1/21. Management of traumatic luxation of the globe. A case report.PURPOSE: To report the management of a patient who had LeFort type III fractures and traumatic luxation of the globe with avulsion of the optic nerve and all extraocular muscles except for the medial rectus. methods: Eight hours after the trauma, the detached and retracted superior and lateral recti muscles could be found and sutured to their original insertions. The inferior rectus could not be retrieved. RESULTS: Although the left eye had no light perception, most of its motility was restored resulting in an unblemished cosmesis. CONCLUSION: Avoiding primary enucleation helped to alleviate the psychological burden of the trauma on the patient. In case of the eventual development of phthisis bulbi, the patient will have a chance to be fitted with a prosthesis over his own eye with a resulting better motility.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/21. Traumatic optic neuropathy. A case report.A case of visual loss following cranio-maxillofacial trauma is reported. The patient had a sudden partial blindness associated with a fracture of the roof, medial and lateral orbital walls. Access to the orbit was achieved through a transethmoidal approach using the Howarth-Lynch medial incision and resecting the bone fragments which impinged on the optic nerve. The patient had total return of visual acuity, without surgical complications. The role of orbital and optic decompression in the management of patients with traumatic optic neuropathy is discussed. Its indications are controversial and the procedure should be considered only within the context of the specific needs of the individual patient.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
3/21. optic nerve injury in children. A prospective study of 35 patients.Thirty-five children under 15 years of age with optic nerve injury are prospectively studies for their clinical presentation, radiological findings, visual evoked potentials and outcome. Over 50% were under 10 years of age. In half of the children, injury was due to fall from a height. Fracture of the skull was recorded in a third of the patients, and optic canal fracture was seen only in three children. Visual evoked potentials (VEP) were record in 30 children and were repeated several times in first three weeks. All the patients received corticosteroids and optic canal decompression was not carried out routinely. overall spontaneous visual recovery was observed in 12 patients. Among the 30 children in whom Veps were recorded, 17 children had repeatedly absent VEP, and none of the children showed wave formation, 10 (77%) had visual recovery. Only in 5 patients an optic canal decompression was carried out several weeks after injury. This study brings out the role of VEP in children with optic nerve injury.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
4/21. Bilateral complete avulsion of ocular globes in a Le Fort III maxillofacial fracture: a case report and review of the literature.PURPOSE: The purpose of this paper is to demonstrate a case of bilateral complete avulsion of the globes following maxillofacial trauma. methods: A 23-year-old man with bilateral complete globe avulsion following a maxillofacial trauma. Both globes were luxated out of the orbit and suspended on the skin of the upper lid below the brows. No direct or indirect light reflexes or any eye movements could be noted. Computerized tomography showed complete lacerations of both optic nerves at a level just anterior to the optic canal. There were also multiple fractures corresponding to Le Fort III fracture with Le Fort II components. The brain parenchyma was normal with an exception of brain edema. As the globes were unsuitable for repositioning, both were enucleated. The maxillofacial fractures were immobilized with plates and screws. Although the patient gained consciousness with normal vital signs in the early postoperative period, he died on the ninth day due to pseudomonas aeruginosa infection, despite invasive antibiotic treatment. DISCUSSION: The optic nerve and the globes are very resistant to mild and moderate trauma. The avulsion of the nerve at the canalicular or more posterior level may demonstrate central nervous system complications resulting in life-threatening conditions. The most critical issue in complete globe avulsions with a transected optic nerve is to rescue the vision. In total transected optic nerves the final eyes could only have had cosmetic benefits. In spite of promising experimental research on optic nerve regeneration, there are unknowns, such as the methods to eliminate the risk of anterior segment ischemia and phthisis bulbi. CONCLUSIONS: Globe avulsions with a complete optic nerve cut remain a challenging problem. More research is required to better understand the pathophysiology of optic nerve repair.- - - - - - - - - - ranking = 7keywords = fracture (Clic here for more details about this article) |
5/21. optic nerve blindness following a malar fracture.optic nerve blindness following a malar fracture is an uncommon and usually permanent complication. When the loss of vision is immediate and total, the prognosis is poor. The case of a patient who suffered immediate and complete loss of vision after a malar fracture is presented. Computed tomography revealed compression of the optic nerve by bony fragments. No improvement was observed after megadose steroids and surgical treatment. The incidence, pathogenesis, diagnostic approach and therapeutic possibilities are discussed and the importance of establishing precisely the moment of the loss of vision is stressed.- - - - - - - - - - ranking = 6keywords = fracture (Clic here for more details about this article) |
6/21. optic nerve decompression via the lateral facial approach.Two cases of visual loss after lateral orbital wall fracture are presented: one with retrobulbar hematoma and evidence of optic nerve compression who failed to respond to lateral canthotomy and high-dose corticosteroid administration, and the second with immediate, total blindness associated with fracture of the bony optic canal. In both, extradural decompression of the orbit and optic nerve was achieved through the lateral facial approach with partial return of visual acuity and without surgical complications. The role of orbital and optic nerve decompression in the management of patients with blindness following orbital trauma is controversial. Orbital decompression may be of value for cases of post-traumatic visual loss unresponsive to medical management. If optic nerve injury is suspected as the cause, the additional step of decompression of the optic nerve is a logical but unproven procedure. The indications for optic nerve decompression are not established and should be considered only within the context of the specific needs of the individual patient.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
7/21. Predictive value of visual evoked potentials in unilateral optic nerve injury.Forty-five patients with posttraumatic unilateral blindness were prospectively analyzed. The computed tomography scan was normal in all and an optic canal fracture was recorded in only one patient. Visual evoked potentials were performed within 48 hours of initial evaluation and repeated within 7 to 10 days. Five patients had normal visual evoked potentials and 15 patients had abnormal responses. No visual evoked potentials were recorded in 25 patients. Five patients with normal visual evoked potentials had good visual recovery. Thirteen of the 15 patients with abnormal responses also showed significant visual improvement. This study showed that positive visual evoked potentials were reliable in predicting the visual outcome; 90% of the patients with positive visual evoked potentials had complete or partial visual recovery.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
8/21. Reversible visual loss due to impacted lateral orbital wall fractures.Impaction of the sharp medial edge of the orbital plate of the greater sphenoid wing into the orbital apex is a unique type of lateral orbital wall fracture that can produce a potentially reversible optic neuropathy. Two patients in whom the lateral or temporal approach to the orbit was used to reduce this type of fracture will be presented. In both patients, improvement in vision appeared to be related to removal of a bone fragment compressing the optic nerve in the orbital apex.- - - - - - - - - - ranking = 6keywords = fracture (Clic here for more details about this article) |
9/21. Monocular blindness secondary to a non-displaced malar fracture.We report a case of monocular blindness subsequent to a non-displaced malar fracture. Injury to the optic nerve, secondary to orbital apex syndrome, was implicated as the cause of blindness. Although most non-displaced malar fractures require no surgical intervention and resolve quite uneventfully, they can be associated with significant morbidity. patients diagnosed as having non-displaced malar fractures should be followed on admission by careful observation and ophthalmologic consultation.- - - - - - - - - - ranking = 7keywords = fracture (Clic here for more details about this article) |
10/21. Radiographical documentation of direct injury of the intracanalicular segment of the optic nerve in the orbital apex syndrome.In the radiographical evaluation of the orbital apex syndrome, standard radiographs, tomograms, and computed tomographic scans have proved useful in the demonstration of the bony pathology, especially for optic canal fractures. The limitation of these methods, however, remains in their inability to provide accurate delineation of the associated soft tissue pathology, including the presence of optic nerve sheath hematoma. Recent developments in computer technology and graphic imaging are now available to provide an accurate three-dimensional radiographical analysis of the extent of skeletal and soft tissue injury in the orbital apex syndrome. The physician, in essence, can perform a radiographical "living autopsy". The technique was used to evaluate a patient with bilateral apex syndrome. It clearly showed that a severe direct injury to the intracanalicular portion of the optic nerve was responsible for the development of blindness in this patient. The progression of optic nerve injury, from perineural sheath hematoma to the ultimate development of optic nerve atrophy and fibrosis, was radiographically documented.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
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