Bone wax migrates to the orbit in a patient with a frontal sinus abnormality: a case report
Abstract Background Bone 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, granulo...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-01-01
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| Series: | BMC Ophthalmology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12886-019-1037-x |
| _version_ | 1818290534395936768 |
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| author | Yangbo Zhou Minhong Li Xin Wei Xue Yang Jialin Zhang Xin Qi |
| author_facet | Yangbo Zhou Minhong Li Xin Wei Xue Yang Jialin Zhang Xin Qi |
| author_sort | Yangbo Zhou |
| collection | DOAJ |
| description | Abstract Background Bone 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 presentation A 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. Conclusions We 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. |
| first_indexed | 2024-12-13T02:29:42Z |
| format | Article |
| id | doaj.art-f971714b8dbe4714a50b26a9eb033e11 |
| institution | Directory Open Access Journal |
| issn | 1471-2415 |
| language | English |
| last_indexed | 2024-12-13T02:29:42Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Ophthalmology |
| spelling | doaj.art-f971714b8dbe4714a50b26a9eb033e112022-12-22T00:02:32ZengBMCBMC Ophthalmology1471-24152019-01-011911610.1186/s12886-019-1037-xBone wax migrates to the orbit in a patient with a frontal sinus abnormality: a case reportYangbo Zhou0Minhong Li1Xin Wei2Xue Yang3Jialin Zhang4Xin Qi5Department of Neurosurgery, the 2nd Xiangya Hospital, Central South UniversityDepartment of Neurosurgery, the 2nd Xiangya Hospital, Central South UniversityDepartment of Ophthalmology, the 2nd Xiangya Hospital, Central South UniversityDepartment of Ophthalmology, the 2nd Xiangya Hospital, Central South UniversityDepartment of Radiology, Hainan Fifth People’s hospitalDepartment of Ophthalmology, the 2nd Xiangya Hospital, Central South UniversityAbstract Background Bone 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 presentation A 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. Conclusions We 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.http://link.springer.com/article/10.1186/s12886-019-1037-xBone wax migrationOrbitPtosisProptosisCraniotomyFrontal sinus |
| spellingShingle | Yangbo Zhou Minhong Li Xin Wei Xue Yang Jialin Zhang Xin Qi Bone wax migrates to the orbit in a patient with a frontal sinus abnormality: a case report BMC Ophthalmology Bone wax migration Orbit Ptosis Proptosis Craniotomy Frontal sinus |
| title | Bone wax migrates to the orbit in a patient with a frontal sinus abnormality: a case report |
| title_full | Bone wax migrates to the orbit in a patient with a frontal sinus abnormality: a case report |
| title_fullStr | Bone wax migrates to the orbit in a patient with a frontal sinus abnormality: a case report |
| title_full_unstemmed | Bone wax migrates to the orbit in a patient with a frontal sinus abnormality: a case report |
| title_short | Bone wax migrates to the orbit in a patient with a frontal sinus abnormality: a case report |
| title_sort | bone wax migrates to the orbit in a patient with a frontal sinus abnormality a case report |
| topic | Bone wax migration Orbit Ptosis Proptosis Craniotomy Frontal sinus |
| url | http://link.springer.com/article/10.1186/s12886-019-1037-x |
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