From the Research
The most likely complication of a Lynch-Howarth procedure in a patient with massive periorbital cellulitis is diplopia. This complication occurs due to potential damage to the extraocular muscles or their innervation during the surgical approach. The Lynch-Howarth procedure involves an incision between the medial canthus and nasal bridge to access the ethmoid sinuses, which places the medial rectus muscle and its nerve supply at risk. Manipulation of orbital contents during surgery can cause temporary or permanent muscle dysfunction, leading to misalignment of the eyes and double vision. This complication is more likely in cases of severe periorbital cellulitis where inflammation and anatomical distortion are already present. While CSF leak and lacrimal sac injury are possible complications, they are less common than diplopia in this specific procedure when treating orbital complications of sinusitis, as seen in studies such as 1 which focused on endoscopic closure of frontal sinus CSF leaks but did not report diplopia as a common complication, suggesting that the risk may be more associated with the specific approach and anatomy involved in the Lynch-Howarth procedure. Key considerations in minimizing the risk of diplopia include precise surgical technique and careful handling of orbital tissues. Given the potential for significant morbidity associated with diplopia, including impacts on vision and quality of life, careful preoperative planning and postoperative monitoring are essential in managing patients undergoing the Lynch-Howarth procedure for massive periorbital cellulitis. The provided studies, such as 2, 3, 4, and 5, offer insights into various aspects of sinus surgery and complications but do not directly address the specific risk of diplopia in the context of the Lynch-Howarth procedure for periorbital cellulitis, highlighting the need for careful consideration of surgical approach and potential complications in this context.