J.ophthalmol.(Ukraine).2021;4:53-56.

http://doi.org/10.31288/oftalmolzh202145356

Received: 15 June 2021; Published on-line: 16 August 2021


Endonasal orbitotomy as a first treatment for posttraumatic intraorbital hemorrhages in patients with frontal basilar trauma

О. D. Bondarchuk 1, 2, I. V. Dmytrenko 1, 2, N. D. Didyk 2, A. S. Isniuk 1

1 National Pirogov Memorial Medical University, Vinnytsya; Vinnytsia (Ukraine)

2 Mykola Pyrohov Vinnytsia Regional Hospital; Vinnytsia (Ukraine) 

E-mail:  eskulap20009@gmail.com

TO CITE THIS ARTICLE:Bondarchuk О.D., Dmytrenko I.V., Didyk N.D., Isniuk A.S. Endonasal orbitotomy as a first treatment for posttraumatic intraorbital hemorrhages in patients with frontal basilar trauma  http://doi.org/10.31288/oftalmolzh202145356


Background: Intraorbital hemorrhages are one of the most dangerous complications of frontal bone trauma and frontal and orbital trauma because of the close and intricate anatomical relationships among the cranial cavity, orbit, nose and paranasal sinuses. Failure to solve the problem promptly will inevitably lead to disability. Effective treatment requires a multidisciplinary surgical team including a neurosurgeon, otorhinolaryngologist, ophthalmologist and a maxillofacial surgeon.

Purpose: To assess the efficacy of endonasal endoscopic transethmoidal orbitotomy (TEO) and transcutaneous orbitotomy (TCO) in patients with post-traumatic intraorbital hemorrhages.

Material and Methods: Fifteen patients (9 men and 6 women) with retrobulbar hematoma were included in this study. Patient age ranged from 33 years to 65 years. Of the 15 patients, 8 received endonasal endoscopic TEO and 7, TCO. Preoperatively, each patient underwent an eye examination, ultrasonography of the orbit, and spiral computed tomography of the paranasal and periorbital sinuses. Postoperative examinations were performed at 7 days and 1 month. Exophthalmos was assessed using a Hertel’s exophthalmosmeter (ALMAS YZ9). Sivtsev-Golovin charts were used to assess visual acuity. Statistical analyses were conducted using Microsoft Excel and Statistica (StatSoft, Tulsa, OK, USA) software.

Results: The preoperative exophthalmos was 18.5 ± 2.12 mm in patients scheduled for TEO and 16.9 ± 1.78 mm in those scheduled for TCO. On day 7 after surgery (the day of discharge), exophthalmos reduced to 6.4 ± 0.77 mm in patients undergoing TEO (p < 0.0005) and 8.8 ± 0.94 mm in those undergoing TCO (p < 0.005). The preoperative visual acuity (VA) was 0.07 ± 0.03 in patients scheduled for TEO and 0.09 ± 0.05 mm in those scheduled for TCO. On day 7, mean VA improved to 0.81 ± 0.12 (p < 0.00005) in patients undergoing TEO, and to 0.56 ± 0.34 in those undergoing TCO. The two groups showed practically the same pattern of a longitudinal decrease in chemosis. Diplopia in upward and downward gaze and any restriction in ocular motility disappeared in patients undergoing TEO by the day of discharge (day 7), which was 4-5 days earlier than in patients undergoing TCO, with a postoperative period 4.25 ± 0.75 days longer (p<0.05) in the latter patients. At one month, mean VA improved to 0.89 ± 0.08 (p < 0.00005) in patients of the TEO group, and to 0.75 ± 0.15 (p < 0.005) in patients of the TCO group. 

Conclusion: Endonasal endoscopic transethmoidal orbitotomy was significantly more advantageous than transcutaneous orbitotomy, with a faster recovery, particularly, shorter postoperative period, faster restoration of visual acuity and ocular motility, minimum trauma to soft orbital tissues, and no external damage to facial skin.

Keywords:  endonasal orbitotomy, frontal basilar trauma, retrobulbar hematoma

 

References

1.Rodriguez ED, Stanwix MG, Nam AJ. Twenty–six–year experience treating frontal sinus fractures: a novel algorithm based on anatomical fracture pattern and failure of conventional techniques. Plast Reconstr Surg. 2008;122:1850-60.

Crossref  PubMed

2.Manson PN. Facial fractures. Perspect Plast Surg. 1998;2:1-36.

3.Gruss JS, Pollock RA, Phillips JH. Combined injuries of cranium and face. Br J Plast Surg. 1989;42:385-9.

Crossref 

4.Manolidis S, Weeks BN, Kirby M. Classification and surgical management of orbital fractures. J Craniofac Surg. 2002;13:726-737.

Crossref  PubMed

5.Prein J. Manual of Internal fixation in the cranio–facial sckeleton. Berlin: Springer; 1998. 

6.Rohrich RJ, Hollier LH. Management of frontal sinus fractures. Clin Plast Surg. 1992;19(1):219-232.

Crossref 

7.Aleksyeyev VN, Sadkov VI, Kugleyev MA. [Ophthalmology]. St. Petersburg: SPbDMA; 2008. Russian.

8.Morozov VI, Yakovlev AA. [Pharmacotherapy of eye diseases]. Moscow: Meditsina; 2001. Russian.

9.Astakhov IuS, Angelopulo GV, Dzhaliashvili OA. [Eye Diseases: A Reference Guide for General Practitioners]. St. Petersburg: Spetslit; 2001. Russian.

10.Somov EE. [Eye diseases and injuries]. St. Petersburg: SPbMI; 2008. Russian.

11.Chrapek O. Soucasne moznosti lecby vlhke formy vekem podminene makularni degenerace. Remedia. 2007;6:610-6. Czech.

12.Dolezalova J, Karel I, Hallova H. Nase dvoulete zkusenosti s lecbou vlhke formy vekem podminene makularni degenerace bevaci-zumabem (Avastin). Ceska a Slovenska Oftalmologie. 2010;1:10-1. Czech.

13.Bezkorovayna IM, Ryadnova VV, Voskresens'ka LK. [Ophthalmology: a manual for students of higher medical institutions]. Pol-tava: Dyvosvit; 2012. Ukrainian.

14.Khyzhniak AA, Dubivs'ka SS. [Emergency care for acute diseases and eye injuries: guidelines for the training of interns and stu-dents of pre-certification cycles specializing in emergency medicine]. Kharkiv: Kharkiv National Medical University; 2013. Ukrainian.

15.Bondarchuk OD. [Fractures of the frontal sinus walls: criteria for choosing the tactics of surgical treatment and indication for oblite-ration]. Otorynolaryngologiya. 2019;1:66-70. Ukrainian.

Crossref  

16.Lekishvili SE. [Practical ophthalmology: a tutorial]. Sumy: Sumy State University; 2016. Ukrainian.

17.Povertovskii G. [Frontal facial injuries. Mechanism, pathology and principles of surgical treatment]. Warsaw: Polish State Medical Publishers; 1968. Russian.

18.Chavtur AG. [Concomitant traumatic brain injury with damage to the orbits and upper paranasal sinuses[. [Thesis for the degree of Cand Sc (Med)]. St. Petersburg: A.l. Polenov Russian Research Institute of Neurosurgery; 1983. Russian.

19.Blagoveshсhenskaya NS, Tarasevich TN. [Combinations of lesions of the frontal sinuses and brain]. Moscow: Meditsina; 1972. Russian.

20.Danylevych MO. [Severe cranio-facial trauma: features of the clinical course and a multidisciplinary approach to comprehensive treatment]. [Abstract of the dissertation for the degree of Dr Sc (Med)]. St. Petersburg: A.l. Polenov Russian Research Institute of Neurosurgery; 2016. Russian.

21.Eolchiyan SA, Potapov AA, VanDamm FA. [Craniofacial trauma. A Clinical Guide to Traumatic Brain Injury]. Moscow: Antidor; 2002. Russian.

22.Baker NJ, Evans BT, Neil–Dwyer G, Lang DA. Frontal sinus fractures. In: Maxillofacial trauma and esthetic facial reconstruction. Edinburgh: Churchill Livingstone; 2003. 

23.Gerbino G, Roccia F, Benech A. Analysis of 158 frontal sinus fractures: current management and complications. J Craniomaxillofac Surg. 2000;28:133-9.

Crossref  PubMed 

24.Levchenko OV, Kalandari AA, Kutrovskaya NY, Revazyan KV. Transorbital Endoscopic Medial Orbitotomy and Decompression of the Optic Nerve in Patients with Endocrine Ophthalmopathy Complicated by Optical Neuropathy. Russian Sklifosovsky Journal "Emergency Medical Care". 2020;9(1):167-72. Russian.

Crossref  

25.Ekgardt VF. [Orbitotomy in the complex treatment of endocrine ophthalmopathy]. Vestnik OSU. 2012;12:148. Russian

Conflict of Interest Statement:

The authors declare no conflict of interest which could influence their opinions on the subject or the materials presented in the manuscript.