Onerci T Metin, Ayhan Keramettin, Oğretmenoğlu Oğuz
Department of Otorhinolaryngology Head and Neck Surgery, Hacettepe University, Ankara, Turkey.
Am J Otolaryngol. 2004 Sep-Oct;25(5):354-6. doi: 10.1016/j.amjoto.2004.03.005.
Our aim in this work is to define the importance of anatomical knowledge in septoplasty operation and to prevent complications. Septoplasty is one of the most common operations in otorhinolaryngology to treat the nasal obstruction caused by septal deviation. During and after septoplasty, there are some recorded complications, such as hemorrhage, hematoma, septal abscess, septal perforation, saddle nose, infection, anosmia, visual disturbances, cavernous sinus thrombosis, meningitis, pneumoencephalos, subarachnoid hemorrhage, subdural empyma, brain abscess, periorbital emphysema, toxic shock syndrome, and cerebrospinal fluid (CSF) rhinorrhea. Some of the complications are rare, but their results are life threatening. We report a rare complication of septoplasty CSF rhinorrhea. Two consecutive cases of CSF fistulas after septoplasty operation are presented. Both of the cases were treated endoscopically. The possible mechanisms and different treatment options are discussed. Prevention of the CSF fistula in septoplasty is more important than its treatment. Realizing the anatomic variations and gentle manipulation at the ethmoid roof is essential.
我们这项工作的目的是明确鼻中隔成形术中解剖学知识的重要性并预防并发症。鼻中隔成形术是耳鼻喉科治疗鼻中隔偏曲所致鼻阻塞最常见的手术之一。在鼻中隔成形术期间及术后,有一些已记录的并发症,如出血、血肿、鼻中隔脓肿、鼻中隔穿孔、鞍鼻、感染、嗅觉丧失、视觉障碍、海绵窦血栓形成、脑膜炎、气脑、蛛网膜下腔出血、硬脑膜下积脓、脑脓肿、眶周气肿、中毒性休克综合征和脑脊液鼻漏。其中一些并发症很罕见,但后果危及生命。我们报告一例鼻中隔成形术罕见并发症——脑脊液鼻漏。本文介绍了两例鼻中隔成形术后连续发生脑脊液瘘的病例。两例均采用内镜治疗。讨论了可能的机制和不同的治疗选择。在鼻中隔成形术中预防脑脊液瘘比治疗更为重要。认识到解剖变异并在筛窦顶部轻柔操作至关重要。