Orbital Floor Fracture With Haller Cells and Inferior Rectus Injury Post-Endoscopic Sinus Surgery

Area of Science:

• Ophthalmology
• Otolaryngology
• Neurosurgery

Background:

• Diplopia and gaze limitation are potential complications following endoscopic sinus surgery (ESS).
• Iatrogenic injuries to extraocular muscles, particularly the inferior rectus (IR) muscle, can occur secondary to orbital floor fractures during ESS.

Purpose of the Study:

• To report a case of iatrogenic inferior rectus muscle injury after ESS.
• To highlight the importance of preoperative imaging and intraoperative assessment for orbital wall fractures and associated muscle injuries.

Main Methods:

• A 27-year-old male patient presenting with diplopia post-ESS was evaluated.
• Preoperative CT and MRI scans were utilized to diagnose an orbital floor fracture involving Haller cells and IR muscle injury.
• Intraoperative findings and management, including fracture reduction, were documented.
• Postoperative extraocular movement (EOM) and visual outcomes were assessed at multiple time points.

Main Results:

• The patient developed diplopia and gaze limitation attributed to iatrogenic IR muscle injury and orbital floor fracture.
• Preoperative imaging confirmed the injury.
• Intraoperative reduction of the fracture and herniated tissue improved upward EOM but downward EOM remained limited.
• While initial postoperative improvement was noted, a decline in function was observed at the 1-year follow-up, suggesting muscle injury-induced paralysis.

Conclusions:

• Facial bone surgeons must consider both orbital wall fractures and rectus muscle injuries in patients with diplopia after ESS.
• Preoperative imaging (CT/MRI) is essential for diagnosis.
• IR muscle injury can lead to IR palsy, potentially presenting with initial improvement but a less favorable long-term prognosis.