Medial Rectus Muscle Injuries Associated With Functional Endoscopic Sinus Surgery

Huang, Christine M.; Meyer, Dale R.; Patrinely, James R.; Soparkar, Charles N. S.; Dailey, Roger A.; Maus, Marlon; Rubin, Peter A. D.; Yeatts, R. Patrick; Bersani, Thomas A.; Karesh, James W.; Harrison, Andrew R.; Shovlin, Joseph P.

doi:10.1097/00002341-200301000-00004

Cited by 56 publications

(70 citation statements)

References 30 publications

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“…However, an attempt to recover the stump was indicated in 4 patients and the following results were not promising. Although marked improvement in primary ocular alignment was achieved after a MR posterior stump was reattached to the globe, there was rarely a recovery of the adduction function 12,15,23,25. Four patients in this study also obtained good ocular alignment through VRM transposition without any attempts to recover the MR stump.…”

Section: Discussionmentioning

confidence: 67%

“…It is seldom possible to examine the MR more posteriorly in the orbit through a conjuncival incision during conventional strabismus surgery 20. An orbital exploration may be indicated if the remaining posterior stump of MR is quite long and the patient presents within a few days after injury 12,15. However, the posterior stump may retract posteriorly, necessitating orbital surgery…”

Section: Discussionmentioning

confidence: 99%

“…Among the damage to the EOM, damage to the medial rectus (MR), inferior rectus (IR) and superior oblique have been reported. The incidence of complications related to the MR, including muscle contusion, hematoma, the entrapment of bony defects, paralysis and transection, are most common 8,12-13,15-17…”

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confidence: 99%

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Vertical Rectus Muscles Transposition in Large Exotropia with Medial Rectus Muscle Transection Following Endoscopic Sinus Surgery

Cho

Rah

Kim

et al. 2008

Korean J Ophthalmol

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PurposeTo evaluate the effect of transposition procedures on the vertical rectus muscle (VRM) in the patients who underwent a medial rectus muscle (MR) transection after endoscopic sinus surgery (ESS).MethodsIn 4 patients with exotropia (XT) and a lack of adduction after ESS, orbital CT or MRI revealed a complete transection of the midportion of the MR. Full-tendon VRM transposition was performed within 3 months after injury (early surgery) in 2 patients with 40Δ XT. Two patients with 70Δ and 85Δ XT underwent an X-type augmented Hümmelsheim procedure, which involved pulling each half-tendon and crossing it through the undersurface of the severed MR to the other end of the MR insertion, concurrently with an ipsilateral lateral rectus (LR) recession 11 months and 36 months after ESS, respectively. The adduction deficits were divided into -1 through to -8. The patients were followed up for more than than 1.5 years.ResultsPostoperatively, 3 patients showed orthophoria and no diplopia in the primary position. The adduction deficits improved to -3.5 or -4. One patient who underwent an X-type augmented Hümmelsheim procedure showed a residual XT of 25Δ.ConclusionsVRM transposition is effective in correcting a large XT secondary to a MR transection after ESS. When a longstanding large-angle XT with severe contracture of the ipsilateral LR and massive scarring of the adjacent tissues is present, the X-type augmented Hümmelsheim procedure coupled with an ipsilateral LR recession had an augmenting effect.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Vertical Rectus Muscles Transposition in Large Exotropia with Medial Rectus Muscle Transection Following Endoscopic Sinus Surgery

Cho

Rah

Kim

et al. 2008

Korean J Ophthalmol

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“…Huang et al [12] have analyzed 30 cases of medial rectus injury following FESS in the largest reported case series. They asserted that the MR injury following FESS can lead to one of the following four patterns:…”

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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“…Management involving a partially transected muscle is still under debate. Huang et al (8) reported that observation alone did not result in improvement, and that late repair led to little or no recovery. On the other hand, Hong et al (9) reported that the treatment with Botox® in the early period yielded improved outcomes over observation or surgery alone by preventing contraction of the antagonist muscle and more rapidly facilitating binocular single vision.…”

Section: Discussionmentioning

confidence: 99%

Management of Ophthalmic Complications Secondary to Functional Endoscopic Sinus Surgery

Tuğcu¹,

Araz-Ersan²,

İnci³

et al. 2015

Bezmialem Science

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Orbital complications of functional endoscopic sinus surgery (FESS) may cause irreversible damage to the orbital structures, including optic nerve, extraocular muscles, and lacrimal drainage system. The clinical diagnosis and management of these patients may be extremely difficult because of the complexity and severity of the injuries. We describe a patient with ocular motility disturbances, anisocoria, and optic neuropathy in the right eye secondary to FESS. Early medical and surgical intervention resulted in symptom resolution.

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Medial Rectus Muscle Injuries Associated With Functional Endoscopic Sinus Surgery

Cited by 56 publications

References 30 publications

Vertical Rectus Muscles Transposition in Large Exotropia with Medial Rectus Muscle Transection Following Endoscopic Sinus Surgery

Vertical Rectus Muscles Transposition in Large Exotropia with Medial Rectus Muscle Transection Following Endoscopic Sinus Surgery

Iatrogenic Injury to Medial Rectus After Endoscopic Sinus Surgery

Management of Ophthalmic Complications Secondary to Functional Endoscopic Sinus Surgery

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