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Central retinal artery occlusion after sinus surgery
P206
OtolaryngologyHead and Neck Surgery August I999
Scientific Posters
improvement of tinnitus (80%). The same happened to 7 of 12 patients with improvement after lidocaine who used carbamazepine (58.3%). Conclusion: The intravenous lidocaine was an efficient method for relieving persistent tinnitus in 83.3% of the cases. The oral carbamazepine as a long-term treatment was effective in 64.7% of the cases with favorable results after lidocaine. These preliminary results encourage us to consider the future advantages of lidocaine/carbamazepine associated with the classic acute treatment of sudden deafness in order to reinforce tinnitus treatment in addition to hearing.
15 Intraoral Cortical Bone-Screw Fixation: An Alternative to Arch Bars A JOHN VARTANIAN MD MS; AIJAZ ALVI MD FACS, Chicago IL; Philadelphia PA
Objectives: Intraoral cortical bone screw fixation of the mandible can be used to achieve effective, quick, and easily reversible intraoperative intermaxillary fixation (IMF), hence ensuring proper occlusion prior to plating of mandibular fractures. Intraoperative proper occlusion is temporarily achieved by wire ligation of opposing cortical bone screws placed in the maxilla and mandible. The mandibular fracture can then be plated, with the subsequent removal of bone screws and ligating wires prior to termination of anesthesia. In this retrospective study, we evaluate the use of this "mini-IMF" technique as a viable alternative to arch-bar maxillomandibular fixation prior to plating of mandibular fractures. Methods: A retrospective evaluation of 23 patients with 40 mandibular fractures who underwent mandibular fracture repairs was performed. In all patients the mini-lMF technique was used instead of arch bars to ensure proper dental occlusion. All fractures were plated using 3-dimensional 2.0-mm miniplates (Leibinger; Freiburg, Germany) after the temporary application of the mini-IME Results: Normal occlusion was observed in 21 patients (91.3%), class II occlusion was noted in 1 patient, and 1 patient was edentulous. No complications related to the use of the mini-IMF were observed. Conclusion: The use of the mini-IMF technique can serve as a viable alternative to arch-bar maxillomandibular fixation offering the advantages of decreased intraoperative time, decreased cost, potentially lower frequency of percutaneous and mucosal wire punctures, and overall ease of use for the surgeon. 16 Central Retinal Artery Occlusion after Sinus Surgery JEPTHA NEWTON COLE MD; VIN9
K ANAND MD; Jackson MS
Objectives: Central retinal artery occlusion is an extremely
rare complication of head and neck surgery. Many mechanisms have been implicated for intraoperative and postoperative blindness and include direct nerve injury or retinal arteriolar occlusion secondary to vasospasm or embolus. Methods: A 31-year-old woman underwent right medial maxillectomy for a small but multifocal nasal wall adenosquamous carcinoma. Right eye vision loss with cherry red macula was noted immediately after surgery. The patient underwent emergent paracentesis without improvement. Intravenous fluorescein angiography confirmed central retinal artery occlusion. Anticoagulation measures were considered but not employed. Results: Postoperative coagulopathy and cardiac, neurologic, and ophthalmological studies were unable to find the cause of occlusion. The etiology remained uncertain although vasospasm was a possible factor. High-dose steroid therapy started immediately after surgery failed to improve vision. Conclusion: Central retinal artery occlusion is a rare complication of sinus surgery and has not been previously documented after medial maxillectomy. This case illustrates the importance of visual changes after surgery and the need to consider emergent measures for treatment.
17 Peripheral Facial Palsy Related Middle Ear Infections AURA DIAZ M DE PALACiOS MD; SERGIO A ARENAS MD; NORA E HERNANDEZ MD; EFRAIN GONZALEZ MD; Caracas Venezuela
Objectives: To record the occurrence of facial nerve palsy as a complication of patients who underwent hospitalization at ENT Service of Hospital Universitario de Caracas, Venezuela, carrying acute or chronic middle ear infections. Methods: A prospective study was made with 446 patients hospitalized in the Hospital Universitario de Caracas with the diagnosis of complicated chronic otitis media from 1986 to 1998. The purpose of the study was to determine the occurrence of peripheral facial palsy observed in patients with complicated chronic medial otitis, alone or associated with other manifestations. Microbiological findings, radiological and electrophysiological studies, and therapeutic considerations were done. Results: Two hundred ninety-two patients were hospitalized showing symptoms of chronic otitis media. Sixty-three of these (14.l%) had complications, including peripheral facial palsy in 27 (42.8%). The bacterial strains more frequently seen were Pseudomonas aeruginosa and Proteus mirabilis. The severity of the complication was staged by House's classification. Conclusion: Peripheral facial palsy is the most frequently seen complication in patients with chronic otitis media. Its early management is needed to avoid permanent damage to vital organs.
OtolaryngologyHead and Neck Surgery August I999
Scientific Posters
improvement of tinnitus (80%). The same happened to 7 of 12 patients with improvement after lidocaine who used carbamazepine (58.3%). Conclusion: The intravenous lidocaine was an efficient method for relieving persistent tinnitus in 83.3% of the cases. The oral carbamazepine as a long-term treatment was effective in 64.7% of the cases with favorable results after lidocaine. These preliminary results encourage us to consider the future advantages of lidocaine/carbamazepine associated with the classic acute treatment of sudden deafness in order to reinforce tinnitus treatment in addition to hearing.
15 Intraoral Cortical Bone-Screw Fixation: An Alternative to Arch Bars A JOHN VARTANIAN MD MS; AIJAZ ALVI MD FACS, Chicago IL; Philadelphia PA
Objectives: Intraoral cortical bone screw fixation of the mandible can be used to achieve effective, quick, and easily reversible intraoperative intermaxillary fixation (IMF), hence ensuring proper occlusion prior to plating of mandibular fractures. Intraoperative proper occlusion is temporarily achieved by wire ligation of opposing cortical bone screws placed in the maxilla and mandible. The mandibular fracture can then be plated, with the subsequent removal of bone screws and ligating wires prior to termination of anesthesia. In this retrospective study, we evaluate the use of this "mini-IMF" technique as a viable alternative to arch-bar maxillomandibular fixation prior to plating of mandibular fractures. Methods: A retrospective evaluation of 23 patients with 40 mandibular fractures who underwent mandibular fracture repairs was performed. In all patients the mini-lMF technique was used instead of arch bars to ensure proper dental occlusion. All fractures were plated using 3-dimensional 2.0-mm miniplates (Leibinger; Freiburg, Germany) after the temporary application of the mini-IME Results: Normal occlusion was observed in 21 patients (91.3%), class II occlusion was noted in 1 patient, and 1 patient was edentulous. No complications related to the use of the mini-IMF were observed. Conclusion: The use of the mini-IMF technique can serve as a viable alternative to arch-bar maxillomandibular fixation offering the advantages of decreased intraoperative time, decreased cost, potentially lower frequency of percutaneous and mucosal wire punctures, and overall ease of use for the surgeon. 16 Central Retinal Artery Occlusion after Sinus Surgery JEPTHA NEWTON COLE MD; VIN9
K ANAND MD; Jackson MS
Objectives: Central retinal artery occlusion is an extremely
rare complication of head and neck surgery. Many mechanisms have been implicated for intraoperative and postoperative blindness and include direct nerve injury or retinal arteriolar occlusion secondary to vasospasm or embolus. Methods: A 31-year-old woman underwent right medial maxillectomy for a small but multifocal nasal wall adenosquamous carcinoma. Right eye vision loss with cherry red macula was noted immediately after surgery. The patient underwent emergent paracentesis without improvement. Intravenous fluorescein angiography confirmed central retinal artery occlusion. Anticoagulation measures were considered but not employed. Results: Postoperative coagulopathy and cardiac, neurologic, and ophthalmological studies were unable to find the cause of occlusion. The etiology remained uncertain although vasospasm was a possible factor. High-dose steroid therapy started immediately after surgery failed to improve vision. Conclusion: Central retinal artery occlusion is a rare complication of sinus surgery and has not been previously documented after medial maxillectomy. This case illustrates the importance of visual changes after surgery and the need to consider emergent measures for treatment.
17 Peripheral Facial Palsy Related Middle Ear Infections AURA DIAZ M DE PALACiOS MD; SERGIO A ARENAS MD; NORA E HERNANDEZ MD; EFRAIN GONZALEZ MD; Caracas Venezuela
Objectives: To record the occurrence of facial nerve palsy as a complication of patients who underwent hospitalization at ENT Service of Hospital Universitario de Caracas, Venezuela, carrying acute or chronic middle ear infections. Methods: A prospective study was made with 446 patients hospitalized in the Hospital Universitario de Caracas with the diagnosis of complicated chronic otitis media from 1986 to 1998. The purpose of the study was to determine the occurrence of peripheral facial palsy observed in patients with complicated chronic medial otitis, alone or associated with other manifestations. Microbiological findings, radiological and electrophysiological studies, and therapeutic considerations were done. Results: Two hundred ninety-two patients were hospitalized showing symptoms of chronic otitis media. Sixty-three of these (14.l%) had complications, including peripheral facial palsy in 27 (42.8%). The bacterial strains more frequently seen were Pseudomonas aeruginosa and Proteus mirabilis. The severity of the complication was staged by House's classification. Conclusion: Peripheral facial palsy is the most frequently seen complication in patients with chronic otitis media. Its early management is needed to avoid permanent damage to vital organs.