Traumatic Cerebrospinal Fluid Rhinorrhea following Septorhinoplasty

Background Septoplasty/septorhinoplasty is a common ENT procedure offered for those patients with deviated septum who are suffering from nasal obstruction and/functional or cosmeticproblems. Although it is increasingly a daycase, a basic straightforward, and simple procedure, it could lead to catastrophic complications including major skull base injuries which result in cerebrospinal fluid (CSF) leaks.

Methods We have reported the possibility of two cases of CSF leakage following septoplasty/septorhinoplasty and studied to describe the factors responsible for that, how to avoid them and their management strategies.

Results We describe two different cases of traumatic CSF leaks at two different sites. The first patient suffered a traumatic CSF leak following septoplasty and he was presented to our institution. The leak was still active at presentation and surprisingly identified as coming from a defect at the roof of the sphenoid sinus and this case was repaired surgically. The second patient was presented 4 days after her cosmetic septorhinoplasty to another hospital with a CSF leak and significant pneumocephalus postseptorhinoplasty and she was managed conservatively.

Conclusion Understanding the anatomical variations of the paranasal sinuses and implementing proper surgical techniques are crucial in preventing intracranial complications when performing either septoplasty or septorhinoplasty. A good quality CT of the nose and paranasal sinuses is a valuable investigation to avoid major complications especially CSF leaks following either procedure.