Complication of Dacryocystorhinostomy (DCR) in Elderly Patient

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(A) Coronal view of brain CT demonstrating left pneumocephalus in the left anterior frontal convexity (horizontal arrow) and a suspected microfistula in the left orbital wall (vertical arrow). (B) Sagittal view of brain CT reveals pneumocephalus in the left anterior frontal convexity (horizontal arrow).

Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy

Dacryocystorhinostomy is a surgical procedure used for restoring the flow of tears from the lacrimal sac into the nose. The surgery creates a new tear drain between your eyes and nose. You may require the surgery if your tear duct has become blocked. Although this procedure is the standard treatment for nasolacrimal duct obstruction, complications are often possible. In this case an 85-year-old man underwent endoscopic DCR and after 1 month developed a complication. Doctors diagnosed him with delayed unilateral pneumocephalus.

The 85-year-old Asian man presented with epiphora and binocular stinging sensation. His history revealed that he had a cerebrovascular accident and hypertension. In addition to this, he also underwent a bilateral cataract surgery in 2015 and an eye glaucoma surgery in 2010. Irrigation of the lacrimal canaliculi showed that both lacrimal ducts were obstructed. The patient also underwent bilateral endoscopic DCRs with silicone tube intubation. There were no signs of anatomic variation during the procedure. Doctors discharged him in good health on the 4th day of admission.

4 days after the procedure the patient revisited the emergency room.

4 days later the patient returned to the emergency room with complaints of generalised weakness and poor oral intake. However, there were no signs of mental change or headaches. Doctors advised blood tests and urinalysis for further investigations which showed no significant findings. His vital signs were also normal. The patient was discharged after supportive treatment and hydration without any ophthalmologic complications.

A month later the patine returned to the emergency room and was admitted with lethargy and drowsiness for 2 days. All examinations including fiberoptic examination was normal. There was no sign of fever, although, his C-reactive protein was elevated. Further investigations showed no signs of cerebrospinal fluid rhinorrhoea or bony dehiscence. Chest CT was evident of aspiration pneumonia.

Doctors concluded that the symptoms were a because of delayed unilateral pneumocephalus after bilateral endoscopic DCR.

References

Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient https://casereports.bmj.com/content/14/5/e241540

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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