Missed Dehiscence of Lamina Papyracea: Orbital Herniation Mimicking Sinusitis and Potential Complications

Introduction: Accidental injury of the lamina papyracea (LP) during functional endoscopic sinus surgery (FESS), has been described in up to 5% of cases. Preventing complications begins with preoperative planning and careful review of computed tomographic (CT) scans. The aim of this study is to emphasize the critical requirement for surgeons to conduct a thorough preoperative review of CT scan images. This independent evaluation is critical to minimizing reliance on radiology reports. Methodology: This was a multicentric national survey to report any case of LP defect lamina papyracea dehiscence (LPD). that was not reported by radiologists. Multiple rhinologists from different provinces of Saudi Arabia were invited to report any patient with such an incidence in the last 2 years. Patient-specific data were all included in this study. Results: The data of 16 patients, 11 males and 5 females, were reviewed retrospectively. The median age at diagnosis was 37 years. The right side was the most prevalent location of LPD (eight patients), even though most cases had no history of trauma or sinus surgery. Five patients had left-side LPDs and three had bilateral LPDs. Conclusion: Injury to the LP is a well-known avoidable complication of FESS. Rarely, radiologists might miss a dehiscent lamina papyracea; thus, surgeons should not rely exclusively on radiologist’s report during the interpretation of a CT scan. It is crucial for surgeons to perform a careful and attentive review of CT scan images pre-operatively.