A Preoperative Imaging Evaluation to Avoid Orbital Complications in Functional Endoscopic Sinus Surgery

Area of Science:

• Otolaryngology
• Radiology
• Medical Imaging

Background:

• Functional endoscopic sinus surgery (FESS) is a widely adopted procedure globally.
• Serious complications associated with FESS necessitate thorough preoperative imaging.
• Identifying potential risks preoperatively is essential for patient safety.

Purpose of the Study:

• To evaluate the diagnostic utility of 0.5 mm slice CT images compared to conventional 2 mm slice CT images for preoperative assessment in FESS.
• To determine the incidence of orbital blowout fractures in patients undergoing FESS and assess their detectability with different CT resolutions.

Main Methods:

• Retrospective review of 112 patients who underwent FESS.
• Comparison of 0.5 mm slice CT images reconstructed from sinus CT data with standard 2 mm slice CT images.
• Extraction and analysis of patient demographics, surgical history, diagnoses, and CT findings.

Main Results:

• Orbital blowout fractures were identified in 6 patients (5.4%).
• Half of these orbital blowout fractures were only detectable on the 0.5 mm slice CT images.
• The 0.5 mm slice CT imaging demonstrated superior capability in identifying subtle fractures.

Conclusions:

• 0.5 mm slice CT imaging is highly valuable for preoperative evaluation in FESS, enhancing the detection of orbital blowout fractures.
• Surgeons must be aware of "stealth" blowout fractures, which may be asymptomatic and unrecognized without high-resolution imaging.
• Utilizing thin-slice CT protocols can help mitigate surgical complications by improving preoperative risk assessment.