Evaluation of Globe Position Asymmetry in Endocrine Orbitopathy Patients and a Control Group - A Computed Tomography-Based 3D Cephalometric Analysis.

Eplasty Pub Date : 2023-01-01
Konstantin Volker Hierl, Thomas Hierl, Daniel Kruber, Matthias Krause, Ina Sterker
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Abstract

Background: Previous studies have shown that patients suffering from endocrine orbitopathy (EO) seem to present with profound asymmetry in proptosis. As asymmetry might pose a major problem in planning decompression surgery, information on the amount of variation between sides and a concise evaluation method should be available. Therefore, a study based on a concise 3D cephalometric analysis was conceived to evaluate globe position.

Methods: A 3D-cephalometric analysis was performed on computed tomography (CT) data from 52 orbitopathy and 54 control data sets. Using 36 anatomic landmarks, 33 distances were evaluated to measure sagittal, vertical, and horizontal globe position.

Results: EO patients presented with marked exophthalmos and statistically significant asymmetry. Depending on the 2 measured distances, 38% and 42%, respectively, presented sagittal asymmetry of >2 mm, and 12% and 13%, respectively, presented with sagittal asymmetry >4mm. No such asymmetry was seen in the control group. Furthermore, EO patients showed a larger interglobe distance due to lateral globe position. Marked asymmetry correlated with male sex. Proptosis measured to the deep bony orbit correlated with values measured to the orbital aperture or with constructed Hertel values.

Conclusions: Use of 3D cephalometry and CT-based analysis confirmed findings from previous clinical studies on profound sagittal asymmetry in EO. Endocrine orbitopathy leads to a sagittal-lateral globe displacement that is even more pronounced in the current study than in earlier investigations. Concerning surgical therapy, presurgical asymmetry, especially if profound, has to be considered to achieve an esthetic symmetrical outcome. Use of 3D orbital analysis is an appropriate method to describe globe position beyond clinical measurements.

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评价内分泌眼病患者和对照组的眼球位置不对称-基于计算机断层扫描的三维头颅测量分析。
背景:以往的研究表明,内分泌眼病(EO)患者似乎表现出严重的眼球突出不对称。由于不对称可能会在计划减压手术时造成主要问题,因此应提供有关两侧变异量的信息和简明的评估方法。因此,一项基于简洁的三维头颅测量分析的研究被设想为评估球体位置。方法:对52例眼病患者和54例对照患者的CT数据进行三维头颅测量分析。使用36个解剖标志,评估33个距离,以测量矢状,垂直和水平的球体位置。结果:EO患者有明显的眼球突出和有统计学意义的不对称性。根据2个测量距离的不同,矢状面不对称> 2mm的分别占38%和42%,矢状面不对称>4mm的分别占12%和13%。在对照组中没有发现这种不对称。此外,EO患者由于球位外侧,球间距离较大。明显的不对称与男性有关。深骨眶突测量值与眶孔径测量值或构建的Hertel值相关。结论:使用三维头颅测量和基于ct的分析证实了先前临床研究中关于EO中严重矢状面不对称的发现。内分泌眼窝病导致矢状-外侧眼球移位,在当前研究中比在早期研究中更为明显。关于手术治疗,术前不对称,特别是如果深度,必须考虑实现美观对称的结果。使用三维轨道分析是描述超出临床测量的地球位置的合适方法。
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