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Surgical Management of Crs
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
A. Simon Carney, Raymond Sacks
Anti-coagulation drugs, non-steroidal anti-inflammatory drugs (NSAIDS) and homeopathic preparations (e.g. fish oil and multivitamins) that can affect bleeding should be stopped pre-operatively. The CT scans will identify dehiscence of the lamina papyracea, angulation of the vertical lamella of the cribriform plate and congenital defects in the skull base and over the carotid artery, which all carry higher risk.
Orbit
Published in Mostafa Khalil, Omar Kouli, The Duke Elder Exam of Ophthalmology, 2019
Mostafa Khalil, Omar Kouli, Rizwan Malik
The orbit is a pyramidal-shaped space with the apex situated posteriorly and the base anteriorly. It is madeup of seven bones which are grouped as follows: Roof: Frontal bone and lesser wing of the sphenoid.Lateral wall: Zygomatic bone and greater wing of the sphenoid.Floor: Zygomatic, maxillary and palatine bones.Medial wall: Maxillary, lacrimal, sphenoid and ethmoid bones. The lamina papyracea is a paper-thin plate which covers the ethmoidal cells and forms a part of the medial wall. It can act as a route of entry for infection from the ethmoid sinus.
Nose
Published in Marie Lyons, Arvind Singh, Your First ENT Job, 2018
Orbital damage. The ethmoidal complex lies very close to the eye. This is why scanning is so important, as it will alert the surgeon to abnormal anatomy. The lamina papyracea of the eye is extremely thin and easily breached. This is not a major disaster so long as it is recognised and the operation is finished at this point. This is also why any polyps that are removed are placed in saline, as polyps sink but orbital fat does not.
Endoscopic endonasal resection of orbital schwannoma assisted with small-incision medial orbitotomy: case series and surgical technique
Published in Orbit, 2021
Justin D. Pennington, Benjamin S. Bleier, Suzanne K. Freitag
All patients underwent endoscopic endonasal resection of their orbital schwannoma assisted by medial transorbital lesion mobilization (see Video, Supplemental Digital Content 1, which demonstrates the presented surgical technique from the endoscopic view). The orbital lesion was identified by CT or MRI with contrast of the orbits during initial evaluation of each patient (Figure 1a,c,e). The lesions were located medial to the optic nerve and thought to be accessible by an endoscopic endonasal approach in all patients. A FusionTM stereotactic image guidance system (Medtronic, Jacksonville, Fl) was utilized for all cases. Using a 0-degree 4 mm endoscope, a standard complete sinus surgery was performed including maxillary antrostomy, complete ethmoidectomy, sphenoidotomy, and frontal sinusotomy with skeletonization of the lamina papyracea and optic canal.
Current clinical diagnosis and management of orbital cellulitis
Published in Expert Review of Ophthalmology, 2021
Sara A. Khan, Ahsen Hussain, Paul O. Phelps
In the absence of diabetes or immunosuppression, orbital cellulitis is then most likely secondary to sinus disease [1,24]. It has been shown that 64–75% of orbital infections are caused by paranasal sinusitis [12,27,28], most commonly the ethmoid and maxillary sinuses [1,12,28–31]. In a recent study, adult patients admitted for rhinosinusitis were found to have a prevalence of orbital complications of 1.7%, and within that population, 38.5% had postseptal involvement [32]. The implicated sinus depends on the age of the patient, as younger patients tend to have orbital cellulitis due to ethmoiditis. Adolescents and adults develop ossification of the laminae papyracea. Therefore, they are more likely to have primary infections within their more developed frontal and maxillary sinuses [1,28]. The relationship between paranasal disease and orbital cellulitis has also been shown through seasonal distribution of disease, with greater cases in the winter months [12,16,17]. A history of known dental infection, abscess, or recent dental extraction should be determined in the patient history [5,7,16,33,34].
Factors that prolong the duration of recovery in acute rhinosinusitis with orbital complications
Published in Acta Oto-Laryngologica, 2019
Tomoyasu Tachibana, Shin Kariya, Yorihisa Orita, Michihiro Nakada, Takuma Makino, Takenori Haruna, Yuko Matsuyama, Yasutoshi Komatsubara, Yuto Naoi, Yasuharu Sato, Kazunori Nishizaki
Orbital complications are mainly caused by invasion of inflammation from the paranasal sinus to the orbital cavity [1,2]. As a mechanism of inflammation into the orbital cavity, natural defects in the bony wall between the orbital and paranasal compartments, erosion of the sinus walls secondary to bony necrosis, and via the numerous valveless venous channels have been reported [2]. In young children, the ethmoid paranasal sinuses are well developed compared with the maxillary or frontal sinuses [3]. The lamina papyracea of children is characterized by a very thin layer of bone plate [1]. In addition, the nasal cavity of children is narrower and the nasal mucosa is tenderer than that of adults [1]. Therefore, ARS easily causes orbital complications especially in pediatric patients. However, in the present study, the number of adults was larger than that of pediatric cases. Young patients, especially children, respond better to conservative treatment [10]. This might be explained by the fact that even with orbital complications, child cases treated successfully with conservative treatment by family practitioners are not referred to core hospitals.