Abstract ID: 26-232
From Jaw to Orbit: Acute Globe Proptosis Revealing an Iatrogenic Carotid–Cavernous Fistula After Orthognathic Surgery
Author: Dimitra Kavroulaki Base Hospital / Institution: 1st Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital of Athens ”G.Gennimatas”
Presentation Type: ePoster Presentation
Purpose
The purpose of this report is to present a rare, sight- and life-threatening complication of orthognathic surgery and highlight early clinical indicators of carotid–cavernous fistula (CCF).
Methods
Case report.
Results
A 32-year-old woman was referred with presumed orbital apex syndrome following orthognathic surgery complicated by intraoperative arterial injury and hemorrhage. She developed acute visual loss and rapidly progressive right orbital swelling. Examination demonstrated severe proptosis with globe prolapse, diffuse chemosis, conjunctival injection, complete ophthalmoplegia, fixed pupil, and inferolateral globe displacement. Visual acuity was counting fingers. Fundoscopy revealed optic disc edema, venous congestion, and peripapillary hemorrhages.
CT scanning was free from retrobulbar hemorrhage and orbital apex pathology, but there was dilation of the superior ophthalmic vein with stranding of the retrobulbar fat.
CT angiography demonstrated enlargement of the right cavernous sinus, a displaced bony fragment within it, and hemorrhagic content in the right sphenoid sinus. A nodular vascular structure raised suspicion for aneurysm or pseudoaneurysm.
The patient underwent urgent endovascular embolization, which revealed several sites of internal carotid artery injuries which had to be sealed. There was rapid clinical improvement.
Conclusion
Acute orbital congestion after maxillofacial surgery may indicate CCF rather than isolated orbital pathology. Bilateral or atypical findings should prompt urgent vascular imaging. Early multidisciplinary management is critical for optimal outcome.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Maria | Sotirianakou | 1st Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital of Athens ”G.Gennimatas” |
| Eleni | Pogka | 1st Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital of Athens ”G.Gennimatas” |
| Maria | Theofilatou | 1st Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital of Athens ”G.Gennimatas” |