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Transforniceal lateral deep bone decompression--a modified technique to prevent postoperative diplopia in patients with disfiguring exophthalmos due to dysthyroid orbitopathy.
J Formos Med Assoc 2006; 105(8):611-6JF

Abstract

BACKGROUND/PURPOSE

Postoperative diplopia remains a significant complication of orbital decompression in dysthyroid orbitopathy. This study evaluated the results of orbital decompression treatment using a transforniceal approach to sculpt the lateral orbital deep bone area.

METHODS

The two areas of bone in the deep lateral orbit (the basin of the inferior orbital fissure and the sphenoid door jamb) were exposed using a transforniceal swinging eyelid approach. An electric drill was used to sculpt these deep bone areas of the lateral orbit, and approximately 1 mL intraconal fat was removed simultaneously. Between October 1999 and March 2003, transforniceal lateral deep bone decompression was performed in 35 consecutive patients (62 orbits) with disfiguring dysthyroid orbitopathy. Data on proptosis reduction effect, new-onset diplopia and other complications of lateral wall decompression were analyzed.

RESULTS

The average preoperative Hertel value was 21.2 +/- 1.3 mm (range, 18-23 mm) and decreased to 17.4 +/- 1.2 mm (range, 15-19.5 mm) postoperatively. The mean decrease in proptosis 3 months postoperatively was 3.8 +/- 0.91 mm (range, 1.5-4.6 mm). New-onset downgaze diplopia occurred in two (5.7%) of the 35 patients. Persistent trigeminal paresthesia was noted in one patient (2.8%). No cerebrospinal fluid leak, globe injury or vision deterioration was noted during 9.5 +/- 1.7 months of follow-up. The cosmetic appearance was improved in all patients after surgery.

CONCLUSION

Transforniceal lateral deep bone decompression produces less new-onset, persistent diplopia than traditional inferomedial wall decompression, and provides good cosmesis by using a hidden small incisional wound. This approach appears to be a safe and effective procedure for patients with disfiguring exophthalmos, especially for Asian patients without crease fold.

Authors+Show Affiliations

Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan. lang89@ha.mc.ntu.edu.tw

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16935761

Citation

Liao, Shu-Lang, et al. "Transforniceal Lateral Deep Bone Decompression--a Modified Technique to Prevent Postoperative Diplopia in Patients With Disfiguring Exophthalmos Due to Dysthyroid Orbitopathy." Journal of the Formosan Medical Association = Taiwan Yi Zhi, vol. 105, no. 8, 2006, pp. 611-6.
Liao SL, Shih MJ, Chang TC, et al. Transforniceal lateral deep bone decompression--a modified technique to prevent postoperative diplopia in patients with disfiguring exophthalmos due to dysthyroid orbitopathy. J Formos Med Assoc. 2006;105(8):611-6.
Liao, S. L., Shih, M. J., Chang, T. C., & Lin, L. L. (2006). Transforniceal lateral deep bone decompression--a modified technique to prevent postoperative diplopia in patients with disfiguring exophthalmos due to dysthyroid orbitopathy. Journal of the Formosan Medical Association = Taiwan Yi Zhi, 105(8), pp. 611-6.
Liao SL, et al. Transforniceal Lateral Deep Bone Decompression--a Modified Technique to Prevent Postoperative Diplopia in Patients With Disfiguring Exophthalmos Due to Dysthyroid Orbitopathy. J Formos Med Assoc. 2006;105(8):611-6. PubMed PMID: 16935761.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transforniceal lateral deep bone decompression--a modified technique to prevent postoperative diplopia in patients with disfiguring exophthalmos due to dysthyroid orbitopathy. AU - Liao,Shu-Lang, AU - Shih,Mei-Ju, AU - Chang,Tien-Chun, AU - Lin,Luke Long-Kuang, PY - 2006/8/29/pubmed PY - 2006/10/27/medline PY - 2006/8/29/entrez SP - 611 EP - 6 JF - Journal of the Formosan Medical Association = Taiwan yi zhi JO - J. Formos. Med. Assoc. VL - 105 IS - 8 N2 - BACKGROUND/PURPOSE: Postoperative diplopia remains a significant complication of orbital decompression in dysthyroid orbitopathy. This study evaluated the results of orbital decompression treatment using a transforniceal approach to sculpt the lateral orbital deep bone area. METHODS: The two areas of bone in the deep lateral orbit (the basin of the inferior orbital fissure and the sphenoid door jamb) were exposed using a transforniceal swinging eyelid approach. An electric drill was used to sculpt these deep bone areas of the lateral orbit, and approximately 1 mL intraconal fat was removed simultaneously. Between October 1999 and March 2003, transforniceal lateral deep bone decompression was performed in 35 consecutive patients (62 orbits) with disfiguring dysthyroid orbitopathy. Data on proptosis reduction effect, new-onset diplopia and other complications of lateral wall decompression were analyzed. RESULTS: The average preoperative Hertel value was 21.2 +/- 1.3 mm (range, 18-23 mm) and decreased to 17.4 +/- 1.2 mm (range, 15-19.5 mm) postoperatively. The mean decrease in proptosis 3 months postoperatively was 3.8 +/- 0.91 mm (range, 1.5-4.6 mm). New-onset downgaze diplopia occurred in two (5.7%) of the 35 patients. Persistent trigeminal paresthesia was noted in one patient (2.8%). No cerebrospinal fluid leak, globe injury or vision deterioration was noted during 9.5 +/- 1.7 months of follow-up. The cosmetic appearance was improved in all patients after surgery. CONCLUSION: Transforniceal lateral deep bone decompression produces less new-onset, persistent diplopia than traditional inferomedial wall decompression, and provides good cosmesis by using a hidden small incisional wound. This approach appears to be a safe and effective procedure for patients with disfiguring exophthalmos, especially for Asian patients without crease fold. SN - 0929-6646 UR - https://www.unboundmedicine.com/medline/citation/16935761/Transforniceal_lateral_deep_bone_decompression__a_modified_technique_to_prevent_postoperative_diplopia_in_patients_with_disfiguring_exophthalmos_due_to_dysthyroid_orbitopathy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0929-6646(09)60159-5 DB - PRIME DP - Unbound Medicine ER -