Surgical Rehabilitation in Patients with Thyroid Eye Disease; Favourable Results of Orbital Decompression by Coronal and Anterior Approach (Swinging Eyelid)
von Arx G., Hammer B., Rohner D.
Cranio-Facial Centre, Hirslanden, Klinik im Schachen, Aarau
Purpose: To show the efficiency and reliability comparing different methods of orbital decompression in thyroid associated eye disease.
Method: Bilateral orbital decompression by coronal and anterior approach was performed in 122 orbits for cosmetic and reconstructive reasons. Surgery was performed by an interdisciplinary team of orbital and maxillofacial surgeons in the inactive stage of the disease.
Results: Proptosis reduction averaged 5.4 mm (Hertel) 12 months after surgery. All patients are satisfied with the functional and cosmetic results obtained. Advantages of the surgical techniques used are good access to all orbital walls and excellent view of the surgical field, facilitating adequate proptosis reduction without significant scar formation or complications. No visual loss was recorded in our group and the incidence of postoperative iatrogenic diplopia was 3.2% in the coronal approach and less than 1% in the swinging eyelid approach, to our knowledge the lowest percentage in the literature.
Conclusions: Orbital decompression in thyroid associated eye disease is efficient and safe. It is the most important first step to functional and esthetic recovery in these patients with longstanding and traumatising disease with somatic and psychosocial impact.
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