Post-rhinoplasty cerebrospinal fluid leak caused by intraoperative nasal packing

Background: Cerebrospinal fluid (CSF) leak is a very rare complication of rhinoplasty that typically occurs secondary to improper handling of the perpendicular plate of the ethmoid bone. If left untreated, it can lead to devastating intracranial sequelae. Case report: We report a previously unrecognized cause of CSF leak attributed to injudicious nasal packing. A 22-year-old woman was referred to our clinic with left-sided, clear rhinorrhea one day after cosmetic rhinoplasty surgery that was performed at another facility. Electrophoresis was positive for beta-2 transferrin, and CT imaging suggested a left anterior ethmoidal roof defect. Damage to the axilla of the middle turbinate was noticed intraoperatively. It appeared that the packing forceps caused a skull base defect, which was repaired successfully in layers. The patient was discharged 48 hours later and remains healthy 6 months post-operatively. This case is a reminder of the importance of awareness of nasal anatomy when performing nasal packing.