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

Abstract

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.

Effect of body position on reaction time: A simulation for foot pedal‐activated instruments

“…Yet, while any instrument can cause iatrogenic injury, the microdebrider may pose significant additional risks. For example, even seemingly minor trauma can result in damage to the anterior ethmoid artery, transection of extraocular muscles, 2 or intracranial injury 4 . Thus, optimizing RT by ceasing power to the microdebrider and quickly removing the instrument is critical and has the potential to minimize unintended injury.…”

“…Thus, the importance of the proper surgical stool is paramount 7 . Based on a rotational speed of 5000 rpm, these results estimate the sitting position potentially prevents about five revolutions 2 . Similarly, using the dominant foot results in two fewer revolutions compared with the nondominant foot.…”

“…7 Based on a rotational speed of 5000 rpm, these results estimate the sitting position potentially prevents about five revolutions. 2 Similarly, using the dominant foot results in two fewer revolutions compared with the nondominant foot. Thus, the sitting surgeon using the dominant foot may have real-world potential to reduce the extent of iatrogenic injury.…”

“…1 However, the speed of the rotating blade also increases the potential for complications to occur quickly, including damage to adjacent structures like the orbit and skull base. 1,2 Thus, optimizing surgeon body position while using the pedal-operated tool is crucial to avoid iatrogenic injury.…”

The role of structured reporting and structured operation planning in functional endoscopic sinus surgery

“…Such complications may include injuries of the anterior skull base, the orbit, optic nerve or internal carotid artery with potential lethal bleedings, ischemic stroke or need for blood transfusions [5][6][7][8][9]. Especially in the era of powered instruments such as microdebriders, a profound understanding of the anatomy is of utmost importance, as these particular instruments can cause severe complications when handled without sufficient care [10,11]. Therefore, a solid preoperative knowledge of the anatomy using radiological and surgical knowledge is key for any successful interdisciplinary surgical treatment planning which may prevent premature revision surgery [12].…”