ORBITAL INVOLVEMENT IN SINONASAL DISEASES
Abstract
BACKGROUND:
The purpose of this study was to:
- To enlist diagnoses of all the patients with sinonasal disease, in which orbit was also involved unilaterally or bilaterally
- To analyze the management strategy and final outcome in all the cases
MATERIALS & METHODS
- Hundred consecutive patients having orbital symptoms along with sinonasal complaints that presented in ENT department of Shaikh Zayed federal postgraduate medical institute were included in our prospective study. .
- CT scan and/or MRI were done in all the cases and ophthalmological consultation was done.
- Patients having orbital signs and symptoms, which did not show clinical and radiological evidence of sinonasal involvement, were excluded from our study.
- Final diagnosis was made after histopathological confirmation
RESULTS
- 37% of the patients were diagnosed to be having Allergic fungal rhinosinusitis 16% had mucormycosis, 16% had chronic invasive fungal sinusitis. Other pathologies identified were Nasopharyngeal CA (4%), Squamous cell Ca (4%), cavernous sinus thrombosis (3%), Adenocarcinoma (3%), Angiofibroma (2%) fibrous dysplasia (2%) and Acute complicated Rhinosinusitis (2%)
- Other rare pathologies that were identified, included lymphoma (1 patient), Osteoma (1 patient), Rhabdomyosarcoma (1 patient), Transitional cell ca arising from inverted papilloma (1 patient), Hemangiopericytoma (1 patient), Spindle cell sarcoma (1 patient), Pituitary adenoma (1 patient), Giant cell sarcoma (1 patient), Malignant undifferentiated tumour, (1 patient), and plexiform neurofibroma (1 patient). One patient was diagnosed to be having sinonasal tuberculosis
- Most common orbital symptom was proptosis (84%) followed by diplopia (8%), visual loss (4%) and ophthalmoplegia (4%)
CONCLUSION Orbital involvement in most of the sinonasal diseases indicate extensive and aggressive nature of the pathology and many of these, even if they are not malignancies are difficult to treat. This is especially true for acute fulminant and chronic invasive fungal rhinosinusitis.
Background: Orbital involvement in sinonasal diseases can present as proptosis, ophthalmoplegia or even as blindness due to optic nerve damage. There are a number of sinonasal diseases which can involve eyes. The purpose of this study was to enlist diagnoses of all the patients with sinonasal disease, in which orbit was also involved unilaterally or bilaterally and to analyse the management strategy and final outcome in all the cases. Methods: Hundred consecutive patients having orbital symptoms along with sinonasal complaints that presented in ENT department of Shaikh Zayed federal postgraduate medical institute were included in our prospective study. CT scan and/or MRI were done in all the cases and ophthalmological consultation was done. Patients with sinonasal complaints without clinical involvement of orbit and those with primary orbital pathology were excluded from our study. Final diagnosis was made after histopathological confirmation. Results: A total of 37% of the patients were diagnosed to be having Allergic fungal rhinosinusitis 17% had mucormycosis, 16% had chronic invasive fungal sinusitis. Other pathologies identified were Nasopharyngeal CA (4%), Squamous cell Ca (4%), cavernous sinus thrombosis (3%), Adenocarcinoma (3%), Angiofibroma (2%) fibrous dysplasia (2%) and Acute complicated Rhinosinusitis (2%) Following rare pathologies were identified in only one patient each. These included Lymphoma, Osteoma, Rhabdomyosarcoma, Transitional cell carcinoma arising from inverted papilloma, Hemangiopericytoma, Spindle cell sarcoma, Pituitary adenoma, Giant cell sarcoma, Malignant undifferentiated tumour, Plexiform neurofibroma and sinonasal tuberculosis. Most common orbital symptom was proptosis. Eighty-one patients had proptosis followed by 23 patients with diplopia, 22 patients with ophthalmoplegia, 16 patients with visual loss and 15 patients with ptosis. Conclusion: Orbital involvement in most of the sinonasal diseases indicate extensive and aggressive nature of the pathology and many of these, even if they are not malignancies are difficult to treat. This is especially true for acute fulminant and chronic invasive fungal rhinosinusitis.
Keywords: Sinonasal; Orbital; Proptosis; Rhinosinusitis
References
Slack R, Sim R. Complications of rhinosinusitis. In: Scott-Brown's Otorhinolaryngology, Head and Neck Surgery. 7th ed. London: Edward Arnold (Publishers) Ltd; 2008.1539-48.
Dunlop IS, Billson FA. Visual failure in allergic aspergillus sinusitis: case report. British Journal of Ophthalmology .1988; 72:127-30.
Venugopal M, Sagesh M. Proptosis: The ENT Surgeon's Perspective. Indian J Otolaryngol Head Neck Surg. 2013 Aug; 65(2):247-50.
El-Sayed Y. Orbital involvement in sinonasal disease Saudi J Ophthalmol .1995; 9:29-37.
Samil KS, Yasar C, Ercan A, Hanifi B, Hilal K. Nasal Cavity and Paranasal Sinus Diseases Affecting Orbit. J Craniofac Surg. 2015; 26(4):348-51.
Yang C, Hong-gang L, Zhen-kun YU. Patterns and incidence of sinonasal malignancy with orbital invasion. Chin Med J. 2012; 125(9):1638-42.
Sinha V, Bhardwaj D, George A, Memon RA. Proptosis through eyes of e.n.t. surgeon. Indian Journal of Otolaryngology and Head and Neck Surgery.2005; 57(3):247-50.
Chang WJ, Shields CL, Shields JA, Carol L, DePotter PV, Schiffman R et al .Bilateral orbital involvement with massive allergic fungal sinusitis. Arch Ophthalmol. 1996; 114:767-768.
Heier JS, Gardner TA, Hawes MJ, McGuire KA, Walton WT, Stock J. Proptosis as the initial presentation of fungal sinusitis in immunocompitent patients. Ophthalmology. 1995; 102(5):713-17.
Masud ZS, Bano S .Diagnostic role of CT scan in proptosis in paediatric age group. JPMI.2003; 18(3):439-42.
DelGaudio JM, Swain Jr RE, Kingdom TT, Muller S, Hudgins PA. Computed Tomographic Findings in Patients With Invasive Fungal Sinusitis. Arch Otolaryngol Head Neck Surg. 2003; 129:236-40.
Duggal P1, Wise SK. Invasive fungal rhinosinusitis. Am J Rhinol Allergy.2013; 27 (1):28-30.
Biswas SS, Al-Amin Z, Razib FA, Mahbub S. Acute invasive fungal rhinosinusitis: our experience in immunocompromised host. Mymensingh Med J. 2013 Oct; 22(4):814-9.
Halderman A1, Shrestha R, Sindwani R. Chronic granulomatous invasive fungal sinusitis: an evolving approach to management. Int Forum Allergy Rhinol. 2014; 4(4):280-3.
Mehta R, Panda NK, Mohindra S, Chakrabarti A, Singh P. Comparison of Efficacy of Amphotericin B and Itraconazole in Chronic Invasive Fungal Sinusitis. Indian J Otolaryngol Head Neck Surg. 2013; 65(2): 288-294.
Lee DH, Yoon TM, Lee JK, Joo YE, Park KH, Lim SC. Invasive fungal sinusitis of the sphenoid sinus. Clin Exp Otorhinolaryngol.2014; 7(3):181-7.
Suárez C, Ferlito A, Lund VJ, Silver CE, Fagan JJ, Rodrigo JP et al. Management of the orbit in malignant sinonasal tumors. Head Neck. 2008; 30(2):242-50.1. Slack R, Sim R. Complications of rhinosinusitis. In: Scott-Brown WG, Gleeson M, Browning GG, editors. Scott-Brown's otolaryngology, head and neck surgery. 7th ed. London: Hodder Arnold; 2008. p.1539-48.
Dunlop IS, Billson FA. Visual failure in allergic aspergillus sinusitis: case report. Br J Ophthalmol 1988;72(2):127-30.
Venugopal M, Sagesh M. Proptosis: The ENT Surgeon's Perspective. Indian J Otolaryngol Head Neck Surg 2013;65(2):247-50.
El-Sayed Y. Orbital involvement in sinonasal disease. Saudi J Ophthalmol 1995;9:29-37.
Samil KS, Yasar C, Ercan A, Hanifi B, Hilal K. Nasal Cavity and Paranasal Sinus Diseases Affecting Orbit. J Craniofac Surg 2015;26(4):e348-51.
Chu Y, Liu HG, Yu ZK. Patterns and incidence of sinonasal malignancy with orbital invasion. Chin Med J 2012;125(9):1638-42.
Sinha V, Bhardwaj D, George A, Memon RA. Proptosis through eyes of E.N.T. surgeon. Indian J Otolaryngol Head Neck Surg 2005;57(3):247-50.
Chang WJ, Shields CL, Shields JA, DePotter PV, Schiffman R, Eagle RC Jr, et al. Bilateral orbital involvement with massive allergic fungal sinusitis. Arch Ophthalmol 1996;114(6):767-8.
Heier JS, Gardner TA, Hawes MJ, McGuire KA, Walton WT, Stock J. Proptosis as the initial presentation of fungal sinusitis in immunocompitent patients. Ophthalmology 1995;102(5):713-7.
Masud ZS, Bano S. Diagnostic role of CT scan in proptosis in paediatric age group. J Postgrad Med Inst 2003;18(3):439-42.
DelGaudio JM, Swain RE Jr, Kingdom TT, Muller S, Hudgins PA. Computed Tomographic Findings in Patients With Invasive Fungal Sinusitis. Arch Otolaryngol Head Neck Surg 2003;129(2):236-40.
Duggal P, Wise SK. Invasive fungal rhinosinusitis. Am J Rhinol Allergy 2013;27(Suppl 1):S28-30.
Biswas SS, Al-Amin Z, Razib FA, Mahbub S. Acute invasive fungal rhinosinusitis: our experience in immunocompromised host. Mymensingh Med J 2013;22(4):814-9.
Halderman A, Shrestha R, Sindwani R. Chronic granulomatous invasive fungal sinusitis: an evolving approach to management. Int Forum Allergy Rhinol 2014;4(4):280-3.
Mehta R, Panda NK, Mohindra S, Chakrabarti A, Singh P. Comparison of Efficacy of Amphotericin B and Itraconazole in Chronic Invasive Fungal Sinusitis. Indian J Otolaryngol Head Neck Surg 2013;65(2):288-94.
Lee DH, Yoon TM, Lee JK, Joo YE, Park KH, Lim SC. Invasive fungal sinusitis of the sphenoid sinus. Clin Exp Otorhinolaryngol 2014;7(3):181-7.
Suárez C, Ferlito A, Lund VJ, Silver CE, Fagan JJ, Rodrigo JP, et al. Management of the orbit in malignant sinonasal tumors. Head Neck 2008;30(2):242-50.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
