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Transient Unilateral Abducens Nerve Palsy after Functional Endoscopic Sinus Surgery-Case Report

功能性內視鏡鼻竇手術術後暫時性單側外旋神經麻痺─病例報告

摘要


Unilateral abducens nerve palsy (UANP) is a very rare condition in adults, especially as a postoperative complication in otorhinolaryngology surgeries. The most recognized etiologies of UANP include cerebrovascular disease, undetermined factors, and trauma, whereas other causes such as spontaneous intracranial hypotension, local anesthetic effects, intracranial neoplasm, multiple sclerosis, inflammatory disease, and viral infection are occasionally encountered. We present a 51-year-old woman who suffered from sudden onset of isolated left lateral rectus muscle palsy following functional endoscopic sinonasal surgery. The patient denied any underlying systemic disease, previous surgical history, neurological signs, or trauma history. Preoperative physical and fiberscopic examinations revealed hypertrophic turbinates, deviated nasal septum, and mucopus postnasal dripping. Sinonasal computed tomography without contrast reported chronic rhinosinusitis. The procedure was uneventful, and a blood loss of 300 mL was recorded. The postoperative neurological examination was normal except the occurrence of isolated left lateral rectus palsy. Her muscle power was intact in both upper and lower limbs as well. The left lateral rectus muscle paralysis recovered nearly an hour after the operation. However, only a few cases of postoperative UANP have been reported by the earlier scientists in the literature, wherein most etiologies include spontaneous intracranial hypotension, local anesthetic effect, and idiopathic origin. Finally, we propose that clinicians shall rule out the local anesthetic effect initially after functional endoscopic sinus surgery and undergo detailed surveys of spontaneous intracranial hypotension in healthy adults and cerebrovascular diseases in patients with systemic diseases.

並列摘要


在成人中單側外旋神經麻痺是十分少見的情況,尤其是耳鼻喉科手術術後之併發症更為少見。最常見的病因包括腦血管疾病、不明原因與外傷、自發性低顱內壓、局部麻醉、顱內腫瘤、多發性硬化症、發炎性疾病與病毒感染等也是可能的原因。個案為1名51歲女性,在接受功能性鼻竇內視鏡手術後,立即發生左側眼外直肌麻痺的情況,病患自述本身沒有任何系統性疾病,也沒有任何手術史、神經學症狀以及外傷史。術前理學檢查與內視鏡檢查顯示下鼻甲肥大、鼻中隔彎曲與黏液性鼻涕倒流。術前鼻竇電腦斷層診斷為慢性鼻竇炎。鼻竇內視鏡手術過程平順,失血量為三百毫升,術後神經學檢查除了左側眼外直肌麻痺外無其他異常,術後上下肢肌力健全。左側眼外直肌麻痺在約1小時後完全恢復,回顧過去文獻,僅有少數個案報告曾提及術後發生單側外旋神經麻痺,大部分病生理學是由於自發性低顱內壓與局部麻醉造成。我們提出此例報告,臨床上接觸術後單側眼外直肌麻痺之病患,在鼻竇內視鏡手術術後病人中,應先將局部麻醉效應列為優先診斷,並做詳細檢查排除自發性低顱內壓與腦血管疾病。

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