Enucleation as Endoscopic Sinus Surgery Complication

Chang, Jessica R.; Grant, Michael P.; Merbs, Shannath L.

doi:10.1001/jamaophthalmol.2015.0706

Cited by 14 publications

(13 citation statements)

References 4 publications

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“…Finally, globe perforation and aspiration times were measured as to outline the timeline for enucleation as a potential surgical complication of microdebrider use, as evidenced by a recently published case report. (12) With one dissection group achieving complete enucleation in less than one minute (47 seconds), the capabilities of the microdebrider and powered instruments, as a whole, must be appreciated and respected. With the expansion in the customization of blade configurations, rotational velocity, and aspiration speeds, microdebriders have been continually expanding their role over the previous years.…”

Section: Discussionmentioning

confidence: 99%

“…(8) However, this concept has been challenged as evidenced by numerous case studies that have shown that, when misplaced, the indiscriminate aspirating function and limited tactile feedback of the microdebrider can lead to major surgical complications. (9–12)…”

Section: Introductionmentioning

confidence: 99%

“…(13) Additionally, the medial rectus (MR) and inferior rectus muscles are at an increased risk of injury due to their intimacy with the LP, and injury to these extraocular muscles can result in permanent diplopia. Recent case reports have highlighted the potential for optic nerve (ON) injury (11) and even enucleation (12) as potential complications of microdebrider use during FESS. While knowledge of sinonasal anatomy, surgical experience, proper technique, and preoperative preparation are critical to reducing the incidence of iatrogenic injury during FESS, severe complications can occur even in the hands of the most experienced surgeon.…”

Section: Introductionmentioning

confidence: 99%

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Modeling microdebrider-mediated ophthalmic damage: a word of caution in endoscopic sinus surgery

Worden¹,

A.²,

Senior³

et al. 2019

RHINOL

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Background: The microdebrider has become nearly universal in the treatment of sinonasal pathology; however, recent case reports have demonstrated the potential for major ophthalmic complications. The goal of this study was twofold: 1) determine the anatomical proximity of ophthalmic structures to the paranasal sinuses, and 2) assess the timeframe at which ophthalmic injury may occur with the use of a microdebrider during FESS utilizing a cadaveric model. Methodology/Principal: Computed tomography scans from 50 patients were accessed retrospectively. The distances between the lamina papyracea (LP) and orbital structures were determined at varying depths. Seven cadavers (14 sides) were studied using three microdebrider systems operated by otolaryngology residents. Following removal of a window of LP, the time from activation of the microdebrider on the periorbita until transection of the medial rectus (MR), optic nerve (ON), and to aspiration of the globe were measured. Results: The mean distance between the LP and MR at the level of the anterior aspect of the anterior ethmoid and basal lamella were 3.59 ±1.2mm and 1.5 ±0.8mm, respectively. The mean distance between the LP and ON at the level of the basal lamella was 8.1 ±2.1mm. Mean transection times for the MR and ON were 13.4 ± 7.3 seconds and 37.3 ± 9.2 seconds, respectively, with minimum times of 4 seconds and 26 seconds. Conclusions: The proximity of orbital structures to the paranasal sinuses and the rapidity of ophthalmic damage following violation of the periorbita reaffirms the need for cautious use of the microdebrider during FESS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Modeling microdebrider-mediated ophthalmic damage: a word of caution in endoscopic sinus surgery

Worden¹,

A.²,

Senior³

et al. 2019

RHINOL

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“…5 Additionally, the globes themselves may be penetrated by instrumentation or even inadvertently enucleated during functional endoscopic sinus surgery. 6 Optic nerve compression can occur secondary to retrobulbar hemorrhage, particularly in patients who are on anticoagulants, or in the setting of prolonged and aggressive retraction, malpositioned implants, or other malpositioned surgical materials. Vision loss from ischemic causes can occur secondary to anterior ischemic optic neuropathy, posterior ischemic optic neuropathy, central retinal artery occlusion, and ophthalmic artery occlusion.…”

Section: Vision Lossmentioning

confidence: 99%

Principles of Protection of the Eye and Vision in Orbital Surgery

Dohlman

Yoon

2020

J Neurol Surg B Skull Base

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Orbital surgery can result in damage to ocular and orbital structures, leading to a range of structural and visual sequelae, including corneal abrasions, globe malposition, diplopia, and blindness. Vision loss in particular is the most feared and devastating complication, occurs with an overall incidence of 0.84%, and can occur secondary to direct injury, optic nerve compression, or ischemic events. Different types of orbital surgery and surgical approaches carry their own hazards, and it is important to be mindful of these risks in addition to having a thorough understanding of individual risk factors and anatomical variations for each patient. Although universal guidelines for preserving vision in orbital surgery do not yet exist, there are concrete steps that every surgeon can take at the preoperative, intraoperative, and postoperative stages to minimize the risk of injury and maximize the likelihood of preserving the eye and visual function.

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“…In one such report, a complete enucleation of the orbit was sustained and was only appreciated by the surgeon after marked enophthalmos was noted. 33 …”

Section: Advances In Instrumentationmentioning

confidence: 99%

Thirty years of endoscopic sinus surgery: What have we learned?

Tajudeen

Kennedy

2017

World j. otorhinolaryngol.-head neck surg.

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Prior to adaptation of endoscopic approaches for sinonasal pathology, patients regularly endured significant morbidity from open approaches to the sinonasal cavity that were often fraught with failure. With improvements in transnasal endoscopy, functional endoscopic sinus surgery subsequently emerged from the work of Messerklinger and other pioneers in the field. The popularity of endoscopic sinus surgery quickly escalated and expanded to pathology other than inflammation. Here, we discuss the evolution of endoscopic sinus surgery as it relates to improvements in understanding disease pathogenesis, improvements in instrumentation and expansion of indications.

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Enucleation as Endoscopic Sinus Surgery Complication

Cited by 14 publications

References 4 publications

Modeling microdebrider-mediated ophthalmic damage: a word of caution in endoscopic sinus surgery

Modeling microdebrider-mediated ophthalmic damage: a word of caution in endoscopic sinus surgery

Principles of Protection of the Eye and Vision in Orbital Surgery

Thirty years of endoscopic sinus surgery: What have we learned?

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