Surgical treatment of thyroid ophthalmopathy – own observations
Journal Title: Journal of Stomatology (Czasopismo Stomatologiczne) - Year 2013, Vol 66, Issue 3
Abstract
Grave’s ophthalmopathy is a chronic autoimmune condition characterized by inflammatory and oedematous changes in the orbit which, apart from aesthetic disturbances, might cause loss of sight. Optic neuropathy is the most severe complication of thyroid ophthalmopathy (TO) and main indication for surgical intervention, namely orbital decompression, in cases of ineffective therapy. Aim of the study. To evaluate the effectiveness of surgical tactics in the treatment of TO on the basis of retrospective study of patients treated from 2002 to 2010. Material and methods. Analysis of 24 patients (12 female, 12 male) with evaluation of functional and aesthetic aspects of surgical decompression of 45 orbits in TO. Results. Exophthalmos before surgery ranged from 22 to 35 mm, average 28.5 mm. Decompression of the orbits with subciliary approach, controlled by Hertl’s exophthalmometry, was performed in 24 patients, including 3 (12.5%) unilaterally. The range of surgery comprised three-wall decompression in 23 (96.0%) patients, in 1 case two-wall decompression was performed. Reduction of exophthalmos, 4.8 mm on average, caused improvement in aesthetic appearance in all patients. Out of 10 patients with diplopia, diplopia disappeared in 2 cases postoperatively, and in 2 cases progression of diplopia was observed. Conclusions. 1. Decompression of the orbit is one of the stages of thyroid ophthalmopathy treatment. 2. Subciliary approach enables the removal of three orbital walls (floor, lateral, medial), and fat excision under direct visual control. 3. Exophthalmometric control of all stages of surgery (own modification) helps to achieve symmetric position of eyeballs. 4. Due to complications following orbital decompression, in order to improve final results of treatment, corrective eyelid and ocular muscles surgery should be considered.
Authors and Affiliations
Jan Zapała, Grażyna Wyszyńska-Pawelec, Piotr Koryczan, Michał Gontarz, Mariusz Szuta
Keywords
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