Zygomatic implants can be used to support dental prostheses in patients with inadequate maxillary bone volume. While maxillary sinusitis is the most common reported complication of ZI placement, rarely, intraorbital penetration has occurred.
A 21-year-old man with congenital maxillary hypoplasia and partial edentulism underwent placement of 2 zygomatic implants and 3 conventional dental implants. During the procedure, when the surgeon was drilling into the left zygoma, the patient developed sub conjunctival hemorrhage of the left eye. The drill was immediately withdrawn, and a conventional implant rather than a zygomatic implant was placed on the left side. CT scan at an outside emergency room showed a small osseous fragment adjacent to the left inferolateral aspect of the orbital rim and deformity of the left lateral rectus muscle. Upon presentation to Bascom Palmer 1 day later, his exam was notable for a severe abduction deficit of the left eye. MRI of the orbits demonstrated a partially transected lateral rectus muscle. He continued to follow in the pediatric ophthalmology clinic over the next 3 months, during which there was no improvement in his diplopia or the large angle, non-comitant left esotropia. Four months after the initial injury, he underwent surgical exploration with lateral rectus muscle retrieval and advancement in conjunction with medial rectus recession. No suture adjustment was necessary. At post op day 2, he had a 4-prism diopter esophoria, and no diplopia in primary gaze.
Presentation Date: 01/16/2020
Issue Date: 08/01/2020
Continuing Medical Education (CME)