Left Medial Orbital Wall Research Articles

Traumatic acute retrobulbar haemorrhage complicated with central retinal artery occlusion

AbstractPurpose: To present the vascular complications of traumatic acute retrobulbar haemorrhage and describe its management through a case report.Methods: A case report of a patient having an acute retrobulbar haemorrhage complicated with central retinal artery occlusion (CRAO).Results: A 50‐year‐old male patient exposed to blunt orbital trauma two hours prior was referred to the emergency with complaints of pain and loss of vision in the left eye. The negative light perception was noted in this eye. A tense hematoma, proptosis, ophthalmoplegia, and a non‐reactive pupil were also noted. Biomicroscopic examination, revealed corneal edema, subconjunctival haemorrhage, and chemosis. The fundus examination was not possible. Intraocular pressure (IOP) was 60 mmHg. The patient was diagnosed with acute retrobulbar haemorrhage. Computerized tomography was performed immediately showing a fracture of the left medial orbital wall and haemorrhage within the retrobulbar space. Intravenous mannitol and topical dorzolamide‐timolol associated with oral corticosteroid were administered. IOP decreased to 30 mmHg, but the patient's visual acuity did not improve. The fundus examination revealed a total CRAO confirmed by the fluorescein angiography and OCT‐A showing massive ischemic edema and occluded perimacular arterioles with interruption to the choroidal blood flow. OCT images demonstrated an increased reflectivity and thickness of the inner retina and subretinal fluid, which corresponds to the acute phase of CRAO. The time of surgical treatment was missed, and as a result, the patient missed their chance for visual recovery.Conclusions: Retrobulbar haemorrhage is a complication from ocular trauma that may cause permanent vision loss. Retrobulbar haemorrhage can potentially lead to dangerous increases in intraorbital pressure, a condition that is also described as orbital compartment syndrome. This increase in pressure is sufficient to cause vision loss, whether through direct compression of the optic nerve leading to optic neuropathy, a central retinal artery occlusion, or compression of the vessels that provide nutrition to the optic nerve.

Age- and Sex-Related Morphometric Changes and Asymmetry in the Orbito-Zygomatic Region.

The aims of this study were to obtain cephalometric data of orbito-zygomatic skeleton using CT axial images and to determine the presence of sexual dimorphism, normal range of facial asymmetry, and the age-related changes.This study used data from 315 CT scan series of skeletally normal subjects (159 males and 156 females) between the ages of 18 to 90. Two different levels of axial sections were used. In total, 11 measurements were performed and 5 of them were bilateral.The mean values and standard deviations were calculated. Gender and age related changes and asymmetry degree were investigated.Mean values of measurements except left medial orbital wall length, right and left medial orbital wall protrusion, right and left lateral orbital wall angle were significantly larger in males for all age groups. Majority of the measurements was formed by the individuals with larger right side. Similar tendencies were observed for craniofacial asymmetry in both sexes and in different age groups. There were no significant craniofacial asymmetries between age and gender groups in terms of the cephalometric measurements. Mid-interorbital distance had a negative correlation (r = -0.11 and P = 0.043) and interzygomatic buttress distance had a positive correlation (r = 0.15 and P = 0.005) with age.Morphological properties such as sexual dimorphism, symmetry, age related changes are important parameters especially for plastic surgery discipline. The authors hope the data can be helpful in diagnosis and surgical treatment of craniofacial diseases, estimating the prognosis and preparation of the facial prosthesis.

Trans-septal suture retraction for endoscopic orbital surgery

ABSTRACT Purpose We describe a novel technique for endonasal endoscopic orbital surgery. Previously described strategies for minimally invasive orbital surgery include mobilization of the medial rectus muscle and cryosurgical retraction of the pathologic lesion. Herein we describe endoscopic trans-septal suture retraction of an orbital cavernous hemangioma to facilitate intra-orbital dissection from an external approach. Methods A 36-year-old male presented with blurred vision in his left eye for several years, along with several months of progressive left proptosis and decreasing visual acuity. Imaging revealed a 2.5 cm orbital mass consistent with a cavernous hemangioma. The patient underwent a combined transconjunctival and endoscopic approach for resection. Results Following left medial orbital wall and floor decompression, endoscopic trans-septal suture retraction facilitated dissection of the lesion from intraorbital structures. A complete extracapsular resection of the lesion was achieved. The inferomedial orbit was reconstructed with a synthetic implant. Conclusion Trans-septal suture retraction is an effective adjunctive technique for endonasal endoscopic orbital tumor surgery. This technique facilitates safe retraction and dissection of soft tissue lesions from critical intraorbital structures.

Endoscopic Endonasal Approach of Orbital Medial Wall Reconstruction using Septal Cartilage: A Rare Surgical Case Report

ABSTRACT Orbital fractures can cause facial disfigurement and disturbs vision. Medial orbital wall fractures are diagnosed with frequent use of computed tomography (CT) scans in the diagnosis of orbital trauma. Orbital reconstruction plays a challenging role for the surgeons as it comes in a multitude of different forms. We report a case of 45-year male with a history of assault presented with diminution of vision, restricted abduction and diplopia of the left eye. Computed tomography scan showed fracture of the left medial orbital wall fracture and the patient was treated by endoscopic endonasal approach of medial orbital wall reconstruction using septal cartilage. How to cite this article Rajasekar MK, Vivek M, Narendrakumar V. Endoscopic Endonasal Approach of Orbital Medial Wall Reconstruction using Septal Cartilage: A Rare Surgical Case Report. Clin Rhinol An Int J 2015;8(1):30-33.

Horner Syndrome Due to Vertebral Artery Stenosis

The author reports a rare case of Horner syndrome in a patient who resulted from stenosis of the vertebral artery after blunt trauma. A 31-year-old man was transferred to our department for evaluation of left medial orbital wall and nasal bone fractures. Five days ago, he was hospitalized due to multiple second to fourth rib fractures of the right chest following blunt trauma of the face, neck, and chest. Surgery was performed. Ten days later, he complained of drooping of the right eyelid. Physical examination revealed a discrete miosis and ptosis with normal levator function in the right eye. A workup for Horner syndrome was performed. Magnetic resonance angiography of the head and neck revealed a stenosis of the distal part of the right vertebral artery without the abnormality of carotid artery. He wore a cervical collar and underwent anticoagulation. However, Horner syndrome was not resolved over the next 12 months. Acute traumatic Horner syndrome may be associated with vertebral artery dissection in which the possibility of life-threatening injury can be masked.

Massive Orbital Emphysema-An Unusual Clinical Presentation of Isolated Medial Orbital Wall Fracture

Orbital emphysema is an unusual complication of orbital fractures which are the common sequelae of periorbital trauma. Most cases are due to inferior orbital wall fractures. Here we report a case with an unusual clinical presentation of isolated left medial orbital wall fracture complicated with massive orbital emphysema. Without ophthalmic or neurologic defect, conservative management with cold compression and analgesics was prescribed. He was also advised not to blow his nose. On follow-up at 1 and 4 months, the orbital emphysema subsided, and the patient remained free of any optic impairment. Relevant literature is also reviewed.

Injury of the Medial Rectus Muscle by Using a Microdebrider During Endoscopic Sinus Surgery : A Case Report

A microdebrider is increasingly used in endoscopic sinus surgery. Although it has many advantages over conventional instruments, it has been associated with severe complications. We treated a case of rupture of the left medial rectus muscle after use of a microdebrider during endoscopic sinus surgery in a 50 year-old female patient who complained of binocular diplopia and exotropia. The patient showed marked limitation on adduction and about 40 prism diopters of left exodeviation. The orbital computed tomography showed a bony defect at the left medial orbital wall, and injury of the medial rectus muscle. The exodeviation was corrected after ophthalmologic surgery. We report a case of the rupture of the medial rectus muscle after use of a microdebrider during endoscopic sinus surgery and review the medical literature.

Pfählungsverletzung der Orbita

A 71-year-old female patient fell in her garden, inducing a skin wound on the temporal left eyebrow. Skin disinfection and wound closure were performed elsewhere, an X-ray image did not reveal a foreign body. She was referred to our service three days later with a progressive left periorbital swelling. Clinical inspection demonstrated a painfully, fluctuant swelling around the wound with an inflammatory pseudoptosis of the left eye. Vision was reduced on the left eye; anterior and posterior segments of both eyes were unharmed. After opening the wound sutures a purulent liquid was drained and a wooden fragment was found, measuring 22 x 0.5 mm. Because of restriction of abduction of the left eye, magnetic resonance imaging (MRI) was performed, detecting another organic intraorbital foreign body and a fracture of the left medial orbital wall. Anterior orbitotomy was performed and a wooden fragment was removed, measuring 47 x 0.6 mm. Under administration of intravenous antibiotics vision and ocular motility recovered uneventfully. This case emphasizes the value of MRI in the diagnostics of retained wooden foreign bodies as well as the importance of a soigneuse inspection of skin wounds with a high risk for remaining foreign bodies.

Postoperative mucocele in a pediatric patient

Objectives: Postoperative mucocele formation is a known and late complication of endoscopic sinus surgery in adults. Occurrence in the pediatric population, however, is rare and not reported in the American literature. We report a case of a mucocele in a child after endoscopic sinus surgery. Methods: A 9-year-old female presented with a 1-month history of proptosis. She denied any headache, eye pain, visual disturbance, nasal obstruction, or rhinorrhea. A CT scan of the orbits revealed a 2.1 ± 1.7 cm expansile soft tissue mass within the left anterior ethmoid air cells, with displacement and thinning of the lamina papyracea. She had a history of endoscopic sinus surgery 3 1/2 years ago. Results: She underwent endoscopic exam under general anesthesia and a large mucopyocele was identified, involving the ethmoid sinus and left medial orbital wall. The lamina papyracea was eroded. Endoscopically the mucopyocele was removed. The patient did well postoperatively. At 3 weeks follow-up, her proptosis was improved and there was no evidence of synechia. Conclusion: Pediatric mucoceles of the paranasal sinuses are a rare entity with little reported in the literature. Furthermore, there are no studies in the American literature describing postendoscopic sinus surgery mucoceles in children. With the increasing numbers of pediatric endoscopic sinus procedures, there needs to be an awareness of this entity as a long-term postoperative complication. Treatment of mucoceles in children has been described, and like adults, endoscopic drainage is recommended.