vera Fernandes

Keyword(s):

Parkinson’S Disease ◽

Metabolic Syndrome ◽

Parkinson's Disease ◽

Blood Glucose ◽

Glycaemic Control ◽

Glycated Haemoglobin ◽

Rapid Onset ◽

Proper Treatment ◽

Increased Risk ◽

History Of

Clozapine is an atypical antipsychotic used in refractory schizophrenia, also efficient in alleviating dyskinesia in Parkinson’s disease. Despite its potency, this drug is associated with severe metabolic side effects, including increased risk for diabetes. We report the case of a 45-year-old overweight woman with Parkinson’s disease who presented with rapid-onset hyperglycaemia within 2 months after starting clozapine for refractory dyskinaesia. She had a history of gestational diabetes. At presentation, her blood glucose level was 505 mg/dL and glycated haemoglobin 12.4%, with no catabolic symptoms. Clozapine was suspended and metformin was started, but adequate glycaemic control was achieved only with insulin therapy, along with exenatide and empagliflozin afterwards. We assume that clozapine acted as a trigger for rapid deterioration of glycaemic control through direct pathophysiological mechanisms, rather than an indirect slowly evolving weight gain-related metabolic syndrome pathway. Clinicians should be aware of this complication, enabling timely diagnosis and proper treatment.

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Recurrent Vision Loss After Endoscopic Sinus Surgery Managed With Palmar Pressure

Ophthalmic Plastic and Reconstructive Surgery ◽

10.1097/iop.0b013e318167711d ◽

2008 ◽

Vol 24 (2) ◽

pp. 150-152

Author(s):

Jonathan E. Silbert ◽

Danielle S. Rudich ◽

Eric L. Wasserman ◽

Robert L. Lesser

Keyword(s):

Endoscopic Sinus Surgery ◽

Vision Loss ◽

Sinus Surgery

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Muscle relaxants in critical illness

10.1093/med/9780199600830.003.0047 ◽

2016 ◽

Author(s):

Brian J. Pollard

Keyword(s):

Muscle Relaxant ◽

Rapid Onset ◽

Hepatic Disease ◽

Neuromuscular Blocking ◽

Nerve Stimulator ◽

Neurological Assessment ◽

Onset Of Action ◽

Increased Risk ◽

Rapid Reversal ◽

Train Of Four

The place of neuromuscular blocking agents in the intensive care unit (ICU) has changed markedly over the last 20 years. Originally regarded as a mainstay of the process of ‘sedation’, they are now only used for specific indications. The principal disadvantage is probably the difficulty in neurological assessment when a muscle relaxant is used coupled with the increased risk of awareness, because inadequate sedation will be masked. Of the available agents, the intermediate acting ones are the most popular. The degree of relaxation can be readily controlled and they have few side effects. In the presence of renal and/or hepatic disease atracurium or cisatracurium are preferred. Succinylcholine is only used for securing the airway due to its very rapid onset of action. Rocuronium given in a higher dose also possesses a rapid onset in situations when succinylcholine might be contraindicated. When using a muscle relaxant, its effect should always be monitored with a simple train of four pattern of stimulation from a hand-held nerve stimulator. This will ensure that an adequate and not excessive block is secured. If a more rapid reversal is required then a dose of neostigmine with glycopyrrolate may be used. Alternatively, if rocuronium is the relaxant in use then the new agent sugammadex is effective.

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Symptom Relief after Endoscopic Sinus Surgery: An Outcomes-Based Study

Ear Nose & Throat Journal ◽

10.1177/014556139307200608 ◽

1993 ◽

Vol 72 (6) ◽

pp. 413-420 ◽

Cited By ~ 23

Author(s):

Sanford R. Hoffman ◽

Martin C. Mahoney ◽

James F. Chmiel ◽

Gerald D. Stinziano ◽

Kevin N. Hoffman

Keyword(s):

Patient Outcomes ◽

Endoscopic Sinus Surgery ◽

Chronic Sinusitis ◽

Nasal Congestion ◽

Symptom Relief ◽

Nasal Symptom ◽

Sinus Surgery ◽

Post Surgery ◽

Symptom Prevalence ◽

One Year

Previous studies of patient outcomes after sinus surgery have generally described only a summary measure of overall change in symptoms or health status. This paper describes an outcomes-based longitudinal study of sinus symptom prevalence among thirty-one patients treated with endoscopic surgery for chronic sinusitis. Patients completed structured data collection forms to quantify the prevalence of commonly experienced sinus-related symptoms during an eight-week period both before surgery and six months after undergoing sinus surgery. Significant decreases in nasal symptom prevalence (post-surgery versus pre-surgery) were noted for headaches, nasal drainage, nasal congestion, sinus infection, and breathing difficulties. In addition, the proportion of subjects who rated their current health as “better” compared to one year previously increased from 27% pre-surgery to 58% six months after sinus surgery. These findings aid in quantifying the magnitude of improvement experienced by sinus surgery patients and provide further evidence that endoscopic sinus surgery represents an effective treatment for chronic sinusitis.

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Partial resection of the middle turbinate during endoscopic sinus surgery for chronic rhinosinusitis does not lead to an increased risk of empty nose syndrome: a cohort study of a tertiary practice

International Forum of Allergy & Rhinology ◽

10.1002/alr.22127 ◽

2018 ◽

Vol 8 (8) ◽

pp. 959-963 ◽

Cited By ~ 4

Author(s):

Neil C.-W. Tan ◽

Rachel Goggin ◽

Alkis J. Psaltis ◽

Peter-John Wormald

Keyword(s):

Cohort Study ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Middle Turbinate ◽

Partial Resection ◽

Sinus Surgery ◽

Increased Risk ◽

Empty Nose Syndrome

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A Rare Case of Prostate Carcinoma Metastasis in the Orbital Apex

Ear Nose & Throat Journal ◽

10.1177/0145561320973783 ◽

2020 ◽

pp. 014556132097378

Author(s):

Kento Wada ◽

Takeshi Tsuda ◽

Yukiko Hanada ◽

Yohei Maeda ◽

Kiyoshi Mori ◽

...

Keyword(s):

Soft Tissues ◽

Vision Loss ◽

Neck Region ◽

Sinus Surgery ◽

Pathological Examination ◽

Orbital Apex ◽

Orbital Mass ◽

Head And Neck Region ◽

History Of ◽

Head Computed Tomography

Prostate cancer (PC) is prone to bone metastases, but very rarely it can spread to soft tissues. In the head and neck region, PC can metastasize to the orbital soft tissue, causing various symptoms such as vision loss. In this report, we describe the case of a 79-year-old man with PC metastasis in the orbital apex. He presented to an ophthalmologist at our hospital with progressively worsening vision in his left eye over 3 to 4 months. He complained of a drooping eyelid in the same eye; thus, intracranial disease was suspected. Closer inspection with head computed tomography revealed a space-occupying lesion from the orbit to the posterior ethmoid sinus, and he was referred to our department. He had a history of PC, and we performed endoscopic sinus surgery for the diagnosis of malignancy, including metastasis of PC. As a result, the mass was diagnosed as PC metastasis by pathological examination. The patient began androgen blockade therapy and 3 months postoperatively, magnetic resonance imaging revealed that the extraconal orbital mass had decreased significantly. It is important to determine the metastases of PC in the paranasal region when the patient has a preexisting medical history.

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Meticulous endoscopic sinus surgery to prevent recurrence of massive nasal polyposis

The Journal of Laryngology & Otology ◽

10.1017/s0022215112001193 ◽

2012 ◽

Vol 126 (8) ◽

pp. 789-794 ◽

Cited By ~ 9

Author(s):

S M S Hoseini ◽

B Saedi ◽

K Aghazadeh

Keyword(s):

Endoscopic Surgery ◽

Endoscopic Sinus Surgery ◽

Nasal Polyposis ◽

Demographic Data ◽

Effective Means ◽

Sinus Surgery ◽

Previous Surgery ◽

Endoscopic Findings ◽

History Of

AbstractObjective:To evaluate the effect of meticulous endoscopic surgery, including opening of all involved sinus cells, on the subsequent symptoms and endoscopic findings of patients with massive nasal polyposis.Study design and method:One hundred patients with massive nasal polyposis resistant to medical treatment were selected. We documented each patient's demographic data, associated diseases, endoscopic findings, Lund–Mackay score and Sino-Nasal Outcome Test 22 (SNOT22) symptom score. All patients were followed up for at least two years to evaluate any recurrence.Results:Of the 100 patients, 20 per cent had a history of asthma and 27 per cent had undergone previous surgery. All underwent endoscopic sinus surgery. After two years of follow up, 8 per cent had recurrence requiring surgery. Recurrence was significantly associated with a history of asthma (p < 0.001) and the histopathological presence of eosinophilia (p = 0.014).Conclusion:Meticulous endoscopic opening of all involved sinus cells can be a safe and effective means of controlling massive nasal polyposis, with an acceptable recurrence rate.

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Pneumocephalus and orbital emphysema associated with the use of an autoinflation device: a unique case report and review of the literature

The Journal of Laryngology & Otology ◽

10.1017/s0022215119000070 ◽

2019 ◽

Vol 133 (2) ◽

pp. 157-160

Author(s):

A J Millington ◽

V Perkins ◽

M A Salam

Keyword(s):

Case Report ◽

Otitis Media ◽

Eustachian Tube ◽

Endoscopic Sinus Surgery ◽

Otitis Media With Effusion ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Orbital Emphysema ◽

Tube Dysfunction ◽

History Of

AbstractBackgroundAutoinflation devices are commonly used for otitis media with effusion and Eustachian tube dysfunction. Generally, these are very safe devices, with few or no complications.Case reportThis paper presents a case study of pneumocephalus and orbital emphysema, associated with the use of an autoinflation device, in a 73-year-old woman with Eustachian tube dysfunction and otitis media with effusion, and a history of extensive endoscopic sinus surgery 13 years previously.ConclusionA literature review showed autoinflation-related pneumocephalus in patients with skull base defects relating to cranial surgery or tumours; however, this has not been described previously with the Otovent system or its use in relation to functional endoscopic sinus surgery. Given the theoretical risk of undetected bony abnormalities in post-operative functional endoscopic sinus surgery patients, it is suggested that autoinflation devices are used cautiously in patients with a history of sinus surgery.

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Combined Open Septorhinoplasty and Functional Endoscopic Sinus Surgery

Otolaryngology ◽

10.1016/j.otohns.2005.04.010 ◽

2005 ◽

Vol 133 (3) ◽

pp. 436-440 ◽

Cited By ~ 14

Author(s):

Jonathan H. Lee ◽

David A. Sherris ◽

Eric J. Moore ◽

Jonathan H. Lee ◽

David A. Sherris ◽

...

Keyword(s):

Endoscopic Sinus Surgery ◽

Chart Review ◽

Retrospective Chart Review ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Complication Rates ◽

Patients Âgés ◽

Increased Risk ◽

Clinically Significant ◽

The Individual

OBJECTIVE: To compare perioperative and early postoperative complication rates of performing open septorhinoplasty (OSR) and functional endoscopic sinus surgery (FESS) concomitantly or individually. STUDY DESIGN AND SETTING: Retrospective chart review of 55 patients treated at an academic referral center who had undergone combined OSR and FESS. Complication rates for the combined procedures were compared with published complication rates for the individual procedures. RESULTS: Patients’ ages ranged from 14 to 77 years (average, 43 years). Among the 55 cases, there were no major complications and 6 (11%) minor complications: 4 cases of cellulitis (7%; previously published risk, 1%-3%) and 2 cases of postoperative epistaxis (4%). CONCLUSION: OSR and FESS may be performed safely in combination without a clinically significant increased risk of complications. SIGNIFICANCE: The slightly increased risk of cellulitis may warrant the use of intraoperative sinus irrigation and postoperative antibiotic prophylaxis after combined OSR and FESS.

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