Orbital Emphysema Leading to Blindness Following Routine Functional Endoscopic Sinus Surgery

Rubinstein, Adrian; Riddell, C E; Akram, Imran; Ahmado, Ahmed; Benjamin, Larry

doi:10.1001/archopht.123.10.1452

Cited by 44 publications

(27 citation statements)

References 4 publications

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“…The resolution of these clinical signs is usually uneventful (McKenzie & Rosenberg 2009) but in rare cases the air may disperse further in deeper spaces and lead to pneumomediastinum, airway compromise or air emboli, which are potentially life-threatening complications (Reznick & Ardary 1990, Heyman & Babayof 1995, Fr€ uhauf et al 2005, McKenzie & Rosenberg 2009). Infection of the deeper spaces, damage of the optic nerve and loss of vision as a result of SCE have also been reported (Buckley et al 1990, Rubinstein et al 2015.…”

Section: Introductionmentioning

confidence: 95%

Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management

2019

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Background Subcutaneous emphysema is an infrequent mishap during root canal treatment which, in rare cases, can lead to severe complications. Aim To systematically review the literature on the factors affecting the development of subcutaneous emphysema during root canal treatment, and on its management. Data sources An electronic search was conducted in EMBASE (1947–2018), LILACS (1982–2018), PubMed (1950–2018), SciELO (1997–2018), Scopus (1970–2018), Web of Science (1900–2018) and two grey literature databases. Moreover, all issues of nine journals and four endodontic textbooks were hand‐searched. Study eligibility criteria, participants, interventions The retrieved studies were screened by two reviewers to select clinical studies, case reports or case series describing subcutaneous emphysema that developed during or immediately after root canal treatment in adult patients. Study appraisal and synthesis methods Included studies were critically appraised according to a custom list of quality requirements. The extracted data were arranged in tables, and combined through a narrative synthesis. Results The search retrieved 99 unique articles. Thirty six case reports and 15 case series describing a total of 65 cases of subcutaneous emphysema were included in this review. The methodological quality was medium. Reported cases of emphysema more often involved females and maxillary teeth. Drying of the root canal system with air under pressure, inadvertent extrusion of hydrogen peroxide through the apical foramen, the air‐water spray produced by handpieces or laser devices, and the use of ozone gas were the most commonly suspected causes. Its management involved prescription of antibiotics and NSAIDs/analgesics, local application of ice packs or compresses and hospitalization. The signs and symptoms resolved completely within 1‐17 days. Limitations Case reports and case series are a low level of evidence. Conclusions and implications of key findings Subcutaneous emphysema can develop during both nonsurgical and surgical root canal treatment. Pressurized air streams or air‐water sprays should not be directed towards the root canals or areas with mucosal discontinuity. None of the management approaches were clearly related to expedited recovery. Guidelines should be developed in order to avoid unnecessary or potentially harmful interventions.

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Section: Introductionmentioning

confidence: 95%

Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management

2019

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“…In most cases, trapped air in the orbit may have no significant consequences. However, large pockets of orbital emphysema may cause elevated intraocular pressure, significant proptosis, decreased ocular motility and in very rare instances vascular compromise secondary to a compartment syndrome and permanent visual loss (Linberg, 1982;Rubinstein et al, 2005). Because of the potential for severe permanent visual loss, the rapid diagnosis and management of orbital emphysema is indicated.…”

Section: Discussionmentioning

confidence: 99%

Visual Recovery after Evacuation of Orbital Emphysema

Chaudhry

Alamri

Shamsi

et al. 2007

Orbit

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Orbital emphysema due to orbital trauma is a well-known occurrence. Visual loss due to orbital emphysema, however, is an uncommon phenomenon. A case of unilateral orbital emphysema following door-handle trauma with subsequent proptosis, painful ophthalmoplegia and compressive optic neuropathy resulting in compromised vision is presented in an 8-year-old male child. Conservative management, including intravenous corticosteroids, failed to resolve the patient's symptoms and compressive optic neuropathy. Surgical intervention to evacuate orbital emphysema resulted in prompt resolution of symptoms, including recovery of vision. A review of the medical literature revealed that only few isolated cases of orbital emphysema with compressive optic neuropathy have been reported previously, with no reports due to door-handle trauma.

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“…Intraorbital air from ESS is usually a visually insignificant sign of orbital violation except in a rare reported case [56] of orbital emphysema following ESS that led to complete blindness.…”

Section: Orbitmentioning

confidence: 99%

Neuro-ophthalmic complications of endoscopic sinus surgery

Bhatti

2007

Current Opinion in Ophthalmology

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A wide range of neuro-ophthalmic complications may occur during endoscopic sinus surgery. The use of powered cutting instruments has been a recent advance in endoscopic sinus surgery, but it has also been implicated in rapid, irreversible, and devasting complications. Multiple preoperative and intraoperative factors appear to be involved in the adverse events associated with endoscopic sinus surgery. Ophthalmologists may be asked to evaluate and manage ocular damage in patients who have undergone endoscopic sinus surgery, and in some cases emergent intervention may be required in an attempt to avoid permanent visual loss.

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Orbital Emphysema Leading to Blindness Following Routine Functional Endoscopic Sinus Surgery

Cited by 44 publications

References 4 publications

Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management

Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management

Visual Recovery after Evacuation of Orbital Emphysema

Neuro-ophthalmic complications of endoscopic sinus surgery

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