Higgins Ryan C, Lane Ciaran F, Goyal Neerav
Department of Otolaryngology University of Nebraska Medical Center Omaha Nebraska USA.
Department of Otolaryngology University of Manitoba Winnipeg Manitoba Canada.
Laryngoscope Investig Otolaryngol. 2024 Dec 9;9(6):e70051. doi: 10.1002/lio2.70051. eCollection 2024 Dec.
Orbital decompression is recommended for TED especially in the treatment of severe, refractory cases yet there are no clear guidelines regarding the optimal surgical approach. Previously conducted surveys assessed variations in the management of TED but only amongst ophthalmologists. Our study attempts to better characterize surgical and perioperative preferences amongst otolaryngologists in the management of TED.
A survey was administered to the American Rhinologic Society and Canadian Society of Otolaryngology - Head and Neck Surgery via REDCap with 52 total respondents. Respondent demographic information and pre-operative management, procedural specifics, and post-operative management preferences were collected.
The majority of respondents practiced in a metropolitan (82.7%), academic setting (73.1%) and received subspecialty training in Rhinology & Skull Base Surgery (88.9%). Most elected for corticosteroids (63.5%) and medical management (69.2%) prior to orbital decompression but did not use any classification system (86.5%). Orbital decompression was most often done with ophthalmology collaboration (71.2%). Removal of two bony walls (55.8%) via medial wall (97.9%) and orbital floor (72.3%) removal was most preferred. Removal of one orbital fat aspect (60.6%) via the medial fat pad was most preferred. Combined bone and fat removal (59.6%) completed via an endoscopic approach (71.2% and 97.0%, respectively) was most common. Post-operatively, most patients were not admitted (88.4%) with saline nasal rinses (92.3%) utilized by most respondents.
This survey completed by otolaryngologists highlights several key distinctions in the preferred surgical approach during orbital decompression and the perioperative management of TED when compared to ophthalmologists and current recommendations.
Level 4.
眼眶减压术推荐用于甲状腺相关眼病（TED），尤其是在治疗严重、难治性病例时，但目前尚无关于最佳手术方法的明确指南。此前进行的调查评估了TED治疗方法的差异，但仅针对眼科医生。我们的研究试图更好地描述耳鼻喉科医生在TED治疗中手术及围手术期的偏好。
通过REDCap向美国鼻科学会和加拿大耳鼻咽喉头颈外科学会进行了一项调查，共有52名受访者。收集了受访者的人口统计学信息、术前管理、手术细节及术后管理偏好。
大多数受访者在大都市（82.7%）、学术机构（73.1%）执业，并接受过鼻科学与颅底外科的亚专业培训（88.9%）。大多数人在眼眶减压术前选择使用皮质类固醇（63.5%）和药物治疗（69.2%），但未使用任何分类系统（86.5%）。眼眶减压术最常与眼科合作进行（71.2%）。最常采用通过内侧壁（97.9%）和眶底（72.3%）切除去除两个骨壁（55.8%）。最常采用通过内侧脂肪垫去除一个眼眶脂肪区域（60.6%）。最常见的是通过内镜入路（分别为71.2%和97.0%）完成联合骨和脂肪去除（59.6%）。术后，大多数患者未住院（88.4%），大多数受访者使用生理盐水鼻腔冲洗（92.3%）。
与眼科医生及当前建议相比，本次耳鼻喉科医生完成的调查突出了眼眶减压术及TED围手术期管理中首选手术方法的几个关键差异。
4级。
