Title : Extraocular movement deficit after globe sparing maxillectomy
Abstract:
Purpose: Globe-sparing maxillectomy for sinonasal tumors with orbital involvement can result in extraocular motility (EOM) deficits, significantly impacting quality of life. However, the relationship between extent of resection, reconstructive techniques, surgical team composition, and functional outcomes is understudied. This study evaluates the incidence of EOM deficits following globe-sparing maxillectomy and its associations with degree of orbital tumor involvement and reconstructive techniques.
Methods: A retrospective case series was conducted of all patients who underwent globe-sparing maxillectomy at 3 Mayo Clinic sites from 2005-2024, with at least three months of postoperative ophthalmology follow-up. The primary outcome was presence of a postoperative EOM deficit. Additional data on patient demographics, tumor histology, extent of maxillectomy (anterior: level of the globe; posterior: behind the globe) partial or complete orbital floor and rim resection, reconstructive techniques, and surgical team composition were collected. The Mayo Clinic Institutional Review Board approved this study.
Results: 61 patients (32% female) met inclusion criteria, with a mean age at surgery of 50 ±19 and median follow-up of 3 years (range 1-10 years). EOM deficits were identified postoperatively in 5 of 61 patients (8.2%) following globe-sparing maxillectomy. In 2 of these 5 patients, the motility impairment was new-onset without preoperative EOM deficit; none of the 5 patients had any pre-existing eye disease. All cases with an EOM deficit involved both anterior and posterior extent of maxillectomy, compared to 78% of control cases without EOM deficit (p=0.03). Complete resection of the orbital rim and orbital floor occurred in 2 of 5 cases (40%), both of which underwent dedicated orbital reconstruction with free flap and vascularized bone graft. Patients with ophthalmologist involvement during primary surgery had a significantly lower rates of post- operative EOM deficit than those without (0% vs 48%, p=0.0022).
Conclusions: The incidence of postoperative EOM deficits in this series was 8.2%, with new-onset deficits occurring in 4.9% of patients. All cases with postoperative deficits involved extensive maxillectomy with both anterior and posterior orbital involvement, and none had intraoperative ophthalmologist involvement. These findings suggest that multidisciplinary surgical collaboration and careful attention to orbital reconstruction should be considered for optimizing ophthalmic outcomes in globe-sparing maxillectomy. Comparative studies with larger sample sizes are warranted to establish definitive relationships between surgical team composition, extent of resection, reconstruction techniques, and EOM outcomes.
