ORBITAL INVOLVEMENT IN SINONASAL DISEASES

Authors

  • Zia-us-Salam Qazi Post Graduate Medical Institute Shaikh Zayed Hospital
  • Sarfraz Latif
  • Sadia Maqsood Awan

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 bilaterallyTo analyze the management strategy and final outcome in all the casesMATERIALS & METHODSHundred 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 RESULTS37% 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 tuberculosisMost 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

Author Biography

Zia-us-Salam Qazi, Post Graduate Medical Institute Shaikh Zayed Hospital

Assistant ProfessorDepartment of ENT, Head & Neck SurgeryShaikh Zayed HospitalLahore, Pakistan

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.

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Published

2016-11-27