Missed Dehiscence of Lamina Papyracea by Radiologists: Orbital
Herniation Mimicking Sinusitis and Harboring Potential Complications
Abstract
Introduction: Functional endoscopic sinus surgery (FESS) has
become the gold standard for treating chronic rhinosinusitis (CRS), and
it is regarded as a relatively safe and effective technique. Orbital
complications of FESS have been reported for many years owing to the
close anatomical relationship between the paranasal sinuses and the
orbit. Accidental injury of the lamina papyracea (LP) during FESS, was
described in up to 5% of cases. Preventing complications begins with
preoperative planning and careful review of computed tomographic (CT)
scans. Methods: This was a multicentric national survey to
report any case of lamina papyracea defect (LPD) that was not reported
by radiologists. Multiple rhinologists from different provinces of Saudi
Arabia (SA) were invited to report any patient with such an incidence in
the last two years. patient-specific data were all included in this
study. Results: The data of 16 patients, 11 males and 5
females, were reviewed retrospectively. The median age at diagnosis was
37.4 years. The right side is the most prevalent location of LPD (8
patients, 50%), despite the fact that most cases (75%) had no history
of trauma or sinus surgery. Five patients had left-side LPDs and three
had bilateral LPDs. Conclusion: Injury to the LP is a
well-known avoidable complication of FESS. Careful and attentive review
of CT scan images pre-operatively and by the operating surgeon is of
utmost importance. This should always include the integrity and
configuration of the medial orbital wall and LP without depending on the
report of CT scans.