Three-Wall Orbital Decompression Superiority to 2-Wall Orbital Decompression in Thyroid-Associated Ophthalmopathy
Purpose
We evaluated the results of the 2-wall and 3-wall orbital decompression in patients with Graves’ disease.
Patients and Methods
In this study, we present a consecutive series of 12 patients (18 orbits) who were submitted to orbital decompression by endoscopic transnasal medial wall combined with transantral inferior wall approach and 7 patients (8 orbits) who were submitted to orbital decompression by endoscopic transnasal medial wall, transantral inferior wall combined with transcutaneous lateral wall approach. The degree of exophthalmos was evaluated with the Hertel exophthalmometer preoperatively and postoperatively in the 24th hour, and first, third, and ninth months.
Results
At the end of the third month, the exophthalmos decreased by a mean of 4.38 mm (range, 3 to 7 mm) with the 2-wall decompression and 7.75 mm (range, 5 to 12 mm) with the 3-wall decompression. Visual acuity maintained or improved during the follow-up period. Ocular motility disturbance occurred in 1 patient after 2-wall decompression and in 1 patient after 3-wall orbital decompression. Postoperatively, new-onset diplopia was seen in only 1 patient after 2-wall orbital decompression.
Conclusion
The 3-wall (endoscopic transnasal medial wall, transantral inferior wall combined with transcutaneous lateral wall) approach is as safe as the 2-wall approach. Proptosis reduction is much better with the 3-wall orbital decompression.
⁎Professor, Department of ENT and Head & Neck Surgery, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey.
†Medical Doctor, Department of ENT and Head & Neck Surgery, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey.
‡Medical Doctor, Department of ENT and Head & Neck Surgery, Haseki Hospital, Istanbul, Turkey.
§Medical Doctor, Department of ENT and Head & Neck Surgery, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey.
∥Medical Doctor, Department of ENT and Head & Neck Surgery, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey.
¶Professor, Department of ENT and Head & Neck Surgery, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey.
#Professor, Department of Ophthalmology, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey.
Address correspondence and reprint requests to Dr Yılmaz: Istanbul Üniversitesi Cerrahpaşa Tip Fak KBB ABD, Istanbul, Turkey
ABSTRACT