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Frontal sinusitis associated with orbital decompression for Graves' orbitopathy.

Shun Tatehara1, Go Inokuchi1, Hiroko Takeda1

  • 1Department of Otolaryngology - Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.

Auris, Nasus, Larynx
|February 24, 2020
PubMed
Summary
This summary is machine-generated.

Orbital decompression for Graves' orbitopathy can cause sinusitis. Endoscopic modified Lothrop procedure (EMLP) effectively treats and prevents this complication, particularly when the uncinated process is involved.

Keywords:
Endoscopic modified Lothrop procedureEndoscopic sinus surgeryFrontal sinusitisGraves’ orbitopathyOrbital decompression

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Area of Science:

  • Ophthalmology
  • Otolaryngology
  • Surgical Anatomy

Background:

  • Graves' orbitopathy often requires orbital decompression (OD).
  • OD, particularly medial wall removal, can lead to chronic sinusitis due to orbital fat prolapse obstructing sinus drainage.
  • Sinusitis management following OD is infrequently reported.

Observation:

  • Three patients developed new or worsening obstructive frontal sinusitis after OD involving the superior uncinated process attachment.
  • Endoscopic modified Lothrop procedure (EMLP) successfully managed symptoms and maintained frontal sinus access in these cases.
  • EMLP performed before OD in two patients with pre-existing sinusitis prevented worsening of their condition.

Findings:

  • EMLP is an effective treatment for obstructive frontal sinusitis post-OD.
  • Prophylactic EMLP before OD can prevent sinusitis exacerbation.
  • Anatomical factors, including the uncinated process attachment and frontal sinus drainage patterns, may predict sinusitis risk.

Implications:

  • EMLP offers a valuable surgical approach for managing and preventing sinusitis associated with orbital decompression.
  • Understanding specific anatomical landmarks can help identify patients at higher risk for developing sinusitis after OD.
  • This study highlights the importance of considering sinus management during orbital decompression procedures for Graves' orbitopathy.