Op.: Operatio et reconstructio functionalis septi nasi. Operatio sinus paranasales et orbitae lateris dextri per viam 3D-CAS-RP-endoscopicam (3D-CA-RP-FESS)(cum ablationem in tototumoris et pyocelis sinus ethmoidalis et orbitae lat dextri).
46-year-old male with chronic sinusitis and the shadow intensity characteristic of a mucocele in the righr orbital space and ethmoids, was examined as the first case. MSCT (Siemens, 64 multislice) of the sinuses in coronal, sagital and axial sections demonstrated a disease of the ethmoidal infundibulum on the right side, with homogenous opacification and/or retention in the region of the right anterior and posterior ethmoidal cells and the orbit, as well as frontal sinus, with sphenoidal and the maxillary sinuses of normal transparency. MSCT scanning of the orbit revealed a tumor like shadow, which partially protruded into the anterior and posterior ethmoidal cells, and partially into the orbit. The medial wall of the orbit, right medial rectus muscle, optic nerve and the eyeball was displaced laterally (exophthalmos). A huge inferior turbinate was noticed on the right. Pronounced also chronic inflammatory changes with signs of ostiomeatal block were observed in the region of surrounded ethmoidal cells and frontal sinus. Patient also complained of difficulty breathing easily, with additional headaches in the right fronto-ethmoidal region, and recurrent sinusitis with postnasal dripping (appropriate nasal discharge/rhinosecretion). Visual function was partially reduced on the right eye, with normal finding on the left eye. Postoperatively, antibiotic therapy with local corticosteroids was prescribed. During the diagnostic process, we used the standard 2D-MSCT-imaging sections, virtual endoscopy of the patient's head model over a few applied travel sections through patient's "virtual" head. Physical RP-models of patient's head showed a clear demarcation (anatomic position) between the diseased and healthy tissues in the projection of the nose, paranasal sinuses and orbit. The patient underwent imageguided-CA-VE-FESS. Three months after the surgery, the patient was symptom-free. Generaly speaking, in this case, RP-approach proved efficient not only for the diagnostic purpose of the localization of the tumor shadow, and its identification within the orbital area, but also during the operation itself.
Figure 1. Basic contours of the pathologic process and the structures surrounding the orbit could not be visualized with certainty, neither was it possible to determine whether there actually were disparate, mutually connected fragments of the right orbilat lamina, or a single bony wall, partially dectructed by pathologic tissue