Functional and Esthetic Outcome after Bony Lateral Wall Decompression with Orbital Rim Removal and Additional Fat Resection in Graves’ Orbitopathy with Regard to the Configuration of the Lateral Canthal Region

Abstract

Purpose: To investigate whether en bloc resection of the lateral orbital wall, including the orbital rim, during lateral wall decompression surgery in patients with Graves’ orbitopathy (GO) potentially influences the esthetic and functional aspects of the lateral canthal region.Methods: Lateral wall decompression was performed in 30 orbits of 18 patients using an upper lidcrease approach involving complete removal of the lateral orbital wall combined with additional orbital fat resection. Patients undergoing surgery before January 2010 were evaluated retrospectively for exophthalmos, vertical lid aperture, lagophthalmos and eye motility. Patients undergoing surgery after January 2010 were evaluated prospectively in addition for horizontal lid aperture, pupillary distance, lateral movement of the lateral canthus, and the disease-specific GO-QOL questionnaire, including subjective and objective assessments of the appearance of the lateral canthal region.Results: A mean exophthalmos reduction of 3.0 mm was achieved, accompanied by a significant reduction in vertical lid aperture but without significant influence on horizontal eye movements. GO-QOL scores disclosed significant improvements with regard to both visual and psychosocial functioning. Although 3 out of 18 patients reported some temporal hollowing, this was confirmed objectively in only one patient.Conclusions: Our analysis did not demonstrate any impairment of lateral canthal stability or motility functions. Slight scar retraction was objectively confirmed in only one patient, allaying concerns about significant temporal hollowing. Given the good overall esthetic and functional results of this surgical technique, we advocate lateral wall decompression with resection of the orbital rim in GO patients with mild-to-moderate exophthalmos.