Delayed intraorbital infection after craniofacial bone surgery

Abstract

Intraorbital infection shows a low incidence, but it might cause blindness or even death. This case is unusual in that its origin from a craniofacial bone fracture prior to infection of the maxillary sinus. A 33-year-old female patient was referred for right cheek swelling. When she visited the emergency room, we removed right cheek hematoma and bacterial examination was done. In the past, she had craniofacial bone surgical history due to a traffic accident 6 years ago. Next day, the swelling had remained with proptosis and pus was recognized in the conjunctiva. We planned an emergency operation and removed the pus which was already spread inside the orbit. And the evaluation for sinusitis was consulted to the otorhinolaryngology department simultaneously. There were Prevotella oralis and methicillin-resistant Staphylococcus epidermidis bacterial infection in the intraorbital and sinus respectively. Afterwards, the vigorous dressing was done for over a month with intravenous antibiotics. Though the intraorbital infection was resolved, blindness and extraocular movement limitation were inevitable. In conclusion, close follow up of the maxillary sinus in facial bone fracture patients is important and aggressive treatment is needed when an infection is diagnosed.

Keywords: Eye infection; Facial bones; Sinusitis.

Fig. 1.

The patient’s computed tomography (CT) scan images in the past. (A, C) The preoperative CT scan image of the facial bone fracture in 6 years ago. (B, D) The postoperative CT scan image of the facial bone fracture in 6 years ago.

Fig. 2.

The patient’s enhanced computed tomography (CT) scan images in the present. (A) Diffuse intraorbital infection and proptosis were shown in enhanced CT scan image. (B) Severe sinusitis was shown in enhanced CT scan image.

Fig. 3.

The patient’s clinical photographs. (A) Severe periorbital swelling and proptosis were shown in the initial photograph. (B) Photograph of complete recovery and maintenance 4 months after surgery. (C) Photographs of extraocular movement limitation.

Fig. 4.

The patient’s magnetic resonance image (MRI). (A) Severe intraorbital infection and proptosis were shown in the initial MRI. (B) Intraorbital infection was totally subsided and maintained in the 4 months later.

Fig. 5.

The eosinophil percentage throughout administration until 4 months after surgery. IV, intravenous.