• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.1
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• pp.71-74
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• 2022

Posterior superior alveolar nerve block (PSANB) is one of the most common and safe injection techniques in the field of dentistry. As with any other procedure, it also has inherent complications, of which ophthalmic complications are relatively rare. Transient diplopia following the administration of PSANB is rare and daunting for both the patient and the clinician. We present a case of transient diplopia in a 26-year-old female patient following administration of PSANB and review its probable pathophysiology and management and prevention.

• Kosin Medical Journal
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• v.33 no.2
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• pp.208-214
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• 2018

Although the inferior oblique (IO) muscle is positioned considerably deep in the orbit, transconjunctival lower lid blepharoplasty may affect it and transient or permanent IO muscle palsy might result. Therefore diplopia should be explained before cosmetic blepharoplasty performed with transconjunctival approach.

• Journal of Yeungnam Medical Science
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• v.38 no.2
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• pp.152-156
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• 2021

Diplopia is a rare complication of spine surgery. The abducens nerve is one of the cranial nerves most commonly related to diplopia caused by traction injury. We report a case of a 71-year-old woman who presented with diplopia developing from abducens nerve palsy after C1-C2 fixation and fusion due to atlantoaxial subluxation with cord compression. As soon as we discovered the symptoms, we suspected excessive traction by the instrument and subsequently performed reoperation. Subsequently, the patient's symptoms improved. In other reported cases we reviewed, most were transient. However, we thought that our rapid response also helped the patient's fast recovery in this case. The mechanisms by which postoperative diplopia develops vary and, thus, remain unclear. We should pay attention to the fact that the condition is sometimes an indicator of an underlying, life-threatening condition. Therefore, all patients with postoperative diplopia should undergo thorough ophthalmological and neurological evaluations as well as careful observation by a multidisciplinary team.

• Archives of Craniofacial Surgery
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• v.16 no.3
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• pp.114-118
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• 2015

Background: The reduction of orbital blowout fracture primarily aims to normalize the extra-ocular movement by returning the herniated orbital soft tissue into the original position, and to prevent enophthalmos by normalizing the orbital cavity volume. We introduce a balloon catheter-assisted orbital floor reduction technique. Methods: A retrospective review was performed for all patients with orbital floor fracture who underwent the technique described in the main body of this text. Medical records were reviewed for demographic data, clinical presentation and course, degree of enophthalmos, intraorbital volume on computed tomography scan, and postoperative outcomes. The enophthalmos and intraorbital volume of the injured site were compared to the uninjured eye and orbit. Results: The review identified 14 patients (11 male, 3 female). The mean preoperative difference in en-exopthalmos was 2.13 mm, while the mean orbital volume was 116%. The mean postoperative difference in en-exophthalmos had improved to 0.61 mm with a mean orbital volume of 101.85%. At the time of catheter removal at 10 days, three patients experienced diplopia (n=1), extra-ocular movement disorder (1), or enophthalmos (1). All of these had resolved by the 6-month follow-up visit. Conclusion: Balloon catheter-assisted reduction of the orbital floor fractures was associated with improvements in intraorbital volume and enopthalmos in the 14 patients. Notable complications included diplopia, enophthalmos, and limited extra-ocular movement, all of which were transient in the early postoperative period and had resolved by 6-month follow up.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.1-6
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• 2010

Purpose: Many surgical approaches for reconstruction of blow out fracture have been introduced, which include subciliary incision, transconjunctival incision and transcaruncular incision. Recently endoscopic approach has been attempted. This study was intended to show the effectiveness of the approach through transconjunctival incision combined with transnasal reduction in reconstructing blow out fracture to its original position. Methods: Medical recoreds of 43 patients from March 2008 to March 2009 who underwent surgery for orbital fracture were reviewed, retrospectively. All fractures were operated through transconjuctival incision approach combined with transnasal reduction. The average follow-up period was 10.1 months. To evaluate the surgical outcomes of orbital fracture, we performed CT of the facial bone before and after the surgery. In addition, preoperative and postoperative data of enophthalmos, diplopia and the limitation of extraocular motion was assessed with physical examination. Results: Post-operative CT scan of 43 patients assured that the bone fragments of the orbital fractures were restored to their original positions. Although a few patients developed postoperative transient diplopia or impairment of ocular movement, most of the patients recovered during the follow-up period without complication. Conclusion: From this study, we were able to demonstrate the effectiveness of the transnsasal reduction technique combined with the approach through transconjunctival incision. This technique can be considered as very useful means of repairing orbital fracture. It is not only easy to perform but also it can minimize the damage to the orbital bone. Furthermore, it can restore the fracture to its original position as much as possible.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.152-156
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• 1999

Spontaneous intracranial hypotension (SIH) is a rare syndrome which causes postural headache associated with low cerebrospinal fluid (CSF) pressure, without preceding events such as lumbar puncture, back trauma, operative procedure or illness. The headche is usually accompanied by nausea, vomiting, tinnitus, neck stiffness, vertigo, photophobia and in rare cases diplopia, transient visual obscuration. Brain MRI may show subdural effusion, downward displacement of brain and diffuse and continuous meningeal enhancement when enhanced by gadolinium. Low opening pressure was shown through lumbar puncture. The value of protein and cell count of CSF may be slightly elevated. This syndrome usually resolves itself spontaneously or with strict bed rest. When the headache is persistent or incapacitating, more aggressive treatment may be necessary. We treated two cases of SIH in which epidural blood patch produced immediate and complete relief of the symptoms.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.3
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• pp.227-231
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• 2022

Although rare, complications can occur with anesthetic procedures. The posterior superior alveolar nerve (PSAN) block anesthetic technique has a high success rate, but positive aspiration can cause bruising, transient diplopia, blurred vision, and temporary blindness in approximately 3% cases. When edema occurs, it is occasionally massive, especially in the infratemporal fossa, and the resulting hematoma is usually unsightly. A 20-year-old woman presented with massive edema followed by hematoma in the upper right jaw immediately after PSAN block administration, which subsequently spread to the oral mucosa. The patient did not report any complications during the anesthetic procedure. However, after the injection was administered, the patient experienced anesthetic sensations, which rapidly evolved to facial edema. There was mild pain, but without intraoral or extraoral bleeding. The patient was prescribed medicines and instructed to perform contrast therapy. Although hematomas and edema are rare, they are difficult to prevent. The choice of local anesthetic and appropriate application of the anesthetic technique can minimize their occurrence.

• Journal of Korean Neurosurgical Society
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• v.29 no.1
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• pp.118-125
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• 2000

Objective : Trigeminal neurinomas are rare tumors that may locate in the middle fossa or posterior fossa and straddled both the middle and posterior fossa, according to their origin in the nerve complex. The aim of this study was to analyze the clinical presentation, operative approaches employed and outcome in 15 patients who were treated surgically, with special emphasis on surgical approach. Method : Between 1994 and 1998, a total of fifteen patients were histopathologically identified as neurinomas originating from the trigeminal nerve complex at the tumor clinic in the neuroscience center of the our university. Results : The surgical approach to these tumors depends on their anatomical location and tumor size. Six patients had tumors confined to the middle fossa, five patients had tumors limited to the posterior fossa, and four patients both in middle and posterior fossa components of their tumors. Nine neurinomas were removed via the conventional approach(pterional, subtemporal, suboccipital) and six were excised using skull base approach(transzygomatic subtemporal, orbitozygomatic, transpetrosal). Total resection of the tumor was possible in 10 cases. Total resection of tumor was accomplished in 83% of patients following skull base approach compared with 56% of patients following conventional approach. The surgical outcome was excellent or good in 13 cases, fair in one and, poor in one. There was no operative death. In the immediate postoperative period, aggravation of preoperative facial hypesthesia and 6th cranial nerve palsy were common. Although, these deficits were generally transient, eight patients remained with some degree of trigeminal hypesthesia, two had facial weakness, one neurotrophic keratitis, one diplopia, and one mastication difficulty. Conclusion : Surgical approach to the trigeminal neurinoma depends on the tumor location and tumor size. Skull base approach provides more complete tumor excision without increased morbidity compared to conventional approach. Surgeons have to be meticulous in order to reduce postoperative complication.