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Does reconstruction affect outcomes following exclusively endoscopic endonasal resection of benign orbital tumors: A systematic review with meta-analysis

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2022年第1期8卷 25-35页

作者： Ashton E.Lehmann Manuela von Sneidern Sarek A.Shen Ian M.Humphreys Waleed M.Abuzeid Aria Jafari Department of Otolaryngology-Head and Neck Surgery Vanderbilt University Medical CenterNashvilleTennesseeUSA Department of Otolaryngology-Head and Neck Surgery Geisinger Medical CenterDanvillePennsylvaniaUSA Department of Otolaryngology-Head and Neck Surgery New York University School of MedicineNew YorkNew YorkUSA Department of Otolaryngology-Head and Neck Surgery Johns Hopkins HospitalBaltimoreMarylandUSA Division of Rhinology and Endoscopic Skull Base Surgery Department of Otolaryngology-Head and Neck SurgeryUniversity of WashingtonSeattleWashingtonUSA

Objective:As exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread,high-quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection.The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices.Methods:Data Sources:PubMed,EMBASE,Web of Science.A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted.Articles not reporting orbital reconstruction details were excluded.Patient and tumor characteristics,operative details,and outcomes were recorded.Variables were compared usingχ^(2),Fisher’s exact,and independentt tests.Results:Of 60 patients included from 24 studies,34(56.7%)underwent orbital reconstruction following resection.The most common types of reconstruction were pedicled flaps(n=15,44.1%)and free mucosal grafts(n=11,32.4%).Rigid reconstruction was uncommon(n=3,8.8%).Performance of orbital reconstruction was associated with preoperative vision compromise(P<0.01).The tendency to forego orbital reconstruction was associated with preoperative proptosis(P<0.001),larger tumor size(P=0.001),and operative exposure of orbital fat(P<0.001)and extraocular muscle(P=0.035).There were no statistically significant differences between the reconstruction and nonreconstruction groups in terms of short-or long-term outcomes when considering all patients.In patients with intraconal tumors,however,there was a higher rate of short-term postoperative diplopia when reconstruction was foregone(P=0.041).This potential benefit of reconstruction did not persist:At an average of two years postoperatively,all patients for whom reconstruction was foregone either had improved or unchanged diplopia.Conclusion:Most outcomes assessed did not appear affected by orbital reconstruction status.This general equivalence may suggest that orbital reconstruction is not a necessity in these ca

关键词： cavernous hemangioma diplopia endoscopic endonasal surgery enophthalmos meningioma orbital reconstruction orbital tumor outcomes schwannoma

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Severe absence of intra-orbital fat in a patient with orbital venous malformation:A case report

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World Journal of Clinical Cases 2021年第35期9卷 11024-11028页

作者： Lu-Di Yang Shi-Qiong Xu Ye-Fei Wang Ren-Bing Jia Department of Ophthalmology Ninth People’s HospitalShanghai JiaoTong University School of MedicineShanghai 200025China Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology Shanghai 200025China

BACKGROUND The orbital venous malformation is quite common in orbital diseases.Clinically,it is usually characterized by proptosis.However,among patients with distensible venous malformations,if the lesions continuously progress,they may induce enlargement of the orbital bone or orbital lipoatrophy,which in turn leads to enophthalmos.CASE SUMMARY Here,we report a patient who presented with enophthalmos and had a severe absence of intra-orbital fat secondary to orbital venous malformation.The patient was a 66-year-old female with a 20-year history of enophthalmos.Hertel exophthalmometry readings in a relaxed upright position were 4 mm OD and 13 mm OS with a 97 mm base.It was determined that she had positional“proptosis”.Physical examination also revealed a bulging mass on her hard palate.Computed tomographic scan and magnetic resonance imaging showed an expansion of the right orbit with local bony defects and multiple soft-tissue masses.CONCLUSION Long-term lack of awareness about the presence of orbital venous malformations,persistent venous congestion could lead to compression of the orbital fat,which in turn induces atrophy or the absence of intra-orbital fat.

关键词： Absence of intra-orbital fat Venous malformation enophthalmos Entropion Long medical history Case report

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Secondary silent sinus syndrome:case report

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Chinese Medical Journal 2004年第5期117卷 785-786页

作者：王绪锐赵小冬 Department of Otolaryngology

Silent sinus syndrome (SSS) is characterized by spontaneous and progressive unilateral enophthalmos with no other symptoms. Maxillary sinus atelectasis displayed on CT will be helpful for clinical diagnosis. The operation for better maxillary sinus ventilation shows good therapeutic effects and prognosis. In 1964, Montgometry1 described the first case of patient whose enophthalmos was caused by mucocele of the maxillary sinus. Since then, all otolaryngologists have taken more and more attention to this syndrome. And by June 2000, a total of 45 cases had been reported worldwide.

关键词： maxillary sinus enophthalmos

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Materials to facilitate orbital reconstruction and soft tissue filling in posttraumatic orbital deformaties

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Plastic and Aesthetic Research 2016年第1期3卷 86-91页

作者： Ling-Xiao Ye Xiao-Ming Sun Yu-Guang Zhang Ying Zhang Department of Plastic and Reconstructive Surgery Ninth People’s Hospital affiliated to the Medical School of Shanghai Jiao Tong UniversityShanghai 200011China

Posttraumatic orbital reconstruction has been a challenging mission for decades in craniomaxillofacial surgery.Complications like enophthalmos,diplopia and gaze obstacles emerge when orbital trauma occurs,affecting people’s daily life as well as their appearance.Advances in technology and research gained through years of experience has provided us with a greater understanding of the changes following trauma,as well as providing us with a variety of filling materials that we can choose from to handle the deformities.However,the best type of material for repair of orbital deformities remains controversial.This paper reviewed approximately 60 articles discussing materials used in orbital reconstruction or soft tissue defect filling in the past years,with the aim of giving a comprehensive overview of the advantages and disadvantages of materials used in this field so as to help surgeons to make a better choice.

关键词： Orbital reconstruction soft tissue filling materials enophthalmos

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Silent Sinus Syndrome: Clinical Findings and Differential Diagnosis

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Case Reports in Clinical Medicine 2014年第5期3卷 293-303页

作者： Paolo Bossolesi Barbara Pedruzzi Enzo Emanuelli U.O. di Otorinolaringoiatria Azienda ULSS 8 Asolo Ospedale di Castelfranco Veneto e Montebelluna (TV) Italy U.O.A. Chirurgia Endoscopica delle Vie Aeree Azienda Ospedaliera di Padova Padova Italy U.O.C. Otorinolaringoiatria e Otochirurgia Azienda Ospedaliera di Padova Padova Italy

The Silent Sinus Syndrome (SSS) is a rare condition that causes facial asymmetry, unilateral enophthalmos and diplopia. It is thought to be secondary to chronic maxillary sinus atelectasis (CMA) with reabsorbed bone and subsequent displacement of the orbital floor. Such anatomic modifications occur over time, and therefore it is possible to encounter different stages of the same disease with or without orbital displacement. Clinical findings can be unclear so it makes sense to recognize potentially evolving SSS while other disturbances have to be ruled out. Our purpose is to underline clinical findings for different diagnosis and proper management. We consider Functional Endoscopic Sinus Surgery (FESS) indicated in CMA and SSS to halt the progression of the disease. Nevertheless restitution treatment of enophtalmos due to orbital floor displacement involves plastic reconstruction of the floor of the orbit via transconjunctival approach. We report a case of SSS and discuss distinctive features of non-neoplastic lesions involving the maxillary sinus that should be considered for differential diagnosis.

关键词： Silent Sinus Syndrome SSS Unilateral enophthalmos Diplopia Chronic Maxillary Sinus Atelectasis Displacement of the Orbital Floor Functional Endoscopic Sinus Surgery

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