Department of Otolaryngology - Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Department of Otolaryngology - Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Auris Nasus Larynx. 2020 Dec;47(6):1079-1082. doi: 10.1016/j.anl.2020.01.011. Epub 2020 Feb 20.
Orbital decompression (OD) for Graves' orbitopathy usually includes removal of orbital medial wall. While OD occasionally cause or worsen chronic sinusitis because of the obstructed sinus drainage by prolapsed orbital fat, to date few reports have been published on the management or prevention of sinusitis associated with OD. Here, we present two patients (three sides) with newly developed and one patient (one side) with worsening obstructive frontal sinusitis following OD. These three patients had OD including the removal of the superior attachment of uncinated process to lamina papyracea. Endoscopic modified Lothrop procedure (EMLP) was useful to relieve symptoms and keep an enough access to frontal sinuses for all cases. We also performed EMLP for another two patients (four sides) with pre-existing sinusitis before OD. Worsening of sinusitis could be avoided by EMLP before OD. EMLP was useful approach for both treatment and prevention of sinusitis related to OD. The superior attachment site of uncinated process and the pattern of frontal sinus drainage might predict the occurrence of obstructive frontal sinusitis following OD.
眼眶减压术（OD）治疗格雷夫斯眼病通常包括去除眼眶内侧壁。虽然 OD 偶尔会因脱垂的眶脂肪阻塞鼻窦引流而导致或加重慢性鼻窦炎，但迄今为止，关于 OD 相关鼻窦炎的处理或预防的报道很少。在此，我们报告了 2 例（3 侧）新发生的、1 例（1 侧）OD 后阻塞性额窦炎加重的患者。这 3 例患者行 OD，包括去除钩突上部与纸样板的附着。所有患者的内镜下改良 Lothrop 手术（EMLP）均有助于缓解症状并保持足够的额窦入路。我们还对另外 2 例（4 侧）OD 前存在鼻窦炎的患者进行了 EMLP。OD 前的 EMLP 可避免鼻窦炎加重。EMLP 是治疗和预防 OD 相关鼻窦炎的有效方法。钩突上部附着点和额窦引流模式可能预测 OD 后发生阻塞性额窦炎。
