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David W. Kennedy, MD; Matthew L. Goodstein, MD; Neil R. Miller, MD; S. James Zinreich, MD

Arch Otolaryngol Head Neck Surg. 1990;116(3):275-282.

Abstract
• Orbital decompression for dysthyroid orbitopathy has traditionally been performed through either an external or a transantral approach. The advent of intranasal endoscopes allowed for the development of a transnasal approach for medial and inferior orbital wall decompression. Using this approach, orbital decompressions were performed on 13 orbits in eight patients with severe complicated dysthyroid orbitopathy. Simultaneous bilateral lateral orbitotomies were performed on five patients. Walsh-Ogura decompressions and lateral orbitotomies were performed on two orbits. When combined with lateral orbitotomy, Hertel measurements improved an average of 5.7 mm in orbits decompressed transnasally and 4.5 mm in orbits decompressed with a Walsh-Ogura approach. Transnasal decompression alone improved Hertel measurements an average of 4.7 mm. Visual acuity improved in three of four patients with optic neuropathy, and in all patients with exposure keratopathy. We conclude that the endoscopic transnasal approach provides comparable decompression to traditional methods while avoiding the morbidity of an external ethmoidectomy or Caldwell-Luc antrotomy.

(Arch Otolaryngol Head Neck Surg. 1990;116:275-282)

Author Affiliations
From the Departments of Otolaryngology—Head and Neck Surgery (Drs Kennedy and Goodstein); Ophthalmology, Neurology, and Neurosurgery (Dr Miller); and Radiology and Otolaryngology—Head and Neck Surgery (Dr Zinreich), The Johns Hopkins Medical Institutions, Baltimore, Md.

Footnotes
Accepted for publication November 17, 1989.

Presented in part at the meeting of the American Rhinological Society, New Orleans, La, September 23, 1989.

Reprint requests to Department of Otolaryngology—Head and Neck Surgery, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21205 (Dr Kennedy).

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