Missed Dehiscence of Lamina Papyracea by Radiologists: Orbital Herniation Mimicking Sinusitis and Harboring Potential Complications

Abstract

Introduction: Functional endoscopic sinus surgery (FESS) has become the gold standard for treating chronic rhinosinusitis (CRS), and it is regarded as a relatively safe and effective technique. Orbital complications of FESS have been reported for many years owing to the close anatomical relationship between the paranasal sinuses and the orbit. Accidental injury of the lamina papyracea (LP) during FESS, was described in up to 5% of cases. Preventing complications begins with preoperative planning and careful review of computed tomographic (CT) scans. Methods: This was a multicentric national survey to report any case of lamina papyracea defect (LPD) that was not reported by radiologists. Multiple rhinologists from different provinces of Saudi Arabia (SA) were invited to report any patient with such an incidence in the last two years. patient-specific data were all included in this study. Results: The data of 16 patients, 11 males and 5 females, were reviewed retrospectively. The median age at diagnosis was 37.4 years. The right side is the most prevalent location of LPD (8 patients, 50%), despite the fact that most cases (75%) had no history of trauma or sinus surgery. Five patients had left-side LPDs and three had bilateral LPDs. Conclusion: Injury to the LP is a well-known avoidable complication of FESS. Careful and attentive review of CT scan images pre-operatively and by the operating surgeon is of utmost importance. This should always include the integrity and configuration of the medial orbital wall and LP without depending on the report of CT scans.