Postoperative Ptosis and Diplopia Induced by the Intraoperative Application of Bone Wax

Maki, Yoshinori; Ishibashi, Ryota; Yamada, Daisuke; Morita, Takumi; Chin, Masaki; Yamagata, Sen

doi:10.1016/j.wneu.2017.03.102

Cited by 11 publications

(9 citation statements)

References 5 publications

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“…CT findings of bone wax in orbit in our case (4- a ,4- b white arrows) is consistent with hypodense or fat density lesions as described in previous paper [5] (4- c black arrow)…”

Section: Discussionsupporting

confidence: 92%

“…As in our case, the CT images of bone wax usually reveal hypodense or fat density lesions (Fig. 4) [5]. However, there is no literature examining MRIs of bone wax in the orbit.…”

Section: Discussionsupporting

confidence: 56%

“…Several complications have been reported to be associated with the use of bone wax, such as infection, osteohypertrophy, pain, granuloma formation, allergic reactions, and thrombosis [1, 3, 4]. Rare complications, such as ptosis and diplopia, were reported in a recent case of craniotomy [5]. Here, we presented a similar case of postoperative ptosis and proptosis as a complication of bone wax migration.…”

Section: Discussionmentioning

confidence: 72%

“…Complications related to bone wax migration are rare, and the exact incidence is unknown [1]. To our knowledge, from 1995 to 2018, 19 patients reported complications related to bone wax migration (Table 1) [1, 5–11]. The majority of these cases (14/19) are related to bone wax migration into the sigmoid sinus [7–9], and only one case presented bone wax migration that resulted in ophthalmic symptoms in the orbit [5].…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the postoperative ptosis after a craniotomy, a postsurgical downward shift of the brain due to gravity might have contributed to the tight packing of the bone wax in the orbit [5]. Additionally, a mismatch between the size of bone wax and the bone window may have caused the displacement of bone wax [5]. Moreover, bone defects in the basal frontal sinus were found in the preoperative CT (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Bone wax migrates to the orbit in a patient with a frontal sinus abnormality: a case report

Zhou

Wei

et al. 2019

BMC Ophthalmol

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BackgroundBone wax is the most widely used hemostatic bone sealant because of its availability, ease of use, immediate action, and minimal adverse effects. Several complications have been reported to be associated with the use of bone wax, such as infection, osteohypertrophy, pain, granuloma formation, allergic reaction, and thrombosis. Here, we present a rare complication, namely, bone wax migration, which developed after a craniotomy on a patient who had a frontal sinus abnormality.Case presentationA 51-year-old woman complained of pain and swelling in her left eye accompanied by difficulty opening the left eyelid after undergoing a craniotomy. An examination revealed left eye proptosis with ptosis, eyelid swelling, and increases in intraorbital pressure and intraocular pressure (IOP). According to a CT and an MRI of the orbit, we found that the intraoperative bone wax had migrated to the orbit, thereby causing compression. We also found that the basal frontal sinus of the patient was congenitally defective, which may have induced the migration of the bone wax. Given that the patient recently underwent a craniotomy and given the risks associated with orbital surgery, she refused to undergo a surgery to remove the bone wax. Thus, the patient was administered mannitol intravenously daily, accompanied by topical Timolol, to reduce the intraorbital pressure and IOP. This treatment led to a gradual decrease in IOP and intraorbital pressure, and these parameters remained stable after treatment ended. During the 6-month follow-up, the best corrected visual acuity improved, and ptosis and restricted eye movements also improved significantly.ConclusionsWe report a case of bone wax migration that developed after a craniotomy on a patient who had a congenital defect in the basal frontal sinus. Extra caution should be taken when using bone wax, and a comprehensive understanding of the patient’s intracranial anatomy is important for decreasing the incidence of bone wax migration. Additionally, when a patient presents with symptoms of ocular compression, bone wax migration should be considered in addition to typical radiological changes.

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“…CT findings of bone wax in orbit in our case (4- a ,4- b white arrows) is consistent with hypodense or fat density lesions as described in previous paper [5] (4- c black arrow)…”

Section: Discussionsupporting

confidence: 92%

“…As in our case, the CT images of bone wax usually reveal hypodense or fat density lesions (Fig. 4) [5]. However, there is no literature examining MRIs of bone wax in the orbit.…”

Section: Discussionsupporting

confidence: 56%