Orbital Penetration and Endoscopic Sinus Surgery

Abstract

We reviewed medical records of 910 patients on whom we performed 1600 endoscopic sinus procedures between June 1987 and December 1991 to determine the incidence of orbital penetration during endoscopic sinus surgery. We examined this incidence in relation to the area of the orbit penetrated, sequelae, and responsible surgical maneuver during the procedure. Orbital entry was documented in 33 procedures in 32 patients. All procedures were videotaped and these tapes were reviewed. The area of the orbit most often violated was anterior to the anterior ethmoid artery and the front face of the ethmoid bulla. No sequelae occurred in 12 patients, preseptal periorbital ecchymosis occurred in 17 cases, subcutaneous emphysema occurred in 3 cases, and the only serious sequelae, retrobulbar hematoma, occurred with violation of the lamina papyracea in the region of the anterior ethmoid artery in 1 case. We found that complications occurred most often with removal of the uncinate process in patients with a deviated septum and a lateralized middle turbinate. In such patients, for uncinectomy, we deflect the uncinate process medially with a curved ball probe placed through the semilunar hiatus and directed into the infundibulum. With this revision of our technique for removal of the uncinate process, the incidence of orbital penetration dropped to zero.