Diagnosis and Management of Orbital Fat Exposure During Endoscopic Sinus Surgery

xlomafota13 shared this article with you from Inoreader Diagnosis and Management of Orbital Fat Exposure During Endoscopic Sinus Surgery Via ear nose throat Ear Nose Throat J. 2021 Jun 6:1455613211015438. doi: 10.1177/01455613211015438. Online ahead of print. ABSTRACT BACKGROUND: The orbital complication rate during endoscopic sinus surgery (ESS) is <1%. Orbital fat exposure during ESS can herald orbital complications including orbital hematoma, extraocular muscle trauma, optic nerve injury, or blindness. The objective of this study was to evaluate the current consensus regarding diagnosis and management of orbital fat exposu re during ESS. METHODS: A 24-point survey focused on orbital fat exposure during ESS was distributed to American Rhinologic Society members. Also, a retrospective review of 25 cases of orbital fat exposure drawn from the principal investigator's 30-year experience was performed. RESULTS: Over 10 000 surgical cases of the principal investigator were reviewed. Twenty-five patients had orbital fat exposure. Five developed minor complications while 2 were major (ie, temporary vision changes). Two hundred thirty-six surgeons responded to the survey; 93% had encountered orbital fat during ESS; 88% of surgeons identify orbital fat by either its appearance endoscopically or the "bulb press" test. Almost every responding surgeon will cautiously avoid further manipulation in the area of orbital fat exposure. Nearly half will immediately curtail the extent of surgery. Surgeons do not significantly change postoperative management. Considerations regarding observation in postanesthes ia care unit, close follow-up, and strict nose blowing precautions are common. CONCLUSION: Orbital fat exposure during ESS is a rarely discussed, but clinically important. Orbital fat exposure can be a harbinger for major orbital complications that should be recognized by endoscopic appearance and confirmed with the bulb press test. Caution with "no further manipulation" of orbital fat is the guiding principle for intraoperative management, while postoperative management is generally expectant.Level 4 Evidence. PMID:34092086 | DOI:10.1177/01455613211015438 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.