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Surgical management of thyroid orbitopathy.
J Plast Reconstr Aesthet Surg. 2010 Feb; 63(2):240-6.JP

Abstract

PURPOSE

To examine the outcomes of orbital surgical decompression in patients affected by thyroid orbitopathy with mild-to-severe proptosis. The surgical procedures included fat removal alone or combined with orbital bone walls fracture.

METHODS

An analysis of a retrospective case series of 56 patients (115 orbits) who underwent orbital decompression for Graves' orbitopathy between July 1997 and September 2006 using different surgical techniques: orbital fat decompression alone or combined with bone decompression via coronal, trans-palpebral or trans-nasal access; the endoscopic trans-nasal access for medial orbital wall decompression associated with fat removal has been the procedure of choice in the last 5 years.

RESULTS

The mean proptosis reduction was 3.40 mm (0-8 mm) by fat removal and 5.40 mm (1-10 mm) by fat removal and bone decompression combined. The association of both procedures reduces the amount of fat to be removed, avoiding enophthalmos and thus decreasing the number of orbital walls to be fractured. The incidence of new-onset primary-gaze diplopia was 38%. Most of the patients subsequently underwent eyelid surgery to reduce retraction and to achieve symmetry.

CONCLUSIONS

Orbital decompression is effective in reducing proptosis, exposure keratopathy and congestive apex symptoms, and in improving cosmesis. Endoscopic nasal decompression combined with orbital fat removal allows a precise and gradual medial and infero-medial wall decompression; it permits a less aggressive approach to the bone orbital decompression on the whole. In any case, surgical procedures need to be tailored to the individual patient, knowing that further operations are essential to improve cosmetic results after proptosis correction.

Authors+Show Affiliations

Department of Plastic and Reconstructive Surgery, Padova, Italy. chir.plastica.ped.labf@sanita.padova.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19046663

Citation

Chiarelli, Angelo G M., et al. "Surgical Management of Thyroid Orbitopathy." Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS, vol. 63, no. 2, 2010, pp. 240-6.
Chiarelli AG, De Min V, Saetti R, et al. Surgical management of thyroid orbitopathy. J Plast Reconstr Aesthet Surg. 2010;63(2):240-6.
Chiarelli, A. G., De Min, V., Saetti, R., Fusetti, S., & Al Barbir, H. (2010). Surgical management of thyroid orbitopathy. Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS, 63(2), 240-6. https://doi.org/10.1016/j.bjps.2008.09.017
Chiarelli AG, et al. Surgical Management of Thyroid Orbitopathy. J Plast Reconstr Aesthet Surg. 2010;63(2):240-6. PubMed PMID: 19046663.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical management of thyroid orbitopathy. AU - Chiarelli,Angelo G M, AU - De Min,Valeria, AU - Saetti,Roberto, AU - Fusetti,Stefano, AU - Al Barbir,Hisham, Y1 - 2008/11/30/ PY - 2008/02/15/received PY - 2008/08/31/revised PY - 2008/09/21/accepted PY - 2008/12/3/pubmed PY - 2010/2/26/medline PY - 2008/12/3/entrez SP - 240 EP - 6 JF - Journal of plastic, reconstructive & aesthetic surgery : JPRAS JO - J Plast Reconstr Aesthet Surg VL - 63 IS - 2 N2 - PURPOSE: To examine the outcomes of orbital surgical decompression in patients affected by thyroid orbitopathy with mild-to-severe proptosis. The surgical procedures included fat removal alone or combined with orbital bone walls fracture. METHODS: An analysis of a retrospective case series of 56 patients (115 orbits) who underwent orbital decompression for Graves' orbitopathy between July 1997 and September 2006 using different surgical techniques: orbital fat decompression alone or combined with bone decompression via coronal, trans-palpebral or trans-nasal access; the endoscopic trans-nasal access for medial orbital wall decompression associated with fat removal has been the procedure of choice in the last 5 years. RESULTS: The mean proptosis reduction was 3.40 mm (0-8 mm) by fat removal and 5.40 mm (1-10 mm) by fat removal and bone decompression combined. The association of both procedures reduces the amount of fat to be removed, avoiding enophthalmos and thus decreasing the number of orbital walls to be fractured. The incidence of new-onset primary-gaze diplopia was 38%. Most of the patients subsequently underwent eyelid surgery to reduce retraction and to achieve symmetry. CONCLUSIONS: Orbital decompression is effective in reducing proptosis, exposure keratopathy and congestive apex symptoms, and in improving cosmesis. Endoscopic nasal decompression combined with orbital fat removal allows a precise and gradual medial and infero-medial wall decompression; it permits a less aggressive approach to the bone orbital decompression on the whole. In any case, surgical procedures need to be tailored to the individual patient, knowing that further operations are essential to improve cosmetic results after proptosis correction. SN - 1878-0539 UR - https://www.unboundmedicine.com/medline/citation/19046663/Surgical_management_of_thyroid_orbitopathy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1748-6815(08)00994-7 DB - PRIME DP - Unbound Medicine ER -