Orbital Causes of Ostiomeatal Complex Occlusion.

Purpose: This study aimed to describe uncommon cases of ostiomeatal complex (OMC) occlusion and maxillary atelectasis secondary to orbital pathology.

Methods: A retrospective chart review of cases of ostiomeatal occlusion and maxillary atelectasis at a single institution was performed. Patients with an identifiable orbital cause were included, whereas patients with idiopathic occlusion (silent sinus syndrome) were excluded. Data collected included patient age, sex, clinical presentation, and measurements including exophthalmolmetry, radiographic features, interventions, and outcomes.

Results: Eight patients were identified with mechanical causes of ostiomeatal occlusion arising from the orbit. Five cases had malpositioned orbital floor implants in the setting of remote orbital reconstruction, including after trauma. Two cases had previous orbital decompression for thyroid eye disease with subsequent orbital mucocele and fat prolapse into the OMC. One case had distensible venous malformation of the inferior orbit resulting in occlusion of the OMC. The majority of patients required both endoscopic sinus surgery and treatment of the orbital pathology causing the OMC occlusion.

Conclusions: While rare, orbital pathology may cause OMC occlusion, which may lead to maxillary sinus atelectasis. Orbital surgeons should be aware of these associations and have a high index of suspicion when subclinical maxillary atelectasis is seen in conjunction with orbital pathology. Treatment may require addressing the underlying cause as well as multidisciplinary management of both sinus surgery to restore maxillary sinus ventilation and possible orbital reconstruction.