Related Experiment Video
Updated: May 10, 2025
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Orbital Floor Fracture With Haller Cells and Inferior Rectus Injury Post-Endoscopic Sinus Surgery
Jeeyoon Kim1, Jihyoung Chang, Eun Young Rha
1Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Abstract:
A 27-year-old male developed diplopia and gaze limitation after endoscopic sinus surgery (ESS) due to an iatrogenic inferior rectus (IR) muscle injury caused by an orbital floor fracture involving Haller cells. Preoperative CT and MRI confirmed this injury. Intraoperatively, a fracture and soft tissue herniation were found and their reduction improved upward extraocular movement (EOM), although downward EOM remained limited. Although initial postoperative improvement was observed, at the 1-year follow-up, the patient showed overall recovery compared with the initial injury but declined from the immediate postoperative state, likely due to muscle injury-induced paralysis. Hence, facial bone surgeons should consider both orbital wall fractures and rectus muscle injuries when a patient presents with diplopia after ESS. Preoperative imaging, such as CT or MRI, is essential. IR muscle injury can lead to IR palsy, potentially resulting in an initially improved postoperative condition but a less favorable long-term prognosis.
Insights
Endoscopic sinus surgery can cause inferior rectus muscle injury and diplopia due to orbital floor fractures. Early imaging and surgical consideration of both orbital and muscle damage are crucial for better patient outcomes.
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.
