Skull Base Injury and Intracranial Complication from Office Sinus Surgery

Abstract

A 65-year-old man with a history of sensorineural hearing loss and recurrent otitis externa presented with complaints of otorrhea, nasal congestion, and facial pressure. He was previously treated with two courses of antibiotics for his otitis. In addition, he was administering saline rinses, cetirizine, and fluticasone nasal spray; however, it is unclear if these therapies were targeted to sinonasal complaints as he had no documented history of allergic or rhinologic complaints beyond “mucinous nasal discharge.” Computed tomography (CT) imaging of his sinuses demonstrated mucosal thickening in the maxillary sinuses and opacification of the ethmoid and sphenoid sinuses. A recommendation was made for the patient to proceed with office-based endoscopic sinus surgery (ESS). The patient underwent bilateral ethmoidectomy, frontal sinusotomy, sphenoidotomy, and maxillary antrostomy in the office setting under local anesthesia; image guidance was not used. The ethmoidectomy was completed with Blakesly forceps and a microdebrider, while the maxillary, sphenoid, and frontal sinuses were addressed via balloon sinuplasty; placement of the balloon in the frontal sinus was reportedly confirmed by transillumination. The middle turbinates were avulsed with grasping forceps. No complications were noted intraoperatively and the patient was discharged to home from clinic.