Surgical management of temple-related problems following lateral wall rim-sparing orbital decompression for thyroid-related orbitopathy

Siah, We Fong; Patel, Bhupendra C.; Malhotra, Raman

doi:10.1136/bjophthalmol-2015-307600

Cited by 19 publications

(11 citation statements)

References 21 publications

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“…In recent years, lateral wall bony decompression for TRO has become the first surgical option for many surgeons [12]. Recent studies [5] have shown that DLW decompression (including removal of the greater wing of the sphenoid bone) allows a bigger decompression than that obtained with the traditional lateral wall bony decompression or the paranasal sinuses decompression.…”

Section: Discussionmentioning

confidence: 99%

“…Various techniques and approaches have been described for deep lateral wall (DLW). Bony decompression of the orbit, including coronal approach [7], superior crease [8–12], canthotomy [13, 14], transconjunctival “swinging eyelid” [15], and lateral triangle flap technique [16]. It can be described more simply, when the procedure is performed by an ab interno approach, removing [9] or not removing [11, 17, 18] the orbital rim or ab externo with [5, 12, 19–21] or without rim sparing [10, 21].…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

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“…However, complications such as visible asymmetry, temporal hollowing, or masticatory oscillopsia were reported with this technique [22]. “Rim sparing” decompression was later described; oscillopsia and temporal wasting can occur with this approach as well, though perhaps less frequently [23, 24]. Leaving a thin rim of bone overlying the temporalis muscle has been suggested as a means to prevent these complications [25].…”

Section: Discussionmentioning

confidence: 99%

Practice Patterns in Orbital Decompression Surgery Among American Society of Ophthalmic Plastic and Reconstructive Surgery Members

2019

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IntroductionOrbital decompression surgery for thyroid-associated orbitopathy (TAO) has evolved greatly over the past decades with the development of new surgical techniques and strategies for patient management. However, randomized controlled trials comparing surgical approaches are lacking. The goal of this study was to report the current preferred practices among American Society of Ophthalmic Plastic Surgeons (ASOPRS) members for orbital decompression surgery for TAO, including surgical techniques and perioperative patient management.MethodsAn anonymous electronic survey consisting of 21 questions was sent to the current membership of the ASOPRS, leading to 170 responses in total (response rate: 23.7%). Questions regarding preoperative and postoperative care as well as surgical technique were included.Results54.2% of the respondents prefer two-wall surgery as their initial procedure of choice. Of these, 53.8% prefer balanced lateral and medial decompression as the two-walled procedure of choice, and 44.0% prefer the orbital floor and medial wall. Steroids are routinely used preoperatively by 35.9% and postoperatively by 69.2%. Antibiotics are used preoperatively by 32.9% and postoperatively by 56.4% of respondents.ConclusionPractice patterns for orbital decompression surgery continue to vary widely among ASOPRS members, but balanced medial and lateral wall decompression has gained in popularity as compared to prior studies. Postoperative steroids are preferred by a majority of members.

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“…Five of our patients have undergone fat transplantation to correct the defect, either by injection of fat (three patients) or by using a dermis-fat-graft (two patients). In a recent series of 11 patients with temporal hollowing, Siah et al (2015) used different modalities for correction including Medpore implants, and injections of autologous fat and synthetic fillers. In a recent series of 11 patients with temporal hollowing, Siah et al (2015) used different modalities for correction including Medpore implants, and injections of autologous fat and synthetic fillers.…”

Section: Discussionmentioning

confidence: 99%

“…McNichols et al (2012) suggested that dermis-fat-graft should be used for correcting temporal hollowing. In a recent series of 11 patients with temporal hollowing, Siah et al (2015) used different modalities for correction including Medpore implants, and injections of autologous fat and synthetic fillers.…”

Section: Discussionmentioning

confidence: 99%

Temporal hollowing and other adverse effects after lateral orbital wall decompression

Ueland

Haugen

Rødahl

2016

Acta Ophthalmologica

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Lateral orbital wall decompression has been considered a safe and effective procedure for treatment of TED. Serious side-effects are infrequent, but in rare circumstances, even blindness may occur. Less serious side-effects are relatively common. Among others, a significant number of the patients developed temporal hollowing after the procedure. The patients must be informed about the possible complications before surgery.

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Surgical management of temple-related problems following lateral wall rim-sparing orbital decompression for thyroid-related orbitopathy

Abstract: This is the first paper to show that persistent, troublesome temple-related problems following LWRS orbital decompression can be surgically corrected. Patients should be counselled about the potential risk of these complications when considering LWRS orbital decompression.

Cited by 19 publications

References 21 publications

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

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

Practice Patterns in Orbital Decompression Surgery Among American Society of Ophthalmic Plastic and Reconstructive Surgery Members

Temporal hollowing and other adverse effects after lateral orbital wall decompression

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