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Ethmoid pneumocele presenting with exophthalmos 15 years after endoscopic sinus surgery.

Song M, Ahn SM, Reh DR, Shargorodsky J - Allergy Rhinol (Providence) (2015)

Bottom Line: The diagnostic workup, operative approach, and postoperative results were evaluated.Marsupialization of the pneumocele as well as a revision ethmoidectomy were performed, with a visible return of the orbital contents to a more natural position.The patient experienced worsened diplopia immediately postoperatively that resolved within two weeks.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

ABSTRACT

Introduction: A pneumocele is an abnormal dilation of an air-containing sinus beyond the normal margins of bone, with associated bony thinning. A delayed ethmoid pneumocele after sinus surgery has not previously been reported.

Methods: A case report of a patient with a delayed ethmoid pneumocele after sinus surgery. The diagnostic workup, operative approach, and postoperative results were evaluated.

Results: A 57-year-old female with a history of endoscopic sinus surgery 15 years prior presented with right eye proptosis and severe orbital and facial pressure. A maxillofacial computed tomography showed a markedly expanded air-filled right anterior ethmoid space with a dehiscent lamina papyracea, consistent with a pneumocele. Marsupialization of the pneumocele as well as a revision ethmoidectomy were performed, with a visible return of the orbital contents to a more natural position. The patient experienced worsened diplopia immediately postoperatively that resolved within two weeks.

Conclusions: This case demonstrates that a pneumocele can present even years after endoscopic sinus surgery, and acute but temporary development or worsening of diplopia can result from surgical decompression of the pneumocele as the eye returns to its natural position.

No MeSH data available.


Related in: MedlinePlus

Intraoperative images of the right ethmoid cavity before and after marsupialization of the right ethmoid pneumocele. Image A shows the anterior and inferior aspect of the pneumocele protruding from the ethmoid. Image B demonstrates a soft, dehiscent orbital wall, with a probe pushing on the periorbita. Image C shows the marsupialized pneumocele, again demonstrating the medial orbital wall.
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Figure 2: Intraoperative images of the right ethmoid cavity before and after marsupialization of the right ethmoid pneumocele. Image A shows the anterior and inferior aspect of the pneumocele protruding from the ethmoid. Image B demonstrates a soft, dehiscent orbital wall, with a probe pushing on the periorbita. Image C shows the marsupialized pneumocele, again demonstrating the medial orbital wall.

Mentions: A maxillofacial computed tomography showed a markedly expanded air-filled right anterior ethmoid space with a significantly thinned lateral wall. The air cell was protruding into the medial right orbit, inferolaterally displacing the medial rectus muscle, optic nerve, and globe and laterally displacing the superior oblique muscle (Fig. 1). The air cell also expanded into, and caused partial effacement of, the right frontal sinus and frontal recess. The patient was taken to the operating room for a revision right ethmoidectomy, with an expanded opening and drainage of the pneumocele. Intraoperatively, a large right ethmoid air-filled space was entered, with immediate associated air-bubbling (Fig. 2). The lamina papyracea was noted to be absent. The patient was discharged home postoperatively, but later that evening started noticing worsening diplopia. The diplopia worsened for approximately the next three days. At her one-week visit, she was noted to have significantly improved extraoccular motion but was severely bothered by the diplopia. Nasal endoscopy demonstrated a more medial orbital position as compared with its intraoperative position. An ophthalmologic evaluation demonstrated normal visual acuity, intraocular pressure, and extraoccular motion. At her two-week visit, the diplopia had resolved, and at the one month visit, her endoscopic examination showed her right globe to be in a normal anatomic position (Fig. 3).


Ethmoid pneumocele presenting with exophthalmos 15 years after endoscopic sinus surgery.

Song M, Ahn SM, Reh DR, Shargorodsky J - Allergy Rhinol (Providence) (2015)

Intraoperative images of the right ethmoid cavity before and after marsupialization of the right ethmoid pneumocele. Image A shows the anterior and inferior aspect of the pneumocele protruding from the ethmoid. Image B demonstrates a soft, dehiscent orbital wall, with a probe pushing on the periorbita. Image C shows the marsupialized pneumocele, again demonstrating the medial orbital wall.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541635&req=5

Figure 2: Intraoperative images of the right ethmoid cavity before and after marsupialization of the right ethmoid pneumocele. Image A shows the anterior and inferior aspect of the pneumocele protruding from the ethmoid. Image B demonstrates a soft, dehiscent orbital wall, with a probe pushing on the periorbita. Image C shows the marsupialized pneumocele, again demonstrating the medial orbital wall.
Mentions: A maxillofacial computed tomography showed a markedly expanded air-filled right anterior ethmoid space with a significantly thinned lateral wall. The air cell was protruding into the medial right orbit, inferolaterally displacing the medial rectus muscle, optic nerve, and globe and laterally displacing the superior oblique muscle (Fig. 1). The air cell also expanded into, and caused partial effacement of, the right frontal sinus and frontal recess. The patient was taken to the operating room for a revision right ethmoidectomy, with an expanded opening and drainage of the pneumocele. Intraoperatively, a large right ethmoid air-filled space was entered, with immediate associated air-bubbling (Fig. 2). The lamina papyracea was noted to be absent. The patient was discharged home postoperatively, but later that evening started noticing worsening diplopia. The diplopia worsened for approximately the next three days. At her one-week visit, she was noted to have significantly improved extraoccular motion but was severely bothered by the diplopia. Nasal endoscopy demonstrated a more medial orbital position as compared with its intraoperative position. An ophthalmologic evaluation demonstrated normal visual acuity, intraocular pressure, and extraoccular motion. At her two-week visit, the diplopia had resolved, and at the one month visit, her endoscopic examination showed her right globe to be in a normal anatomic position (Fig. 3).

Bottom Line: The diagnostic workup, operative approach, and postoperative results were evaluated.Marsupialization of the pneumocele as well as a revision ethmoidectomy were performed, with a visible return of the orbital contents to a more natural position.The patient experienced worsened diplopia immediately postoperatively that resolved within two weeks.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

ABSTRACT

Introduction: A pneumocele is an abnormal dilation of an air-containing sinus beyond the normal margins of bone, with associated bony thinning. A delayed ethmoid pneumocele after sinus surgery has not previously been reported.

Methods: A case report of a patient with a delayed ethmoid pneumocele after sinus surgery. The diagnostic workup, operative approach, and postoperative results were evaluated.

Results: A 57-year-old female with a history of endoscopic sinus surgery 15 years prior presented with right eye proptosis and severe orbital and facial pressure. A maxillofacial computed tomography showed a markedly expanded air-filled right anterior ethmoid space with a dehiscent lamina papyracea, consistent with a pneumocele. Marsupialization of the pneumocele as well as a revision ethmoidectomy were performed, with a visible return of the orbital contents to a more natural position. The patient experienced worsened diplopia immediately postoperatively that resolved within two weeks.

Conclusions: This case demonstrates that a pneumocele can present even years after endoscopic sinus surgery, and acute but temporary development or worsening of diplopia can result from surgical decompression of the pneumocele as the eye returns to its natural position.

No MeSH data available.


Related in: MedlinePlus