title: Management of sinonasal complications after endoscopic orbital decompression for Graves' orbitopathy.
abstract: OBJECTIVE
  Endoscopic orbital decompression (EnOD) has proven to be safe and effective for the treatment of Graves' orbitopathy; however, complications do occur. Although the literature focuses on orbital complications, sinonasal complications including postobstructive sinusitis, hemorrhage, and cerebrospinal fluid (CSF) leak can also be challenging to manage. This study examines the incidence and management of sinonasal complications in these patients.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Clinical data, surgical findings, and postoperative outcomes were reviewed of patients who underwent EnOD for Graves' disease between March 2004 and November 2010. The incidence and management of postoperative sinonasal complications requiring an intervention were examined.
  
  
  RESULTS
  The study group consisted of 50 consecutive patients (86 decompression procedures): 11 males and 39 females with an average age of 48.6 years (SD = 12.9). Incidence of significant sinonasal complications was 3.5% (5/86): with one patient experiencing postoperative hemorrhage requiring operative management, three patients with postoperative obstructive sinusitis, and one patient with nasal obstruction secondary to nasal adhesions that required lysis. The maxillary sinus was the most commonly involved and was managed using the mega-antrostomy technique. In the case of frontal sinusitis, an endoscopic transaxillary approach was utilized to avoid injury to decompressed orbital contents. All complications were successfully managed without sequelae.
  
  
  CONCLUSIONS
  Sinonasal complications following EnOD are uncommon. In the setting of a decompressed orbit, even routine types of postoperative issues can be challenging and require additional considerations. Successful management of postoperative sinusitis related to outflow obstruction may require more extensive approaches and novel techniques.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery (.), Saint Louis University, Saint Louis, Missouri, Ohio, and the.
authors.forename: Jastin L
authors.initials: JL
authors.lastname: Antisdel
authors.forename: Divya
authors.initials: D
authors.lastname: Gumber
authors.forename: Janalee
authors.initials: J
authors.lastname: Holmes
authors.forename: Raj
authors.initials: R
authors.lastname: Sindwani
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000009:adverse effects* / Q000379:methods; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012220:Rhinitis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index; D012852:Sinusitis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopic orbital decompression; Graves' orbitopathy; complications; exophthalmos; sinonasal