This case involves a 27-year-old woman who presented to her doctor with recurrent sinusitis. She was referred to a surgeon who decided her condition would be treated best with septoplasty. During the procedure, the surgeon ruptured the patient’s optical muscle, resulting in severe swelling and permanent vision impairment. It appeared that the surgeon punctured a muscle near the eye socket and ruptured the side of the eye with his tool.
Question(s) For Expert Witness
- 1. While this is a risk acknowledged on the consent form, is it likely that this accident was the result of inadequate technique?
- 2. Is it a deviation from the standard of care for a surgeon to tear the optical muscle during an endoscopic sinus surgery?
Expert Witness Response E-000598
This represents a clear deviation from the standard of care. It is likely that the surgeon removed part of the muscle as well. Injuries are not frequent, but are often permanent. However, they are avoidable with a clear knowledge of the anatomy.
Expert Witness Response E-001733
I’m not sure how such an injury would occur during a septoplasty and turbinate reduction. More significant sinus surgery of the maxillary, ethmoid, and possibly other sinuses would likely have been performed at the same time to injure an extra-ocular muscle. This case seems like physician error.