Orbital Wall Research Articles

Iatrogenic Erosion of Orbital Walls due to Expanding Hydrogel Explant.

Hydrogel scleral buckles are a hydrophilic explant that may lead to significant delayed complications. They can insidiously enlarge over decades and may mimic an orbital tumor or cyst. The authors report a case of an expansive hydrogel scleral explant in a previously eviscerated socket. A 58-year-old male presented with a 2-week history of severe pain in his left anophthalmic socket. And 31 years prior, he had sustained OS trauma and undergone a series of surgeries. Details of these procedures were unavailable; however, he had ultimately proceeded to globe evisceration. MRI revealed a large lobulated cyst-like orbital mass with internal calcification, which had expanded the left orbit with erosion of the medial wall, lateral wall, and roof. It extended to involve the ethmoid and frontal paranasal sinuses. He proceeded to a lateral orbitotomy, revealing the lesion to be an expanded hydrogel scleral buckle explant. Postoperatively, there was a significant improvement in his pain.

An Atypical Case of Orbital Wall Infarction Secondary to Sickle Cell Disease in an Adult and Review of Literature.

Sickle cell disease is known to cause painful vaso-occlusive crises in long bones with large marrows. Orbital infarction is a rare complication of sickle cell disease and usually presents in children and adolescents with acute onset periocular swelling mimicking orbital cellulitis. We describe an atypical case of a 38-year-old man with homozygous sickle cell disease who presented with isolated, complete ptosis of his OD with minimal swelling. He described brow aches on the same side, with no features of proptosis, ophthalmoplegia, or compressive optic neuropathy. Orbital imaging revealed infarction in the right frontal bone and orbital roof, with inflammatory soft tissue swelling. His condition resolved completely after 4 days with conservative medical therapy alone.

A review of the ethmoidal foramina and their clinical application.

The ethmoidal foramina (EF), located on the medial orbital wall along the frontoethmoidal sutures, are critical anatomical landmarks for surgeries involving the medial orbital wall. This review aimed to review the surgical anatomy of the EF, including their embryology and radiology. Although the frontoethmoidal sutures mostly have two foramina passing through them, there are reports of single foramen or multiple, up to six foramina. These foramina provide a passage for the ethmoidal arteries and nerves, branches of ophthalmic arteries and nerves. The surgical guideline "24-12-6" is based on the approximate distance between the anterior lacrimal crest, the anterior and posterior ethmoidal arteries, and the optic canal, commonly used to navigate this area. However, some studies from various populations defined different ratios. Embryologically, the EF were formed by the union of intramembranous ossified frontal bones and endochondral ossified ethmoid bones. EF and neurovascular structures can be identified in computed tomography even in the 3 mm sectional intervals. A comprehensive anatomical understanding of EF will help clinicians improve surgical guidelines and ultimately reduce the risk of complications.

Volumetric Analysis of Orbital Volume Discrepancy as a Marker of Change in Globe Position After Three-Point Fixation of Zygomatic Complex Fractures

BackgroundMany researchers have proposed incorporating orbital volume (OV) discrepancies between the affected and unaffected orbits into routine diagnostic processes as an indicator for early surgical repair of zygomatic complex fractures (ZMCFxs) to avoid postoperative ocular complications. PurposeThe study aimed to determine the correlation between the preoperative OV discrepancy and postoperative globe position. Study Design, Setting, SampleA retrospective cohort study was performed on patients with unilateral ZMCFxs associated with orbital floor fractures, treated at Al-Zahraa Hospital, Al-Azhar University, from January 2020 to July 2023. Patients with comminuted ZMCFxs, medial or superior orbital wall fractures, or corrective surgeries were excluded. Predicator VariableThe predictor variable was the preoperative OV discrepancy between the affected and unaffected orbits. Outcome VariablesThe outcome variables were the three-month postoperative globe position, which was classified as normal, enophthalmos, or exophthalmos, and the orbital repair quality, that was categorized as well-corrected, under-corrected, or over-corrected. CovariatesThey included age, sex, ethnicity, side, etiology, type of orbital floor fractures, timing, and indication for surgery. Statistical AnalysisChi-square, Pearson's correlation, and linear regression analyses were used; the statistical significance was set at P < .05. ResultsThe study included 111 patients, with an average age of 30.3± 6.6 years and male predominance. The preoperative OV discrepancy between both orbits was 5.1± 1cc3, associated with enophthalmos in the patients. Postoperatively, the OV discrepancy became 0.9± 0.7 cc3, but the globe position was heterogenic. Thirty-seven patients (33.3%) had normal globe position. Sixty-three (56.8%) subjects had enophthalmos. Eleven (9.9%) individuals had exophthalmos. The preoperative OV discrepancy and postoperative globe position had a significant weak positive linear correlation. For every one-cubic-centimeter change in OV, the globe moved 0.1mm (P< .05). The majority of the patients had under-corrected orbits, followed by over-corrected and well-corrected orbits. Every category of globe position was recorded with every category of orbital repair, and the findings showed no correlation between globe position and orbital repair quality (P= .08). ConclusionPreoperative OV discrepancies between both orbits should not be employed as the sole predictor of globe position because a one-cubic-centimeter change in OV affects globe position by only 0.1mm.

A New Approach for Orbital Wall Reconstruction in a Rabbit Animal Model Using a Hybrid Hydroxyapatite–Collagen-Based Implant

Reconstructing the orbit following complex craniofacial fractures presents significant challenges. Throughout the years, several materials have been used for orbital reconstruction, taking into account factors such as their durability, compatibility with living tissue, cost efficiency, safety, and capacity to be adjusted during surgery. Nevertheless, a consensus has not yet been reached on the optimal material for orbital restoration. This study investigates the potential of a hybrid hydroxyapatite–collagen (HAp-COL) material 3D-printed on Ti mesh to be used as an implant for orbital wall reconstruction. HAp-COL powder was synthesized using a high-pressure hydrothermal technique. The powder was further used to 3D-print HAp-COL structures on titanium mesh, with the latter having potential uses in orbital wall reconstruction. Biocompatibility was assessed by evaluating the effects of the HAp-COL material on the adhesion and proliferation of fibroblasts (3T3) and mesenchymal stem cells (MSCs) in culture. In vitro and in vivo results showed that HAp-COL is highly biocompatible and has a good integration of the implant in the bone. The findings reported in this study offer convincing evidence to support the use of our designed HAp-COL for the restoration of orbital wall fractures, with a high level of safety.

A case report and systematic review of periorbital emphysema following nose blowing or sneezing.

Periorbital emphysema following nose blowing or sneezing is rare. Although it is often self-limiting, air trapping in the orbit can raise the intraocular pressure leading to visual complications. At present, the literature on this topic is confined to case reports. In this article, we present a rare case of periorbital emphysema following nose blowing in a 34-year-old woman and a subsequent systematic review that included 43 case reports of periorbital emphysema following similar mechanisms. Orbital wall fracture was seen in 70% and a defect in the lamina papyracea is the most common finding on computed tomography imaging. Surgical intervention was performed in 30% of patients; indications included visual compromise, paranasal osteoma and inflammatory disease. Most patients can be safely discharged on the same day with oral antibiotics unless there are clinical signs of visual compromise or sinonasal mass that may necessitate surgical intervention. The recurrence rate is low (3%) and almost all will resolve within 4 weeks.

Central retinal artery occlusion following surgery for thyroid eye disease: A case report.

Thyroid eye disease (TED) is the most common orbital disorder in adults and significantly affects patient health. Orbital decompression surgery is an important treatment option. Central retinal artery occlusion (CRAO) after orbital medial wall decompression is rare in patients with TED. Therefore, the earlier the identification and treatment, the more likely it is to reduce visual impairment. This paper examines a case of CRAO occurring postoperatively in a patient who underwent medial wall orbital decompression for TED. Central retinal artery occlusion. During the operation, the pupil was dilated, and eye massage and peribulbal injection of atropine were performed immediately. Fundus fluorescein angiography suggested the possibility of CRAO. Intravenous methylprednisolone 1000 mg, mannitol 50 g, ginkgo biloba extract 20 mL, nimodipine 20 mg tid, cobamamide 0.5 mg tid, and oral citicoline 0.2 g tid, along with periocular injection of atropine and hyperbaric oxygen therapy were also administered. Fifteen days after onset, the patient's retinal edema and retinal blood perfusion greatly improved. The patient's visual acuity recovered from counting fingers to 0.6. Retinal vascular obstruction is a serious threat to vision; therefore, early detection and treatment are very important.

Accuracy of the Image Interpretation Capability of ChatGPT-4 Vision in Analysis of Hess Screen and Visual Field Abnormalities.

OpenAI, the owner of ChatGPT, publicly released the GPT-4 Vision in September 2023. This multimedia chatbot has the capability to receive and analyze various images presented to it by the user. We assessed the accuracy of its interpretation of 2 of the images commonly used in neuro-ophthalmology, namely Hess screen and automated visual field images. We separately uploaded typical images of 5 abnormal Hess screen charts related to third, fourth, and sixth cranial nerve palsy, Brown syndrome, and inferior orbital wall fracture with entrapment of the inferior rectus muscle. Likewise, 5 classic images of automated visual field grayscale maps related to lesions of the optic nerve, the chiasma, the optic tract, the optic radiations, and the occipital lobe were presented. The chatbot was instructed to select the best option among the 5 choices presented in each question. The GPT-4 Vision was able to select the right choice in 2/5 questions on Hess screens and 3/5 of the visual field questions. Despite selection of the correct option, qualitative evaluation of GPT-4 responses revealed flawed analysis of certain aspects of some image findings, such as the side of involvement or the misinterpretation of the physiologic blind spot as a central scotoma. The performance of GPT-4 Vision in the interpretation of abnormalities of Hess screen and visual field involvement was highly variable, even with simple typical cases of classic disorders. As the chatbot's image recognition is currently evolving, its capacity to accurately interpret ophthalmologic images is still limited at this time.

Role of the endonasal endoscopic approach in intraorbital tumor surgery: insights from a single-center experience.

This study aimed to evaluate the effectiveness of the endoscopic endonasal approach (EEA) in the surgical management of intraorbital tumors and analyze the adjunctive role of the transorbital approach (TOA) and extended modified medial maxillectomy (EMMM) in addressing anatomically complex tumors. This study retrospectively reviewed 13 cases of primary intraorbital tumors managed with EEA, integrating TOA and EMMM, based on specific tumor location and extent. A detailed analysis was conducted on the surgical techniques used, tumor size and location in relation to critical structures such as the optic nerve, and overall surgical outcomes, with a focus on the extent of resection and postoperative visual function. Of the 13 cases analyzed (4 cavernous hemangiomas, 3 schwannomas, mucosa-associated lymphoid tissue lymphoma, diffuse large B-cell lymphoma, liposarcoma, inflammatory myofibroblastic tumor, osteoma, and myxoid spindle tumor), the EEA served as the primary surgical method, especially for the 8 intraconal tumors situated medially to the optic nerve, with 1 tumor situated inferiorly to the optic nerve. Extraconal tumors, present in 5 cases, necessitated additional approaches: TOA was utilized for tumors with anterior extension, and EMMM was applied to those extending toward the inferior orbital wall. Gross-total resection was accomplished in 80% of the operative cases, with an overall improvement in visual function observed in 69.2% of the patients postsurgery. Complications were infrequent, with enophthalmos requiring subsequent reconstruction and a permanent slight visual field defect in the upper outer quadrant, occurring in 1 case each, underscoring the safety and efficacy of integrated surgical approaches. The combination of EEA with TOA and EMMM provides a comprehensive and adaptable surgical strategy for intraorbital tumors, accommodating various lesion locations and complexities. This combined approach not only facilitates extensive tumor resection but also maximizes the preservation of ocular function and cosmetic outcomes. The favorable results of this study support the use of a multidisciplinary surgical approach and highlight the potential for improved patient outcomes with the continued development of endoscopic techniques. Further research with a larger cohort is essential to validate these findings and establish guidelines for the combined use of these surgical methods.

Intraoperative navigation in craniofacial surgery.

Craniofacial surgery requires comprehensive anatomical knowledge of the head and neck to ensure patient safety and surgical precision. Over recent decades, there have been significant advancements in imaging techniques and the development of real-time surgical navigation systems. Intraoperative navigation technology aligns surgical instruments with imaging-derived information on patient anatomy, enabling surgeons to closely follow preoperative plans. This system functions as a radiologic map, improving the accuracy of instrument placement and minimizing surgical complications. The introduction of first-generation navigation systems in the early 1990s revolutionized surgical procedures by enabling real-time tracking of instruments using preoperative imaging. Initially utilized in neurosurgery, intraoperative navigation has since become standard practice in otolaryngology, cranio-maxillofacial surgery, and orthopedics. Since the 2000s, second-generation navigation systems have been developed to meet the growing demand for precision across various surgical specialties. The adoption of these systems in craniofacial surgery has been slower, but their use is increasing, particularly in procedures such as foreign body removal, facial bone fracture reconstruction, tumor resection, and craniofacial reconstruction and implantation. In Korea, insurance coverage for navigation in craniofacial surgery began in 2021, and new medical technologies for orbital wall fracture treatment were approved in August 2022. These technologies have only recently become clinically available, but are expected to play an increasingly important role in craniofacial surgery. Intraoperative navigation enhances operative insight, improves target localization, and increases surgical safety. Although these systems have a steep learning curve and initially prolong surgery, efficiency improves with experience. Calibration issues, registration errors, and soft tissue deformation can introduce inaccuracies. Nonetheless, navigation technology is evolving, and the integration of intraoperative computed tomography data holds promise for further enhancements of surgical accuracy. This paper discusses the various types and applications of navigation employed in craniofacial surgery, highlighting their benefits and limitations.

Optimizing surgical approaches for lacrimal gland adenoid cystic carcinoma to minimize cross-organ invasion.

To evaluate the outcomes of eye-sparing surgery for lacrimal gland adenoid cystic carcinoma and the impact on tumor recurrence and orbital integrity. The study enrolled four patients with recurrent lacrimal gland adenoid cystic carcinoma. The outcome focused on the relevance of the integrity of the lateral orbital wall to the occurrence of extraorbital metastasis in the local recurrence of lacrimal gland adenoid cystic carcinoma. Three patients underwent eye-sparing surgery via lateral orbitotomy without postoperative radiotherapy, and one patient who underwent eye-sparing surgery via sub-brow approach. These four patients all demonstrated a recurrence involving the invasion of extraorbital tissues as metastatic form through surgical bone seams. Preserving intact orbital bone tissue is crucial for mitigating direct cross-organ metastasis of lacrimal gland adenoid cystic carcinoma. The findings suggest avoiding the lateral orbitotomy approach with no or limited orbital bone wall invasion.

Analysis of risk factors for patients with traumatic optic neuropathy and comparison of visual outcomes of management strategies

BackgroundTraumatic optic neuropathy (TON) is a rare complication of facial trauma that results in vision loss. Clinical diagnosis of TON is based on a history of head trauma and an ophthalmic examination; however, the risk factors for TON and the ideal treatment strategy remain undetermined. This study investigated the predictive risk factors for TON and analyzed the effectiveness of current treatments with respect to visual outcomes in patients with TON. MethodsThis study retrospectively enrolled patients with periorbital facial bone fracture between 2008 and 2019. Initial facial bone computed tomography, ophthalmic exam results, initial Glasgow Coma Scale, and Injury Severity Score (ISS) were recorded. This study classified patients into 4 intervention groups (i.e., medication, surgery, combination therapy, and observation) to compare the outcome of visual acuity. ResultsThis study enrolled 1168 patients with facial bone fractures, 93 (7.96%) of whom were diagnosed as having TON. Independent risk factors for TON included optic canal fracture, medial orbital wall fracture, retrobulbar hematoma, and head Abbreviated Injury Scale ≥ 4. Patients with TON who initially presented with no light perception tended to have poor final visual acuity (VA) outcomes. The results indicated no significant difference in VA improvement among patients receiving observation, mega-dose corticosteroid therapy, surgical decompression, or combined steroid therapy and decompression. ConclusionClinicians can achieve early prediction of TON in patients with an initial unconscious state and the determined risk factors. The results indicated that conservative observation yielded noninferior VA outcomes in patients with TON compared with those receiving medication or surgical treatment.

Computed tomography of acute orbital trauma in children: a retrospective study

INTRODUCTION: Orbital injuries account for 36 to 64% of all blunt trauma to the facial bones. Diagnosis of orbital wall fractures is carried out using conventional radiography in several projections and computed tomography; magnetic resonance imaging is less commonly used. Often, due to the small displacement of orbital bone fragments, X-ray diagnosis is difficult. Multislice CT with reconstruction of sagittal, coronal projections and 3D in the bone window in such cases is the best visualization method. However, there are still no clear indications for the use of each method and there is no complete view of the CT characteristics of orbital damage.OBJECTIVE: To study the diagnostic value of computed tomography of orbital fractures in pediatric patients with acute trauma.MATERIAL AND METHODS: Retro- and prospectively analyzed the results of CT scans of 94 patients with facial fractures from 01/01/2023 to 09/01/2023 to assess combined orbital injuries. Orbital fractures were detected in 63 children (67.0%). There were 44 boys (69.84%), 19 girls (30.15%) aged from 7 months to 17 years 10 months (average age 10.3). Statistics: For statistical analysis, the method of calculating the nominal correlation using the Kramer coefficient (V) using the IBM SPSS Statistics software package was used.RESULTS: Concomitant injury was observed in 30 (47.6%); isolated 33 (52.36%). The number and frequency of fractures observed were as follows: superior wall of the orbit — 39 (61.9%); zygomatic complex — 19 (30.1%); lower wall of the orbit — 43 (68.2%); nasal bone — 17 (26.9%); lower jaw — 6 (9.5%); medial wall of the orbit — 28 (44.4%); upper jaw — 27 (42.8%); alveolar process — 6 (9.5%); isolated zygomatic arch — 14 (22.2%); Le Fort type I — 1 (1.5%); Le Fort type II — 2 (3.1%); and Le Fort type III — 0 (0%). Orbital hematomas were found in 25 patients (39.6%). It was revealed a strong correlation between the presence of contiguous skull fractures and multiple skull fractures (V=0.878, p&lt;0.001), frontal sinus fractures and frontal sinus hemosinus (V=0.69, p&lt;0.001).CONCLUSION: Orbital fractures are a frequent type of facial fracture occurring in children with blunt isolated and combined trauma. In children with blunt trauma, head CT combined with clinical examination is currently the optimal tool for diagnosing clinically significant orbital injuries. There is a strong correlation between orbital hematomas and orbital vault fractures, orbital hematomas and lattice fractures, adjacent skull and orbital vault fractures, and adjacent skull and lattice fractures. CT examination should include multiplanar (in coronal and sagittal planes) and 3D reconstructions, which help to assess the extent of the fracture, the presence of diastasis, the degree of muscle impingement. Based on the data obtained, the clinician determines the need for surgical intervention.

Innovative Orbital Periosteum Suturing Technique for Endoscopic Medial Orbital Wall Reconstruction

Abstract Background Advances in endoscopic orbital surgery have sparked discussion regarding reconstructive procedures for medial orbital wall defects following tumor removal. This study describes an innovative orbital periosteal suturing technique that addresses the functional and aesthetic concerns created by orbital surgery. Objective Comprehensive clinical evaluation of a novel orbital periosteal suturing technique for endoscopic medial orbital wall reconstruction. Methods A retrospective chart review identified five patients who underwent endoscopic transnasal resection and subsequent orbital periosteal suturing for reconstruction. The surgical approach involved a binostril transseptal technique to create a broad surgical corridor. The postoperative follow-up was 13.4 ± 1.8 months. Results In the five patients, the mean age was 47.6 ± 13.0 years and the lesions were predominantly distributed on the left side (60%). Reconstruction time with the orbital periosteal suture procedure averaged 47.2 ± 6.6 minutes, employing four to five stitches. No patients experienced short-term complications such as visual acuity defect, new or exacerbated diplopia, or cranial nerve palsy within 2 weeks, and no long-term complications such as enophthalmos or prolonged diplopia were observed. Conclusion Orbital periosteal suturing is an effective and resource-efficient technique for endoscopic reconstruction of the medial orbital wall. Surgeons may consider this method among the available options for orbital reconstruction, representing a novel advancement in the field.

Нарушение подвижности глазного яблока у пациентов с травматическим косоглазием

Relevance. Limitation of eyeball mobility is one of the main signs of traumatic strabismus. The following main factors of its occurrence have been identified: trauma to the eye and periorbital region, orbital fracture, concussion and severe cranio-orbital or traumatic brain injury. Oculomotor function may suffer due to paresis/paralysis of the extraocular muscle, its mechanical damage or entrapment in the area of the fracture of the orbital bones (in cases where strabismus has developed as a result of an orbital fracture), or due to the formation of severe tissue fibrosis and restriction. Purpose. To study the dynamics of oculomotor function before and after surgical treatment of traumatic strabismus in patients with dystopia of the eyeball and without it. Material and methods. A retrospective analysis of outpatient records of 269 patients with traumatic strabismus was carried out. Results. Dystopia of the eyeball was detected in 34%. Exophthalmos accounts for approximately a third of all dystopias occurring in traumatic strabismus. An isolated fracture of the orbital wall did not cause exophthalmos. In such cases, other types of dystopias were noted. But in more extensive and severe injuries to the skull, exophthalmos occurred in 10% of cases. Among all cases of exophthalmos, in 40% it developed as a result of injury to the eye or periorbital region, in 60% – with severe cranio-orbital damages (COD) and head injury. It was found that as a result of surgical treatment, the number of patients with normal eyeball mobility increased from 16 to 24%. Lack of eyeball mobility was noted in 7% of patients, while before treatment their number was almost 19%. In the group without dystopia with moderate oculomotor disorders, after treatment, the mobility of the eyeball did not improve in 65% of patients; it improved in 31% of patients; in the group with dystopia, 41% retained the same degree of mobility limitation, and improvement (decrease in the degree of limitation) was detected in 55% of patients. Conclusion.It has been established that dystopia causes more severe oculomotor disorders. However, adequate surgical treatment can improve eye mobility in more than half of the patients. Key words: traumatic strabismus, dystopia, orbital rupture, eyeball mobility, restriction, fibrosis

Clinical characteristics and outcomes of orbital fractures: a sex-based cohort analysis

PurposeThis study aims to identify clinical similarities and differences between males and females presenting with orbital fracture. MethodsPatient charts of adult orbital fracture cases diagnosed via computed tomography and referred by a level 1 trauma center to the McGill University Health Centre between August 2015 to January 2018 were examined and analyzed. Clinical parameters included age, sex, mechanism of injury, morphology of orbital fracture, symptoms and examination features, and rates of ocular pathology. Comparative analyses were performed via Student's t-test and chi-square to assess for sex-related differences. ResultsThe study included 176 males (mean age: 46.2 years) and 68 females (mean age: 58.5 years). The most common etiology of orbital fracture was assault among males (32%) and fall from own or standing height among females (38%). Males had a higher prevalence of bilateral fractures than females (17% vs 6%; p = 0.02) and had more orbital walls fractured per orbit than females (2.0 vs 1.5; p < 0.01). Males were more likely to have their orbital roof fractured (28% vs 15%; p = 0.03) and were more likely to be intubated after their trauma (22% vs 7%; p = 0.004). Post-traumatic ocular pathology occurred in 11% of males versus 9% of females (p = 0.56). ConclusionIn our cohort of adult orbital fractures, males were more prevalent, more likely to have bilateral fractures, more extensive fracture per orbit, and higher prevalence of orbital roof fractures and intubation. Despite these differences, rates of ocular pathology did not differ significantly between males and females, highlighting the importance of a careful assessment in both groups.

Assessing the need for specialty consultation for isolated medial orbital wall fractures

ObjectiveThis objective was to assess if the current practice of interfacility transfer and immediate specialty consult is justified by the rate of surgical repair for isolated medial orbital wall fractures. Study DesignThis is a retrospective descriptive study utilizing the records of all patients with isolated medial orbital wall fractures who presented to the ED at Boston Medical Center from January 2014 to December 2022. A descriptive analysis was completed. Results65 patients with isolated medial orbital wall fractures were identified. No patient underwent surgical intervention for repair of their fracture. 15% of the patients were transferred from an outside facility. The facial trauma team was consulted for 70% of the patients. Concomitant consultation of the ophthalmology and facial trauma teams occurred for 54% of the patients. Patients with no specialty consult had the shortest average length of ED stay. The no-show rate for follow-up appointments was 70%. ConclusionsThe absence of surgical repair for isolated medial orbital wall fractures across multiple surgical specialties, multiple attending providers, a wide age range, and all mechanisms of injury along with a 70% follow-up no-show rate may call into question the conventional approach of interfacility transfer and specialty consult for these fractures.

Assessing the Feasibility of Selective Piezoelectric Osteotomy in Transorbital Approach to the Middle Cranial Fossa: Anatomical and Quantitative Study and Surgical Implications

ObjectivesTo verify the feasibility and to discuss advantages and disadvantages of a piezoelectric orbitotomy (PO) during Superior Eyelid Endoscopic Transorbital Approach (SETOA). MethodsFive adult specimens underwent exoscopic/endoscopic SETOA to middle cranial fossa. The surgical corridor was created via piezoelectric orbitotomy by performing three selective and safe micrometric bone cuts providing a one-piece trapezoid bone flap which was repositioned and secured at the end of procedure. A 3D scan of the bone flap allowed us to reconstruct a 3D model and calculate its volume. An illustrative case demonstrating the application of this novel technique was also presented. ResultsAnatomical-morphometric quantitative analysis showed a mean bony-volume gain of 1,574.26 mm3 by using PO.PO yielded concrete surgical advantages and theoretical benefits in terms of functional and esthetic outcomes. All osteotomies were micrometric clear-cut and precise, resulting in a very thin bony gap; a complete sparing of soft tissues and neurovascular structures in- and around the orbit was observed. Lateral orbital wall reconstruction by replacing the bone flap aims to mitigate the risk of enophthalmos, proptosis, CSF leakage, pseudomeningocele and pulsatile headache, which represent significant challenges in the relevant literature. ConclusionPO may offer a viable, selective, effective, safe alternative to high-speed drilling during SETOA, especially for patients affected by intra-axial pathologies in which a watertight closure is mandatory. This procedure could prevent/decrease the risk of some of the main postoperative complications associated to the standard SETOA, resulting potentially in better functional and esthetic outcome.

A recent algorithm for management of orbital floor fractures with the application of a novel minimally invasive endoscopic surgery

Orbital floor (OF) fractures present a dilemma, with controversies surrounding surgical indication, approach, and ideal material for reconstruction. Our study was conducted on cases of (OF) fracture admitted to a tertiary referral centre. Cases of (OF) associated with zygomaticomaxillary complex (ZMC) fracture were managed as follows: those with ophthalmological problems were subjected to endoscopically assisted transorbital reconstruction of the floor; cases without ophthalmological problems were subjected to reduction and fixation of the ZMC fracture only. The recently developed endoscopic endonasal transmaxillary approach was used to manage cases with pure OF fracture, while the same approach with added endoscopic transethmoidal reconstruction of the medial orbital wall (MOW) was applied to cases with associated MOW fracture. Outcome measurements were the correction of diplopia and enophthalmos, along with the restoration of normal globe function. The study included 80 patients, who were divided into four groups according to the proposed algorithm. OF reconstruction was performed in 32 cases with either septal cartilage (n = 4), titanium plate (n = 11), or porous polyethylene mesh (n = 17). Our study presents the novel role of minimally invasive endoscopic surgery in the management of (OF) fracture, together with a recently developed management plan that could maximize positive outcomes and decrease morbidity.

Pattern And Occurrence of Orbital Fractures Associated with Midface Trauma – A Hospital Based Observational Study

Aims &amp; Objectives: To study the pattern and occurrence of orbital fractures associated with midface trauma and to assess the association of fracture pattern with etiology of orbital fracture. Methodology: All midface trauma patients treated at the Oral and Maxillofacial Surgery Department of Govt Dental College Calicut between June 2019 and June 2020 were included. Plain radiographs and available CT scans were assessed by a senior maxillofacial surgeon to diagnose and evaluate orbital fractures. The etiology of fractures was recorded, and its correlation with orbital fracture patterns was analyzed. Clinical evaluation included assessing eye movements, enophthalmos, hypoglobus, palpebral fissure length, and alignment, as well as the presence of telecanthus. Results: Out of 238 midface trauma cases, 147 had orbital fractures, comprising 139 males (58.40% of total, 94.56% of total orbit) and 8 females (3.36% of total, 5.44% of total orbit). Road traffic accidents were the primary cause (91 cases, 38.24%, 61.90%), followed by falls (35 cases, 14.71%, 23.81%). The most common fracture site was the lateral wall (105 patients, 71.43%), followed by the floor (55 patients, 37.42%). Conclusion: The lateral orbital wall was the most frequently fractured site, likely due to its prominent position and susceptibility to direct impact. Conservative management was predominantly utilized. No statistically significant association was found between the etiology of trauma and fracture patterns