From the Research
The most likely complication of a Lynch-Howarth procedure in a patient with massive periorbital cellulitis is diplopia (option A). When performing this surgical approach to drain an orbital abscess or subperiosteal collection, the medial rectus muscle can be traumatized or temporarily dysfunctional due to surgical manipulation or edema. This muscle controls medial eye movement, and damage can result in horizontal diplopia (double vision) as the affected eye cannot properly align with the unaffected eye. While CSF leak is a potential complication if the procedure extends too far superiorly and breaches the cribriform plate, and lacrimal sac injury can occur if dissection strays too anteriorly, diplopia remains the most common postoperative complication due to the proximity of the medial rectus muscle to the surgical field.
Some key points to consider when evaluating the potential complications of a Lynch-Howarth procedure include:
- The proximity of the medial rectus muscle to the surgical field, which increases the risk of diplopia 1
- The potential for CSF leak if the procedure extends too far superiorly and breaches the cribriform plate, although this is less common 2
- The risk of lacrimal sac injury if dissection strays too anteriorly, which can be mitigated with careful surgical technique 3
- The importance of counseling patients on the potential for temporary or permanent diplopia, and the need for close postoperative follow-up to monitor for complications 4, 5
Overall, while multiple complications are possible with a Lynch-Howarth procedure, diplopia remains the most likely complication due to the anatomical relationships involved.