Rhinology Complications

1
Rhinology Complications

• Iain Nixon

2
DG 24.7.41 8042935

• 64y
• Polpyectomy 1984, 1988, 1992, 1999 (inflammatory)
• Recurrent polyposis
• Listed for
• Revision nasal polypectomy bilateral intranasal
  ethmoidectomy Bilateral antral washouts

3
DG

• Preoperative investigations
• FBC normal
• Procedure
• 2 May 2007
• Polypectomy intranasal ethmoidectomy
• Findings
• Multiple ethmoidal polyps removed
• Adhesions divided
• Bulla uncapped

4
DG

• Post op
• Sialastic splints
• Packs
• Recovery
• Bruising medial canthus
• Limitation of medial gaze
• Acuity not affected
• Opthalmologists called
• ENT senior called

5
DG

• Treatment
• Packs removed
• Steroids
• Close observation
• Swelling localised to medial canthus
• Ward
• Continued improvement
• Reviewed following day opthalmologists

6
Lateral Canthotomy Crimping the lateral canthus
7
Cutting the lateral canthus
8
Cutting the inferior canthal ligament
9
Confirming laxity of inferior ligament
10
AE Mid-afternoon

• 19yr male
• Otherwise well
• Out last night
• Alleged assault
• Punched / kicked in head and face
• Epistaxis at the time
• Went home same night to bed
• Woke up with a black eye

11

• Blowing nose this morning
• Left eye popped
• Sudden onset pain, and swelling
• Pain now subsided not clear if any more bruising
• Examination
• Peri-orbital bruising, no emphysema
• Acuity symmetrical (colour vision)
• Movements symmetrical pain free
• No parasthesia, mid face stable

12

• Investigations
• Plain facial views No fracture seen
• Referral / Admission
• ENT ?
• Opthalmology ?
• Discharge ?