Rhinoliquorrhea after septoplasty and infundibulotomy

Background Rhinoliquorrhea after sinus surgery is a well-known complication due to the anatomical proximity of the surgical site to the skull base. We report the case of laboratory-chemical bilateral rhinoliquorrhea after sinus surgery and septoplasty without clinical symptoms nor physical breach of the integrity of the subarachnoid space is presented. Case description: A 32-year-old female patient with chronic nasal obstruction and bilateral chronic maxillary sinusitis presented to our clinic for surgical therapy. Septoplasty and infundibulotomy were performed bilaterally. On postoperative day 6, the patient presented with frontal cephalgia on the left and bilateral rhinorrhea. Beta trace protein was detected in the nasal secretions. The frontal skull base had no breach of integrity shown by CT. After the removal of the septal splints, the rhinorrhea stopped immediately. With continued positive cerebrospinal fluid evidence, we performed a cMRI, which was unremarkable. For the avoidance of doubting a false positive measurement of beta trace, determination of asialo-transferrin were performed. Again the result were nondescript. Neurosurgery performed an MRI in the prone position, which showed a normal finding. Despite the absence of clinical symptoms, the beta trace was detected bilaterally six months later.

Conclusion/Discussion Bilateral rhinoliquorrhea after septoplasty and sinus surgery is a very rare constellation of findings. We want to discuss possible causes. If a skull base lesion is excluded, the possibility of false positive beta trace protein determinations must also be considered.

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Artikel online veröffentlicht:
12. Mai 2023