Impact of the ethmoid volume on endoscopic medial wall decompression outcomes in Graves’ orbitopathy

Abstract

Background

Endoscopic orbital decompression is a well-established technique for Graves orbitopathy treatment.

Aims

Measurement of the ethmoid volume and its correlation with proptosis reduction in patients undergoing endoscopic orbital decompression for Graves’ orbitopathy.

Methods

We retrospectively reviewed clinical charts of 209 patients (319 orbits) operated by a surgeon at our institution between 1998 and 2019.

Results

Average age was 46.9 years. About 83.3% of the patients were female, 54.6% were smokers, 93.8% were euthyroid at the time of decompression, 3.8% were hypothyroid and 2.4% were hyperthyroid. About 77.5% of the patients underwent bilateral surgery, the remainder and unilateral. Subsequent stages included strabismus surgery in 22.5% patients, Müllerectomy 37.8%, with or without canthoplasty (14.8 vs. 23%). Mean proptosis reduction was 4.61 mm. Mean ethmoid volume was 5.57 mm³. Ethmoid volume had a moderate positive correlation with proptosis reduction (r_s = 0.49, p < .001). Further investigation, statistically significant moderate correlation was found only in the small (SE) and big (BE) ethmoid groups.

Conclusion

We advise evaluating ethmoid sinus pneumatization on computed tomography before decompression to estimate possible anatomical limitations. Additional wall decompression might be advocated in most severe cases.

Chinese abstract

背景：内窥镜眼眶减压术是治疗Graves眼眶病的公认方法。

目的：测量筛窦窦体积；评估接受内窥镜眼眶减压术的Q1格雷夫斯氏眼病患者 的筛网气化与眼球突出减少之间的相关性。

方法：我们回顾性研究了1998年至2019年间在我院外科接受手术的209例患者（319个眼）的临床图表。

结果：患者平均年龄为46.9岁, 约83.3％为女性, 54.6％为吸烟者, 减压时甲状腺功能正常者占93.8％, 甲状腺功能减退者占3.8％, 甲状腺功能亢进者占2.4％。约77.5％的患者接受了双侧手术, 其余的患者则是单侧的。随后的阶段包括：斜视手术患者占22.5％, 穆勒切除术患者占37.8％, 有或没有外翻成形术（分别为14.8% 和23％）。平均眼球突出减少量为4.61 mm。筛骨的平均体积为5.57立方毫米。筛网体积与眼球突出减少有中等正相关（rs¼0.49, p<.001）。经过进一步调查, 仅在小筛窦（SE）和大筛窦（BE）组内发现统计学上显著的中度相关性。

结论：我们建议在减压之前使用计算机体层摄影术之前对筛窦窦气化进行评估, 以估计可能的解剖学局限性。额外的壁减压建议用于最严重的情况。

Keywords:

• Graves’ orbitopathy
• thyroid eye disease
• ethmoid sinus volume
• proptosis reduction

Disclosure statement

The authors report no conflict of interest.