Medial orbital protrusion - a potentially hazardous anomaly during endoscopic sinus surgery

Lim, Jonghyun; Hadfield, P. J.; Ghiacy, Sabour; Bleach, N. R.

doi:10.1017/s0022215100145116

Cited by 14 publications

(12 citation statements)

References 3 publications

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“…Although the sinus instrumentation used during surgery in the described cases is unknown, the lamina papyracea is especially at risk when approached from the nasal space (through the diseased sinus) rather than from the extraperiorbital space, a plane that is clearly defined during external ethmoidectomy. The risk of breach is probably also greater when there are anatomical variants in the sinuses7 or when mechanised systems are used for sinus debridement. Mechanised systems extract tissue very rapidly and provide no tactile feedback to the surgeon about the type of tissue being removed.…”

Section: Discussionmentioning

confidence: 99%

Major orbital complications of endoscopic sinus surgery

René

Rose²,

Lenthall³

et al. 2001

British Journal of Ophthalmology

102

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Background-The paranasal sinuses are intimately related to the orbit and consequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devastating of which is severe visual loss. Methods-A retrospective review was undertaken of four cases of severe orbital trauma during endoscopic sinus surgery. Results-All the cases suVered medial rectus damage, one had additional injury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply. Conclusion-Some ophthalmic complications of endoscopic sinus surgery are highlighted, the mechanisms responsible are discussed, and recommendations for prevention, early recognition, and management are proposed. (Br J Ophthalmol 2001;85:598-603)

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Section: Discussionmentioning

confidence: 99%

Major orbital complications of endoscopic sinus surgery

René

Rose²,

Lenthall³

et al. 2001

British Journal of Ophthalmology

102

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“…Anatomical variations like pre-existing dehiscence of lamina papyracea of ethmoid bone, altered anatomy due to prior sinus surgery or trauma, poor visualization due to excessive intraoperative bleeding further increase the risk of orbital entry and complications during sinus surgery [5][6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Injury to Medial Rectus After Endoscopic Sinus Surgery

Mukherjee

Priyadarshini

Ramasubramanian

et al. 2015

Indian J Otolaryngol Head Neck Surg

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Endoscopic sinus surgery (ESS) is the mainstay of the treatment in sinus disorders, to re-establish the drainage of the affected sinus. The close proximity of the orbital structures to paranasal sinuses makes them vulnerable to inadvertent injury during the sinus surgery. Medial rectus (MR) muscle is the most commonly injured extraocular muscle during ESS due to its anatomic proximity to the thin medial wall of the orbit. This is a non-comparative, retrospective, interventional case series of six patients presenting with MR injury after ESS. We discuss the management, outcome and review the published literature. A total of six patients met the inclusion criteria. The presenting complaints were diplopia, squinting and limitation of ocular movements. Two patients underwent surgical exploration of the MR muscle and reattachment of the muscle along with injection botulinum to the antagonist lateral rectus muscle. Two patients who had small angle strabismus and who were able to fuse were advised orthoptic exercises and prisms as management. Remaining two patients were advised surgical intervention to correct strabismus but they declined further surgical intervention. Management of MR injury following ESS is complex, often resulting in suboptimal outcomes. Since early intervention is associated with better outcomes, early referral by otolaryngologists to ophthalmologists would result in better outcome.

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“…The middle or posterior ethmoid is most at risk – as hardly any fat is situated between the muscle and the bony orbital wall [76], [104], [363], [449]. In rare cases, there is a particular risk due to a congenital or posttraumatic bulge of the lamina papyracea with or without direct embedding of parts of the muscle [107], [450]. Other eye muscles are distinctly less often injured intraoperatively: The inferior rectus muscle may be damaged in surgeries involving the maxillary sinus and the superior oblique (trochlea) muscle may be lacerated in extended endonasal frontal sinus surgery with a drill for instance.…”

Section: Severe or Threatening Complicationsmentioning

confidence: 99%