Introducing 

Prezi AI.

Your new presentation assistant.

Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.

Loading…
Transcript

Clinical features

Diagnosis and Treatment Options

Treatment

Clinical features

Diagnosis

  • Aggressive surgical debridement
  • Depending on the extent of involvement -
  • MMA, Ant, post ethmoidectomy and sphenoidotomy.
  • Orbital/optic nerve decompression with or with out Evisceration or Enucleation.

  • Patients presented with ophthalmologic symptoms like
  • Retro orbital pain which was throbbing type aggravated in the night - initially relieved with NSAID's as it progress not relieved with medications.
  • Progressive dimnision of vision
  • Proptosis - progressive
  • Based on clinical features.
  • Diagnostic nasal endoscopy.
  • CT scan and MRI with contrast.
  • Tissue from the lesion for Histopathology and Microbiological study, Fungal culture.
  • Antifungal antibiotics
  • Amphotericin B - can be given up to 1 to 2g depending on the disease severity and patient tolerance
  • Liposomal Amphotericin - less side effects compaired to Amphotericin B

Case Reports

Case 2

Case 3

Case 1

Pathogenesis

  • 35yrs male patient presented with history of nasal obstruction, nasal discharge and proptosis
  • previous history of surgery for mass involving paranasal sinuses operated in 2008 and endoscopic polypectomy in 2012.
  • He underwent endoscopic fungal sinus clearance and was put on itraconazole.
  • This patient presented with cheek swelling and proptosis since 6 months.
  • Examination revealed polypoidal mass in left middle meatus.
  • Diffuse swelling and tenderness over LT infra orbital region.
  • CT and MRI - soft tissue mass in the left maxillary sinus with destruction of superior, lateral and antero lateral walls. extension of mass into floor of the orbit.
  • Biopsy - Invasive aspergillosis
  • Left FESS + Lt orbital decompression was done and pt put on syp. posaconazole 200mg TID.
  • This patient presented with history of right eye pain, gradually progressive proptosis and dimnishing vision since 8 months,
  • she is a known hypertensive and asthamatic but not a diabetic.
  • Examination revealed - edema of eyelids and proptosis. fundus examination showed optic atrophy and PL was negative.
  • Biopsy showed fungal elements.
  • she underwent endoscopic fungal clearance in PNS with excenteration of right eye with fronto parietal craniotomy and MCF dural defect repair using intradural pericranial flap.
  • she given Amphotericin B - 1.5gm.
  • Rapid spread of fungi through vascular invasion into the orbit and CNS.
  • It is common in patients with diabetes and in patients who are immunocompromised and has been reported in immunocompetent individuals.
  • Most common way of spread is by interference of venous drainage of orbital contents
  • Many direct connections of veins of the nose and paranasal sinus with veins of the orbit and cavernous sinus are directly responsible for involvement of orbit.
  • Involvement of orbital contents secondary to infection of sinus is primarily due to anatomic contiguity of the two structures.
  • The direct erosion of the bone by the disease process.
  • Congential bony dehiscence of orbit exposes orbital contents directly to sinus infections.

ORBITAL COMPLICATIONS OF INVASIVE FUNGAL SINUSITIS IN NON IMMUNOCOMPROMISED PATIENTS

Case 4

Case 5

  • 60 yrs old female presented with retro orbital pain with epiphora with occasional nasal block.
  • CT Scan showed lesion involving sphenoid and posterior ethmoid sinus and optic nerve.
  • Ant and post ethmoidectomy with sphenoidotomy with optic nerve decompression.
  • IV liposomal Amphoterecin B was given.
  • 45 yrs old female patient presented with history of hemifacial pain and numbness
  • she had proptosis and abducted right eye.
  • CT brain showed frontal, ethmoidal and sphenoidal sinusitis with intra cranial involvement
  • endoscopic debridement and orbital decompression were done
  • Biopsy showed invasive aspergillosis
  • she was started on Amphotericin -B and voriconazole.
  • she developed brain stem infarct.

In all our patients who are not immunocompromised disease spread from ethmoid and sphenoid sinus to orbital apex then spread intracranially except for one patient who had maxillary sinus involvement and erosion of the orbital walls.

Dr Narasimharaju B G

Anatomy

Conclusion

  • The medial wall is formed by 5 bones.
  • Venous drainage of orbit is by superior and inferior ophthalmic veins
  • Orbit is bounded on 3 sides by para nasal sinuses
  • The medial wall is important as it is the most commonly involved during infections
  • Unlike routine presentations of fungal sinusitis with orbital involvement, Our patients presented primarily with ophthalmic symptoms like retro orbital pain, proptosis and progressive dimnision of vision.
  • All patients underwent surgical intervention i.e., sphenoethmoidotomy with orbital and optic nerve decompression according to involvement of disease followed by medical management with antifungals.

Ethmoid bone has horizontal and vertical parts

Thank You

Learn more about creating dynamic, engaging presentations with Prezi