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Eckstein A, Welkoborsky HJ. [Interdisciplinary Management of Orbital Diseases]. Laryngorhinootologie 2024; 103:S43-S99. [PMID: 38697143 DOI: 10.1055/a-2216-8879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Diagnosis and therapy of orbital diseases is an interdisciplinary challenge, in which i.e. otorhinolaryngologists, ophthalmologists, radiologists, radiation therapists, maxillo-facial surgeons, endocrinologists, and pediatricians are involved. This review article describes frequent diseases which both, otolaryngologists and ophthalmologists are concerned with in interdisciplinary settings. In particular the inflammatory diseases of the orbit including orbital complications, autoimmunological diseases of the orbit including Grave´s orbitopathy, and primary and secondary tumors of the orbit are discussed. Beside describing the clinical characteristics and diagnostic steps the article focusses on the interdisciplinary therapy. The review is completed by the presentation of most important surgical approaches to the orbit, their indications and possible complications. The authors tried to highlight the relevant facts despite the shortness of the text.
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Affiliation(s)
| | - H-J Welkoborsky
- Univ. Klinik für Augenheilkunde Universitätsmedizin Essen, Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Klinikum Nordstadt der KRH
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Abstract
This article provides an overview of rare orbital diseases. Congenital
malformations, inflammatory diseases, benign and malignant neoplasias are
described. Although it represents a relatively small area of the body the
orbit contains multiple different tissues. Therefore, a great variety of
diseases can be found within the orbital space. That is the reason, why both
the completeness and the level of detail in the description of particular
diseases must be somewhat limited. Nevertheless, clinical manifestations,
important aspects of diagnosis, treatment strategies, and, when specific
data are available, the prognosis are described. The authors tried to
highlight the most characteristic aspects of the different diseases to
describe their relevant aspects in spite of the brevity of the
subsections.
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Affiliation(s)
- Ulrich Kisser
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
| | - Jens Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde, Halle/S. (Klinikdirektor: Prof. Dr. med. A. Viestenz)
| | - Alexander Glien
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
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Abstract
A disease or symptom of disease spreading from the vicinity of the orbit to the internal structures of the orbit is referred to as an orbital complication. Orbital complications can have a traumatic, inflammatory, allergic, or autoimmunologic cause. They are more frequent in children than adults. The present review aims to provide a description of orbital complications, their etiology, pathogenesis, and treatment. Recent literature in the field is acknowledged and discussed, and results from the authors' own patient groups are analyzed. Particular attention is paid to orbital complications due to acute sinusitis and those caused by acute hemorrhage. The term "orbital phlegmon" frequently used for orbital complications with inflammatory causes is confusing and should be replaced by differentiated grading. Diagnosis and treatment of orbital complications requires interdisciplinary collaboration, whereby inclusion of ophthalmologists is particularly important. Treatment of orbital complications depends on their cause. In inflammatory cases affecting only the preseptal tissues and compartment, conservative therapy is indicated. If clinical findings worsen within 24 h of conservative therapy, or if the patient presents with a high-grade orbital complication with loss of visual acuity or impairment of globe mobility, surgery is required. In cases of acute hemorrhage into the orbit, a procedure for decreasing intra-orbital pressure is mandatory (i. e., canthotomy, cantholysis, orbital decompression).
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Affiliation(s)
- S Graß
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde und regionale plastische Chirurgie, Kopf-Hals-Tumorzentrum, KRH Klinikum Nordstadt, Akademisches Lehrkrankenhaus, Haltenhoffstr. 41, 30167, Hannover, Deutschland.
| | - H-J Welkoborsky
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde und regionale plastische Chirurgie, Kopf-Hals-Tumorzentrum, KRH Klinikum Nordstadt, Akademisches Lehrkrankenhaus, Haltenhoffstr. 41, 30167, Hannover, Deutschland
| | - H Möbius
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde und regionale plastische Chirurgie, Kopf-Hals-Tumorzentrum, KRH Klinikum Nordstadt, Akademisches Lehrkrankenhaus, Haltenhoffstr. 41, 30167, Hannover, Deutschland
| | - S K Plontke
- Medizinische Fakultät Martin-Luther-Universität Halle-Wittenberg, Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - A Glien
- Medizinische Fakultät Martin-Luther-Universität Halle-Wittenberg, Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
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Abstract
Bacterial orbital cellulitis is a life-threatening infection of the postseptal orbital tissue. It can occur in the context of sinusitis, particularly in children and adolescents. Ocular complications include exposure keratopathy, increased intraocular pressure, occlusion of the central retinal artery or vein and optic neuropathy. Rarely, a subperiosteal abscess can occur, and osteomyelitis can lead to spread of the infection to the cerebrum. A rapid diagnosis and targeted therapy are essential for saving the eye as well as the life of the patient.
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Affiliation(s)
- A Bajor
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Hannover, Deutschland.
| | - C P Lang
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - E Bültmann
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - C Framme
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K Hufendiek
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Hannover, Deutschland
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Matsuba Y, Strassen U, Hofauer B, Bas M, Knopf A. Orbital complications:diagnosis of different rhinological causes. Eur Arch Otorhinolaryngol 2014; 272:2319-26. [PMID: 25323154 DOI: 10.1007/s00405-014-3338-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 10/11/2014] [Indexed: 11/28/2022]
Abstract
To evaluate the clinical course of orbital complication using a standardised diagnostic pathway. Seventy-three patients with orbital complications underwent a multimodal diagnostic pathway comprising ENT examination, leucocytes/CRP, CT-/MRI-scanning and disease-related data. Twenty-nine patients suffered from rhinosinusitis, 28 from mucoceles, 13 patients from neoplasms and three patients from rheumatic disorders. Clinical examination diagnosed 60 patients with eyelid swelling, 55 patients with ocular pain, 14 patients with diplopia, 4 patients with exophthalmus, 29 patients with visual field defect and 4 patients with visual loss. The diagnostic pathway identified acute rhinosinusitis with a sensitivity/specificity of 90 %/90 %, mucoceles with 79 %/100 %, neoplasms with 100 %/96 % and granulomatosis with polyangiitis with 100 %/100 %, respectively. All patients left the hospital in good general condition and with regular ocular motility; two patients suffered persistent visual loss. The standardised application of a widely accepted diagnostic pathway reliably distinguishes different causes of orbital complication.
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Affiliation(s)
- Yumiko Matsuba
- Hals-, Nasen-, Ohrenklinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
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Welkoborsky HJ, Graß S, Deichmüller C, Bertram O, Hinni ML. Orbital complications in children: differential diagnosis of a challenging disease. Eur Arch Otorhinolaryngol 2014; 272:1157-63. [PMID: 25056021 DOI: 10.1007/s00405-014-3195-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
Orbital swelling in children presents diagnostic and therapeutic challenges. Most are associated with acute sinusitis with complicating factors possibly including: amaurosis, meningitis, intracranial abscess or even cavernous sinus thrombosis. However not all acute orbital swelling is associated with acute sinusitis. A careful evaluation is critical prior to initiating therapy. Clinical records of 49 children (27 girls, 22 boys, with an average age of 11.8 years) were retrospectively reviewed. Historical data evaluated included all available information from parents and previous treating physicians. All patients underwent intensive pediatric, ophthalmologic, and otorhinolaryngologic examinations. Computed tomography (CT scans) were additionally performed in 40 % of children. The results of any examinations were also evaluated. Eighteen of the 49 patients had an orbital complication due to acute sinusitis. All 18 had elevated body temperature, C-Reactive Protein (CRP) values and white blood cell counts. Endoscopy of the nose revealed pus in the middle meatus in each case. According to Chandlers' classification, ten children presented with a preseptal, and eight children had a postseptal orbital cellulitis. All patients were admitted to the hospital and treated with intravenous antibiotics. CT scans further demonstrated signs of subperiostal abscess in four children. Functional endoscopic sinus surgery (FESS) was required in six children, including all patients with subperiostal abscess. Twenty children experienced orbital swelling unrelated to acute sinusitis, i.e. atheroma, inflammed insect stings, dental related abscess, conjunctivitis, and Herpes simplex associated superinfection. In three children, acute orbital swelling was caused by an orbital tumor. Orbital complications of an acute sinusitis occur often in the pediatric patient group, and most of these patients can be treated conservative with intravenous antibiotics. Indications for FESS include failure to improve or worsening of clinical symptoms during 24 h of therapy, signs for subperiostal abscess in CT scan, and/or vision loss. Patients with infectous orbital complications had fever, elevated CRP and white blood cell counts. This symptom complex is key in making the correct diagnosis. Interestingly, 61 % of patients in this study demonstrated non-sinusitis related diseases leading to acute orbital swelling, which also required prompt recognition and appropriate therapy.
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Affiliation(s)
- Hans-J Welkoborsky
- Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital and Childrens' Hospital "Auf Der Bult", Academic Hospital, Haltenhoffstrasse 41, 30167, Hannover, Germany,
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Bach FS, Bodo G, Kuemmerle JM, Bienert-Zeit A, Hainisch EK, Simhofer H. Bacterial meningitis after sinus surgery in five adult horses. Vet Surg 2014; 43:697-703. [PMID: 24467610 DOI: 10.1111/j.1532-950x.2014.12132.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 12/01/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report meningoencephalitis as a complication after paranasal sinus surgery in 5 horses. STUDY DESIGN Case series. ANIMALS Adult horses (n = 5). METHODS Medical records (2005-2010) of 5 horses that developed neurologic signs after sinus surgery were reviewed to identify potential risk factors, cause(s), or common pathways for infection. RESULTS Underlying diseases were primary (n = 1) and secondary sinusitis (4) because of apical dental infection (1), sinus cyst (2), or masses in the ethmoturbinate region (2). Horses were treated by conventional surgical approaches and aftercare including repeated sinus lavage. Four horses had undulating pyrexia postoperatively despite antimicrobial therapy. All horses developed neurologic signs, eventually unresponsive to treatment. Suppurative meningoencephalitis was diagnosed macro- and/or microscopically on necropsy in all horses. CONCLUSION Meningitis is a rare but fatal complication after sinus surgery in horses.
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2011; 19:486-8. [PMID: 22555543 DOI: 10.1097/MOO.0b013e32834e4a77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Neumann A. Augenschmerzen aus Hals-Nasen-Ohren-ärztlicher Sicht. Ophthalmologe 2011; 108:1127-1133. [DOI: 10.1007/s00347-011-2397-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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