- Amazingly, the Lateral Canthotomy almost completely healed itself in 2 weeks.
Obviously the eyes need to be exposed during the case. Often what is going on intranasally gives little indication of the problem. The eye rapidly grows proptotic and tense. Immediate cantholysis and canthotomy is necessary to allow the globe to release anteriorly. The next move I made was to decompress the orbit a bit intranassaly. I also made an immediate Lynch incision and bipolared the offending artery. Some Arista was also used and the final ethmoid packing was fairly loose.
It is not unusual for recurrent polyps or papillomatous sinus disease to lead to dehissance of the Lamina Papyrecea. The Anterior Ethmoid Artery is in close proximitry to this region and injury is possible. I have probably done as many sinus surgeries as anyone alive and kind of felt that my super human skills left me immune to this complication, until now. The intranasal surgery showed little sign of any problem, but the exposed eye become immediately proptotic and tense.
This patient had alar stenosis and nasal airway obstruction due primarily to a skin cancer resection. She also had a deviated septum, nasal polyps, and a boney nasal dorsal hump.
I removed a dorsal hump and opened her sinuses at the same setting I reconstructed the nasal ala with a Melolabial flap wrapped around a conchal cartilage graft (autologous ear cartilage).