From the Research
The most likely complication of a Lynch-Howarth procedure for massive periorbital cellulitis is diplopia (double vision). This occurs because the procedure involves surgical drainage of an orbital abscess through an incision in the medial orbital wall. During this operation, manipulation of the extraocular muscles, particularly the medial rectus muscle, can cause temporary or permanent misalignment of the eyes. The medial rectus is especially vulnerable due to its proximity to the surgical approach. Postoperative edema, scarring, or direct trauma to the muscle or its nerve supply can disrupt normal eye movement coordination. Patients may experience diplopia immediately after surgery or develop it during the healing process. While diplopia is often temporary and resolves with time as inflammation subsides, in some cases it may persist and require further intervention such as prism glasses or strabismus surgery. Other potential complications include CSF leak and lacrimal sac injury, but diplopia remains the most common significant complication of this orbital approach.
Key Points to Consider
- The Lynch-Howarth procedure is a surgical approach used to drain orbital abscesses, which can lead to complications such as diplopia, CSF leak, and lacrimal sac injury.
- Diplopia is the most common significant complication of this procedure, occurring due to manipulation of the extraocular muscles during surgery.
- The medial rectus muscle is particularly vulnerable to injury during this procedure, leading to temporary or permanent misalignment of the eyes.
- Postoperative edema, scarring, or direct trauma to the muscle or its nerve supply can also contribute to the development of diplopia.
Evidence-Based Recommendation
Based on the available evidence, including studies such as 1, which examined the long-term results of the Lynch-Howarth procedure in 60 patients, diplopia is the most likely complication of this procedure. While other complications such as CSF leak and lacrimal sac injury are possible, diplopia remains the most common significant complication of the Lynch-Howarth procedure. It is essential to carefully weigh the potential risks and benefits of this procedure and to discuss these with patients before surgery.