Gire J, Facon F, Guigou S, Fauquier S, Malet T
Service d'ophtalmologie, centre hospitalier Henri-Duffaut, 305, rue Raoul-Follereau, 84902 Avignon cedex 9, France.
J Fr Ophtalmol. 2012 Oct;35(8):623.e1-4. doi: 10.1016/j.jfo.2011.10.017. Epub 2012 Sep 10.
We report a case of a late ethmoidal mucocele occurring after transpalpebral bony orbital decompression. A 39-year-old man presented with a recurrence of a right-sided proptosis without signs of orbital inflammation. The patient had undergone bilateral transpalpebral bony orbital decompression for dysthyroid orbitopathy 2 years prior. Orbital CT scan showed a large mucocele in the supero-lateral right ethmoidal sinus with lateral extension to the medial rectus. The patient was therefore referred to an ear, nose and throat (ENT) surgeon, who performed an anterior ethmoidectomy with marsupialization and drainage of the mucocele via an endoscopic approach. A complete postoperative resolution of proptosis was observed without recurrence of the mucocele to date, approximately 6 months postoperative. Sinus complications occurring after orbital decompression may include sinusitis, hematoma, imploding antrum syndrome and mucoceles. Recurrent proptosis secondary to an ethmoidal mucocele is a rare event after bony orbital decompression surgery, with only two cases reported in the international literature. Management requires ophthalmologic diagnosis and collaboration between the ophthalmologist and otorhinolaryngologist.
我们报告一例经睑眶骨减压术后发生的迟发性筛窦黏液囊肿病例。一名39岁男性患者,右侧眼球突出复发,无眼眶炎症迹象。该患者于2年前因甲状腺相关眼病接受了双侧经睑眶骨减压术。眼眶CT扫描显示右侧筛窦上外侧有一个大的黏液囊肿,并向内侧直肌外侧延伸。因此,该患者被转诊至耳鼻喉科医生处,医生通过内镜方法进行了前筛窦切除术、黏液囊肿造袋引流术。术后观察到眼球突出完全消退,截至术后约6个月,黏液囊肿未复发。眼眶减压术后发生的鼻窦并发症可能包括鼻窦炎、血肿、窦腔塌陷综合征和黏液囊肿。筛窦黏液囊肿继发的复发性眼球突出是眼眶骨减压手术后罕见的情况,国际文献中仅报道过两例。治疗需要眼科诊断以及眼科医生和耳鼻喉科医生之间的协作。