Comparison of rim-sparing versus rim-removal techniques in deep lateral wall orbital decompression for Graves’ orbitopathy

Zhang, S.; Li, Yinsheng; Wang, Ying; Zhong, Shengyi; Liu, Xinyu; Huang, Yazhuo; Fang, Sijie; Zhuang, Ai; Sun, Jing; Zhou, Huifang; Fan, Xianqun

doi:10.1016/j.ijom.2018.08.016

Cited by 19 publications

(23 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study population is comparable to previous studies, with a female preponderance and a mean age of 52.6 ± 13.9 years [5, 18, 20, 23]. The indication for surgery in all of our cases was disfiguring proptosis with ocular exposure symptoms [5, 23]. However, in our series, the majority of patients had bilateral surgery, while in other series, the surgeries were mostly unilateral [5, 23].…”

Section: Discussionsupporting

confidence: 85%

“…Other authors [8, 34] noted temporal depression following removal of the orbital rim after DLW decompression, being less noticeable if the rim was left intact. Zhang et al recommend using DLW-PRS decompression to minimize iatrogenic temporal depression caused by disruption of the temporal muscle [23]. As in Metha and Durrani's paper [5], there were no cases of temporal depression in our series.…”

Section: Discussionmentioning

confidence: 57%

“…There are very few papers looking at this technique. In Cho et al's paper, SONOPET® ultrasonic bone removal was used for DLW-PRS decompression using a temporal fossa access [5, 19, 20, 23]. Our series reports a larger number of procedures with more outcomes and longer follow-up, of at least 6 months, which is the time where maximum exophthalmos reduction is expected to be present, as well as resolution of transient diplopia [7].…”

Section: Discussionmentioning

confidence: 99%

“…In our series, we partially preserve the orbital rim. We feel its removal does not help the reduction of proptosis, as shown by Zhang et al [23]. Besides, the orbital rim plays an important role in the protection of the ocular globe; it helps define the external shape of the orbit and is an essential structure in the lateral support of the orbit in the lateral vertical maxillary buttress, which is essential in face stability [6, 13, 23, 32].…”

Section: Discussionmentioning

confidence: 99%

“…There are only a few authors who have reported partial rim sparing (PRS) using a high- speed drill [20] or high-speed drill and rongeurs [5, 23]. The first report of ultrasonic bone removal in the orbit was performed by Sivak-Callcott et al [24] who used the SONOPET® in 13 lateral orbital decompressions and 6 external dacryocystorhinostomies.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Deep Lateral Wall Partial Rim-Sparing Orbital Decompression with Ultrasonic Bone Removal for Treatment of Thyroid-Related Orbitopathy

Bengoa-González

Galindo‐Ferreiro

Mencía‐Gutiérrez

et al. 2019

Journal of Ophthalmology

View full text Add to dashboard Cite

Purpose To describe the results of thyroid-related orbitopathy (TRO) treated by ultrasonic deep lateral wall bony decompression with partial rim sparing (DLW-PRS). Methods A review was carried out, from January 2015 to September 2017, of all patients treated with ultrasonic DLW-PRS decompression using a SONOPET® (Stryker, Kalamazoo, MI, USA) ultrasonic aspirator, using a lateral, small triangle flap incision for access. The primary outcome was the change in proptosis (measured by the difference in Hertel exophthalmometry measurements). Other secondary outcomes were changes in visual acuity (VA) (using Snellen scale, decimal fraction), presence of lagophthalmos, eyelid retraction (measured by upper eyelid margin distance to the corneal reflex (MRD1) and lower eyelid margin distance to the corneal reflex (MRD2), and presence of exposure keratopathy). Results A total of 58 orbital decompressions in 35 patients were reviewed, with 23 patients (65.7%) having bilateral decompressions. There was a female preponderance with 26 patients (74.2%), and the mean age ± standard deviation was 52.6 ± 13.9 years. Mean proptosis was 24.51 ± 1.76 mm preoperatively, reduced to 19.61 ± 1.27 mm in final follow-up. The mean reduction was 4.9 ± 1.54 mm. VA improved from 0.8 ± 0.14 to 0.9 ± 0.12, p=0.039. 5 of 13 patients (38.4%) with preoperative diplopia reported improvement or complete resolution after surgery. MRD1 was reduced from 5.25 ± 0.88 mm to 4.49 ± 0.7 mm. MRD2 was also reduced from 6.3 ± 0.88 mm to 5.0 ± 0.17 mm. Presence of lagophthalmos was reduced from 35 eyes (60.3%) to five (8.6%); the presence of epiphora was also reduced from 20 patients (57.1%) to 3 (8.5%) following decompression. Complications of the surgery included zygomatic hypoaesthesia in 14 (40%) patients in the early postoperative period and chewing alterations in 10 (28.5%) of the patients. All of these complications were resolved at the 6-month follow-up visit. We noted no surgical complications such as ocular or soft tissue damage, infection, inflammation, or visual loss. Conclusions The SONOPET® ultrasonic bone curette can be used safely and effectively for DLW orbital decompression surgery. The main benefits were good visualization and handling of tissues and speed and ease of use of the equipment. This trial is registered with ClinicalTrials.gov identifier: NCT04025034.

show abstract