Endoscopic transnasal removal of an intraconal foreign body using an image-guided surgical system

Teh, Daphne; Mohamad, Nor Fadhilah; Lim, Elizabeth; Zulkiflee, Abu Bakar; Prepageran, Narayanan; Kamalden, Tengku Ain

doi:10.3109/24699322.2016.1170884

Cited by 10 publications

(11 citation statements)

References 15 publications

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“…Recently, endoscopic surgery has been used by several authors for the successful removal of medial IOrbFBs. 16,17 The minimally invasive endoscopic surgery has the advantages of least collateral damage to the surrounding tissue and avoidance of bigger facial or skin scars. However, the inadvertent optic nerve injury is a disadvantage of the endoscopic technique.…”

Section: Discussionmentioning

confidence: 99%

Long-term ophthalmic anatomical and functional outcomes after surgical removal of intraorbital foreign bodies

Mehta

Singh

Yadav

et al. 2019

European Journal of Ophthalmology

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Purpose: To analyze the anatomical and functional ophthalmic parameters after the surgical removal of various intraorbital foreign bodies. Methods: A retrospective analysis of medical records was performed featuring detailed history, ophthalmic examination, orbital computed tomographic scans, treatment details, and outcomes. The analyzed anatomical factors included extraocular movements, the position of the eyeball (proptosis, dystopia, and enophthalmos), and fullness of orbital sulci. The functional assessment was based on visual acuity, pupillary reactions, and diplopia. The outcomes were defined as complete, partial, and failure after a minimum follow-up of 1 year. Results: Of 32 patients, the organic and inorganic intraorbital foreign bodies were surgically removed from 18 (56.25%) and 14 (43.75%) orbits, respectively. At presentation, anatomically the extraocular movement restriction, proptosis/dystopia/enophthalmos, and orbital sulcus fullness were noted in 26 (81.25%), 24 (75%), and 15 (46.88%), respectively. Functionally, diminished visual acuity, diplopia, and pupil abnormalities were seen in 27 (84.38%), 14 (43.75%), and 8 (25%), respectively. After intraorbital foreign body removal at a mean follow-up of 14 months, the improvement of anatomical factors (same sequence) were observed in 8 (30.77%), 20 (83.33%), and 12 (80%), respectively. In functional factors (same sequence), the improvement was noted in none (0%), 13 (92.86%), and 5 (62.5%), respectively. Hence, the majority of patients (n = 20, 62.5%) achieved partial success, while 8 (25%) had complete success. Four (12.5%) had treatment failure despite similar management protocols. Conclusion: The anatomical outcomes are better than the functional outcomes after surgical removal of the intraorbital foreign bodies. The visual acuity does not improve considerably after the surgical removal of intraorbital foreign bodies. Overall, the wooden intraorbital foreign bodies have poorer anatomical and functional prognosis.

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Section: Discussionmentioning

confidence: 99%

Long-term ophthalmic anatomical and functional outcomes after surgical removal of intraorbital foreign bodies

Mehta

Singh

Yadav

et al. 2019

European Journal of Ophthalmology

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“…12 EEAs have been utilized to manage lesions originating in the intraconal space; however, their indication has been restricted mainly to lesions (eg, cavernous hemangioma, retrobulbar abscess, foreign body) arising from the inferomedial intraconal space. [13][14][15] Both the transethmoidal and prelacrimal approaches have been well described for access into the inferomedial intraconal space. 16,17 Nonetheless, with the progressive development of endoscopic techniques and surgical instruments, the application of EEAs for the management of orbital lesions may be further expanded; moreover, the feasibility to access the superomedial orbit has not been sufficiently explored.…”

Section: Introductionmentioning

confidence: 99%

Intraconal Anatomy of the Anterior Ethmoidal Neurovascular Bundle: Implications for Surgery in the Superomedial Orbit

London

Prevedello

et al. 2020

Am J Rhinol�Allergy

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Background The anterior ethmoidal artery (AEA) branches from the ophthalmic artery in the superomedial intraconal space. The feasibility of management of lesions arising from the superomedial intraconal space via an endoscopic endonasal approach has not been sufficiently explored. Objective To yield a detailed anatomic description of the anterior ethmoidal neurovascular bundle and its variants to serve as the foundation for possible management of lesions in the superomedial intraconal space. Methods Eight cadaveric specimens (16 sides) were dissected using an endonasal approach, tracing the AEA proximally through the superomedial intraconal space. Furthermore, the anatomy of adjacent structures was noted, and distances from the anterior ethmoidal foramen to the origin of the AEA at the ophthalmic artery were measured. Results Supraorbital cells were found in 13/16 sides (81.25%), and a bony dehiscence of the anterior ethmoidal canal was observed in 5/16 sides (31.25%). The nasociliary nerve, ophthalmic artery, superior division of the oculomotor nerve, superior rectus muscle, and levator palpebrae superioris were routinely identified in the superomedial intraconal space. The AEA passed through a corridor between the medial rectus and superior oblique muscles after arising from the ophthalmic artery (lateral to the foramen) in all specimens. The average distance from its origin to the anterior ethmoidal foramen was 5.19 ± 0.98 mm. Conclusion Anatomically, it is feasible to access the superomedial intraconal space via an endoscopic endonasal approach. This study provides the anatomical basis for procedures in the superomedial intraconal space.

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“…Transnasal endoscopic removal is safe, less damaging, and easy because it gives you direct visualization. Endoscopic removal of a bullet from the orbit has been reported in the literature [ 13 – 15 ]. Furthermore, the navigation system has been shown to be an essential element, working in combination with endoscopic intervention, for precise location of the target, thereby enabling surgeons to make the smallest possible opening in the bone and periorbita [ 16 , 17 ]; so, transnasal endoscopic surgery is becoming increasingly popular as a safe surgical technique to access the medial intraconal space.…”

Section: Discussionmentioning

confidence: 99%

Removal of intraconal bullet through endoscopic transnasal surgery with image-guided navigation system 8 months after injury: a case report

Promsopa

Prapaisit

2019

J Med Case Reports

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BackgroundLodgment of a bullet within the orbit is uncommon. The decision to remove these objects poses a challenge to surgeons due to a high risk of complications. Currently, endoscopic transnasal surgery with navigator assistance facilitates the localization of foreign bodies allowing their safe removal with minimal surrounding tissue damage or optic nerve injury.Case presentationWe describe a case of a 26-year-old Thai woman with a chronic intraorbital foreign body located within her medial intraconal space. The chronic intraorbital foreign body was successfully removed by endoscopic transnasal surgery, combined with assistance from a navigation system, 8 months after injury without any damage to her eye or disturbance in vision.ConclusionIntraconal foreign bodies, such as bullets, are a chronic problem and should be observed in the long term; prompt surgical removal should be performed if indicated.

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Endoscopic transnasal removal of an intraconal foreign body using an image-guided surgical system

Cited by 10 publications

References 15 publications

Long-term ophthalmic anatomical and functional outcomes after surgical removal of intraorbital foreign bodies

Long-term ophthalmic anatomical and functional outcomes after surgical removal of intraorbital foreign bodies

Intraconal Anatomy of the Anterior Ethmoidal Neurovascular Bundle: Implications for Surgery in the Superomedial Orbit

Removal of intraconal bullet through endoscopic transnasal surgery with image-guided navigation system 8 months after injury: a case report

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