Clinical characterization of severe orbital complications after endoscopic sinus surgery

Abstract

To summarize the clinical feature of severe orbital complications after endoscopic sinus surgery and to explore the precautions. A retrospective review study. Twenty-two cases of severe orbital complications after endoscopic sinus surgery between January 2002 and December 2012 were included. The main parameters for analyzing were history of paranasal sinuses, clinical manifestation of complications, imaging findings, site of injury, the relationship between injury site and clinical signs. Twenty-two cases of patients with serious complications, including: visual loss in 7 cases (32%), ptosis in 5 cases (23%), ocular position deviation in 15 cases (68%), limitation of ocular motility in 17 cases (77%), enophthalmos in 10 cases (45%). Imaging display: medial rectus involvement in 14 cases, inferior rectus involvement in 6 cases. The most common site of entry into the orbit was the medial orbital wall (14 cases, 64%), followed by the inferomedial wall (6 cases, 27%). Radiological imagings showed the medial displacement of optic nerve in 7 cases (32%) and foreign bodies in the orbit or paranasal sinuses in 8 cases (36%). Medical treatment was given in 1 cases and surgical repair in 9 cases. Removal of foreign bodies was performed in 6 cases. One patient received inferior rectus and orbital wall repair, but no improvement in ocular movement. Orbital reconstruction for endophthalmos was performed in two cases. The improvement was recorded only in one case. The most severe complication is vision loss and the most common complication is limitation of ocular motility and ocular position deviation. The most common site of injury was within the rectus muscle, often accompanied by the defect of inner wall. Except foreign bodies, other complications were difficult to treat with poor prognosis. Emphasis should be placed on prevention.