Balanced orbital decompression for thyroid-associated orbitopathy and the role of stereotactic navigation in infraorbital nerve preservation.

Introduction: Thyroid-associated orbitopathy (TAO) is the most common adult inflammatory eye disease. Proptosis is a TAO common clinical sign. Besides daily physical discomfort, TAO impacts negatively mental health. Proptosis is treated by orbital decompression surgery. Infraorbital nerve dysesthesia is a common complication. Stereotactic navigation is an imaging-guided surgery. This less invasive procedure could reduce postoperative complications and improve recovery. This study aims to evaluate the impact of navigation on patients' outcomes.

Methods: A retrospective study was conducted, including TAO patients treated for unilateral or bilateral balanced orbital decompression between 2021 and 2024. One surgeon performed all the procedures. Pre, per and postoperative data such as lipectomy, surgery duration, proptosis, diplopia, symmetry of eyeball protrusion, infraorbital nerve injury with hypo or dysesthesia impacting daily life and subjective impact of the surgery on disfiguration were evaluated. Postoperative evaluation was conducted at least 6 months after the operation.

Results: The current study included 91 patients and 166 orbits, respectively, 135 in the classic surgery (Cs) group, 31 in the stereotactic surgery (Sts) group. The average time spent in the operating theatre in all surgery types was longer in the Sts approach. In both cases, the improvement in right-left symmetry was statistically significant (p<0.001). Six months after surgery, 51 patients complained of hypo- or dysaesthesia (32.69%). No significant differences were observed between the Sts or Cs approaches regarding first surgery or revision cases. No significant differences between the two groups were observed regarding the onset of new diplopia (p=0.92).