Transantral orbital decompression for malignant exophthalmos

Walsh, Theodore E.; Ogura, Joseph H.

doi:10.1288/00005537-195706000-00002

Cited by 278 publications

(121 citation statements)

References 12 publications

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“…10 This technique employs a two-wall removal in which both medial and inferior orbital walls are removed. However, this technique provides poor access to the posterior lamina papyracea and this may be inadequately removed with this technique.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic orbital decompression for Graves’ ophthalmopathy

Wee¹,

Carney²,

Thorpe³

et al. 2002

J. Laryngol. Otol.

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Graves' disease may occasionally result in signi cant proptosis that is either cosmetically unacceptable or causes visual loss. This has traditionally been managed surgically by external decompression of the orbital bony skeleton. Trans-nasal endoscopic orbital decompression is emerging as a new minimally-invasive technique, that avoids the need for cutaneous or gingival incisions. Decompression of the medial orbital wall can be performed up to the anterior wall of the sphenoid sinus. This can be combined with resection of the medial and posterior portion of the orbital oor (preserving the infra-orbital nerve). This technique produces decompression which is comparable to external techniques.We present a series of 10 endoscopic orbital decompressions with an average improvement of 4.4.mm in orbital proptosis. There was an improvement in visual acuity in all patients with visual impairment. Endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques.

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Section: Discussionmentioning

confidence: 99%

Endoscopic orbital decompression for Graves’ ophthalmopathy

Wee¹,

Carney²,

Thorpe³

et al. 2002

J. Laryngol. Otol.

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“…Operative technique: The operative technique described by Walsh and Ogura (Walsh & Ogura 1957) was used.…”

Section: Methodsmentioning

confidence: 99%

“…The most used technique today is the two-wall decompression through the transantral approach (Walsh & Ogura 1957). This technique results in a good reduction of the exophthalmos, but the major disadvantage is the risk of postoperative motility imbalance.…”

mentioning

confidence: 99%

Results of transantral orbital decompression in patients with thyroid‐associated ophthalmopathy

Tallstedt

Papatziamos²,

Lundblad³

et al. 2000

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To present the results of orbital decompression in patients with thyroid-associated ophthalmopathy (TAO). Methods: Transantral orbital decompression was performed in 63 patients with TAO. In 40 patients (63%) the operation was made because of progressive ophthalmopathy not responding to medical therapy, and in 23 patients (37%) the operation was made for rehabilitative reasons. The long-term hypesthesia engaging the infraorbital nerve was assessed with a questionnaire using a Visual Analogue Scale (VAS). Results: The mean proptosis reduction was 3.2 mm (range 0-8 mm). Twentyone patients had impaired visual acuity preoperatively, and 20 improved. Altogether 30 patients (40%) had worsened ocular motility postoperatively. Fortythree patients did not have diplopia in the primary position preoperatively, and new diplopia developed in 22 of these (51%). Hypesthesia in the infraorbital nerve area was reported for half of the operated sides, but was a major cause of distress (VAS-scoring ±5) to eleven patients. Conclusions: Transantral orbital decompression is indicated in patients with progressive TAO or in patients with prominent exophthalmos, and results in a good proptosis reduction, but the risk of postoperative diplopia is significant. Postoperative hypesthesia is common but often not a major problem.

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“…[1][2][3][4][5][6] The mainstay of treatment has been two wall decompression originally described by Walsh and Ogura 4 in 1957, modified into an endoscopic formulation by Kennedy in 1990. 7 Although inferomedial orbital decompression has afforded good results in terms of proptosis reduction, it accrues a large risk of postoperative diplopia, with rates of postoperative motility imbalance as high as 80%.…”

Section: Introductionmentioning

confidence: 99%

The application of stereotactic navigation surgery to orbital decompression for thyroid-associated orbitopathy

Millar

Maloof

2009

Eye

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Objectives To describe the application of stereotactic guidance, its preoperative workup, and limitations, if any, during orbital decompression surgery of the lateral orbital wall for thyroid-associated orbitopathy (TAO). Methods Case-controlled series of seven patients who underwent stereotactic-guided surgical navigation during external approach balanced orbital decompression with maximal debulking of the lateral wall. Results A progressive increase in debulking of the greater wing of sphenoid and exposure of dura was noted in the series. The average proptosis reduction was 9.36 mm. No complications were encountered during any of the cases, nor was there any new onset postoperative diplopia. In all cases, exposure of dura was planned and did not present as a surprise. Stereotactic setup added 10 min to preparation time. Conclusions Stereotactic guidance improves anatomic localization and precision during orbital decompression, increasing confidence, and reducing surgical stress. The ability to accurately determine the maximal limits of decompression real time, while confirming depth of bone removal, offers the possibility of reduced risk of iatrogenic injury. Stereotactic navigation allows for improved intraoperative localization that may improve the ability to maximally decompress the lateral wall, including the zygoma, orbital roof, and trigone, and extending towards the optic nerve with exposure of dura through smaller incisions.

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Transantral orbital decompression for malignant exophthalmos

Cited by 278 publications

References 12 publications

Endoscopic orbital decompression for Graves’ ophthalmopathy

Endoscopic orbital decompression for Graves’ ophthalmopathy

Results of transantral orbital decompression in patients with thyroid‐associated ophthalmopathy

The application of stereotactic navigation surgery to orbital decompression for thyroid-associated orbitopathy

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