Abstract
Purpose
The purpose of this study is to describe the clinical characteristics and treatment results of medial rectus muscle (MR) transection incurred during endoscopic sinus surgery.
Methods
This retrospective study included 16 patients with MR transection incurred during endoscopic sinus surgery between 1994 and 2015. The operative notes of the surgical procedure, the pattern of strabismus, the type of muscle injury, the type of corrective strabismus surgery, and the surgical outcomes were reviewed.
Results
Nine patients had partial resection of MR and seven patients had complete transection of MR, resulting from an injury incurred during endoscopic sinus surgery. Three of the nine patients with partial resection injury were initially diagnosed as complete resection and subsequently re-diagnosed as partial resection in a review of the images during this study. Five of the nine patients with partial MR resection underwent only simple recession/resection surgery. Patients with complete MR transection underwent muscle transposition or globe fixation surgeries and often multiple operations were required.
Conclusions
The results of this study showed that the treatment strategies could vary depending on the nature of muscle injury. In cases with complete transection, muscle transposition or globe fixation surgeries are often required, with multiple operations. However, partial muscle resection with only simple recession/resection surgery shows a favorable outcome in many cases. The use of proper imaging techniques, a thorough review of the images with various planes, and close follow-up are important for determining the nature of the muscle injury.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Han JK, Higgins TS . Management of orbital complications in endoscopic sinus surgery. Curr Opin Otolaryngol Head Neck Surg 2010; 18: 32–36.
Thacker NM, Velez FG, Demer JL, Rosenbaum AL . Strabismic complications following endoscopic sinus surgery: diagnosis and surgical management. J AAPOS 2004; 8: 488–494.
Trotter WL, Kaw P, Meyer DR, Simon JW . Treatment of subtotal medial rectus myectomy complicating functional endoscopic sinus surgery. J AAPOS 2000; 4: 250–253.
Yang SQ, Guo X . [Management of large exotropia with medial rectus muscle transection following endoscopic sinus surgery]. Zhonghua Yan Ke Za Zhi 2010; 46: 974–977.
Sohn JH, Hong SD, Kim JH, Dhong HJ, Chung SK, Kim HY et al. Extraocular muscle injury during endoscopic sinus surgery: a series of 10 cases at a single center. Rhinology 2014; 52: 238–245.
Tse DT, Shriver EM, Krantz KB, Tse JD, Capo H, McKeown CA . The use of titanium T-plate as platform for globe alignment in severe paralytic and restrictive strabismus. Am J Ophthalmol 2010; 150: 404–411 e401.
Underdahl JP, Demer JL, Goldberg RL, Rosenbaum AL . Orbital wall approach with preoperative orbital imaging for identification and retrieval of lost or transected extraocular muscles. J AAPOS 2001; 5: 230–237.
Park KA, Oh SY . Muscle union procedure with medial rectus recession for unilateral abducens palsy. J Pediatr Ophthalmol Strabismus 2013; 50 Online: e11–e14.
Thacker NM, Velez FG, Demer JL, Wang MB, Rosenbaum AL . Extraocular muscle damage associated with endoscopic sinus surgery: an ophthalmology perspective. Am J Rhinol 2005; 19: 400–405.
Ela-Dalman N, Velez FG, Rosenbaum AL . Importance of sagittal orbital imaging in evaluating extraocular muscle trauma following endoscopic sinus surgery. Br J Ophthalmol 2006; 90: 682–685.
Acknowledgements
Study design, conduction of the study, and data collection and management (KAP and SYO); data analysis, interpretation, and drafting the manuscript (KAP); and review and final approval of the manuscript (SYO).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Park, KA., Oh, S. Extraocular muscle injury during endoscopic sinus surgery: an ophthalmologic perspective. Eye 30, 680–687 (2016). https://doi.org/10.1038/eye.2016.15
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2016.15
