Paranasal Sinusitis Following Orbital Decompression in Patients with Graves' Ophthalmopathy

Abstract

Purpose: To investigate the incidence, management, and outcome of paranasal sinusitis following orbital decompression in patients with Graves' ophthalmopathy. Design: Retrospective review study. Participants: A total of 144 patients received orbital decompression between December 1988 and October 2004. Ninety-four patients were available for follow up. Methods: We reviewed the clinical records of all patients who underwent orbital decompression and used telephone interviews. The orbital decompression operation we performed was transfornicial floor and transcaruncular medial wall and/or lateral wall decompression. If a patient had any symptoms associated with sinusitis, we would ask the patient to return to the hospital to have computed tomography (CT) scan examination and an ENT consultation. Results: Three patients were excluded because they had sinusitis before the decompression operation. Of the 91 remaining patients, 11 (12.1%) had definite diagnosis of sinusitis. Eight (72.7%) patients' symptoms subsided after antibiotics and 3 (27.3%) patients received FESS operation. Conclusion: The number of patients with sinusitis was higher than anticipated. Occlusion of the maxillary sinus ostium by prolapsed orbital contents was the most common cause of post-decompression sinusitis. Preventing prolapsed orbital contents from obstructing the maxillary sinus ostium or performing a wide middle meatal antrostomy during the initial operation can prevent post-decompression sinusitis.