Management of Orbital Hematoma in Endoscopic Sinus Surgery

A 27-year-old female referred to tertiary rhinology practice 2 weeks after surgery for presumed inflammatory disease. Pathology revealed poorly differentiated squamous cell carcinoma and patient presents for definitive treatment. Her nasal endoscopy revealed significant sinonasal edema and no clear tumor pedicle was identified. She had no other pertinent past medical or surgical history. Of note, she denied any visual disturbances or history of facial trauma. Coronal images of her preoperative CT and post-contrast MRI can be seen in Fig. 2.1. The patient was counseled on the significance of the pathology and decided to proceed with definitive surgery to appropriately map the tumor and for possible complete extirpation. She was properly informed of the risks of endoscopic sinus surgery, including the risks of CSF leak, orbital injury with temporary or permanent vision loss, nasal bleeding, epiphora, loss of smell, and the potential for additional future procedures.