Clinical and radiological characteristics of Graves' orbitopathy patients showing spontaneous decompression

• Published in: Journal of cranio-maxillo-facial surgery Vol. 43; no. 1; pp. 48 - 52
• Main Authors: Kang, Eun Min, Yoon, Jin Sook
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.01.2015
• Subjects: Adult; Aged; Bone Remodeling - physiology; Compressive optic neuropathy; Dentistry; Ethmoid Sinus - diagnostic imaging; Female; Follow-Up Studies; Fractures, Spontaneous - diagnostic imaging; Graves Ophthalmopathy - diagnostic imaging; Graves' orbitopathy; Humans; Male; Middle Aged; Nerve Compression Syndromes - diagnostic imaging; Oculomotor Muscles - diagnostic imaging; Optic Nerve Diseases - diagnostic imaging; Orbit - diagnostic imaging; Orbital Fractures - diagnostic imaging; Remission, Spontaneous; Retrospective Studies; Spontaneous decompression; Surgery; Tomography, X-Ray Computed - methods; Spontaneous decompression; Graves' orbitopathy; Compressive optic neuropathy
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2014.10.008

Abstract Objective To investigate clinical implications and radiological characteristics of spontaneous decompression in patients with Graves' orbitopathy (GO). Methods The medical records and images of GO patients showing spontaneous decompression in computed tomography (CT) scans without any other cause, such as orbital surgery or trauma were retrospectively reviewed. Clinical parameters, including clinical activity score (CAS), modified NOSPECS score, exophthalmometry results, extraocular muscle involvement, and the presence of optic nerve compression were evaluated. Paired orbit analyses of maximum recti muscle diameters, area of lamina papyracea, and number of ethmoid air cell septa were determined quantitatively in the unilaterally decompressed group. Results 77 orbits of 55 patients were found to present spontaneous decompression, which was observed only in the medial orbital wall in all cases. In the paired orbit comparison, maximal diameters of medial ( P  = 0.009) and lateral recti muscles ( P  = 0.023) were significantly larger in decompressed orbits than in non-decompressed orbits. However, the incidence of optic neuropathy was not significantly different ( P  = 0.500). There was no difference in anatomic features of lamina papyracea or ethmoid air cells between decompressed and non-decompressed orbits. Conclusions Spontaneous decompression occurred in the medial wall, associated with enlarged horizontal recti muscles, but not with structures of lamina papyracea or the ethmoidal sinus. Orbital bone remodeling by spontaneous decompression by lowering intraorbital pressure, might have provided a protective effect against the development of optic neuropathy.