Comparative endoscopic techniques of medial rectus muscle retraction for approaching intraconal tumors: Our experience with five cases

Linli Chen; Xiaorong Yan; Yunshan Fu; Tingting Wang; Zhiyun Zhan; Shengnan Ye; Changzhen Jiang; Guohao Chen

doi:10.3389/fsurg.2022.923712

Comparative endoscopic techniques of medial rectus muscle retraction for approaching intraconal tumors: Our experience with five cases

Front Surg. 2022 Jul 15:9:923712. doi: 10.3389/fsurg.2022.923712. eCollection 2022.

Authors

Linli Chen¹, Xiaorong Yan², Yunshan Fu³, Tingting Wang⁴, Zhiyun Zhan⁴, Shengnan Ye¹, Changzhen Jiang², Guohao Chen¹

Affiliations

¹ Department of Otorhinolaryngology, Fujian Institute of Otorhinolaryngology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
² Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
³ Department of Otorhinolaryngology, Minnan Hospital Affiliated to Fujian Medical University, Quanzhou, China.
⁴ Department of Ophthalmology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.

Abstract

Objective: To examine the role of transnasal endoscopic approaches in the management of intraconal tumors and demonstrate the use of an eyelid speculum in comparison with different techniques of medial rectus muscle (MRM) retraction.

Methods: Retrospective data of five patients with intraconal tumors operated on and followed up by the senior authors between December 2019 and April 2022 was collected. Presenting symptoms, technical details, imaging and histology findings, outcomes, and complications were evaluated.

Results: Four primary and one recurrent tumor were identified. The mean patient age was 50 (range, 29-64) years. One tumor was located lateral to the optic nerve, one central and three medial. A complete surgical resection was obtained in four primary cases and a partial resection was achieved in the recurrent case. The MRM was retracted using three different techniques: (1) an infant eyelid speculum creating an operative window between the medial and inferior rectus muscle, (2) external MRM disinsertion transconjunctivally, (3) a four-handed technique performed transseptally by two surgeons. Transient postoperative ophthalmoplegia was recorded in four cases and transient ptosis in one. Three patients completely recovered in 2-3 months while one undergoing MRM disinsertion ended up in restricted strabismus at 15-month follow-up. No other long-term complications have been noted in all five patients with a mean follow-up of 22 (range, 14-32) months. No patients with primary tumors have required additional surgery for tumor recurrence.

Conclusion: The indication of endoscopic intraconal surgery may expand to lesions lateral to the optic nerve when the nerve is not in its natural position. The well-known advantages of the endoscopic techniques, namely the lack of external scars, better visualization, less bleeding, and fewer complications, were confirmed. An eye speculum provides a better surgical corridor and eases the pressure exerted on the MRM, which has a promising application prospect.

Keywords: endoscopic orbital surgery; eyelid speculum; intraconal tumors; medial rectus muscle retraction; tumors lateral to the optic nerve.