Department of Otolaryngology-Head & Neck Surgery (.), Saint Louis University, Saint Louis, Missouri, Ohio, and the.
Laryngoscope. 2013 Sep;123(9):2094-8. doi: 10.1002/lary.23948. Epub 2013 Jul 9.
OBJECTIVES/HYPOTHESIS: Endoscopic orbital decompression (EnOD) has proven to be safe and effective for the treatment of Graves' orbitopathy; however, complications do occur. Although the literature focuses on orbital complications, sinonasal complications including postobstructive sinusitis, hemorrhage, and cerebrospinal fluid (CSF) leak can also be challenging to manage. This study examines the incidence and management of sinonasal complications in these patients.
Retrospective review.
Clinical data, surgical findings, and postoperative outcomes were reviewed of patients who underwent EnOD for Graves' disease between March 2004 and November 2010. The incidence and management of postoperative sinonasal complications requiring an intervention were examined.
The study group consisted of 50 consecutive patients (86 decompression procedures): 11 males and 39 females with an average age of 48.6 years (SD = 12.9). Incidence of significant sinonasal complications was 3.5% (5/86): with one patient experiencing postoperative hemorrhage requiring operative management, three patients with postoperative obstructive sinusitis, and one patient with nasal obstruction secondary to nasal adhesions that required lysis. The maxillary sinus was the most commonly involved and was managed using the mega-antrostomy technique. In the case of frontal sinusitis, an endoscopic transaxillary approach was utilized to avoid injury to decompressed orbital contents. All complications were successfully managed without sequelae.
Sinonasal complications following EnOD are uncommon. In the setting of a decompressed orbit, even routine types of postoperative issues can be challenging and require additional considerations. Successful management of postoperative sinusitis related to outflow obstruction may require more extensive approaches and novel techniques.
目的/假设：内镜眶减压术（EnOD）已被证明可安全有效地治疗格雷夫斯眼病；然而，仍会出现并发症。尽管文献主要关注眼眶并发症，但鼻窦并发症，包括阻塞后鼻窦炎、出血和脑脊液（CSF）漏，也可能难以处理。本研究检查了这些患者的鼻窦并发症的发生率和处理方法。
回顾性研究。
回顾了 2004 年 3 月至 2010 年 11 月期间接受 EnOD 治疗格雷夫斯病的 50 例连续患者（86 次减压手术）的临床数据、手术发现和术后结果。检查了需要干预的术后鼻窦并发症的发生率和处理方法。
研究组包括 50 例连续患者（86 次减压手术）：11 名男性和 39 名女性，平均年龄为 48.6 岁（标准差=12.9）。显著鼻窦并发症的发生率为 3.5%（5/86）：1 例患者术后出血需要手术治疗，3 例患者术后阻塞性鼻窦炎，1 例患者因鼻粘连导致鼻阻塞需要松解。上颌窦是最常受累的部位，采用 mega-antrostomy 技术进行处理。对于额窦炎，采用经额下入路的内镜方法，以避免对减压的眶内容物造成损伤。所有并发症均成功处理，无后遗症。
EnOD 后发生的鼻窦并发症并不常见。在减压后的眼眶环境中，即使是常规类型的术后问题也可能具有挑战性，需要额外考虑。成功处理与流出道阻塞相关的术后鼻窦炎可能需要更广泛的方法和新技术。
