The lamina push test: an alternative to the globe push test for identifying the medial orbit during endoscopic sinus surgery

Shah, Riddhi; Thomas, William W.; Kuan, Edward C.; Kennedy, David W.

doi:10.1002/alr.22176

Cited by 4 publications

(2 citation statements)

References 5 publications

(5 reference statements)

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“…The lamina push test, in which a blunt instrument is used to gently probe the lateral ethmoid wall, has been proposed as alternative to the bulb press test. 24 In this alternative test, if the lamina wall is seen to move as a unit then adequate surgery is complete. If there is little, or no, movement then additional ethmoid partitions can be removed.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Orbital Fat Exposure During Endoscopic Sinus Surgery

et al. 2021

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Background: The orbital complication rate during endoscopic sinus surgery (ESS) is <1%. Orbital fat exposure during ESS can herald orbital complications including orbital hematoma, extraocular muscle trauma, optic nerve injury, or blindness. The objective of this study was to evaluate the current consensus regarding diagnosis and management of orbital fat exposure during ESS. Methods: A 24-point survey focused on orbital fat exposure during ESS was distributed to American Rhinologic Society members. Also, a retrospective review of 25 cases of orbital fat exposure drawn from the principal investigator’s 30-year experience was performed. Results: Over 10 000 surgical cases of the principal investigator were reviewed. Twenty-five patients had orbital fat exposure. Five developed minor complications while 2 were major (ie, temporary vision changes). Two hundred thirty-six surgeons responded to the survey; 93% had encountered orbital fat during ESS; 88% of surgeons identify orbital fat by either its appearance endoscopically or the “bulb press” test. Almost every responding surgeon will cautiously avoid further manipulation in the area of orbital fat exposure. Nearly half will immediately curtail the extent of surgery. Surgeons do not significantly change postoperative management. Considerations regarding observation in postanesthesia care unit, close follow-up, and strict nose blowing precautions are common. Conclusion: Orbital fat exposure during ESS is a rarely discussed, but clinically important. Orbital fat exposure can be a harbinger for major orbital complications that should be recognized by endoscopic appearance and confirmed with the bulb press test. Caution with “no further manipulation” of orbital fat is the guiding principle for intraoperative management, while postoperative management is generally expectant. Level 4 Evidence

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Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Orbital Fat Exposure During Endoscopic Sinus Surgery

et al. 2021

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“…Skull Base Surgery and surgery for various sinuses should later on be confirmed by imaging of paranasal sinuses for any remnants 14 . Clinically seen that the Lamina Push Test is an alternative to the Globe Push Test for identifying the medial orbit during endoscopic sinus surgery 15 . Intraoperative navigation is an important tool for the treatment of isolated blowout fractures of the medial orbital wall.…”

Section: Prevention Of Post-operative Adhesionsmentioning

confidence: 99%

Nasal Adhesions – A New Perspective

Khan

2019

APMC

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Objective: The objective of the study is to explore various causes of adhesions or faults what different surgeons commonly do and how to combat this problem. Study design: Randomized Control Trial. Settings: ENT Unit-I, Allied Hospital, Faisalabad. Duration: July, 2016 to June, 2018. Methodology: 500 patients undergoing septoplasty and SMR, over a period of 2 years were included in this study. Those requiring combination procedures were excluded. The study involved 400 males and 100 females. The age range was 15-75 years with a mean age of 34 years. All patients had a pre-operative nasal packing by undertraining medical officers using a roll gauze soaked in 4% Xylocaine with Topical Adrenaline 1:1000 in a ratio of 50:50 half an hour before surgery. 300 cases were operated under local anesthesia with no intravenous supplement and the remaining 200 under General Anesthesia. Results: 20 patients (04%) presented with adhesions out of which 15 were operated under General Anesthesia and 5 under local anesthesia. All these patients belonged to the non-splinted group. 07 patients (1.4%) complained of slight discomfort due to splints particularly those made of the cut drips. 03 patients (0.6%) complained of the unsightly look of the anterior ends of the splints as they were secured with stitches over the columella. Crust formation was the main problem encountered during the splinting period. Conclusion: Splints have been found to be very effective in preventing adhesion formation which are sometimes very troublesome. However, because of the very low incidence, (04%) in our studies compared to (8.1%) in other series after a single procedure on the nose, one must be very cautious in placing splints and should be placed where the surgeon strongly fears the formation of adhesions, such as in difficult cases. Suggestions: Prevention from unwanted adhesions is the best strategy to avoid adhesions.

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Extraocular Muscle Injury

Senior

Gelpi

2021

Lessons Learned From Rhinologic Procedure Complications

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The lamina push test: an alternative to the globe push test for identifying the medial orbit during endoscopic sinus surgery

Cited by 4 publications

References 5 publications

Diagnosis and Management of Orbital Fat Exposure During Endoscopic Sinus Surgery

Diagnosis and Management of Orbital Fat Exposure During Endoscopic Sinus Surgery

Nasal Adhesions – A New Perspective

Extraocular Muscle Injury

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