Orbital Injury in Endoscopic Sinus Surgery for Sinonasal Inflammatory Disorders: Juntendo’s Ten-Year Experience

Orbital injury and complications are commonly encountered in endoscopic sinus surgery (ESS) despite advances in techniques and instrumentation. For the recent 10 years, we summarized the experience of the rhinology unit of our department regarding orbital injury and complications of ESS for sinonasal inflammatory disorders. One thousand seventy-three patients (1869 sides) from January 1, 2003 to December 31, 2012 undergoing ESS for sinonasal inflammatory diseases were enrolled in the present study. The age of the patients ranged from 8 to 81 years, mean age 49 years. Orbital injury and complications were observed in 13 patients (13 sides), which corresponded to 0.7% of the operated sides and 1.2% of the patients. Eight patients showed herniation of orbital fat alone through the injury of the lamina papyracea. The protruding orbital fat was snipped and cut using forceps in 2 patients. Removal of exposed orbital fat using powered instruments was performed in 3 patients, two of whom transiently showed periorbital edema postoperatively. No permanent complications were observed. Meticulous preoperative and perioperative planning is critical to prevent orbital complications. Especially, exposure of the periorbit and herniation of orbital fat after lamina injury with powered instrumentation dramatically increases the potential for more severe complications.