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Management of sinonasal complications after endoscopic orbital decompression for Graves' orbitopathy
Author(s) -
Antisdel Jastin L.,
Gumber Divya,
Holmes Janalee,
Sindwani Raj
Publication year - 2013
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.23948
Subject(s) - medicine , sinusitis , surgery , decompression , incidence (geometry) , cerebrospinal fluid leak , sinus (botany) , orbit (dynamics) , exophthalmus , retrospective cohort study , maxillary sinus , cerebrospinal fluid , eye disease , optics , physics , botany , engineering , pathology , biology , genus , aerospace engineering
Objectives/Hypothesis Endoscopic orbital decompression ( EnOD ) has proven to be safe and effective for the treatment of Graves' orbitopathy; however, complications do occur. Although the literature focuses on orbital complications, sinonasal complications including postobstructive sinusitis, hemorrhage, and cerebrospinal fluid ( CSF ) leak can also be challenging to manage. This study examines the incidence and management of sinonasal complications in these patients. Study Design Retrospective review. Methods Clinical data, surgical findings, and postoperative outcomes were reviewed of patients who underwent EnOD for Graves' disease between March 2004 and November 2010. The incidence and management of postoperative sinonasal complications requiring an intervention were examined. Results The study group consisted of 50 consecutive patients (86 decompression procedures): 11 males and 39 females with an average age of 48.6 years ( SD = 12.9). Incidence of significant sinonasal complications was 3.5% (5/86): with one patient experiencing postoperative hemorrhage requiring operative management, three patients with postoperative obstructive sinusitis, and one patient with nasal obstruction secondary to nasal adhesions that required lysis. The maxillary sinus was the most commonly involved and was managed using the mega‐antrostomy technique. In the case of frontal sinusitis, an endoscopic transaxillary approach was utilized to avoid injury to decompressed orbital contents. All complications were successfully managed without sequelae. Conclusion Sinonasal complications following EnOD are uncommon. In the setting of a decompressed orbit, even routine types of postoperative issues can be challenging and require additional considerations. Successful management of postoperative sinusitis related to outflow obstruction may require more extensive approaches and novel techniques. Level of Evidence 4. Laryngoscope , 123:2094–2098, 2013