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The complications of transethmoidal decompressive orbitotomy associated with endocrine ophthalmopathy.

Abstract The objective of the present study was the analysis of the results of transethmoidal decompressive orbitotomy (TEDO) with the resection of the bone matrix of the medial and inferior orbital walls in the patients presenting with endocrine ophthalmopathy (EOP) with the purpose of reduction of the risk of development of this pathological conditions. A total of 51 patient with EOP at the stage of complete remission or pharmacotherapeutic compensation underwent transethmoidal decompressive medial orbitotomy in the ENT Clinic of 1 I.M. Sechenov First Moscow State Medical University during the period from 2006 to 2016. Twenty two of these patients presented with the unilateral process and 29 ones with bilateral exophthalmos. The surgical intervention was performed on the total of 80 eye orbits. The main complaints of the treated patients during the post-operative period included difficulties in nasal breathing (33%), dryness of the nose and crust formation (43%), discharge from the nose and along the posterior pharyngeal wall (15%), nasal bleeding (2%), pain in the forehead and maxillary region (8%), headache (2%). As far as the state of eyes and sight is concerned, 14 (27%) patients reported double vision at the primary gaze position while 6 others (12%) complained of the appearance of diplopia upon a change in the gaze position during the post-operative period. The post-operative endoscopic study revealed synechiae of different localization in the nasal cavity (47%), discharge from the maxillary sinuses (16%) and from the frontal sinus (2%). Eight (16%) patients were found to suffer from maxillary sinusitis, one had acute frontitis, and one sphenoidal sinus mucocelle. These complications were eliminated by pharmacotherapy and additional surgical interventions (2%). Analysis of the results of the study has demonstrated that the above complications were associated with the inadequate post-operative care for the nasal cavity, the excessively large size of the bone window formed during transethmoidal decompressive orbitotomy, resection of the inferior orbital wall, intrusion of the medial rectus muscle of the eye into the wide bone window. We evaluated the possible influence of the orbital soft tissues on the physiological parameters of the functioning of the paranasal sinuses in the post-operative period including blockade of the paranasal drainage pathways by the prolapsed orbital tissues. A few possible approaches to the reduction of the risk of post-operative complications are proposed. The authors emphasize the importance of the further improvement of the surgical treatment of endocrine ophthalmopathy.
PMID
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Transethmoidal decompressive orbitotomy in the patients presenting with endocrine ophthalmopathy at the stage of remission: peculiarities of the surgical intervention and the results of exophthalmos correction.

Authors

Mayor MeshTerms

Decompression, Surgical

Diplopia

Nasal Obstruction

Ophthalmologic Surgical Procedures

Keywords
Journal Title vestnik otorinolaringologii
Publication Year Start




PMID- 28514361
OWN - NLM
STAT- MEDLINE
DA  - 20170517
DCOM- 20170710
LR  - 20170713
IS  - 0042-4668 (Print)
IS  - 0042-4668 (Linking)
VI  - 82
IP  - 2
DP  - 2017
TI  - [The complications of transethmoidal decompressive orbitotomy associated with
      endocrine ophthalmopathy].
PG  - 33-37
LID - 10.17116/otorino201782233-37 [doi]
AB  - The objective of the present study was the analysis of the results of
      transethmoidal decompressive orbitotomy (TEDO) with the resection of the bone
      matrix of the medial and inferior orbital walls in the patients presenting with
      endocrine ophthalmopathy (EOP) with the purpose of reduction of the risk of
      development of this pathological conditions. A total of 51 patient with EOP at
      the stage of complete remission or pharmacotherapeutic compensation underwent
      transethmoidal decompressive medial orbitotomy in the ENT Clinic of 1 I.M.
      Sechenov First Moscow State Medical University during the period from 2006 to
      2016. Twenty two of these patients presented with the unilateral process and 29
      ones with bilateral exophthalmos. The surgical intervention was performed on the 
      total of 80 eye orbits. The main complaints of the treated patients during the
      post-operative period included difficulties in nasal breathing (33%), dryness of 
      the nose and crust formation (43%), discharge from the nose and along the
      posterior pharyngeal wall (15%), nasal bleeding (2%), pain in the forehead and
      maxillary region (8%), headache (2%). As far as the state of eyes and sight is
      concerned, 14 (27%) patients reported double vision at the primary gaze position 
      while 6 others (12%) complained of the appearance of diplopia upon a change in
      the gaze position during the post-operative period. The post-operative endoscopic
      study revealed synechiae of different localization in the nasal cavity (47%),
      discharge from the maxillary sinuses (16%) and from the frontal sinus (2%). Eight
      (16%) patients were found to suffer from maxillary sinusitis, one had acute
      frontitis, and one sphenoidal sinus mucocelle. These complications were
      eliminated by pharmacotherapy and additional surgical interventions (2%).
      Analysis of the results of the study has demonstrated that the above
      complications were associated with the inadequate post-operative care for the
      nasal cavity, the excessively large size of the bone window formed during
      transethmoidal decompressive orbitotomy, resection of the inferior orbital wall, 
      intrusion of the medial rectus muscle of the eye into the wide bone window. We
      evaluated the possible influence of the orbital soft tissues on the physiological
      parameters of the functioning of the paranasal sinuses in the post-operative
      period including blockade of the paranasal drainage pathways by the prolapsed
      orbital tissues. A few possible approaches to the reduction of the risk of
      post-operative complications are proposed. The authors emphasize the importance
      of the further improvement of the surgical treatment of endocrine ophthalmopathy.
FAU - Kochetkov, P A
AU  - Kochetkov PA
AD  - I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 119991.
FAU - Grusha, Ya O
AU  - Grusha YO
AD  - I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 119991; The 
      Helmholtz Moscow Research Institute of Eye Diseases, Moscow, Russia, 119021.
FAU - Svistushkin, V M
AU  - Svistushkin VM
AD  - I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 119991.
FAU - Danilov, S S
AU  - Danilov SS
AD  - The Helmholtz Moscow Research Institute of Eye Diseases, Moscow, Russia, 119021.
LA  - rus
PT  - Journal Article
TT  - Oslozhneniia transetmoidal'noi dekompressionnoi orbitotomii pri endokrinnoi
      oftal'mopatii.
PL  - Russia (Federation)
TA  - Vestn Otorinolaringol
JT  - Vestnik otorinolaringologii
JID - 0416577
SB  - IM
MH  - Adult
MH  - *Decompression, Surgical/adverse effects/methods
MH  - *Diplopia/etiology/prevention & control
MH  - Female
MH  - Graves Ophthalmopathy/*surgery
MH  - Humans
MH  - Intraoperative Care/methods
MH  - Male
MH  - *Nasal Obstruction/etiology/prevention & control
MH  - *Ophthalmologic Surgical Procedures/adverse effects/methods
MH  - Orbit/surgery
MH  - Outcome and Process Assessment (Health Care)
MH  - Postoperative Complications/*prevention & control
EDAT- 2017/05/18 06:00
MHDA- 2017/07/14 06:00
CRDT- 2017/05/18 06:00
PST - ppublish
SO  - Vestn Otorinolaringol. 2017;82(2):33-37. doi: 10.17116/otorino201782233-37.