Sino-orbital fistula: a complication of exenteration.
OBJECTIVE
To report the incidence, characteristics, and management of sino-orbital fistulas, a complication of orbital exenteration.


METHODS
Retrospective interventional case series.


METHODS
One hundred ten patients who underwent orbital exenteration at 2 orbital units.


METHODS
Retrospective chart review of all cases of orbital exenteration between 1993 and 2005 at one orbital unit and between 1999 and 2005 at a second orbital unit.


METHODS
Incidence of sino-orbital fistulas.


RESULTS
Seventy-three and 37 orbital exenterations were performed at the first and second orbital units, respectively. Five patients developed sino-orbital fistulas, 1 of whom developed 2 fistulas at separate sites. In the first unit, 4 fistulas developed in 3 of 73 (4.1%) patients who underwent orbital exenteration. In the second unit, 2 fistulas developed in 2 of 37 (5.4%) exenterated orbits. The majority (5/6) of fistulas occurred medially to the ethmoid sinus, whereas 1 occurred superiorly to the frontal sinus. Risk factors that may have contributed to fistula formation include radiotherapy (3/6), sinus disease (3/6), intraoperative penetration into a sinus (3/6), and immunocompromise (1/6). Management was tailored to the individual case and ranged from conservative socket hygiene to surgical repair with grafts or flaps. Four of the 6 fistulas recurred after repair. Three of these subsequently were closed successfully. Only 1 fistula persisted until the patient died from malignant disease.


CONCLUSIONS
Sino-orbital fistulas are uncommon but not rare complications of orbital exenteration that may be predicted by several risk factors. Bothersome symptoms may necessitate treatment, which can range from conservative management to surgical repair with various grafts or flaps. Despite repair, fistulas may be difficult to eradicate.
Limawararut
Vanessa
V
Oculoplastic and Orbital Division, Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia.
Leibovitch
Igal
I
Davis
Garry
G
Rees
Guy
G
Goldberg
Robert A
RA
Selva
Dinesh
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005402:Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D009916:Orbital Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D009918:Orbital Neoplasms / Q000601:surgery; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors