Montgomery County ENT Malpractice Lawsuit

Palombi v. Metropolitan ENT & Facial Plastic Surgery

Doctor examining FaceThis surgical malpractice claim was filed in Montgomery County when a doctor allegedly improperly placed an implant to correct a woman's orbital floor fracture, causing permanent visual impairment. It was filed in Health Claims Arbitration on January 16, 2018, and it is the 24th medical malpractice case filed in Maryland this year.

Summary of Plaintiff's Allegations

A woman fell in her home and injured her right eye, but experienced no vision loss at that time. At Holy Cross Hospital a CT scan identified a right orbital blowout fracture with herniation of the right inferior rectus muscle and the intra-orbital fat through the fracture defect. In other words, the muscle and fat controlling eye movement were pushed through the part of her eye socket that had broken in the fall. Her vision and eye movement were still normal, so she was discharged home with instructions to follow up with a reconstructive otolaryngologist/plastic surgeon.

During the follow-up appointment, the doctor determined that the woman would require surgical correction. The fracture in her orbital floor was so large that it would have to be repaired with an implant. The woman underwent surgery two weeks later at Holy Cross Hospital. The doctor sized and cut the orbital implant to cover the fracture, placed the implant, and affixed it with three screws.

Immediately after surgery, the woman was unable to move her right eye, couldn't keep it open, and complained of double vision (diplopia). The doctor evaluated her one week later and said she was healing normally, even though she was still experiencing pain with eye movements, diplopia, and limited range of motion.

After obtaining a second and third opinion, the woman underwent a CT scan, revealing that her orbital floor plate was displaced and trapping the tissue around her eye muscle. To make matters worse, the plate was not adequately covering her orbital floor fracture, allowing her eye muscle and fat to continue herniating through the defect.

One month after the initial procedure, the woman underwent another surgery to repair her orbital floor fracture and remove the implant. Even though the second procedure was successful, the woman still experiences right nose and upper lip numbness, double vision, and up-gaze restriction. She uses corrective lenses, prisms, and scotch tape occlusion, but the severe double vision still impairs her ability to walk and drive safely.

Additional Comments
  • Unfortunately, surgical implant errors such as this are relatively common. When the eye muscle becomes entrapped, a patient's chances of recovery are better the sooner the muscle is released. As such, it is important for doctors to perform forced deduction test during surgery and take CT scans after surgery in order to make sure the implant was placed properly, and reposition the implant quickly if necessary. Because this claimant's eye muscle was entrapped for more than a month, she sustained permanent muscle damage.

  • When a patient experiences eyelid, upper lip, or nose numbness after an eye surgery such as this, it is most often due to infraorbital nerve damage. The maxillary nerves, which run across the front of the face from the lip up to the eyes, is renamed the infraorbital nerve once it reaches the infraorbital canal, or the base of the eye socket. This claimant's right infraorbital nerve was affected during surgery, causing numbness in the extremities of her right maxillary nerve.

  • Plaintiff has a local expert which is often hard to find in medical malpractice cases.
Jurisdiction
  • Montgomery County
Defendants
  • Metropolitan ENT & Facial Plastic Surgery
  • A Rockville otolaryngologist (ENT)
Hospitals Where Patient was Treated
  • Holy Cross Hospital
Negligence
  • Failing to properly place the implant across the entire orbital floor fracture.
  • Failing to identify the incorrectly placed implant during or immediately after surgery.
Specific Counts Pled
  • Medical Negligence: The claimant's vision is permanently impaired as a result of surgical negligence.
  • Informed Consent: The claimant was not educated about the foreseeable risks and complications of the procedure beforehand.
Plaintiff's Experts and Areas of Specialty
  • Shannath L. Merbs, M.D., Board Certified in Ophthalmology, specializing in Ophthalmic Plastic and Reconstructive Surgery. She is located in Baltimore and is affiliated with Johns Hopkins.
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