title: Retrieval of ruptured medial rectus muscle with an endoscopic endonasal orbital approach. A case report and indication for surgical technique.
abstract: BACKGROUND
  Rupture of the extraocular muscle is extremely rare, and a traumatic event is especially uncommon. Although retrieval of an injured MRM is usually performed by an anterior approach by an ophthalmologist, missing muscles in the orbital retrobulbar space are sometimes difficult to identify. This is the first report to demonstrate direct muscle to muscle anastomosis by an endoscopic endonasal orbital approach by a single otolaryngologist.
  
  
  METHODS
  A 67-year-old man presented with left medial rectus muscle (MRM) rupture due to a traffic accident 4 months after injury. The MRM was completely ruptured, and the muscle was repaired by an endoscopic endonasal orbital approach. After surgery, his eye abduction was improved in the primary position, and adduction ability was markedly restored on right gaze without diplopia.
  
  
  CONCLUSIONS
  Our endonasal endoscopic approach provides excellent access to the MRM in the orbital retrobulbar space and avoids a facial scar. We could suture both ends of the muscle together by an endonasal endoscopic approach and could obtain a good result without any complications.
authors.affiliation: Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kita-gun, Miki-cho, Ikenobe 1750-1, Kagawa 761-0793, Japan. Electronic address: kakaka@med.kagawa-u.ac.jp.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Akiyama
authors.affiliation: Tanaka ENT Clinic, Tyuou-ku, Shinshigai 7-17, Kumamoto 860-0803, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Karaki
authors.affiliation: Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kita-gun, Miki-cho, Ikenobe 1750-1, Kagawa 761-0793, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hoshikawaa
authors.affiliation: Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kita-gun, Miki-cho, Ikenobe 1750-1, Kagawa 761-0793, Japan.
authors.forename: Nozomu
authors.initials: N
authors.lastname: Mori
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D006801:Humans; D008297:Male; D009296:Nasal Cavity; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009801:Oculomotor Muscles / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D009917:Orbital Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D012421:Rupture / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Blowout fracture; Endoscope; Endoscopic endonasal surgery; Medial rectus muscle