Peri-orbital surgical emphysema following functional endoscopic sinus surgery, during extubation

We present a case of peri-orbital surgical emphysema following functional e ndoscopic sinus surgery (FESS), due to extubation with simultaneous manual inhalation with a closed expiratory valve. This complication has not been p reviously reported in association with general anaesthetic and FESS. Patien ts undergoing FESS are advised against nose blowing. However. we recommend that the anaesthetist working with a surgeon who performs FESS should also be warned not to use manual inhalation with a closed expiratory valve while extubating, as this can cause peri-orbital surgical emphysema.