Lehmann Ashton E, von Sneidern Manuela, Shen Sarek A, Humphreys Ian M, Abuzeid Waleed M, Jafari Aria
Department of Otolaryngology-Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee USA.
Department of Otolaryngology-Head and Neck Surgery Geisinger Medical Center Danville Pennsylvania USA.
World J Otorhinolaryngol Head Neck Surg. 2022 Mar 31;8(1):25-35. doi: 10.1002/wjo2.13. eCollection 2022 Mar.
As exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread, high-quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection. The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices.
Data Sources: PubMed, EMBASE, Web of Science. A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted. Articles not reporting orbital reconstruction details were excluded. Patient and tumor characteristics, operative details, and outcomes were recorded. Variables were compared using , Fisher's exact, and independent tests.
Of 60 patients included from 24 studies, 34 (56.7%) underwent orbital reconstruction following resection. The most common types of reconstruction were pedicled flaps ( = 15, 44.1%) and free mucosal grafts ( = 11, 32.4%). Rigid reconstruction was uncommon ( = 3, 8.8%). Performance of orbital reconstruction was associated with preoperative vision compromise ( < 0.01). The tendency to forego orbital reconstruction was associated with preoperative proptosis ( < 0.001), larger tumor size ( = 0.001), and operative exposure of orbital fat ( < 0.001) and extraocular muscle ( = 0.035). There were no statistically significant differences between the reconstruction and nonreconstruction groups in terms of short- or long-term outcomes when considering all patients. In patients with intraconal tumors, however, there was a higher rate of short-term postoperative diplopia when reconstruction was foregone ( = 0.041). This potential benefit of reconstruction did not persist: At an average of two years postoperatively, all patients for whom reconstruction was foregone either had improved or unchanged diplopia.
Most outcomes assessed did not appear affected by orbital reconstruction status. This general equivalence may suggest that orbital reconstruction is not a necessity in these cases or that the decision to reconstruct was well-selected by surgeons in the reported cases included in this systematic review.
随着单纯经鼻内镜切除良性眼眶肿瘤的应用日益广泛，关于何时以及如何在切除术后重建眶内侧壁的决策，目前缺乏高质量的疗效数据。本研究的目的是系统回顾相关文献，以评估与眼眶重建实践相关的临床疗效。
数据来源：PubMed、EMBASE、科学网。对报告单纯经鼻内镜切除良性眼眶肿瘤的研究进行系统回顾。排除未报告眼眶重建细节的文章。记录患者和肿瘤特征、手术细节及疗效。使用卡方检验、Fisher精确检验和独立样本t检验对变量进行比较。
在24项研究纳入的60例患者中，34例（56.7%）在切除术后进行了眼眶重建。最常见的重建类型是带蒂皮瓣（n = 15，44.1%）和游离黏膜移植（n = 11，32.4%）。刚性重建不常见（n = 3，8.8%）。眼眶重建的实施与术前视力受损相关（P < 0.01）。放弃眼眶重建的倾向与术前眼球突出（P < 0.001）、肿瘤较大（P = 0.001）以及术中暴露眶脂肪（P < 0.001）和眼外肌（P = 0.035）有关。考虑所有患者时，重建组和未重建组在短期或长期疗效方面无统计学显著差异。然而，在圆锥内肿瘤患者中，放弃重建时术后短期复视发生率较高（P = 0.041）。这种重建的潜在益处并未持续：术后平均两年时，所有放弃重建的患者复视情况均有所改善或未改变。
评估的大多数疗效似乎不受眼眶重建状态的影响。这种总体等效性可能表明在这些情况下眼眶重建并非必要，或者在本系统回顾纳入的报告病例中，外科医生对重建的决策选择得当。
