The patient was diagnosed as squamous cell carcinoma on the left palate and Lt. maxilla with T4N0M0, stage Ⅳ.
After 2 cycles of chemotherapy, we performed total maxillectomy under general anesthesia. During the operation, the anterior ethmoid bone was removed, and then cerebrospinal fluid leaked. The perforated site was plugged with surgical, gelform,
and
temporal muscle. The plain skull film and computerized tomogram provided prompt diagnosis as subdural pneumocephalus.
As the fluid pours out, air bubbles fills to the top of the container and the possible mechanism for entry of air into the intracranial compartment is analogous to the entry of air into an inverted bottle.
Pneumocephalus appears to be one possible complication during total maxillectomy of the ethmoid bone involved.
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