Irawati Yunia, Wardani Retno Sulistyo, Natalia Michelle Eva Rebeca, Anggraini Neni
Plastic Reconstructive Surgery Division, Ophthalmology Department, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.
Rhinology Division, Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.
Int J Surg Case Rep. 2022 Jun;95:107196. doi: 10.1016/j.ijscr.2022.107196. Epub 2022 May 13.
Sino-orbital cutaneous fistula (SOCF) directly connects the sinus, orbital space, and outer skin. SOCF has been reported mostly as a complication of orbital exenteration, although it may occur from other infrequent etiologies. The patient can be treated using an endoscopy-guided technique which requires a multidisciplinary approach.
We present three cases of SOCF due to less common etiologies (mucocele, chronic inflammation, and malignancy) in young adult patients with a history of orbital and surgical complications. The endoscopy-guided technique benefits from a minimally invasive procedure, having less tissue removal and a faster healing time.
Risk factors of developing SOCF are poor surgical technique, post-operative radiotherapy, concomitant immunocompromised state, diabetes mellitus, hypoproteinemia, or destruction caused by the tumor. The most commonly affected sinus is the frontal (60-89%). Fistula can occur with or without orbital/nasal wall destruction and bony erosion. Before starting the treatment, it is essential to make a precise diagnosis of the etiology and rule out the possibility of recurrence. SOCF can be treated with conservative or invasive management, depending on the severity of the fistula.
It is essential to perform a thorough diagnostic examination with radiographic imaging to determine the specific cause before deciding on definitive treatment. By using the endoscopy-guided technique, long-term favorable results can be achieved. Multidisciplinary collaborative teamwork is needed to have a successful result.
鼻窦-眶周皮肤瘘（SOCF）直接连通鼻窦、眶腔和皮肤外层。尽管鼻窦-眶周皮肤瘘可能由其他罕见病因引起，但大多作为眶内容剜出术的并发症被报道。患者可采用内镜引导技术进行治疗，这需要多学科方法。
我们报告了3例鼻窦-眶周皮肤瘘病例，病因较为少见（黏液囊肿、慢性炎症和恶性肿瘤），患者为年轻成年，有眼眶及手术并发症病史。内镜引导技术得益于微创手术，组织切除少且愈合时间快。
发生鼻窦-眶周皮肤瘘的危险因素包括手术技术欠佳、术后放疗、合并免疫功能低下状态、糖尿病、低蛋白血症或肿瘤造成的破坏。最常受累的鼻窦是额窦（60% - 89%）。瘘管可伴有或不伴有眶壁/鼻壁破坏及骨质侵蚀。在开始治疗前，准确诊断病因并排除复发可能性至关重要。根据瘘管的严重程度，鼻窦-眶周皮肤瘘可采用保守或侵入性治疗。
在决定最终治疗方案前，通过影像学检查进行全面的诊断性检查以确定具体病因至关重要。采用内镜引导技术可取得长期良好效果。需要多学科协作团队合作才能获得成功结果。
