Subperiosteal Orbital Hematoma From SVC Occlusion During Cardiac Surgery: To See or Not to See

We present a case in which the superior vena cava (SVC) cannula was inadvertently clamped for a short while during cardiopulmonary bypass, completely occluding SVC drainage. This resulted in a rarely seen complication – bilateral subperiosteal orbital hematomas causing orbital compartment syndrome. Other instances of intentional SVC occlusion include during the creation of a bidirectional cavo-pulmonary shunt and for emergency control of bleeding during thoracic surgery.

Diagnosis and Management of Orbital Fat Exposure During Endoscopic Sinus Surgery

Background: The orbital complication rate during endoscopic sinus surgery (ESS) is <1%. Orbital fat exposure during ESS can herald orbital complications including orbital hematoma, extraocular muscle trauma, optic nerve injury, or blindness. The objective of this study was to evaluate the current consensus regarding diagnosis and management of orbital fat exposure during ESS. Methods: A 24-point survey focused on orbital fat exposure during ESS was distributed to American Rhinologic Society members. Also, a retrospective review of 25 cases of orbital fat exposure drawn from the principal investigator’s 30-year experience was performed. Results: Over 10 000 surgical cases of the principal investigator were reviewed. Twenty-five patients had orbital fat exposure. Five developed minor complications while 2 were major (ie, temporary vision changes). Two hundred thirty-six surgeons responded to the survey; 93% had encountered orbital fat during ESS; 88% of surgeons identify orbital fat by either its appearance endoscopically or the “bulb press” test. Almost every responding surgeon will cautiously avoid further manipulation in the area of orbital fat exposure. Nearly half will immediately curtail the extent of surgery. Surgeons do not significantly change postoperative management. Considerations regarding observation in postanesthesia care unit, close follow-up, and strict nose blowing precautions are common. Conclusion: Orbital fat exposure during ESS is a rarely discussed, but clinically important. Orbital fat exposure can be a harbinger for major orbital complications that should be recognized by endoscopic appearance and confirmed with the bulb press test. Caution with “no further manipulation” of orbital fat is the guiding principle for intraoperative management, while postoperative management is generally expectant. Level 4 Evidence

Orbitofrontal Extradural Hematoma: Unusual Cause of Proptosis

<b><i>Introduction:</i></b> Frontal extradural hematoma (EDH) extending into orbit is an uncommon entity. Clinical presentation can be subacutely progressive proptosis following head injury. <b><i>Case Presentation:</i></b> We present a case of frontal EDH with orbital extension which had delayed progressive proptosis. The patient improved clinically after surgical evacuation of EDH. <b><i>Conclusion:</i></b> It is important to look for orbital roof fractures, orbital hematoma in cases of head injury. Such cases should be treated surgically at the earliest.

Posttraumatic Subperiosteal Orbital Hematoma With Intracranial Hemorrhage in A Male Infant

Background: To the best of our knowledge, there has been no report of subperiosteal orbital hematoma combined with intracerebral hemorrhage in pediatric patients.Case presentation: A healthy 9-month-old boy with left superior tarsal conjunctival prolapse was admitted to the emergency room after left periorbital blunt trauma. Computer tomography of the brain showed a left orbital roof fracture and subperiosteal orbital hematoma with acute intracerebral hemorrhage. He received emergency craniotomy. Three days after the craniotomy, the subperiosteal hematoma and proptosis increased. An anterior orbitotomy with orbital subperiosteal hematoma evacuation and drain placement were performed. Nine months after surgery, the left blepharoptosis and conjunctival prolapse improved and fix and follow were good in his both eyes. However, a new-onset intermittent exotropia and left hypotropia were detected. Conclusions: Orbital subperiosteal hematoma must be considered in the differential diagnosis of acute unilateral proptosis after trauma. In infants and children, a thorough work-up to detect concomitant intracerebral hemorrhage is necessary. Prompt surgical removal of hematoma is recommended to prevent complications