Cases reported "Eye Injuries"

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1/29. 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.
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2/29. Unilateral retinal hemorrhages in documented cases of child abuse.

    PURPOSE: To describe the occurrence of unilateral retinal hemorrhages in four cases of documented child abuse, including a case in which retinal hemorrhages were an incidental finding on routine examination. methods: case reports. RESULTS: Three children, 5 to 17 months of age, with suspected child abuse had fundus examinations with a dilated pupil as part of their evaluation. An additional child, 6 months of age, received fundus examination with a dilated pupil as part of follow-up for regressed retinopathy of prematurity. Each of the four children had extensive retinal or preretinal hemorrhages in one eye only. Three of the four had ecchymoses on the ipsilateral face or neck. Two had evidence of bone fractures on skeletal surveys. All four had neuroimaging that documented cerebral hemorrhage or infarct. In all four cases an adult caretaker was found responsible for shaking, choking, or squeezing the child. One child died. Two had resolution of retinal hemorrhage, whereas one required vitrectomy. All three had at least partial recovery of vision in the affected eye after amblyopia treatment. CONCLUSION: In cases of documented child abuse, unilateral retinal or preretinal hemorrhages may be present. Ophthalmologists should recognize that unilateral retinal or preretinal hemorrhages may be associated with child abuse.
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keywords = bone
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3/29. Surgical treatment of penetrating orbito-cranial injuries. Case report.

    Penetrating orbital injuries are not frequent but neither are they rare. The various diagnostic and therapeutic problems are related to the nature of the penetrating object, its velocity, shape and size as well as the possibility that it may be partially or wholly retained within the orbit. The authors present another case with unusual characteristics and discuss the strategies available for the best possible treatment of this traumatic pathology in the light of the published data. The patient in this case was a young man involved in a road accident who presented orbito-cerebral penetration caused by a metal rod with a protective plastic cap. Following the accident, the plastic cap (2.5x2 cm) was partially retained in the orbit. At initial clinical examination, damage appeared to be exclusively ophthalmological. Subsequent CT scan demonstrated the degree of intracerebral involvement. The damaged cerebral tissue was removed together with bone fragments via a bifrontal craniotomy, the foreign body was extracted and the dura repaired. Postoperative recovery was normal and there were no neuro-ophthalmological deficits at long-term clinical assessment. Orbito-cranial penetration, which is generally associated with violent injuries caused by high-velocity missiles, may not be suspected in traumas produced by low-velocity objects. Diagnostic orientation largely depends on precise knowledge of the traumatic event and the object responsible. When penetration is suspected and/or the object responsible is inadequately identified, a CT scan is indicated. The type of procedure to adopt for extraction, depends on the size and nature of the retained object. Although the possibility of non-surgical extraction has been described, surgical removal is the safest form of treatment in cases with extensive laceration and brain contusion.
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ranking = 1
keywords = bone
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4/29. 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.
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keywords = bone
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5/29. A case of traumatic globe luxation.

    We observed a case of traumatic globe luxation. A 26-year-old man who was sitting at the back seat of the car without fastening his safety belt was admitted to the emergency room after an automobile accident. He was in semi-comatose condition. His left globe was dislocated anteriorly, and the lids were tightly closed behind it. No laceration was observed in cornea, sclera and extraocular muscles. The pupil was dilated and did not respond to light stimulation. Computerized tomography scan analysis revealed a normal optic nerve, but multiple fractures in the nasal, inferior and temporal walls of the orbit and in the nasal bone. Phthisis of the eye was detected by the end of second month. We believe that the back seats of automobiles should also be furnished with air bags for better security of passengers.
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ranking = 1
keywords = bone
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6/29. Large subconjunctival emphysema causing diplopia and lagophthalmos.

    PURPOSE: To describe a patient who developed diplopia, lagophthalmos and exposure keratopathy due to a large subconjunctival emphysema. methods: A 24-year-old man sustained an injury in his left eye from a compressed air hose. The patient complained of pain and diplopia. He underwent slit-lamp examination, funduscopy and computed tomography. RESULTS: Ophthalmic examination revealed a decrease in vision in the left eye to 0.5, a conjunctival laceration adjacent to the medial limbus, subconjunctival hemorrhage, a large subconjunctival emphysema, lagophthalmos, hypertropia and superficial punctate keratopathy. The posterior pole was intact as were the orbital bones. Two weeks after the injury the conjunctival emphysema, diplopia, lagophthalmos and superficial keratopathy resolved, and visual acuity improved to 1. CONCLUSIONS: Large subconjunctival emphysema can result in diplopia, lagophthalmos and exposure keratopathy.
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ranking = 1
keywords = bone
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7/29. Multidisciplinary approaches to complicated vascular lesions of the orbit.

    BACKGROUND: Hemodynamically active vascular lesions of the orbit are often clinically challenging to treat, both because of the complexity of the vascular anatomy and the delicacy of the cardinal structures that are involved and vulnerable to damage. Attempts to achieve complete embolization of such vascular lesions may result in damage to vital visual structures. Conversely, incomplete closure of the feeders or vascular shunts will usually result in recanalization and, therefore, recurrence of such lesions. methods: Surgical excision after selective optimal embolizations may convert dynamic lesions into static ones with controlled surgical risks and could provide a solution to these problems. Cyanoacrylic polymerization was used to embolize the lesions, which were then excised with careful microsurgical and microvascular techniques. RESULTS: The authors present four cases of different hemodynamically active orbital vascular lesions (a post-traumatic arteriovenous fistula, a complex venous anomaly, a cavernous hemangioma of bone, and an arteriovenous malformation), which were treated successfully with the combination of presurgical embolization and surgery. CONCLUSION: The authors believe that, from their experience with these cases, a multidisciplinary approach to complicated orbital vascular lesions is ideal and practical.
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ranking = 1
keywords = bone
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8/29. Severe panfacial fracture with facial explosion: integrated and multistaged reconstructive procedures.

    Midface fractures, especially if related to traffic accidents, represent a remarkable problem from a surgical, psychological, and social standpoint. In trauma dynamics, the pattern of the fractures can extend to all bony fragments and is often associated with soft tissue injuries and loss of bony structures. This can lead to posttraumatic deformities that greatly influence the patient psychologically and limit his social rehabilitation, sometimes permanently. Panfacial trauma includes midface fractures associated with fractures of other areas (i.e., mandible, frontal bone). Orbits and the nasoethmoidal area are often involved with loss of soft tissue and, in severe cases, loss of orbital contents. We report an unusual complex clinical case representative of this kind of pathological profile in which the guidelines described in the literature were followed in the reconstructive procedure.
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ranking = 1
keywords = bone
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9/29. 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.
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ranking = 3
keywords = bone
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10/29. 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.
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ranking = 2
keywords = bone
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