Tags

Type your tag names separated by a space and hit enter

Orbital Decompression in the Endoscopic Age: The Modified Inferomedial Orbital Strut.
Otolaryngol Head Neck Surg 2016; 154(5):963-9OH

Abstract

OBJECTIVE

Postoperative diplopia occurs in up to 45% of patients following orbital decompression for exophthalmos associated with Graves' orbitopathy. We sought to describe outcomes of our balanced orbital decompression strategy that includes the preservation of a modified inferomedial orbital strut (mIOS).

STUDY DESIGN

Case series with chart review.

SETTING

Academic medical center.

SUBJECTS AND METHODS

A total of 115 consecutive orbital decompressions were performed on 73 patients (42 bilateral) with Graves' orbitopathy. All patients underwent (1) a balanced decompression technique incorporating an endoscopic medial and external lateral decompression and (2) a mIOS technique with preservation of the anterior half of the inferomedial orbital strut. A periorbital periosteal (orbital) sling was utilized in patients (n = 54) without threatened vision loss, proptosis >28 mm, or periorbital disruption to prevent prolapse of the medial rectus muscle.

RESULTS

Utilization of the mIOS technique with or without a sling did not adversely affect the reduction in proptosis (5.1 mm with sling vs 5.0 mm without sling; P = .85).The incidence of new-onset postoperative diplopia was 17% (n = 6). The sling was not associated with postoperative diplopia (odds ratio = 0.54, 95% confidence interval: 0.08-3.40, P = .51), while it was associated with resolution of preexisting diplopia (odds ratio = 6.67, 95% confidence interval: 1.06-42.06, P = .04). No intraoperative complications occurred, and no patients suffered a decrement in visual acuity.

CONCLUSION

Balanced orbital decompression utilizing a mIOS in patients with Graves' orbitopathy provides a safe and effective reduction in proptosis with a low rate of new-onset diplopia as compared with historical values. Utilization of an orbital sling may be beneficial in reducing postoperative diplopia in select patients.

Authors+Show Affiliations

Department of Otorhinolaryngology, University of Texas Medical School at Houston, Houston, Texas, USA William.C.Yao@uth.tmc.edu.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26932949

Citation

Yao, William C., et al. "Orbital Decompression in the Endoscopic Age: the Modified Inferomedial Orbital Strut." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 154, no. 5, 2016, pp. 963-9.
Yao WC, Sedaghat AR, Yadav P, et al. Orbital Decompression in the Endoscopic Age: The Modified Inferomedial Orbital Strut. Otolaryngol Head Neck Surg. 2016;154(5):963-9.
Yao, W. C., Sedaghat, A. R., Yadav, P., Fay, A., & Metson, R. (2016). Orbital Decompression in the Endoscopic Age: The Modified Inferomedial Orbital Strut. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 154(5), pp. 963-9. doi:10.1177/0194599816630722.
Yao WC, et al. Orbital Decompression in the Endoscopic Age: the Modified Inferomedial Orbital Strut. Otolaryngol Head Neck Surg. 2016;154(5):963-9. PubMed PMID: 26932949.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Orbital Decompression in the Endoscopic Age: The Modified Inferomedial Orbital Strut. AU - Yao,William C, AU - Sedaghat,Ahmad R, AU - Yadav,Prashant, AU - Fay,Aaron, AU - Metson,Ralph, Y1 - 2016/03/01/ PY - 2015/08/25/received PY - 2016/01/14/accepted PY - 2016/3/3/entrez PY - 2016/3/5/pubmed PY - 2017/7/18/medline KW - Graves’ disease KW - balanced decompression KW - endoscopic orbital decompression KW - orbital decompression KW - orbital sling KW - orbital strut SP - 963 EP - 9 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 154 IS - 5 N2 - OBJECTIVE: Postoperative diplopia occurs in up to 45% of patients following orbital decompression for exophthalmos associated with Graves' orbitopathy. We sought to describe outcomes of our balanced orbital decompression strategy that includes the preservation of a modified inferomedial orbital strut (mIOS). STUDY DESIGN: Case series with chart review. SETTING: Academic medical center. SUBJECTS AND METHODS: A total of 115 consecutive orbital decompressions were performed on 73 patients (42 bilateral) with Graves' orbitopathy. All patients underwent (1) a balanced decompression technique incorporating an endoscopic medial and external lateral decompression and (2) a mIOS technique with preservation of the anterior half of the inferomedial orbital strut. A periorbital periosteal (orbital) sling was utilized in patients (n = 54) without threatened vision loss, proptosis >28 mm, or periorbital disruption to prevent prolapse of the medial rectus muscle. RESULTS: Utilization of the mIOS technique with or without a sling did not adversely affect the reduction in proptosis (5.1 mm with sling vs 5.0 mm without sling; P = .85).The incidence of new-onset postoperative diplopia was 17% (n = 6). The sling was not associated with postoperative diplopia (odds ratio = 0.54, 95% confidence interval: 0.08-3.40, P = .51), while it was associated with resolution of preexisting diplopia (odds ratio = 6.67, 95% confidence interval: 1.06-42.06, P = .04). No intraoperative complications occurred, and no patients suffered a decrement in visual acuity. CONCLUSION: Balanced orbital decompression utilizing a mIOS in patients with Graves' orbitopathy provides a safe and effective reduction in proptosis with a low rate of new-onset diplopia as compared with historical values. Utilization of an orbital sling may be beneficial in reducing postoperative diplopia in select patients. SN - 1097-6817 UR - https://www.unboundmedicine.com/medline/citation/26932949/Orbital_Decompression_in_the_Endoscopic_Age:_The_Modified_Inferomedial_Orbital_Strut_ L2 - http://journals.sagepub.com/doi/full/10.1177/0194599816630722?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -