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Fath L, Léon A, Djennaoui I, Debry C. Transcaruncular anterior ethmoidal artery ligation. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:46-48. [PMID: 35842350 DOI: 10.1016/j.anorl.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recurrence of epistaxis after ligation or embolization of the sphenopalatine artery may require ligation of the ipsilateral anterior ethmoidal artery, which cannot be embolized because of the risk to the ophthalmic artery. We describe a transconjunctival transcaruncular approach that allows reliable low-risk access to the anterior ethmoidal artery. This technique offers a minimally invasive approach to the surgical site, without unsightly scar.
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Affiliation(s)
- L Fath
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg, France; Unité Inserm 1121 Biomatériaux et Bioingénierie, CRBS, 1, rue Eugène Boeckel, 67000 Strasbourg, France.
| | - A Léon
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg, France
| | - I Djennaoui
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg, France
| | - C Debry
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg, France; Unité Inserm 1121 Biomatériaux et Bioingénierie, CRBS, 1, rue Eugène Boeckel, 67000 Strasbourg, France
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Eshraghi B, Moayeri M, Pourazizi M, Rajabi MT, Rafizadeh M. Decreased Bell's phenomenon after inferior and medial orbital wall decompression in thyroid-associated ophthalmopathy: a double-edged sword in management of the patients. Graefes Arch Clin Exp Ophthalmol 2021; 260:1701-1705. [PMID: 34851466 DOI: 10.1007/s00417-021-05509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the changes in Bell's phenomenon after inferior and medial orbital wall decompression in patients with thyroid-associated ophthalmopathy (TAO). METHODS This prospective interventional study included patients with moderate to severe non-active TAO, who underwent inferior and medial wall orbital decompression. Bell's phenomenon and adjusted Bell's phenomenon were evaluated at baseline and six months after surgery. Bell's phenomenon was assessed by holding the upper lid open during forced eyelid closure. Afterwards, the upward excursion, the distance between lower eyelid margin and lower corneal limbus, was measured. Adjusted Bell's phenomenon distance is defined as the difference between margin reflex distance two (MRD2) and Bell's phenomenon distance. RESULTS Thirty TAO patients, including 15 males (50%), with a mean age of 43.6 ± 11.6 years, were enrolled. The distance of Bell's phenomenon significantly decreased after surgery by an average of 3.25 ± 1.57 mm (P < 0.001). In addition, the difference between pre- and post-operative distance of adjusted Bell's phenomenon was - 1.58 ± 2.13 (P < 0.001) corresponding to the worsening in the adjusted Bell's phenomenon. CONCLUSION The result of our study demonstrated that Bell's phenomenon decreases significantly after inferior and medial wall decompression, which could be considered a complication of this form of orbital wall decompression in TAO.
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Affiliation(s)
- Bahram Eshraghi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Moayeri
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohsen Pourazizi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Rafizadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Takahashi Y, Vaidya A, Yo K, Kawade Y, Kakizaki H. Comparison of degree of medial rectus muscle misalignment after medial orbital wall decompression with or without periosteal flap. Graefes Arch Clin Exp Ophthalmol 2021; 260:1025-1031. [PMID: 34536118 DOI: 10.1007/s00417-021-05413-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare the degree of postoperative medial rectus (MR) muscle misalignment in patients who underwent medial orbital wall decompression with or without a periosteal flap along the MR muscle. METHODS This retrospective, observational study included 40 sides from 26 patients. The following parameters were measured on axial computed tomographic images taken post- and/or preoperatively: the distance of the anteroposterior line between the posterior lacrimal crest and the junction of the ethmoid and sphenoid sinuses from the most medial point of the medial margin of the MR muscle; the angle created at the point of the MR globe insertion, the most medial point of the MR muscle, and the junction of the ethmoid and sphenoid sinuses; and the MR muscle cross-sectional area. Postoperative changes in the distance (MR muscle shift) and area (MR muscle expansion) were calculated, and MR muscle shift, MR muscle angle, and the rate of MR muscle expansion were compared between the groups with (22 sides) and without (18 sides) a periosteal flap. RESULTS MR muscle shift (P = 0.325), MR muscle angle (P = 0.219), and the rate of MR muscle expansion (P = 0.904) were not significantly different between the groups. CONCLUSIONS Preservation of the periosteum along the MR muscle is thought to prevent MR muscle misalignment after medial orbital wall decompression. However, the results of this study indicate that preservation of a periosteal flap may not contribute to lessening MR muscle shift after surgery.
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Affiliation(s)
- Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.
| | - Aric Vaidya
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.,Department of Oculoplastic, Orbital & Lacrimal Surgery, Rapti Eye Hospital, Dang, Nepal
| | - Kinga Yo
- Department of Otorhinolaryngology, Aichi Medical University, Aichi, Japan
| | - Yuka Kawade
- Department of Otorhinolaryngology, Aichi Medical University, Aichi, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan
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Abstract
PURPOSE To report a multicenter large case series of orbital decompression for non-thyroid eye disease proptosis. METHODS Retrospective chart review of cases of orbital decompression performed by 9 experienced orbital surgeons from different countries from 2014 to 2017 for non-thyroid eye disease proptosis. Patients were divided into 3 groups: 1) negative vector (high axial length or shallow orbit), 2) inflammatory, and 3) tumor. Types of orbital decompression and Hertel exophthalmometry (preoperative and minimum 6 months postoperative) were recorded. Charts were also assessed for serious complications. The amount of exophthalmometry improvement was recorded according to the above groups. RESULTS The analysis included 41 orbits of 29 patients (14 women and 15 men) with a mean age of 38.9 years (ranging from 9 to 74; standard deviation (SD) 15.66). There were 17 orbits of 11 patients in the negative vector group, 16 orbits of 10 patients in the inflammatory group, and 8 orbits of 8 patients in the tumor group. The mean reduction of proptosis was 2.95 mm in the negative vector group, 2.54 mm in the inflammatory group, and 5.75 mm in the tumor group. There were no serious complications. CONCLUSIONS Orbital decompression was safe and effective in reducing proptosis for non-thyroid eye disease indications in this series. The amount of exophthalmometry improvement was less in the inflammatory orbitopathy group compared with other proptosis etiology groups.Orbital decompression may have a role in improving proptosis in non-thyroid eye disease entities.
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Gioacchini FM, Kaleci S, Cassandro E, Scarpa A, Tulli M, Cassandro C, Ralli M, Re M. Orbital wall decompression in the management of Graves' orbitopathy: a systematic review with meta-analysis. Eur Arch Otorhinolaryngol 2021; 278:4135-4145. [PMID: 33599843 DOI: 10.1007/s00405-021-06698-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To systematically review outcomes of orbital bony wall decompression for Grave's orbitopathy according to the surgical approach. METHODS A systematic search for studies published in "Ovid MEDLINE", "Web of Science" and "Embase" of patients with surgical treatment of Grave's orbitopathy was performed. The overall postoperative change in Hertel exophthalmometry was calculated by random-effect meta-analysis model with 95% confidence interval (CI). RESULTS A total of 33 studies, including 1686 patients and 2946 procedures, were included. The weighted mean Hertel value overall reduction was - 4.56 mm (95% CI - 5.05 to - 4.07 mm). According to surgical techniques the reduction was - 4.36 mm (95% CI - 5.22 to - 3.50) for infero-medial technique, - 4.88 mm (- 5.68 to - 4.08) for medial-lateral technique, - 4.32 mm (- 4.80to - 3.84) for lateral technique, - 5.45 mm (- 6.16 to - 4.74) for three-wall technique and - 3.47 mm (- 5.81 to - 1.12) for medial technique. The overall rate of new-onset of primary gaze diplopia was reported in 23 studies. The included procedures were 653 and results were heterogeneous (heterogeneity: Q = 78.8 df = 22, I2 = 72.09%, p < 0.01). The pooled proportion (95% CI) rate of new-onset of primary gaze diplopia was 12% (7-16). CONCLUSION Our metanalysis highlights that orbital bony wall decompression represents an effective surgical procedure. The three wall approach was associated with the best results in terms of exophthalmos reduction. Data suggest that an exclusive lateral approach may help to avoid the new-onset of primary gaze diplopia during the postoperative period.
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Affiliation(s)
- Federico Maria Gioacchini
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020, Ancona, Italy.
| | - Shaniko Kaleci
- Department of Diagnostic Medicine, Clinical and Public Health, University Hospital of Modena, Modena, Italy
| | - Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Michele Tulli
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020, Ancona, Italy
| | | | - Massimo Ralli
- Department of Sense Organs, Sapienza University Rome, Rome, Italy
| | - Massimo Re
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020, Ancona, Italy
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Park NR, Lee JK. The Clinical Result of Medial Orbital Decompression in Patients with Thyroid-associated Orbitopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.11.1015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Na Ri Park
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong Kyu Lee
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Jefferis JM, Jones RK, Currie ZI, Tan JH, Salvi SM. Orbital decompression for thyroid eye disease: methods, outcomes, and complications. Eye (Lond) 2017; 32:626-636. [PMID: 29243735 DOI: 10.1038/eye.2017.260] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 10/04/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeTo determine the safety and effectiveness of orbital decompression for thyroid eye disease (TED) in our unit. To put this in the context of previously published literature.Patients and methodsA retrospective case review of all patients undergoing orbital decompression for TED under the care of one orbital surgeon (SMS) between January 2009 and December 2015. A systematic literature review of orbital decompression for TED.ResultsWithin the reviewed period, 93 orbits of 55 patients underwent decompression surgery for TED. There were 61 lateral (single) wall decompressions, 17 medial one-and-a-half wall, 11 two-and-a-half wall, 2 balanced two wall, and 2 orbital fat only decompressions. For the lateral (single) wall decompressions, mean reduction in exophthalmometry (95% confidence interval (CI) was 4.2 mm (3.7-4.8), for the medial one-and-a-half walls it was 2.9 mm (2.1-3.7), and for the two-and-a-half walls it was 7.6 mm (5.8-9.4). The most common complications were temporary postoperative numbness (29% of lateral decompressions, 17% of other bony decompressions, OR 0.50, 95% CI 0.12-2.11) and new postoperative diplopia (9% of lateral decompressions, 39% of other bony decompressions, OR 6.8, 95% CI 1. 5-30.9). Systematic literature searching showed reduction in exophthalmometry for lateral wall surgery of 3.6-4.8 mm, with new diplopia 0-38% and postoperative numbness 12-50%. For other bony decompressions, reduction in exophthalmometry was 2.5-8.0 mm with new diplopia 0-45% and postoperative numbness up to 52%.ConclusionDiffering approaches to orbital decompression exist. If the correct type of surgery is chosen, then safe, adequate surgical outcomes can be achieved.
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Affiliation(s)
- J M Jefferis
- The Eye Department, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
| | - R K Jones
- The Eye Department, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
| | - Z I Currie
- The Eye Department, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
| | - J H Tan
- The Eye Department, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
| | - S M Salvi
- The Eye Department, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
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Boboridis KG, Uddin J, Mikropoulos DG, Bunce C, Mangouritsas G, Voudouragkaki IC, Konstas AGP. Critical Appraisal on Orbital Decompression for Thyroid Eye Disease: A Systematic Review and Literature Search. Adv Ther 2015; 32:595-611. [PMID: 26202828 PMCID: PMC4522025 DOI: 10.1007/s12325-015-0228-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Orbital decompression is the indicated procedure for addressing exophthalmos and compressive optic neuropathy in thyroid eye disease. There are an abundance of techniques for removal of orbital bone, fat, or a combination published in the scientific literature. The relative efficacy and complications of these interventions in relation to the specific indications remain as yet undocumented. We performed a systematic review of the current published evidence for the effectiveness of orbital decompression, possible complications, and impact on quality of life. METHODS We searched the current databases for medical literature and controlled trials, oculoplastic textbooks, and conference proceedings to identify relevant data up to February 2015. We included randomized controlled trials (RCTs) comparing two or more interventions for orbital decompression. RESULTS We identified only two eligible RCTs for inclusion in the review. As a result of the significant variability between studies on decompression, i.e., methodology and outcome measures, we did not perform a meta-analysis. One study suggests that the transantral approach and endonasal technique had similar effects in reducing exophthalmos but the latter is safer. The second study provides evidence that intravenous steroids may be superior to primary surgical decompression in the management of compressive optic neuropathy requiring less secondary surgical procedures. CONCLUSION Most of the published literature on orbital decompression consists of retrospective, uncontrolled trials. There is evidence from those studies that removal of the medial and lateral wall (balanced) and the deep lateral wall decompression, with or without fat removal, may be the most effective surgical methods with only few complications. There is a clear unmet need for controlled trials evaluating the different techniques for orbital decompression. Ideally, future studies should address the effectiveness, possible complications, quality of life, and cost of each intervention.
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Affiliation(s)
- Konstadinos G. Boboridis
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36 Thessaloniki, Greece
- 3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Moorfields Eye Hospital, London, UK
| | | | - Dimitrios G. Mikropoulos
- 3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Irini C. Voudouragkaki
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36 Thessaloniki, Greece
| | - Anastasios G. P. Konstas
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36 Thessaloniki, Greece
- 3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Leray B, Imbert P, Thouvenin D, Boutault F, Caron P. [Diagnosis and treatment of dysthyroid orbitopathy: a multidisciplinary disease]. J Fr Ophtalmol 2013; 36:874-85. [PMID: 24239215 DOI: 10.1016/j.jfo.2013.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 06/19/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
Graves' disease is a common autoimmune disorder that can be complicated, especially in smokers, by an orbitopathy which can sometimes jeopardize vision and result in functional sequelae affecting quality of life of these patients. Although the diagnosis of dysthyroid orbitopathy is usually obvious, clinical evaluation must specify the stage of progression (clinical activity score) and severity according to the European Group EUGOGO classification. At first, rapid restoration of the euthyroid state, smoking cessation and simple symptomatic ophthalmic treatment are suggested. In the case of severe or active orbitopathy, oral or intravenous corticosteroid therapy with or without orbital radiation therapy (and even emergency orbital surgery in the case of compressive optic neuropathy) should be implemented. Ultimately, orbital surgery (orbital decompression in cases of exophthalmos), oculomotor surgery (diplopia) or eyelid surgery (retraction) may be required depending on the severity of sequelae. A multidisciplinary approach involving ophthalmologist, endocrinologist and orbital surgeon should facilitate an overall diagnosis and treatment plan for these patients.
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Affiliation(s)
- B Leray
- Service d'ophtalmologie, CHU Purpan, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
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