Graves’ Disease: Orbital Bony Decompression and Mini-Osteotomy of the Infraorbital Nerve. Case Report

Graves’ Disease: Orbital Bony Decompression and Mini-Osteotomy of the Infraorbital Nerve. Case Report

Luigi Clauser, MD, DMD¹, Riccardo Luoni Orsi, DMD¹, and Andrea Edoardo Bianchi, MD, DMD^1,2

¹Unit of Maxillofacial Surgery, Istituto Stomatologico Italiano, Via Pace, 21 20122 MILANO, Italy; ^1,2UniCamillus, Saint Camillus International Medical University, Via di Sant’Alessandro,8,00131 ROME, Italy

Aim: Graves’ disease or endocrine orbitopathy (EO) is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). EO is characterized by the symptomatic triad of hyperthyroid goiter, orbitopathy, and dermatopathy. The surgical techniques used to correct EO can be fat decompression by using the Olivari technique, 3-wall bony decompression, or the combination of these surgical strategies. Fat decompression is indicated when the intraconal and extraconal fat tissue is increased, whereas bony decompression is used  when there is extraocular muscle involvement associated with a normal quantity of intraconal-extraconal fat. Surgical techniques include the transconjunctival approach and ostectomy of the medial wall (when possible, through endoscopy), orbital floor, and lateral wall of the orbit. Complications of bony decompression are often represented by sensitivity disorders of the second branch of the trigeminal nerve, compressed by the intraorbital contents when they prolapse into the sinus. Possible sensitivity disorders are paresthesia, anesthesia, hypoesthesia, dysesthesia, and hyperesthesia.

Methods: The technique consists of performing a mini-osteotomy around the infraorbital foramen with removal of a small bony fragment. This causes the nerve to relax and makes it easier for the descent of periorbital tissue into the maxillary sinus, allowing a larger expansion of the orbit contents. The absence of compression significantly reduces sensitive complications.

Conclusion: The use of the mini osteotomy of the infraorbital foramen combined with a 3-wall bony expansion leads to a significant reduction of sensitive complications that otherwise often cause patient discomfort.

Keywords: Graves’ disease, endocrine orbitopathy, exophthalmos, orbital fat decompression, orbital   bony decompression, orbital surgery,infra-orbital nerve,sensitivity disorders

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How to cite this article:

Luigi Clauser, Riccardo Luoni Orsi, Andrea Edoardo Bianchi.Graves’ Disease: Orbital Bony Decompression and Mini-Osteotomy of the Infraorbital Nerve. Case Report. International Journal of Case Reports, 2023, 7:290. DOI: 10.28933/ijcr-2023-03-1603lc

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