Name of the Procedure:

Nasal/sinus endoscopy, surgical, with orbital decompression; medial or inferior wall

Summary

In this surgical procedure, doctors use an endoscope to view and operate on the nasal and sinus passages to relieve pressure on the eye by decompressing the medial or inferior wall of the orbit. This helps create more space around the eye to alleviate symptoms caused by various conditions.

Purpose

The primary aim of this procedure is to treat conditions that cause increased pressure within the orbit (eye socket). Conditions such as thyroid eye disease (Graves' orbitopathy) can cause bulging eyes, pain, and vision problems, which might be relieved by orbital decompression. The goal is to decrease eye pressure, improve eye appearance, reduce discomfort, and potentially preserve or enhance vision.

Indications

• Thyroid eye disease (Graves' orbitopathy)
• Orbital tumors
• Trauma to the orbital wall
• Elevated intraorbital pressure leading to pain or vision issues

Patients who experience severe eye bulging (proptosis), visual disturbances, or orbital pain that do not respond to medication might be candidates for this procedure.

Preparation

• Fasting for at least 6-8 hours prior to surgery
• Adjustments to medications as instructed by the healthcare provider
• Preoperative diagnostic tests like CT or MRI scans to assess the extent of decompression needed

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Endoscope Insertion: An endoscope—a thin, flexible tube with a camera—is inserted through the nasal passages.
3. Accessing the Orbital Wall: The surgeon carefully navigates the endoscope to reach the medial or inferior wall of the orbit.
4. Decompression: Using specialized instruments, the surgeon removes or repositions the bony structures and soft tissues compressing the orbit.
5. Closure: The instruments are withdrawn, and temporary nasal packing may be applied to control bleeding.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

This surgery is usually performed in a hospital or an outpatient surgical center equipped with advanced surgical and imaging technology.

Personnel

• Surgeon: A specialist trained in endoscopic sinus surgery, often an otolaryngologist (ENT) or an ophthalmologist.
• Nurses: Assist with surgical preparation and postoperative care.
• Anesthesiologist: Manages anesthesia during the procedure.

Risks and Complications

• Bleeding
• Infection
• Double vision (diplopia)
• Injury to surrounding structures, including the eye muscles or optic nerve
• Temporary or permanent vision changes
• Scar tissue formation

Benefits

• Relief from eye bulging (proptosis)
• Reduction in eye pain and discomfort
• Improvement or stabilization in vision
• Enhanced cosmetic appearance of the eyes

These benefits are often noticeable soon after recovery from the surgery.

Recovery

• Initial recovery involves rest and head elevation to reduce swelling.
• Patients may experience nasal congestion and mild discomfort.
• Use of prescribed nasal sprays or pain medications as directed.
• Follow-up appointments to monitor healing and address any complications.
• Typically, patients can return to normal activities within 2-4 weeks, although rigorous activities should be avoided for several weeks longer.

Alternatives

• Medical management with corticosteroids or other medications
• Radiation therapy for some conditions
• Traditional open orbital decompression surgery
• Observation and symptomatic treatment

The choice of alternative treatments depends on the severity of the condition, patient-specific factors, and consultation with healthcare specialists to weigh the benefits and risks.

Patient Experience

Patients are under general anesthesia during the procedure and will not feel anything. Postoperatively, they might experience nasal stuffiness, mild pain, and swelling. Discomfort is usually manageable with medication, and many patients report significant symptom relief within weeks.