One-stage bone strip reconstruction technique with balloon sinus dilatation surgery for chronic maxillary atelectasis

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 Metrop...

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Autores principales:	Kashima T, Goldberg RA, Kohn JC, Rootman DB
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	silent sinus syndrome chronic maxillary atelectasis bone strip cartilage graft balloon surgery Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/c9379bed1b734f1982258eead2af2c08
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spelling	oai:doaj.org-article:c9379bed1b734f1982258eead2af2c082021-12-02T07:25:58ZOne-stage bone strip reconstruction technique with balloon sinus dilatation surgery for chronic maxillary atelectasis1177-5483https://doaj.org/article/c9379bed1b734f1982258eead2af2c082016-11-01T00:00:00Zhttps://www.dovepress.com/one-stage-bone-strip-reconstruction-technique-with-balloon-sinus-dilat-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Tomoyuki 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 Kashima TGoldberg RAKohn JCRootman DBDove Medical Pressarticlesilent sinus syndromechronic maxillary atelectasisbone stripcartilage graftballoon surgeryOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 10, Pp 2363-2368 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	silent sinus syndrome chronic maxillary atelectasis bone strip cartilage graft balloon surgery Ophthalmology RE1-994
spellingShingle	silent sinus syndrome chronic maxillary atelectasis bone strip cartilage graft balloon surgery Ophthalmology RE1-994 Kashima T Goldberg RA Kohn JC Rootman DB One-stage bone strip reconstruction technique with balloon sinus dilatation surgery for chronic maxillary atelectasis
description	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
format	article
author	Kashima T Goldberg RA Kohn JC Rootman DB
author_facet	Kashima T Goldberg RA Kohn JC Rootman DB
author_sort	Kashima T
title	One-stage bone strip reconstruction technique with balloon sinus dilatation surgery for chronic maxillary atelectasis
title_short	One-stage bone strip reconstruction technique with balloon sinus dilatation surgery for chronic maxillary atelectasis
title_full	One-stage bone strip reconstruction technique with balloon sinus dilatation surgery for chronic maxillary atelectasis
title_fullStr	One-stage bone strip reconstruction technique with balloon sinus dilatation surgery for chronic maxillary atelectasis
title_full_unstemmed	One-stage bone strip reconstruction technique with balloon sinus dilatation surgery for chronic maxillary atelectasis
title_sort	one-stage bone strip reconstruction technique with balloon sinus dilatation surgery for chronic maxillary atelectasis
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/c9379bed1b734f1982258eead2af2c08
work_keys_str_mv	AT kashimat onestagebonestripreconstructiontechniquewithballoonsinusdilatationsurgeryforchronicmaxillaryatelectasis AT goldbergra onestagebonestripreconstructiontechniquewithballoonsinusdilatationsurgeryforchronicmaxillaryatelectasis AT kohnjc onestagebonestripreconstructiontechniquewithballoonsinusdilatationsurgeryforchronicmaxillaryatelectasis AT rootmandb onestagebonestripreconstructiontechniquewithballoonsinusdilatationsurgeryforchronicmaxillaryatelectasis
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One-stage bone strip reconstruction technique with balloon sinus dilatation surgery for chronic maxillary atelectasis

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