1/64. Functional indications for enophthalmos repair.PURPOSE: In general, orbital augmentation to correct enophthalmos is pursued to prevent or address an aesthetic deformity. In some cases, however, functional deficits may accompany enophthalmos and may serve as an indication for surgical intervention. The authors describe a series of patients with such deficits. methods: A retrospective review at a tertiary health care center of all patients with enophthalmos was conducted to identify a subset of cases in which the enophthalmos was associated with nonaesthetic, functional deficits that could not be attributed to muscular or neural dysfunction, or soft tissue scarring. RESULTS: Six patients with either traumatic enophthalmos (orbital fractures) or non-traumatic enophthalmos (sinus disease and orbital soft tissue atrophy) demonstrated nonaesthetic ocular dysfunction, including gaze-evoked diplopia, eyelid retraction, lagophthalmos, and exposure keratitis. The symptoms and signs resolved in the three patients who underwent orbital augmentation. CONCLUSIONS: In some patients with enophthalmos and globe ptosis, globe malposition may alter the underlying eyelid mechanics or extraocular muscle alignment, resulting in functional as well as aesthetic problems. In these patients, restoring the native orbital anatomy through orbital augmentation can reverse eyelid malposition, ocular surface exposure, and symptomatic diplopia, avoiding the need for eyelid or strabismus surgery.- - - - - - - - - - ranking = 1keywords = orbital (Clic here for more details about this article) |
2/64. Transient vertical diplopia and silent sinus disorder.A 57-year-old man had isolated transient recurrent vertical diplopia. Left hypoglobus and enophthalmos were present. Investigations revealed an otherwise asymptomatic left maxillary chronic aspecific sinusitis, with 8 mm lowering of the left orbital floor. Transient diplopia was thought to be secondary to transient fusion impairment. Orbital floor reconstruction cured the patient.- - - - - - - - - - ranking = 0.16666666666667keywords = orbital (Clic here for more details about this article) |
3/64. Asymptomatic enophthalmos: the silent sinus syndrome.Although uncommon, enophthalmos may be a presenting symptom of chronic maxillary sinusitis with secondary attentuation of the orbital floor. As such, as awareness of this entity, known as the "silent sinus syndrome," is important to all practising otolaryngologists. Two such cases are presented herein, together with a discussion of the pathophysiology, management, and current literature.- - - - - - - - - - ranking = 0.16666666666667keywords = orbital (Clic here for more details about this article) |
4/64. Missed orbital wall blow-out fracture as a cause of post-enucleation socket syndrome.BACKGROUND: Post-enucleation socket syndrome (PESS: deep upper lid sulcus, ptosis or upper lid retraction, enophthalmos and lower lid laxity) is a well-recognised complication of a volume-deficient anophthalmic socket. A patient requiring enucleation following severe ocular trauma may have an underlying orbital wall blow-out fracture which if overlooked can cause severe volume deficit with poor cosmesis and limited prosthesis motility. PURPOSE: To establish the prevalence of an undiagnosed blow-out fracture in patients with PESS and a history of relevant trauma. methods: medical records and orbital computed tomography (CT) scans were reviewed for all patients presenting with PESS and a history of relevant trauma. RESULTS: Undiagnosed blow-out fractures were found in 15 (33%) of 45 patients presenting between August 1993 and December 1996. These were significant enough to warrant surgical repair in 13 (29%) patients. CONCLUSIONS: We suggest that any patient presenting with PESS and a history of relevant trauma should be considered to have an orbital wall blow-out fracture until proven otherwise by CT scanning of the orbit. Similarly any patient requiring enucleation following severe ocular trauma should undergo CT scanning to rule out a coexisting blow-out fracture which could be repaired at the time of enucleation.- - - - - - - - - - ranking = 1.1666666666667keywords = orbital (Clic here for more details about this article) |
5/64. The use of the Naugle orbitometer in maxillofacial trauma.BACKGROUND AND OBJECTIVES: Objective measuring of globe position is not a universal practice in the management of orbital trauma. Few studies in the literature advocate its routine use. methods AND MATERIALS: The Hertel exophthalmometer is the most widely used instrument; however, in trauma involving the lateral orbital rim (e.g., in zygoma fractures), the results are inaccurate because the displacement of the zygomatic bone interferes with its reference point on the lateral orbital rim. A more recent measuring device, the Naugle orbitometer, was introduced in 1992. It uses the superior orbital rim (frontal bar) and inferior orbital rim (malar eminence) as reference points. RESULTS AND/OR CONCLUSIONS: This article reports experience with this instrument in objective measuring the position of the globe in orbital trauma. These measurements are used 1) to monitor fractures that may not require repair but should be followed and observed for dystopia or enophthalmos, 2) to determine the adequacy of fracture repair, and 3) to determine the volume adjustment required for correcting enophthalmos. Future studies will be directed to compare the accuracy of Naugle and Hertel exophthalmometers.- - - - - - - - - - ranking = 1keywords = orbital (Clic here for more details about this article) |
6/64. Endoscopic repair of posttraumatic enophthalmos using medial transconjunctival approach: a case report.A blowout fracture of the medial orbital wall should be suspected when periorbital trauma results in epistaxis, orbital hemorrhage, horizontal dysmotility or dystopia of the globe, and/or orbital emphysema. Large medial orbital wall blowout fractures are frequently complicated by posttraumatic enophthalmos. Clinicians should consider a medial transconjunctival approach for repair of these fractures when surgical repair is indicated by a comprehensive clinical and radiologic orbital evaluation. Excellent cosmetic and functional results can be achieved through the use of an extended transcaruncular incision, rigid endoscope, and high-density porous polyethylene implant placement. The technique can be used in the early, delayed, and late stages of medial orbital wall blowout fracture repair. The technique can be used alone in isolated medial orbital wall fractures or combined with other craniofacial approaches.- - - - - - - - - - ranking = 1.3333333333333keywords = orbital (Clic here for more details about this article) |
7/64. Orbital volumetric analysis: clinical application in orbitozygomatic complex injuries.Fifteen patients with unilateral orbitozygomatic complex fractures and five with bilateral injuries were analyzed with respect to the differences in orbital volume between the affected and the uninjured, or other, side. The study was conducted using the ALLEGRO Workstation and software package from ISG Technologies, which was capable of calculating volume partitions from either axial or coronal images. patients without postoperative enophthalmos demonstrated a maximum volume difference of 3.8%; those with enophthalmos demonstrated differences of 4% or greater. The Critical Volume Difference at which enophthalmos becomes clinically apparent (whereby the orbital-corneal distance measured by Hertel exophthalmometry is greater than 3 mm on the affected side) is in the range of 4% to 5%. Volume analysis of the orbits by manipulation of the computed tomography data may allow a better understanding of changes in orbital configuration, which can result in better-directed primary and secondary reconstructions.- - - - - - - - - - ranking = 0.5keywords = orbital (Clic here for more details about this article) |
8/64. Bilateral enophthalmos associated with paget disease of the skull: a case report.PURPOSE: To describe a case of familial Paget disease of bone associated with bilateral enophthalmos and mild exposure keratopathy. methods: Case report and literature review. RESULTS: A 71-year-old woman with familial Paget disease of bone had a long history of "receding eyes," headaches, and moderately dry eyes. She had bilateral enophthalmos with mild exposure keratopathy. Radiologic and endocrinologic investigation confirmed Paget disease of bone affecting the skull. CONCLUSIONS: enophthalmos in association with Paget disease of bone is rare and is likely to result from differential expansion of the cranium compared with the orbital bones.- - - - - - - - - - ranking = 0.16666666666667keywords = orbital (Clic here for more details about this article) |
9/64. Computer-assisted secondary reconstruction of unilateral posttraumatic orbital deformity.Until now, computer-assisted surgery has not been practiced as part of the surgical routine of posttraumatic orbital reconstruction. The purpose of this study was to investigate the use of a navigation system for computer-assisted preoperative planning with virtual reconstruction to obtain symmetry of the orbits and intraoperative control of virtual contours in comparison with the clinically achieved surgical results. A further objective of the computer-assisted orbital analysis was to use an ideal measurement for the two-dimensional and three-dimensional changes following orbital reconstruction and to check the equality of the postoperative values for the affected orbits in comparison with those of the unaffected sides. patients with unilateral posttraumatic orbital defects (n = 18) underwent computer-assisted surgery and preoperative planning using a spiral computed tomography database. Surgical procedures were preplanned with virtual correction by mirroring an individually defined three-dimensional segment from the unaffected side onto the deformed side, creating an ideal unilateral reconstruction. These computer-models were intraoperatively used as virtual templates to navigate the preplanned contours and the globe projection using the Stryker-Leibinger navigation system. Individual noninvasive registration with an overall inaccuracy of approximately 1 mm was achieved by using a maxillary occlusal splint with four markers. The mirroring of the unaffected side allowed an ideal virtual reconstruction. A mean decrease in enlarged orbital volume of 4.0 (SD /- 1.9) cm was achieved, as was a mean increase in the sagittal globe projection of 5.88 (SD /- 2.98) mm. With a paired Student test, the decrease between the preoperative and postoperative differences of the affected and unaffected sides was proved significant for orbital volume, globe projection, and computed tomography-based Hertel scale changes (p < 0.01). In 15 of 18 cases, simultaneous malar bone advancement resulted primarily in an additional increase in orbital volume before intraorbital augmentation with calvarial split-bone grafts could be performed. Intraorbital bony augmentation included one (n = 1), two (n = 7), three (n = 8), and all four (n = 2) orbital walls. Computer-assisted preoperative planning enables the surgeon to predict reconstructive surgical steps before the operation. Highly vulnerable structures such as the optic nerve can be detected and avoided intraoperatively, and virtually preplanned bone graft positions and/or orbital frame contours can be checked. Computer-assisted preoperative planning and surgery thus advance the difficult surgical field of orbital reconstruction, particularly through a greater exploitation of radiologic information without additional radiation to the patient.- - - - - - - - - - ranking = 2.6666666666667keywords = orbital (Clic here for more details about this article) |
10/64. enophthalmos associated with primary breast carcinoma.BACKGROUND AND OBJECTIVE: The most common source of metastases to the orbit is from breast carcinoma. The orbital presentation can be the presenting sign of the cancer. Proptosis or exophthalmos is the more usual way metastases present, associated with ocular motility problems or diplopia. We present a case of enophthalmos associated with breast carcinoma whereby there is as yet no radiological evidence of an actual orbital metastatic lesion. patients AND methods: A 51-year-old Caucasian woman with a known history of breast cancer presented with a 10-month history of vertical diplopia, particularly on upgaze. She noted that her left eye was becoming more "sunken" and examination confirmed an 8-mm enophthalmos on that side with restricted vertical eye movements and abduction. RESULTS: A provisional diagnosis of metastatic breast cancer was made. CT and MRI scans were performed. The main feature noted was that of orbital fat atrophy with no evidence of an orbital mass. She has been followed up for a period of 2(1/2) years with 6-monthly scans. There has been no progression of her clinical signs and no orbital lesion found so far. We are continuing to review her. CONCLUSION: Although no actual orbital mass has been found yet, we are treating her case as enophthalmos associated with scirrhosing breast carcinoma; she may, however, have spontaneous orbital fat atrophy, triggered by the cancer.- - - - - - - - - - ranking = 1.1666666666667keywords = orbital (Clic here for more details about this article) |
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