Total Oculomotor Nerve Palsy With Protracted Recovery Following Endoscopic Medial Maxillectomy: Case Report and Review of the Literature

Oculomotor nerve palsy (ONP) is an extremely-uncommon complication of endoscopic endonasal surgery (EES). To date, there have been only 6 reports of immediate ONP post-EES in the PubMed/MEDLINE-indexed literature. This report illustrates the clinical presentation of complete, pupil-involving ONP that recovered fully over 6 months after surgery in a 28 year-old man who underwent medial maxillectomy through endoscopic modified Denker's approach for sinonasal inverted papilloma. An attempt has been made to evaluate the possible etiology for such a complication through a thorough literature review, and following an in-depth introspection of the surgical team. The relevant surgical anatomy and the management aspects are also discussed in detail. This report provides a caveat to the endoscopic endonasal surgeons and the residents regarding ONP as an unexpected and unusual complication of sinus and skull-base surgery. It further underlines the importance of being knowledgeable of the somatic and parasympathetic neural anatomy of the oculomotor nerve in the skull base, and of the finesse and meticulous dissection that are needed for a safe surgery around the confines of the orbit.