1/19. Repair of orbital floor fractures with hydroxyapatite block scaffolding.PURPOSE: To determine the efficacy of using a scaffold of hydroxyapatite blocks within the maxillary sinus to treat patients with large orbital floor fractures and secondary vertical globe dystopia. methods: Case series of five patients. Hydroxyapatite blocks were stacked within the maxillary antrum to support the reconstructed orbital floor. RESULTS: All patients had good results, though mild residual enophthalmos persisted in three patients. The orbital floor implants and globe positions remained stable during follow-up intervals ranging from 46 to 65 months. No adverse postoperative complications, such as sinusitis, developed. CONCLUSIONS: Hydroxyapatite block scaffolding is a useful alternative to metallic floor implants and autologous bone grafts in the reconstruction of large traumatic orbital floor defects associated with vertical globe dystopia.- - - - - - - - - - ranking = 1keywords = floor (Clic here for more details about this article) |
2/19. Internal orbital fractures in the pediatric age group: characterization and management.OBJECTIVE: To evaluate the specific characteristics and management of internal orbital fractures in the pediatric population. DESIGN: Retrospective observational case series. PARTICIPANTS: Thirty-four pediatric patients between the ages of 1 and 18 years with internal orbital ("blowout") fractures. methods: Records of pediatric patients presenting with internal orbital fractures over a 5-year period were reviewed, including detailed preoperative and postoperative evaluations, surgical management, and medical management. MAIN OUTCOME MEASURES: Ocular motility restriction, enophthalmos, nausea and vomiting, and postoperative complications. RESULTS: Floor fractures were by far the most common fracture type (71%). Eleven of 34 patients required surgical intervention for ocular motility restriction. Eight were trapdoor-type fractures with soft-tissue incarceration; five had nausea and vomiting. Early surgical intervention (<2 weeks) resulted in a more complete return of ocular motility compared with the late intervention group. CONCLUSIONS: Trapdoor-type fractures, usually involving the orbital floor, are common in the pediatric age group. These fractures may be small with minimal soft-tissue incarceration, making the findings on computed tomography scans quite subtle at times. Marked motility restriction and nausea/vomiting should alert the physician to the possibility of a trapdoor-type fracture and the need for prompt surgical intervention.- - - - - - - - - - ranking = 0.11111111111111keywords = floor (Clic here for more details about this article) |
3/19. Mechanisms of orbital floor fractures: a clinical, experimental, and theoretical study.PURPOSE: The purpose of this study was to investigate the two accepted mechanisms of the orbital blowout fracture (the hydraulic and the buckling theories) from a clinical, experimental, and theoretical standpoint. methods: Clinical cases in which blowout fractures resulted from both a pure hydraulic mechanism and a pure buckling mechanism are presented. Twenty-one intact orbital floors were obtained from human cadavers. A metal rod was dropped, experimentally, onto each specimen until a fracture was produced, and the energy required in each instance was calculated. A biomathematical model of the human bony orbit, depicted as a thin-walled truncated conical shell, was devised. Two previously published (by the National Aeronautics and Space Administration) theoretical structural engineering formulas for the fracture of thin-walled truncated conical shells were used to predict the energy required to fracture the bone of the orbital floor via the hydraulic and buckling mechanisms. RESULTS: Experimentally, the mean energy required to fracture the bone of the human cadaver orbital floor directly was 78 millijoules (mJ) (range, 29-127 mJ). Using the engineering formula for the hydraulic theory, the predicted theoretical energy is 71 mJ (range, 38-120 mJ); for the buckling theory, the predicted theoretical energy is 68 mJ (range, 40-106 mJ). CONCLUSION: Through this study, we have experimentally determined the amount of energy required to fracture the bone of the human orbital floor directly and have provided support for each mechanism of the orbital blowout fracture from a clinical and theoretical basis.- - - - - - - - - - ranking = 0.88888888888889keywords = floor (Clic here for more details about this article) |
4/19. Bone wax as a cause of a foreign body granuloma in a cranial defect: a case report.Bone wax was used to stop bleeding of the diploic vessels after harvesting cranial bone for reconstruction of an orbital floor defect. After five months a fistula in the overlying skin of the donor site appeared and was eventually surgically explored. Remnants of bone wax and surrounding inflammatory tissue were removed and the fistula was excised. Histological examination revealed a foreign body granuloma. The use of bone wax and possible alternative local haemostatic agents and their complications are discussed.- - - - - - - - - - ranking = 0.11111111111111keywords = floor (Clic here for more details about this article) |
5/19. Complex cranial base trauma resulting from recreational fireworks injury: case reports and review of the literature.Two patients who sustained complex skull base trauma secondary to recreational fireworks injuries are reported. Initial assessment and management included axial and coronal computerized tomography, control of hemorrhage, debridement of wound and brain, isolation of brain from external environment, and reconstruction of the cranial base floor. Secondary orbital and facial reconstruction used available bone fragments and iliac bone graft in one patient and vascularized free tissue transfer in the other. In both patients, reconstruction of both the intracranial and extracranial compartments was successful with acceptable cosmetic result. Modification of multiple conventional approaches, along with a multispecialty surgical team, was used to deal effectively with these unique cases.- - - - - - - - - - ranking = 0.11111111111111keywords = floor (Clic here for more details about this article) |
6/19. Peribulbar anesthesia for the repair of orbital floor fractures.Four patients underwent successful repair of an isolated orbital floor fracture under local anesthesia. The surgical approach was by antero-inferior orbitotomy, with placement of a Nylamid plate (S Jackson Inc, washington, DC). The anesthetic technique used was a peribulbar and infratrochlear nerve block with local supplementation. Digital control of the globe was maintained during the peribulbar injection to prevent ocular perforation. We conclude that local anesthetic for this procedure in carefully selected cases is safe and efficacious, avoiding the morbidity of a general anesthetic.- - - - - - - - - - ranking = 0.55555555555556keywords = floor (Clic here for more details about this article) |
7/19. Oculocerebral perforating trauma by foreign objects: diagnosis and surgery.Two unusual cases of perforating oculocerebral trauma by foreign bodies treated surgically are reported. Both were caused by industrial accidents. In the first a nail shot from a nail gun ricocheted off the target and crossed the right eyeball and the posterior wall of the orbit, lodging in the homolateral temporal lobe. In the second case a metal fragment expelled by an agricultural machine penetrated the left maxillary sinus, crossed the floor of the orbit, the eyeball and the roof of the orbit and lodged in the homolateral frontal lobe. After accurate neuroradiological examination the patients were operated using simultaneous transcranial and transorbital access. In our opinion this is the only approach which can minimize the risk of infection which is so dangerous in this type of trauma. The functional and aesthetic results, which were very satisfactory in both cases, seem to confirm the correctness of this approach.- - - - - - - - - - ranking = 0.11111111111111keywords = floor (Clic here for more details about this article) |
8/19. Avoiding complications of orbital surgery: the orbital branches of the infraorbital artery.Adequate exposure in surgery along the orbital floor requires recognition and often division of the orbital branches of the infraorbital artery. Failure to recognize this orbital vascular bundle may lead to severe complications, including visual loss.- - - - - - - - - - ranking = 0.11111111111111keywords = floor (Clic here for more details about this article) |
9/19. An unusual case of bull gore injury.An unusual and hitherto unreported presentation of a bull gore injury sustained during harvest festival celebrations is described. The patient was seen with the metal horn cover complete with decorative ribbons impacted in his orbit. The injury had caused a blowout fracture of the orbital floor, and at surgery the globe was retrieved from the maxillary antrum. The development of optic atrophy precluded useful vision in the injured eye.- - - - - - - - - - ranking = 0.11111111111111keywords = floor (Clic here for more details about this article) |
10/19. Traumatic simulated Brown's syndrome: a case report.A case report of a simulated Brown's tendon sheath syndrome is presented which masks as an orbital floor fracture with entrapment. Despite a positive forced traction test, additional diagnostic information such as a normal tomographic exam of the orbital floor, vertical saccadic up gaze velocity measurements consistent with edema and hemorrhage, greater limitation to elevation in adduction than abduction, and tenderness and soft tissue injury in the region of the trochlea, persuaded us to conservatively manage this case. It behooves the ophthalmologist to consider a temporary superior restrictive phenomenon produced by edema prior to any surgical approach to improve elevation of the globe.- - - - - - - - - - ranking = 0.22222222222222keywords = floor (Clic here for more details about this article) |
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