Retrieval of ruptured medial rectus muscle with an endoscopic endonasal orbital approach. A case report and indication for surgical technique

• Published in: Auris, nasus, larynx Vol. 42; no. 3; pp. 241 - 244
• Main Authors: Akiyama, Kosuke, Karaki, Masayuki, Hoshikawaa, Hiroshi, Mori, Nozomu
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ireland Ltd 01-06-2015
• Subjects: Accidents, Traffic; Aged; Blowout fracture; Endoscope; Endoscopic endonasal surgery; Humans; Male; Medial rectus muscle; Nasal Cavity; Natural Orifice Endoscopic Surgery - methods; Oculomotor Muscles - diagnostic imaging; Oculomotor Muscles - injuries; Oculomotor Muscles - surgery; Orbital Fractures - complications; Orbital Fractures - diagnostic imaging; Orbital Fractures - surgery; Otolaryngology; Rupture - complications; Rupture - diagnostic imaging; Rupture - surgery; Tomography, X-Ray Computed; Endoscopic endonasal surgery; Blowout fracture; Medial rectus muscle; Endoscope
• ISSN: 0385-8146; 1879-1476
• DOI: 10.1016/j.anl.2014.10.011

Abstract Introduction Rupture of the extraocular muscle is extremely rare, and a traumatic event is especially uncommon. Although retrieval of an injured MRM is usually performed by an anterior approach by an ophthalmologist, missing muscles in the orbital retrobulbar space are sometimes difficult to identify. This is the first report to demonstrate direct muscle to muscle anastomosis by an endoscopic endonasal orbital approach by a single otolaryngologist. Case report A 67-year-old man presented with left medial rectus muscle (MRM) rupture due to a traffic accident 4 months after injury. The MRM was completely ruptured, and the muscle was repaired by an endoscopic endonasal orbital approach. After surgery, his eye abduction was improved in the primary position, and adduction ability was markedly restored on right gaze without diplopia. Conclusions Our endonasal endoscopic approach provides excellent access to the MRM in the orbital retrobulbar space and avoids a facial scar. We could suture both ends of the muscle together by an endonasal endoscopic approach and could obtain a good result without any complications.