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• W2316089116 abstract "Sir: We read the article entitled “Severe Chemosis following Fronto-Orbital Advancement” by Hatef et al. (Plast Reconstr Surg. 2010;125:56e–58e) with great interest. This proposal is about presenting an alternative to the theory recently stated by Hatef et al. regarding severe chemosis following fronto-orbital advancement procedures. Craniosynostosis is a condition in which one or more of the fibrous sutures in an infant's skull fuses prematurely. This results in restricted skull and brain growth. Reshaping the skull with advancement of the fronto-orbital forehead is the cornerstone of many surgical procedures in craniosynostosis. Severe chemosis following fronto-orbital advancement in the treatment of craniosynostosis had never been reported before the article by Hatef et al.1 The pathophysiology of this unexpected postoperative morbidity is not understood. The authors stated that chemosis was caused by a combination of increased postoperative swelling with jugular veins occluded by the tracheostomy collar. Our similar case suggests another cause. A 2-month-old girl presented with severe chemosis in the postoperative course of fronto-orbital advancement. She was operated on for a complex craniosynostosis involving all the skull sutures, called kleeblattschädel syndrome. This syndrome results in increased intracranial pressure and a cloverleaf-shaped head.2 We performed fronto-orbital advancement and cranial vault remodeling. This procedure dramatically improved intracranial pressure and also the shape of the skull. However, unexpected severe chemosis occurred 12 hours after surgery, with a high risk of damaging our patient's vision (Fig. 1). The head of the patient's bed was elevated. The protruding conjunctivae were treated by generously applying an ophthalmic ointment (Lacrivisc gel) and performing bilateral blepharorrhaphy. Chemosis resolved spontaneously and completely in 72 hours, with no visual impairment (Fig. 2).Fig. 1.: Twelve-hour postoperative view demonstrating severe bilateral chemosis.Fig. 2.: One-week postoperative view showing complete resolution of chemosis after generous application of Lacrivisc ointment and bilateral blepharorrhaphy.Our patient had neither tracheostomy nor any type of jugular compression. This case clearly suggests that jugular compression may not be the only factor causing chemosis. It was already demonstrated that in the event of severe craniosynostosis, cerebral venous drainage is compromised by malformation of the jugular foramen. Veinous drainage is then diverged to transcalvarial emissary veins. During scalp dissection, section of those veins would cause brain swelling, hydrocephalus, and even death.3 Starting from this fact, we believe that chemosis is probably attributable to a disorder of the orbital venous drainage, which deteriorated after emissary vein interruption. Because of the risk of chemosis, we suggest that the surgeon should precisely assess cerebral and orbital venous drainage by means of magnetic resonance angiography, adapt the surgical procedure in every individual case, and take special care of the main emissary veins. Mehdi Laghmari, M.D. Mohammed Lmejjatti, M.D. Houssine Ghannane, M.D. Department of Neurosurgery Ibtissam Hajji, M.D. Tarik Baha Ali, M.D. Abdeljalil Moutaouakil, M.D. Department of Ophthalmology Saïd Ait Benali, M.D. Department of Neurosurgery University Hospital Mohammed VI Cadi Ayyad University Marrakesh, Morocco PATIENT CONSENT Parents or guardians provided written consent for the use of patient images." @default.
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• W2316089116 date "2011-02-01" @default.
• W2316089116 modified "2023-10-16" @default.
• W2316089116 title "Venous Drainage Disorders as a Cause of Severe Chemosis following Fronto-Orbital Advancement" @default.
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• W2316089116 doi "https://doi.org/10.1097/prs.0b013e318200b033" @default.
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