1/87. Less common orbital fracture patterns: the role of computed tomography in the management of depression of the inferior oblique origin and lateral rectus involvement in blow-in fractures.During the past decade, advances in radiographic imaging have made it possible for the surgeon managing orbital fractures to adopt a rational therapeutic strategy based on a knowledge of alterations in surgical anatomy secondary to traumatic injury. To illustrate the value of computed tomography in the surgeon's armamentarium for management of orbital fractures, cases are presented in which imaging proved decisive in planning a course of therapy. Two patients presented with two types of isolated lateral blow-in fracture, an uncommon fracture pattern. The other cases underscore the value of defining involvement of the inferior oblique origin and lateral rectus muscles in imaging complex orbital fractures, issues not emphasized in earlier literature. Although diplopia alone does not always warrant surgical intervention, diplopia in the context of computed tomography-defined muscle entrapment or muscle origin displacement justifies operative therapy. These cases demonstrate the value of computed tomography in directing surgical therapy with resolution of diplopia and prevention and correction of enophthalmos.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/87. Long-term sequelae after surgery for orbital floor fractures.A surgical technique involving exact repositioning and rigid fixation is required for the reduction of fractures of the orbital floor. Even then, sequelae may be present long after the trauma. The aim of this study was to establish the frequency and type of sequelae after surgery for orbital floor fractures and to investigate the extent to which the method of surgery had any impact on the severity of the sequelae. A questionnaire was sent to all 107 patients (response rate 77%) 1 to 5 years after the injury. Further clinical data were obtained from the patients' charts. Eighty-three percent of the patients were affected by some kind of permanent sequelae in terms of sensibility, vision, and/or physical appearance. A high frequency of diplopia (36%) was related to the reconstruction of the orbital floor with a temporary "supporting" antral packing in the maxillary sinus, a technique which has now been abandoned at our department in favor of orbital restoration with sheets of porous polyethylene. Our conclusion is that, because long-term sequelae are common, the surgical technique must be subjected to continuous quality control to minimize future problems for this group of patients.- - - - - - - - - - ranking = 0.46153846153846keywords = fracture (Clic here for more details about this article) |
3/87. Benefits of stereolithography in orbital reconstruction.OBJECTIVE: To describe the benefits of the stereolithography (SLA) modeling system in the evaluation and surgical planning of selected bony orbital pathology. DESIGN: Two case reports. PARTICIPANTS: One patient presented with a displaced left orbital roof fracture into his orbit causing globe compression and binocular vertical diplopia. A second patient underwent removal of his right orbital floor, medial wall, and inferior portion of his lateral wall during excision of a cylindrical cell papilloma of the paranasal sinuses. Postoperatively, he suffered from globe ptosis and binocular oblique diplopia. INTERVENTION: Stereolithographic models of the patients' orbits were obtained from computed tomography data to better assess the bony orbital pathology. In the second patient, the model was used as a template to create a temporary custom fit prosthesis to repair the defect of his orbital walls. RESULTS: The SLA models were useful in evaluating the dimensions of the bony defects and in preoperative surgical planning. Intraoperatively, the SLA models facilitated orbital surgical rehabilitation. Postoperatively, both patients noted resolution of their diplopia after reconstruction of more normal bony anatomy. CONCLUSIONS: In selected cases, SLA offers highly accurate models of the bony orbit for preoperative evaluation, surgical planning, and teaching and can act as a template for custom prosthesis manufacturing. This technology increases the orbital surgeon's options in managing complex orbital pathology.- - - - - - - - - - ranking = 0.080289515946908keywords = fracture, compression (Clic here for more details about this article) |
4/87. diplopia secondary to aniseikonia associated with macular disease.OBJECTIVE: To provide an explanation for diplopia and the inability to fuse in some patients with macular disease. methods: We identified 7 patients from our practices who had binocular diplopia concurrent with epiretinal membranes or vitreomacular traction. A review of the medical records of all patients was performed. In addition to complete ophthalmologic and orthoptic examinations, evaluation of aniseikonia using the Awaya New aniseikonia Tests (Handaya Co Ltd, tokyo, japan) was performed on all patients. RESULTS: All patients were referred for troublesome diplopia. Six of the patients had epiretinal membranes and 1 had vitreomacular traction. All 7 patients had aniseikonia, ranging from 5% to 18%. In 5 of the patients the image in the involved eye was larger, and in the other 2 patients it was smaller than in the fellow eye. All patients had concomitant small-angle strabismus and at least initially did not fuse when the deviation was offset with a prism. Response to optical management and retinal surgery was variable. CONCLUSIONS: aniseikonia caused by separation or compression of photoreceptors can be a contributing factor to the existence of diplopia and the inability to fuse in patients with macular disease. Concomitant small-angle strabismus and the inability to fuse with prisms may lead the clinician to the incorrect diagnosis of central disruption of fusion. Surgical intervention does not necessarily improve the aniseikonia.- - - - - - - - - - ranking = 0.0033664390238306keywords = compression (Clic here for more details about this article) |
5/87. Emergency department presentation of pituitary apoplexy.pituitary apoplexy is an acute infarction of pituitary gland, and potentially life-threatening condition that may be highly variable in its clinical presentation. We report a 54-year-old man presenting to the emergency department with an isolated oculomotor nerve palsy. Computed tomography (CT) scan revealed an isodense mass within sellar region and subsequently, magnetic resonance imaging (MRI) revealed a pituitary apoplexy causing a compression of right oculomotor nerve. The patient received hydrocortisone immediately, and did well with medical management. An isolated oculomotor nerve palsy is very rarely the presenting sign of pituitary apoplexy. When correctly diagnosed and treated, the third nerve palsy appears to be reversible. A pathophysiology, differential diagnosis, and treatment is described.- - - - - - - - - - ranking = 0.0033664390238306keywords = compression (Clic here for more details about this article) |
6/87. Sino-orbital fistula: two case reports.A fistula between the paranasal sinuses and the orbit as a late complication of orbital fractures is rare and may present with intermittent symptoms due to air passing into the orbit. A case note review of two patients with sino-orbital fistula is presented. Two patients, 23- and 30-year-old males, presented with intermittent symptoms of globe displacement, diplopia or discomfort months after repair of an orbital floor fracture with a synthetic orbital floor implant. The symptoms occurred after nose blowing. They were both cured by removal of the implant and partial removal of the tissue surrounding the implant. A sino-orbital fistula may complicate the otherwise routine repair of an orbital floor fracture, but may be cured by removal of the implant and part of the surrounding pseudocapsule.- - - - - - - - - - ranking = 0.23076923076923keywords = fracture (Clic here for more details about this article) |
7/87. Intranasal endoscopy-assisted repair of medial orbital wall fractures.The repair of medial orbital blow-out fractures remains a challenging surgical procedure for most surgeons. Endoscopic intranasal visualization of the medial orbital wall or lamina papyracea is a technique familiar to most otolaryngologists. This endoscopic view would allow for confirmation of orbital content reduction and bimanual manipulation of an orbital implant. To determine the effectiveness of a new surgical technique, a cadaveric study was performed to evaluate the ability to (1) reduce the herniated orbital contents and (2) restore the normal anatomic orbital configuration and volume with the addition of an orbital implant. Excellent visualization of the fracture was achieved in all cadaveric specimens. In addition, endoscopic intranasal visualization of the medial orbital wall greatly facilitated the anatomic reduction of orbital contents and proper placement of the orbital implant. The surgical technique is described and a clinical case is reported in which this endoscopic technique was effectively used. Arch Facial Plast Surg. 2000;2:269-273- - - - - - - - - - ranking = 0.46153846153846keywords = fracture (Clic here for more details about this article) |
8/87. Subarachnoid cyst and ascent to high altitude--a problem?A 31-year-old man suffered diplopia and ataxia on two occasions when he ascended from sea level to 4,000 m. Evaluation revealed a moderate-sized subarachnoid cyst in the left frontal region, which did not communicate with the cerebral ventricles. The cyst might have acted as a space-occupying lesion, and caused symptoms on ascent due to hypoxic brain swelling, brain compression against the cyst, and elevated intracranial pressure. Subarachnoid cysts are common, and they should be considered in the differential diagnosis of neurological problems at high altitude.- - - - - - - - - - ranking = 0.0033664390238306keywords = compression (Clic here for more details about this article) |
9/87. Abrupt-onset oculomotor paralysis: an endocrine emergency.pituitary apoplexy is a severe and potentially life-threatening condition that may be highly variable in its clinical presentation. We report a 37-year-old man presenting to the emergency department with diplopia that abruptly developed while he was eating canned and bottled food prepared at home. A computed tomography scanning revealed an isodense mass within the sellar region and, subsequently, a magnetic resonance imaging showed a pituitary apoplexy causing a compression of the right III and VI oculomotor nerves. There was no improvement with hydrocortisone therapy and the patient underwent a transsphenoidal excision of the mass with an uneventful course. pituitary apoplexy may raise in the appropriate setting the suspicion of botulism. The abrupt-onset paralysis of oculomotor nerves has been described as the chief presenting sign of pituitary apoplexy in only few cases including this. A pathophysiology, differential diagnosis with botulism and other causes of multiple cranial nerve paralysis, and treatment are described.- - - - - - - - - - ranking = 0.0033664390238306keywords = compression (Clic here for more details about this article) |
10/87. Orbital hemorrhage following face-mask barotrauma.A 41-yr-old female recreational diver suffered an orbital hemorrhage following face-mask barotrauma This case illustrates the potential for significant orbital injury to occur as a result of face-mask barotrauma Barotraumatic orbital hemorrhage is an unusual disorder, but recognition of this entity is important for diving physicians. The signs and symptoms should not be mistaken for decompression sickness or arterial gas embolism. patients with barotraumatic orbital hemorrhage require emergency referral to an ophthalmologist so that potentially vision-threatening ocular complications may be identified and treated. barotrauma may result in several different types of cranial neuropathies and should be recognized as another possible cause for neurologic deficits following a dive.- - - - - - - - - - ranking = 0.0033664390238306keywords = compression (Clic here for more details about this article) |
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