Sino-orbital Fistula: A Complication of Exenteration
Received 21 February 2006; accepted 21 June 2006. published online 21 November 2006.
Purpose
To report the incidence, characteristics, and management of sino-orbital fistulas, a complication of orbital exenteration.
Design
Retrospective interventional case series.
Participants
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.
Main Outcome Measures
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.
1Oculoplastic and Orbital Division, Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia.
2South Australian Institute of Ophthalmology, Adelaide, Australia.
3Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California.
4Department of Otolaryngology, University of Adelaide, Adelaide, Australia.
Reprint requests to Dinesh Selva, FRACS, FRANZCO, Department of Ophthalmology & Visual Sciences, Royal Adelaide Hospital, Level 8, North Terrace, Adelaide, SA 5000, Australia.
Manuscript no. 2006-223.
The authors have not received any financial support for this publication.
The authors have no conflicting relationships involving any products, materials, or ideas discussed in the article.
ABSTRACT