Sino-orbital cutaneous fistula with endoscopy guided technique: A case series

Sino-orbital cutaneous fistula (SOCF) directly connects the sinus, orbital space, and outer skin. SOCF has been reported mostly as a complication of orbital exenteration, although it may occur from other infrequent etiologies. The patient can be treated using an endoscopy-guided technique which requires a multidisciplinary approach.

We present three cases of SOCF due to less common etiologies (mucocele, chronic inflammation, and malignancy) in young adult patients with a history of orbital and surgical complications. The endoscopy-guided technique benefits from a minimally invasive procedure, having less tissue removal and a faster healing time.

Risk factors of developing SOCF are poor surgical technique, post-operative radiotherapy, concomitant immunocompromised state, diabetes mellitus, hypoproteinemia, or destruction caused by the tumor. The most commonly affected sinus is the frontal (60-89%). Fistula can occur with or without orbital/nasal wall destruction and bony erosion. Before starting the treatment, it is essential to make a precise diagnosis of the etiology and rule out the possibility of recurrence. SOCF can be treated with conservative or invasive management, depending on the severity of the fistula.

It is essential to perform a thorough diagnostic examination with radiographic imaging to determine the specific cause before deciding on definitive treatment. By using the endoscopy-guided technique, long-term favorable results can be achieved. Multidisciplinary collaborative teamwork is needed to have a successful result.