내시경적 부비동 수술 시행 후 내직근 절제로 발생한 외사시를 1년이 지난 시점에서 수술적 치료를 통하여 교정한 1예
Sequential Correction for Large Exotropia: A Case of Iatrogenic Exotropia Developed after Excision of Medial Rectus Muscle During Functional Endoscopic Sinus Surgery (FESS)
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목적: 이비인후과 내시경적 부비동 수술시 발생한 내직근 절제로 인한 우안 외사시 환자에 대해 수상 1년 후 내직근을 제외한 상직근과하직근의 전위술 및 외직근의 후전술을 차례로 시행하여 만족스러운 결과를 보였기에 이를 보고하고자 한다. 증례요약: 내시경적 부비동 수술 후, 우안 내직근 절제로 우안 외사시 발생한 41세 남자 환자로, 수상 1년 후 본원 내원하였으며, 안와자기 공명 영상에서 내직근 절제 소견 확인되었으며, 초진 시 95PD의 우안 외사시 소견 보였다. 1차 수술로 우안 상직근 및 하직근전위술을 시행하였다. 수술 6주 후 원거리, 근거리 외사시각 35PD 남은 상태로 교정되었으며, 남은 교정을 위해 2차 수술로 우안의외직근 후전술(7 mm)을 시행하였다. 2차 수술 후 우안 외사시각 10PD 남은 상태로 교정되었으며 환자 미용적으로 만족하고 있으며,복시도 호전되었다. 결론: 내시경적 부비동 수술 중 발생한 내직근 절단에 의한 의인성 우안 외사시에 대하여, 수상 후 1년이 지난 시점에서 1차 수술로상직근, 하직근의 전위술(6 mm) 및 2차 수술로 외직근의 후전술(7 mm)을 시행함으로써, 외사시와 미용적 이상 및 복시증상을 교정하였기에 이를 보고하고자 하는 바이다.
Abstract
Purpose: To report a case of iatrogenic exotropia caused by accidental excision of medial rectus muscle during functional endoscopic sinus surgery (FESS), which was successfully corrected by sequential surgical intervention (superior and inferior rectus muscle transposition followed by lateral rectus muscle recession). Case summary: Forty one year old male patient visited our clinic with large exotropia of the right eye developed after functional endoscopic sinus surgery (FESS) which was performed one year ago. At the initial visit in our clinic, there was a large exotropia (95 PD) of the right eye and transection of the medial rectus muscle was observed at the orbital MRI. In order to correct this large iatrogenic exotropia, sequential surgery was planned. Initially, full-tendon transposition of the right superior and inferior rectus muscle was performed which reduced the deviation to 35 PD. Six weeks after the initial surgery,7 mm right lateral rectus muscle recession was additionally performed, which resulted in exotropia of 10 PD. Diplopia was also improved and the patient was esthetically satisfied with the result. Conclusions: Even in a case of iatrogenic exotropia following one year after an accidental excision of medial rectus muscle during intranasal sinus surgery, sequential surgery such as transposition of superior and inferior rectus muscle followed by lateral rectus muscle recession can result in satisfying cosmetic and functional improvement.
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