CT evaluation of proptosis

A Study of Otorhinolaryngological Diseases with Ophthalmic Complications: At a Tertiary Care Center

The eyeball and the orbit are neighbours of the ENT region. This close proximity, makes the involvement of the orbit and there of ophthalmological manifestations fairly common in the practise of Otorhinolaryngology. This was a prospective study. All the patients presenting with ophthalmological manifestations due to various ear, nose, throat and head-neck pathologies were constituted in this study. This study was carried out on 50 patients of all age groups with ophthalmological complications along with ENT diseases who came to the department of ENT and head-neck surgery and department of Ophthalmology of N.S.C.B. Government Medical College, Jabalpur from August 2018 to August 2019. The diseases of ENT with orbital extension must be considered whenever a patient presents with signs and symptoms of orbital disease such as proptosis, orbital mass, restriction of eye movements, neurological dysfunction of eye, chemosis, vision disturbances or epiphora. A firmer knowledge of orbital anatomy with respect to sinonasal region is required for any surgeon dealing with this important area, for a safer and more secure management in this complex region. Surgery remains the main stay of treatment for sinonasal diseases with orbital complications. Rapid diagnosis and treatment are of utmost importance in preserving vision and life in these patients.

Proptosis with Increased Orbital Fat in an Obese Patient

Computational tomography (CT) is a well-documented modality in the workup of proptosis. We present a case of proptosis due to increased orbital fat in an obese patient. We review the literature to discuss the most likely causes of increased orbital fat, and we discuss the utility of CT imaging in assessing this pathology.

Proptosis in Otorhinolaryngology: An Overview

Introduction  Ear, nose and throat (ENT)pathologies can present with proptosis as the early manifestation. The majority of ENT pathologies present with ocular manifestations, due to close anatomical relationship.

Objective  To study proptosis in ENT disorders in terms of etiology, pathogenesis, and management.

Methods  The present article is a prospective study conducted at a tertiary care center, in Telangana, India. Patients presenting with proptosis secondary to ENT disorders were thoroughly evaluated and subjected to surgical exploration after providing a signed informed consent.

Results  Sixty cases of proptosis secondary to ENT disorders have been reported. The most common cause was sinonasal squamous cell carcinoma followed by juvenile nasopharyngeal angiofibroma and allergic fungal rhinosinusitis.

Conclusion  Many ENT disorders can present with proptosis. Proptosis needs to be evaluated completely for proper management and to limit the morbidity associated with it.

MR imaging of cavernous sinus thrombosis

•

Quantitative & qualitative parameters on CEMRI are essential for diagnosis of CST.

•

Enlarged sinus, compressed cavernous ICA & dilated SOV should raise a suspicion.

•

Heterogenous signal intensity of the sinus on plain MRI should prompt evaluation.

•

Bulging lateral walls with abnormal dural enhancement & filling defects are good predictors.

•

Filling defects on post contrast images & orbital apex involvement are also seen.

Purpose

To determine the role of Contrast enhanced MRI (CEMRI) in the evaluation of Cavernous sinus thrombosis (CST).

Method

The study included 7 patients with an imaging diagnosis of cavernous sinus thrombosis. A retrospective analysis of Contrast enhanced MRI of 9 affected cavernous sinuses and a control group of 7 patients (14 cavernous sinuses) was conducted. Various qualitative and quantitative parameters were then compared.

Results

In the patient group, the mean Cavernous sinus (CS) diameter, Cavernous Internal Carotid Artery (ICA) diameter and Superior Ophthalmic Vein (SOV) diameter were 9.14 ± 0.56 mm, 3.5 mm ± 0.9 mm and 3.8 mm ± 1.79 mm respectively. While in the control group, the mean CS diameter, ICA diameter and SOV dimeter were 6.58 ± 0.54 mm, 4.6 mm ± 0.44 mm and 1.1 mm ± 0.11 mm respectively. The differences in the CS size, ICA and SOV diameters was statistically significant. (p < 0.05). Cut off points of ≥ 10 mm for CS diameter, ≥ 2.9 mm for SOV dilation, and ≤ 4.2 mm for ICA flow void diameter were estimated using receiver operating characteristic curves. Various other qualitative parameters, like bulging lateral walls of the sinus, heterogenous signal intensity with filling defects on post contrast images, abnormal dural enhancement along the lateral wall of the sinus and orbital apex involvement were more frequently observed in the CST group, in comparison to the control group.

Conclusions

CEMRI plays an invaluable role not only in the diagnosis of cavernous sinus thrombosis, but also in evaluating the extent of disease and its associated complications. The quantitative and qualitative parameters described here, provide more objectivity and accuracy in diagnosis of CST, thus, aiding prompt diagnosis and early treatment.

Routes of Spread to Eye from the Notorious Neighbour i.e. Nose, Sinuses and Nasopharynx

Due to close anatomical relationship of eye with nose and sinuses it is liable to get involved secondary to sinonasal and nasopharyngeal pathology. Sinonasal and nasopharyngeal pathology may present with varied ophthalmic manifestations. Ocular involvement from sinonasal diseases occur due to direct spread to orbit, venous spread due to valveless nature of veins, cranial nerve involvement, nasolacrimal apparatus involvement and intracranial spread. The present study is to determine the sociodemographics, ocular manifestations due to sinonasal and nasopharyngeal pathology, etiological factors and routes of spread. The most common etiology in present study was sinonasal squamous cell carcinoma followed by nasal vestibulitis. The most common ocular pathology was proptosis followed by preseptal cellulitis. The most common route was erosion followed by compression and vascular. To conclude sinonasal and nasopharyngeal pathology can spread to orbit and increase the mortality and morbidity.

Ophthalmological Manifestations of ENT Diseases: An Overview

A total number of 62 cases of ophthalmological manifestations caused by various ENT diseases, mostly paranasal tumour extensions, nasopharyngeal tumour and furunculosis of nose were analysed in a retrospective study in relation to their age, sex, clinical, radiological and HP profile. CT scan was considered as the most dependable investigating tool. Different modalities of medical and surgical treatment have been adopted according to location and nature of the disease. A close cooperation is needed between otolaryngologist and ophthalmologist to overcome this challenge.