Qazi Zia-Us-Salam, Latif Sarfraz, Awan Sadia Maqsood
Department of ENT, Head and Neck Surgery Federal Postgraduate Medical Institute Shaikh Zayed Hospital Lahore.
Department of Pharmacology and Therapeutics Federal Post Graduate Medical Institute Shaikh Zayed Hospital Lahore, Pakistan.
J Ayub Med Coll Abbottabad. 2016 Oct-Dec;28(4):687-693.
Orbital involvement in sinonasal diseases can present as proptosis, ophthalmoplegia or even as blindness due to optic nerve damage. There are a number of sinonasal diseases which can involve eyes. The purpose of this study was to enlist diagnoses of all the patients with sinonasal disease, in which orbit was also involved unilaterally or bilaterally and to analyse the management strategy and final outcome in all the cases.
Hundred consecutive patients having orbital symptoms along with sinonasal complaints that presented in ENT department of Shaikh Zayed federal postgraduate medical institute were included in our prospective study. CT scan and/or MRI were done in all the cases and ophthalmological consultation was done. Patients with sinonasal complaints without clinical involvement of orbit and those with primary orbital pathology were excluded from our study. Final diagnosis was made after histopathological confirmation.
A total of 37% of the patients were diagnosed to be having "Allergic fungal rhinosinusitis" 17% had "mucormycosis", 16% had "chronic invasive fungal sinusitis". Other pathologies identified were Nasopharyngeal CA (4%), Squamous cell Ca (4%), cavernous sinus thrombosis (3%), Adenocarcinoma (3%), Angiofibroma (2%) fibrous dysplasia (2%) and Acute complicated Rhinosinusitis (2%) Following rare pathologies were identified in only one patient each. These included Lymphoma, Osteoma, and Rhabdomyosarcoma, Transitional cell carcinoma arising from inverted papilloma, Hemangiopericytoma, Spindle cell sarcoma, Pituitary adenoma, Giant cell sarcoma, malignant undifferentiated tumour, plexiform neurofibroma and sinonasal tuberculosis. Most common orbital symptom was proptosis. Eighty-one patients had proptosis followed by 23 patients with diplopia, 22 patients with ophthalmoplegia, 16 patients with visual loss and 15 patients with ptosis.
Orbital involvement in most of the sinonasal diseases indicate extensive and aggressive nature of the pathology and many of these, even if they are not malignancies are difficult to treat. This is especially true for acute fulminant and chronic invasive fungal rhinosinusitis.
鼻窦疾病累及眼眶可表现为眼球突出、眼球运动障碍，甚至因视神经损伤导致失明。多种鼻窦疾病可累及眼部。本研究旨在列出所有鼻窦疾病累及单侧或双侧眼眶患者的诊断，并分析所有病例的治疗策略及最终结果。
我们的前瞻性研究纳入了在谢赫·扎耶德联邦研究生医学研究所耳鼻喉科就诊的连续100例有眼眶症状及鼻窦症状的患者。所有病例均行CT扫描和/或MRI检查，并进行眼科会诊。鼻窦疾病无眼眶临床受累的患者及原发性眼眶病变患者被排除在研究之外。经组织病理学确诊后做出最终诊断。
共37%的患者被诊断为“变应性真菌性鼻窦炎”，17%为“毛霉菌病”，16%为“慢性侵袭性真菌性鼻窦炎”。其他确诊的病理类型包括鼻咽癌（4%）、鳞状细胞癌（4%）、海绵窦血栓形成（3%）、腺癌（3%）血管纤维瘤（2%）、骨纤维发育不良（2%）及急性复杂性鼻窦炎（2%）。以下罕见病理类型仅在1例患者中发现，包括淋巴瘤、骨瘤、横纹肌肉瘤、内翻性乳头状瘤恶变的移行细胞癌、血管外皮细胞瘤、梭形细胞肉瘤、垂体腺瘤、巨细胞肉瘤、恶性未分化肿瘤、丛状神经纤维瘤及鼻窦结核。最常见的眼眶症状是眼球突出。81例患者有眼球突出，其次是23例复视、22例眼球运动障碍、16例视力丧失及15例上睑下垂。
大多数鼻窦疾病累及眼眶表明病变广泛且具有侵袭性，其中许多疾病即使不是恶性肿瘤也难以治疗。急性暴发性和慢性侵袭性真菌性鼻窦炎尤其如此。
