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Unusual complications of bone wax at the skull base

Published online by Cambridge University Press:  17 February 2021

R Panicker
Affiliation:
Department of ENT, Christian Medical College, Vellore, India
R K Moorthy
Affiliation:
Department of Neurological Sciences, Christian Medical College, Vellore, India
V Rupa*
Affiliation:
Department of ENT, Christian Medical College, Vellore, India
*
Author for correspondence: Dr V Rupa, Department of ENT, Christian Medical College Hospital, Vellore632004, India E-mail: [email protected]

Abstract

Objective

This study aimed to describe the clinical presentation, microbiological profile and management of complications of bone wax usage for surgical procedures at the skull base.

Method

The case records of a series of five patients who developed post-operative surgical site complications because of bone wax usage during skull base surgery were reviewed.

Results

In all five patients, persistent site-specific clinical features were noted along with intra-operative presence of excessive bone wax. Three unique cases of presentation, one with a fungal brain abscess because of Aspergillus flavus infection, another with fungal osteomyelitis because of Trichosporon beigelii infection and a third with intradural migration of bone wax into the cerebellopontine angle cistern are highlighted.

Conclusion

The presentation of surgical site infection at the skull base because of excessive use of bone wax can be manifold. The need for testing appropriate cultures including fungal culture is highlighted.

Type
Main Articles
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr V Rupa takes responsibility for the integrity of the content of the paper

References

Horsley, V. Antiseptic wax. Br Med J 1892;1:1165CrossRefGoogle Scholar
Nooh, N, Abdullah, WA, Grawish, ME-A, Ramalingam, S, Javed, F, Al-Hezaimi, K. The effects of surgicel and bone wax hemostatic agents on bone healing: an experimental study. Indian J Orthop 2014;48:319–25CrossRefGoogle Scholar
Johnson, P, Fromm, D. Effects of bone wax on bacterial clearance. Surgery 1981;89:206–9Google ScholarPubMed
Katz, SE, Rootman, J. Adverse effects of bone wax in surgery of the orbit. Ophthalmic Plast Reconstr Surg 1996;12:121–6CrossRefGoogle Scholar
Patel, RB, Kwartler, JA, Hodosh, RM. Bone wax as a cause of foreign body granuloma in the cerebellopontine angle. J Neurosurg 2000;92:362CrossRefGoogle ScholarPubMed
Low, WK, Sim, CS. Bone wax foreign body granuloma in the mastoid. ORL J Otorhinolaryngol Relat Spec 2002;64:3840CrossRefGoogle ScholarPubMed
Spennato, P, Escamilla-Rodrìguez, IE, Di Martino, G, Imperato, A, Mirone, G, Cinalli, G. Intraventricular bone wax as cause of recurrent cerebrospinal fluid infection: a neuroradiologic pitfall. World Neurosurg 2016;88:690.e7690.e9CrossRefGoogle ScholarPubMed
Baird, SM, Teh, BM, Lim, KKM, Campbell, MC. Bone wax extrusion through postauricular wounds: a case series. Laryngoscope 2018;128:369–72CrossRefGoogle ScholarPubMed
Fahradyan, A, Ohanisian, L, Tsuha, M, Park, MJ, Hammoudeh, JA. An unusual complication of bone wax utilization. J Craniofac Surg 2018;29:976–9CrossRefGoogle ScholarPubMed
Byrns, K, Khasgiwala, A, Patel, S. Migration of bone wax into the sigmoid sinus after posterior fossa surgery. ANJR Am J Neuroradiol 2016;37:2129–33CrossRefGoogle ScholarPubMed
Zhou, Y, Li, M, Wei, X, Yang, X, Zhang, J, Qi, X. Bone wax migrates to the orbit in a patient with a frontal sinus abnormality: a case report. BMC Ophthalmol 2019;19:29CrossRefGoogle Scholar
Lüdemann, WO, Stieglitz, LH, Gerganov, V, Samii, A, Samii, M. Fat implant is superior to muscle implant in vestibular schwannoma surgery for the prevention of cerebrospinal fluid fistulae. Neurosurgery 2008;63:3842Google ScholarPubMed
Ates, O, Cayli, SR, Gurses, I. Bone wax can cause foreign body granuloma in the medulla oblongata. Br J Neurosurg 2004;18:538–40CrossRefGoogle ScholarPubMed
Wellisz, T, An, YH, Wen, X, Kang, Q, Hill, CM, Armstrong, JK. Infection rates and healing using bone wax and a soluble polymer. Clin Orthop Relat Res 2008;466:481–6CrossRefGoogle Scholar
Colombo, AL, Padovan, AC, Chaves, GM. Current knowledge of Trichosporon spp. and Trichosporonosis. Clin Microbiol Rev 2011;24:682700CrossRefGoogle ScholarPubMed