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Orbital Complications in Endoscopic Sinus Surgery Using Powered Instrumentation

Authors

  • Scott M. Graham MD,

    Corresponding author
    1. Department of Otolaryngology—Head and Neck Surgery, University of Iowa, Iowa City, Iowa, U.S.A.
    • Scott M. Graham, MD, Department of Otolaryngology—Head and Neck Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 21201 PFP, Iowa City, IA 52242-1093, U.S.A.
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  • Jeffrey A. Nerad MD

    1. Department of Otolaryngology—Head and Neck Surgery, University of Iowa, Iowa City, Iowa, U.S.A.
    2. Oculoplastic and Orbital Service, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, U.S.A.
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Abstract

Objectives/Hypothesis Powered dissection is increasingly used in endoscopic sinus surgery. Although it has certain clear advantages over conventional instrumentation, powered dissection also presents special liabilities. The objectives of the report are to highlight the special dangers of powered instrumentation near the orbit, to suggest techniques that might minimize these risks, and to review the management of orbital injuries.

Study Design Case series.

Methods A retrospective review was performed of patients who were referred to our institution with orbital injury complicating endoscopic sinus surgery in which powered instrumentation had been used. Patient demographics, status as revision or primary surgery, degree of intraoperative blood loss, indications for surgery, intraoperative findings, the complication sustained, time of recognition of the complication, immediate and delayed treatment, and clinical course were obtained from the clinical records.

Results Three patients had medial rectus muscle injuries. In addition to the medial rectus injury, one patient also had blindness, probably from an orbital hemorrhage. One patient underwent orbital exploration in an unsuccessful attempt to reattach the ends of the medial rectus muscle. One patient had continuing diplopia, but declined orbital exploration or strabismus surgery.

Conclusions Intraoperative orbital complications that might be of minor consequence with conventional instrumentation can have dramatic sequelae when powered dissection is used. Special care must be exercised in using powered instrumentation.

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