Clinical Ophthalmology (Nov 2016)
One-stage bone strip reconstruction technique with balloon sinus dilatation surgery for chronic maxillary atelectasis
Abstract
Tomoyuki Kashima,1 Robert A Goldberg,1 Jocelyne C Kohn,2 Daniel B Rootman1 1Division of Orbital and Oculoplastic Surgery, Stein Eye Institute, University of California, Los Angeles, CA, USA; 2Pasteur Ophthalmology Clinic, Oculoplastic, Orbit and Lacrimal Service, Santiago, Vitacura, Santiago Metropolitan Region, Chile Purpose: Chronic maxillary atelectasis is characterized by unilateral spontaneous enophthalmos and hypoglobus due to increased orbital volume secondary to maxillary sinus inward deformation. Reformation of the sinus architecture and reconstruction of the orbit are key to a successful outcome. Here, we introduce a one-staged surgery that addresses both these goals.Patients and methods: We retrospectively reviewed 11 patients treated with one-stage orbital and sinus surgery. A transconjunctival subperiosteal approach was used to create slats in the thinned orbital floor. A nasal endoscopic approach was utilized to access the maxillary sinus and place a modified Foley catheter balloon through the enlarged maxillary ostium. A bridge graft of nasal septal, ear cartilage, or LactSorb was placed on the reconstructed and balloon-supported orbital floor. The balloon was deflated and removed at 10–14 days. All patients underwent complete ophthalmic and orbital evaluation, including standardized photography and radiologic imaging.Results: Eleven patients, mean age 39.5 years, presented with diplopia in upgaze, superior sulcus deformity, and at least 2 mm of relative enophthalmos. After initial overcorrection, enophthalmos improved in all cases. Symmetry within 1 mm was accomplished in 10 of 11 cases. Follow-up time was 259±320 days. Full motility was recovered in all patients.Conclusion: We describe a one-staged surgery consisting of cutting slats in the orbital floor, dilating the maxillary sinus with a balloon, and stabilizing the orbital floor with a cartilage graft placement. Our anecdotal experience suggests that this surgical approach can safely achieve normalization of the pathologic sinus outflow and restoration of the orbit anatomy. The balloon ensures orbital floor stability during the healing process, and it may act to stent open the sinus ostium during early mucosal healing. Keywords: silent sinus syndrome cartilage graft, orbital floor, remodeling
