Case report of orbital violation with placement of ethmoid drug-eluting stent.
BACKGROUND
Delivery of topical therapy is a mainstay in the treatment of chronic rhinosinusitis (CRS). Ethmoid sinus stenting has recently been introduced as a minimally invasive mechanism to deliver medication. We review available literature on ethmoid stenting and present a case report involving orbital violation and a fixed, dilated pupil.


METHODS
Case report and literature review.


RESULTS
A 37 year-old female underwent endoscopic placement of bilateral ethmoid sinus drug-eluting stents for CRS at an outside facility. Postoperatively she complained of right-sided ocular pain and pressure. She was seen in the emergency setting on post-operative day (POD) 2 and had a dilated right pupil. A computed tomography (CT) scan was performed and read as normal. The left stent was removed successfully on POD 19; the right could not be removed in the outpatient setting secondary to pain. The patient was transferred to our facility on POD 21. The CT from POD 2 was reviewed and demonstrated violation of the lamina papyracea and orbit with the stent abutting the lateral orbital wall. On POD 24, the patient underwent medial orbital decompression and successful stent removal but continues to have a dilated pupil in the affected eye.


CONCLUSIONS
This is the first reported case of orbital violation with placement of an ethmoid drug-eluting stent. The literature shows feasibility in cadaveric studies but the practitioner must be diligent in placement. Ethmoid sinus stenting is an option for topical treatment of ethmoid sinusitis but practitioners must be cognizant of potential risks when counseling patients.
Department of Otolaryngology, Head and Neck Surgery, Emory University, Atlanta, GA 30322, USA. crvilla@emory.edu
Craig R
CR
Villari
Ted J
TJ
Wojno
John M
JM
Delgaudio
D000328:Adult; D002404:Catheterization / Q000009:adverse effects; D002908:Chronic Disease; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005005:Ethmoid Sinus; D005260:Female; D006801:Humans; D009915:Orbit / Q000293:injuries*; D012220:Rhinitis / Q000628:therapy*; D012852:Sinusitis / Q000628:therapy*