ABSTRACT
Abstract Introduction: Radiologic evaluation is mandatory to assess the type of endoscopic approach concerning sinonasal pathology and reconstruction of fractured defects before any treatment modalities are instituted related to medial wall of the orbit. Objective: The goal was to provide improved understanding of the lamina papyracea variations and the relationship with the orbital morphometry. Methods: This retrospective study was performed using computed tomography scans of 200 orbits and results were compared with respect to age, sex, laterality and LP variations. Results: Lamina papyracea variations were categorized as type A, 80.5% (161/200); type B, 16% (32/200); type C, 3.5% (7/200). For medial wall the anterior and posterior lamina papyracea heights and angles were found as 17.14 mm, 147.88º and 9.6 mm, 152.72º, respectively. Also, the length of the lamina papyracea, the mean area of the orbital floor, medial wall, lamina papyracea and orbital entrance were 33.3 mm, 7.2 cm2, 6.89 cm2, 4.51 cm2 and 12.46 cm2 respectively. The orbital height and width were measured as 35.9 mm and 39.2 mm respectively. The mean orbital cavity depth was 46.3 mm from optic foramen to the orbital entrance and the orbital volume was 19.29 cm3. We analyzed the morphometric measurements tending to increase with aging and greater in men and the relationship of them with lamina papyracea types. Conclusion: Precise knowledge of the lamina papyracea anatomy using computed tomography is essential for safer and more effective surgery and preforming the dimensions of an implant. In this way, the postoperative complications can be decreased and the best outcome can be provided.
Resumo Introdução: A avaliação radiológica é mandatória para avaliar o tipo de abordagem endoscópica no tratamento cirúrgico de doença nasossinusal e na reconstrução de fraturas antes de quaisquer modalidades de tratamento relacionadas à parede medial orbital. Objetivo: O objetivo foi proporcionar uma melhor compreensão das variações da lâmina papirácea e a relação com a morfometria orbital. Método: Este estudo retrospectivo foi realizado por meio de tomografia computadorizada de 200 órbitas, e os resultados foram comparados em relação à idade, sexo, lateralidade e variações da lâmina pairácea. Resultados: As variações da lâmina papirácea foram categorizadas como tipo A, 80,5% (161/200); tipo B, 16% (32/200); tipo C, 3,5% (7/200). Para a parede medial, as medidas das alturas anteriores e posteriores da lâmina papirácea e ângulos foram de 17,14 mm, 147,88º e 9,6 mm, 152,72º, respectivamente. Além disso, as medidas do seu comprimento da, da área média do assoalho orbital, e da parede medial, lâmina papyracea e entrada orbital foram: 33,3 mm, 7,2 cm2, 6,89 cm2, 4,51 cm2 e 12,46 cm2, respectivamente. As medidas da altura e da largura orbitais foram 35,9 mm e 39,2 mm, respectivamente. A profundidade média da cavidade orbital foi de 46,3 mm, do forame óptico até a entrada orbital, e o volume orbital foi de 19,29 cm3. Analisamos as medidas morfométricas com tendência a aumentar com o envelhecimento e nos indivíduos do sexo masculino, e a relação das mesmas com os tipos de lâmina. Conclusões: O conhecimento preciso da anatomia da lâmina papirácea por meio de tomografia computadorizada é essencial para uma cirurgia mais segura e eficaz, além de permitir pré-moldar as dimensões do implante. Assim, as complicações pós-operatórias podem ser minimizadas, obtendo-se melhores resultados.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Orbit/anatomy & histology , Orbit/diagnostic imaging , Tomography, X-Ray Computed/methods , Endoscopy/methods , Orbit/injuries , Paranasal Sinuses/surgery , Paranasal Sinuses/injuries , Paranasal Sinuses/diagnostic imaging , Postoperative Complications/prevention & control , Retrospective Studies , Ethmoid Bone/injuries , Ethmoid Bone/diagnostic imagingABSTRACT
OBJECTIVE To investigate the CT classification of the lamina papyracea ingression and its significance. METHODS Data of computed tomography(CT) were analyzed retrospectively in 928 patients with nasal symptoms in out-patient department of Huairou Hospital from April 2017 to September 2017. All data were analyzed predicatively to observe the prevalence of lamina papyracea ingression. RESULTS The probability of lamina papyracea ingression in this group was 6.03％(112/1856). The lamina papyracea ingression were divided into four types on the basis of the coronal CT: upper medial rectus type, medial rectus type, under medial rectus type and generalized type. There was no difference in the incidence between the under medial rectus type and the extensive type(P=1.00), there were significant differences in the incidence of the remaining types(P=0.00). CONCLUSION In this study, the classification of the lamina papyracea ingression on coronal CT is helpful to understand lamina papyracea ingression better and reduce the intraorbital complicatians of endoscopic sinus surgery.
ABSTRACT
Natural dehiscence of the lamina papyracea is usually found in ostiomeatal unit CT images and during functional endoscopic sinus surgery. The surgery should be performed on the basis of clinical findings and ostiomeatal unit CT scans to determine the extent of disease and the structural anomalies. Preoperative awareness of dehiscence in the lamina papyracea is essential for avoiding orbital complications during surgery. Sinusitis arising from the natural dehiscence of the lamina papyracea is extremely rare. We report, with a review of the literature, a case of sinusitis due to the natural dehiscence of the lamina papyracea in a 46-year-old female, treated by endoscopic sinus surgery. The CT finding presented a huge natural dehiscence of the lamina papyracea and chronic sinusitis of the maxillary ethmoid sinus. Most of the patient's symptoms resolved without recurrence after endoscopic sinus surgery.
Subject(s)
Female , Humans , Middle Aged , Ethmoid Sinus , Nasal Obstruction , Orbit , Recurrence , SinusitisABSTRACT
BACKGROUND: Orbital complications may be occured by means of surgical injury to lamina papyracea during endoscopic sinus surgery or intranasal ethmoidectomy. The frequency of orbital complications increases when the natural dehiscence of lamina papyracea(NDLP) with or without prolapse of orbital content into ethmoid sinus is present. OBJECTIVES: The aim of this study is to evaluate the incidence and radiologic characteristics of NDLP, and to evaluate association NDLP with anatomical variations of nasal cavity and paranasal sinuses. MATERIALS AND METHOD: The axial and coronal paranasal sinus CT scans of 183 patients with chronic paranasal sinusitis(366 sides) who had undergone endoscopic sinus surgery were retrospectively reviewed and analyzed. The incidence and radiologic features of NDLP, and the association NDLP with anatomical variations of paranasal sinus and nasal cavity were analyzed. RESULTS: The NDLP was found in 18 patients(9.8%, n=183 patients) or 22 sides(6.0%, n=366 sides). The most common site of NDLP was superior portion(45.5%) in coronal image of paranasal sinus CT scans and anterior ethmoid sinus area(68.2%) in axial image. Grade 1 of NDLP(86.4%) was observed most commonly. NDLP was not associated with anatomical variations of paranasal sinus. CONCLUSION: The incidence of NDLP with prolapse of orbital content is far beyond general expectation, and close preoperative evaluation of paranasal sinus CT scans is important to avoid possible orbital complications.