Orbital Cavity Research Articles

Solitary fibrous tumor of head and neck region; A clinicopathological study of 67 cases emphasizing the diversity of histological features and utility of various risk stratification models

BackgroundHead and neck SFT (HNSFT) exhibit diverse histological features and can mimic various neoplasms with different treatment and behavior. While risk stratification systems have been developed for this tumor at various anatomic sites, a specific scheme for head and neck tumors is lacking. Our aim was to describe the histologic patterns present in HNSFT cases as well as assess the utility of risk assessment models in this location. MethodsA retrospective review of pathology reports and microscopy glass slides of HNSFT cases diagnosed between January 2010 and August 2022 was performed.STAT6 was additionally performed on selected cases if needed. Follow up was obtained and various risk stratification models were applied. ResultsSixty seven cases of HNSFT were collected (age range from 11 to 87 years; median 42 years; M:F 1.6:1). Most common tumor sites were orbit (n = 21; 31.3 %), sinonasal tract (n = 18; 26.9 %), and oral cavity (n = 13; 19.4 %). Tumor size ranged from 1 to 16 cm (median 4cm). Apart from common histological features, tumor cells also showed focal epithelioid morphology, clear cell change and nuclear atypia in a subset of cases. Stromal findings included myxoid and lipomatous change, pseudoglandular spaces, pseudovascular spaces and multinucleated stromal giant cells. CD34 and STAT6 were expressed in 57/67 (85.1 %) and 56/56 (100 %) cases, respectively. Recurrence was observed in 4/26 (15.4 %) cases, while none (0/22) of the patients experienced distant metastasis (follow up 1–150 months; median 20.5 months). Clinical outcome was partially concordant with risk-categories of different risk stratification models. ConclusionKnowledge about histological diversity of HNSFT is essential for establishing correct diagnosis. Current risk stratification models do not perfectly predict outcome, and larger studies are needed to develop more accurate criteria for aggressive behavior.

Macromorphoscopic study of the orbital cavities of human dry skulls for sex estimation

Sex estimation was analyzed from the orbital cavities of 304 dry skulls (148 female and 156 male), which were classified as rectangular, circular, and rhomboid. Logistic regression was performed to estimate the probability of the orbital cavity belonging to males or females. In decreasing order, there was a higher occurrence of rectangular, rhomboid, and circular shapes. The estimation of sex resulted in an overall percentage of correctness of 59.9%. The left orbital cavity presented a significant p-value, but the chance of the characteristics of this orbital cavity being considered as predictors for sex was only 0.64 times higher. The morphology of the orbital cavity can provide information for the elaboration of the biological profile. However, studies are still needed to allow the possible use of its anatomy to estimate sex in the Brazilian population.

Accuracy of Orbital Shape Reconstruction-Comparative Analysis of Errors in Implant Shape Versus Implant Positioning: A Cadaveric Study.

Orbital blowout fractures are commonly reconstructed with implants shaped to repair orbital cavity defects, restore ocular position and projection, and correct diplopia. Orbital implant shaping has traditionally been performed manually by surgeons, with more recent use of computer-assisted design (CAD). Accuracy of implant placement is also key to reconstruction. This study compares the placement accuracy of orbital implants, testing the hypothesis that CAD-shaped implants indexed to patient anatomy will better restore orbit geometry compared with manually shaped implants and manually placed implants. The placement accuracy of orbital implants was assessed within a cadaveric blowout fracture model (3 skulls, 6 orbits) via 3-dimensional CT analysis. Defects were repaired with 4 different techniques: manually placed-manually shaped composite (titanium-reinforced porous polyethylene), manually placed CAD composite, indexed placed CAD composite, and indexed placed CAD titanium mesh. Implant placement accuracy differed significantly with the implant preparation method ( P =0.01). Indexing significantly improved the placement accuracy ( P =0.002). Indexed placed titanium mesh CAD implants (1.42±0.33mm) were positioned significantly closer to the intact surface versus manually placed-manually shaped composite implants (2.12±0.39mm). Computer-assisted design implants indexed to patient geometry yielded average errors below the acceptable threshold (2mm) for enophthalmos and diplopia. This study highlights the importance of adequately indexing CAD-designed implants to patient geometry to ensure accurate orbital reconstructions.

Characteristics and applications of synthetic exogenous materials used in surgery for reconstruction of the orbital cavity

This study aims to provide the main features, indications, and contraindications of synthetic exogenous materials used to reconstruct defects in the orbital cavity. In addition, present the available clinical data on these biomaterials. This integrative literature review was carried out in the PubMed, Periódicos CAPES, and Virtual Health Library (VHL) databases in May and June 2022. At first, the search followed the following strategy on the PubMed and CAPES Periodicals platforms - (reconstructive surgical procedures AND orbit AND biomaterials). Then, in the VHL platform, with the combination - (orbit AND biomaterials). There were restrictions for articles published in the last five years. Titanium was the most frequently found material in this search, with 38% of the total number of articles. The material was also associated with Porous Polyethylene, Polyetheretherketone, and in the form of Titanium-Nickel alloy. The following materials were also included: Hydroxyapatite; Non-sintered hydroxyapatite particles and a composite sheet of Poly L'Lactide with adhesion fixation; Porous Polyethylene; Polytetrafluoroethylene; Polyetheretheretherketone; Polydioxanone; Polymethylmethacrylate; and Polycaprolactone. Orbital reconstruction surgeries can be challenging because of the anatomical complexity of the region and the impact that repairing this structure has on the individual. The most common alloplastic materials used for orbit reconstruction are titanium mesh and porous polyethylene. The type of injury, the particularities of each patient, the operator's training, the material's availability, and the technological apparatus should be considered in the clinical decision of which to use. Good results in orbital reconstruction surgeries require more and more innovations in technologies, materials, and professional training.

A rare case of lateral wall blow-in fracture of the orbit

Orbital blow-in fractures encompass a distinctive clinical entity that is characterized by displacement of fracture fragments into the orbital cavity with a consequent diminution in orbital volume. We report a case of a 30-year-old male who presented with outward protrusion of the left eye ball following trauma by bike handle. While fracture of the orbital roof has been documented as a common cause of blow-in fracture, in our case, a fracture of the lateral wall and floor of the orbit led to blow-in fracture. Repositioning of luxated globe was done even in the absence of visual prognosis in view of psychological benefit and prosthetic rehabilitation.

Reconstruction of the Exenterated Orbit with an Island Pericranial Flap: A New Surgical Approach

Background:Reconstruction of the bony socket after orbital exenteration is a matter of much debate. Prompt defect closure with a microvascular flap is desirable but involves a major surgical procedure and hence, places considerable burden on the patient. The new surgical technique presented here permits a technically simpler wound closure with fewer complications after orbital exenteration.Methods:Between May 2014 and June 2022 in the ENT department of Regensburg University, nine patients underwent exenteration and reconstruction with a pericranial flap. The flap was raised via a broken line incision in the forehead or endoscopically, incised in a roughly croissant-like shape, then introduced into the orbit through a tunnel in the eyebrow. A retrospective analysis of the patients and considerations about determining the size, shape, and vascular supply of the flap are presented.Results:Flap healing was uncomplicated in all cases. Only 6 weeks after surgery, the flap was stable, making it possible to start adjuvant therapy and prosthetic rehabilitation swiftly. The flap is adapted to the near cone-shape of the orbit. The mean (± standard deviation) surface area of the measured orbits is (39.58 ± 3.32) cm2. The territory of the angular artery provides the periosteal flap arterial blood supply. Venous drainage is via venous networks surrounding the artery.Conclusions:Use of the pericranial flap makes it possible to close the orbital cavity promptly with minimal donor site defect and a short operating time, thereby minimizing the surgical risk and speeding up physical and psychological recovery.

Supraorbital Rim and Roof Reconstruction with Vascularized Fascia Lata and Autogenous Rib Graft.

Describe a novel technique for reconstruction of complex defects involving supraorbital rim and orbital roof. Retrospective chart review and description of surgical technique. Four patients underwent tumor resection with neurosurgery (2 intraosseous hemangioma, 1 meningioma, and 1 ossifying fibroma), with mean tumor size of 42.6 cubic centimeters on preoperative imaging. All defects involved supraorbital rim and orbital roof. Patients were reconstructed with autogenous osseous rib graft for structure and contour and anterolateral thigh fascia lata (ALTFL) free flap to provide robust vascularity to rib bone and as a barrier between skull base dura and the orbit and/or sinonasal cavities. Two patients underwent resection and reconstruction using minimal access incisions, and two underwent major cranial and skull base resections. All flaps are vascularized via superficial temporal vessels. On postoperative follow-up (mean 33.5 months, range 8-48), all patients report no vision change or diplopia, with excellent contour symmetry to contralateral orbit. Follow-up imaging (mean 29.5 months, range 3-48) demonstrated maintained orbital volume and retention of rib bone graft compared to immediate postoperative imaging. There were no complications related to graft use. Minor complications include 1 patient with cerebrospinal fluid leak managed with lumbar drain placement and 1 patient with mild enophthalmos at 7-month follow-up. We describe a series of patients who underwent a novel technique for reconstruction of complex defects involving supraorbital rim and orbital roof with autogenous osseous rib and vascularized ALTFL-free flap with excellent functional and cosmetic outcomes. This can be accomplished using minimal access techniques to minimize patient morbidity. 4 Laryngoscope, 134:654-658, 2024.

SINONASAL CARCINOMA: A CASE REPORT

SMARCB1 (INI-1)-deficient sinonasal carcinoma is a newly recognized rare and aggressive subtype of sinonasal undifferentiated carcinoma and defined by the loss of nuclear SMARCB1 (INI-1) expression by immunohistochemistry. This report describes a case of SMARCB1-deficient sinonasal carcinoma in a 62-year-old male. Clinical examination revealed an expansive lesion on the left hemiface that affected the orbital cavity, paranasal region, nose, upper lip, maxilla, buccal mucosa, and oropharynx. Computed tomography confirmed an infiltrative mass of the paranasal sinus, with intraoral and orbital extension. Incisional biopsy from the mass was taken and reported as sinonasal undifferentiated carcinoma. Immunohistochemistry showed that the tumor cells were positive for AE1/AE3 and p63. Accordingly, BRD4-NUT, CD99, Chromogranin, EBV, INSM1, NKX2.2, p16, SMARCA4, S100, and Synaptophysin were all negative. INI-1 stain showed loss of expression. Unfortunately, the patient died before receiving the diagnosis of SMARCB1 (INI-1)-deficient sinonasal carcinoma. SMARCB1 (INI-1)-deficient sinonasal carcinoma is a newly recognized rare and aggressive subtype of sinonasal undifferentiated carcinoma and defined by the loss of nuclear SMARCB1 (INI-1) expression by immunohistochemistry. This report describes a case of SMARCB1-deficient sinonasal carcinoma in a 62-year-old male. Clinical examination revealed an expansive lesion on the left hemiface that affected the orbital cavity, paranasal region, nose, upper lip, maxilla, buccal mucosa, and oropharynx. Computed tomography confirmed an infiltrative mass of the paranasal sinus, with intraoral and orbital extension. Incisional biopsy from the mass was taken and reported as sinonasal undifferentiated carcinoma. Immunohistochemistry showed that the tumor cells were positive for AE1/AE3 and p63. Accordingly, BRD4-NUT, CD99, Chromogranin, EBV, INSM1, NKX2.2, p16, SMARCA4, S100, and Synaptophysin were all negative. INI-1 stain showed loss of expression. Unfortunately, the patient died before receiving the diagnosis of SMARCB1 (INI-1)-deficient sinonasal carcinoma.

Prediction of exophthalmos by body mass index for craniofacial reconstruction: consequences for cold cases.

It is inconvenient for a forensic practitioner to gather population-specific data before performing a facial reconstruction. The inconvenience may defeat the point of creating the reconstruction. The objective of this study was to evaluate a non-population-dependent method of determining exophthalmos. The protrusion of the eyeball is known to vary with the contents of the orbital cavity based on bony orbital resorption or increased or decreased fat contents, as well as according to relative eyeball size. Of use are available statistics on body mass index, and this is discussed within the context of eyeball protrusion. A weak positive correlation (0.3263) between the body mass index of the country where the study originated, and the degree of exophthalmos was found. The results suggest that eyeball protrusion rates can be established according to body mass index, and this framework may be more useful considering conventional police practices.

Precautions for Pneumo-Orbital in Cases of Maxillofacial Trauma: Data Mining for Artificial Inteligence of Air Localization on CT-Scan

<span lang="EN-US">Along with rapid mobility, the incidence of traffic accidents is increasing. Maxillofacial trauma often accompanies traffic accidents. Facial bone fractures need serious concern, considering that the face contains several important organs and an important aesthetic aspect daily. Pneumo-orbital, in which air is found in the orbital cavity, is a threat to vision. The development of diagnostic modalities for maxillofacial trauma is developed continuously for determining the accuracy and improving rapid diagnosis. A radiologist is greatly facilitated by the presence of a CT scan that is able to detect certain abnormalities through artificial intelligence (AI) features. The data of this study are preliminary data showing the incidence of pneumo-orbital that was often missed in maxillofacial trauma cases. The maxillofacial trauma cases (classified as Le Fort fractures) were collected from January 2022 to July 2022 consecutively and determined into Le Fort fractures with pneumo-orbital and without pneumo-orbital. From 19 cases, 13 cases (68%) were accompanied by pneumo-orbital, while 6 cases (32%) were not. Multiple pneumo-orbitals with relatively visible sizes are detected easily on CT scan but a single and relatively small pneumo-orbital has potentially not to be seen on CT scan. It is concluded that CT scan nowadays is not only used to see anatomical abnormalities, but also equipped with AI-based features; such as the intracranial bleeding volume calculation and calcium score estimation on cardiac CT. It is possible that a CT scan can also detect the presence of air particles. Thus, the sensitivity of pneumo-orbital detection can be increased.</span>

MORPHOMETRIC ANALYSIS OF ETHMOIDAL FORAMEN IN ADULT DRY INDIAN SKULL

Ethmoid bone is located in the anterior part of the base of the cranium between the orbits. The medial orbital wall separates the content of the orbit from the ethmoidal air sinuses. The anatomical landmarks of orbital cavities are very much important during orbital surgeries which includes surgery of anterior cranial fossa and endonasal microsurgeries of ethmoidal region. On this medial orbital wall, the anterior and the posterior ethmoidal foramina are located along the frontoethmoidal suture and more anteriorly to the optic canal and these are very much important in orbital surgeries. This prospective observational study was undertaken to study the morphology of Ethmoidal foramen in adult dry Indian skull and to study the clinical implications of ethmoid foramen. A total 50 dry adult skulls were measured for the ethmoidal foramen. It was reported that the mean of posterior ethmoidal canal right and left was 2.09±0.75mm and 2.31±0.132mm respectively. The study concluded that to ensure the safety of surgical procedures to be performed among ethmoid foramen it is very important to measure the various landmarks; as the anatomical variations can cause problems and leads to surgery related complications.

Morphometric and volumetric evaluations of orbit using three-dimensional computed tomography in southwestern Iranian population

BackgroundThe aim of the present research was to assess morphometric and volumetric measurements of bony orbit using computed tomography to define the effects of age and gender on orbital anthropometry. Method302 orbital cavities in 151 adult samples (18–90 years with a mean age of 43.10 ± 20.25 years) were investigated (100 males [66.2%] and 51 females [33.8%]). The samples represented no history of orbital trauma, dysplasia, or other diseases with a putative effect on orbital growth. ResultsThe mean orbital height for the right and left sides were 3.75 ± 0.20 and 3.74 ± 0.21 cm, respectively, while the orbital width was 3.44 ± 0.17 and 3.46 ± 0.17 cm, respectively. The mean interorbital-biorbital width was 2.26 ± 0.26 and 9.55 ± 0.41 cm, respectively. The mean OI in both genders was 108.52 ± 6.83. There was no significant difference in OI index between the genders or sides. The study population belonged to the Megaseme category. The mean right/left orbital volume (OV) of both genders was 25.20 and 24.68 cm3, respectively. OV was significantly larger in males than females (P < 0.005) and showed sexual dimorphism. There was a positive, statistically significant association of OV with the samples' age (P < 0.0001) ConclusionThe outcomes of this research showed that the CT and 3D volumetric methods represent useful baseline morphometric data for the southwestern Iranian population using a reliable technique in orbital volumetry. The obtained data can be used for the diagnosis of orbital pathologies and anthropological studies.

Frontal mucocele causing ophthalmoplegia and proptosis

Mucoceles are known to occur as a result of chronic accumulation of mucoid secretions within a sinus as a result of long-standing outflow obstruction secondary to inflammation. This can lead to extension into the orbital and intracranial cavities. It can also get infected to cause mucopyocele. The frontal sinus is the most common site for mucocele. Long-standing symptoms of chronic rhinosinusitis, if ignored, can lead to such complications. Clinical features include frontal pain and swelling. It may displace the orbit inferiorly and laterally. If neglected, it can progress to cause osteomyelitis and erode the posterior wall of the sinus to cause intracranial complications. Imaging is paramount in assessing the lesion's type and extent. Computed tomography can be used to delineate the bony erosions, whereas Magnetic Resonance Imaging helps characterize the lesion’s nature. Surgery remains the mainstay of treatment with the aim of draining the mucocele and removing the mucosa to prevent a recurrence. Surgical approaches can be both endoscopic and open, with the advantages and disadvantages of each.

Morphometry of Skulls from North Indian Population

Introduction: Anthropometric studies have shown significant variations in the cranium and orbits between races and genders due to various factors such as genetics, race, hormones, nutritional differences, and environmental influences. The present study aims to record cranial and orbital dimensions and indices to classify skulls based on these measurements. Materials and Methods: Thirty-five human adult skulls were obtained from the dissecting laboratory and museum of Hind Institute of Medical Sciences, Safedabad. The orbital height, width, interorbital distance, maximum length, and width of the cranium were measured directly using a digital Vernier caliper. The skulls were then classified based on the orbital and cranial indices calculated. Results: The study found a mean orbital index of 83.42, classifying the skulls as mesoseme, and a cranial index of 73.15, classifying them as dolichocephalic. Conclusion: Basic data and records of morphometry of bones belonging to specific regions can help identify the ethnicity and race of a person. Understanding the correlation of dimensions of the orbital cavity and cranium is crucial in certain conditions, such as interpreting fossils, classification of skulls in forensic medicine, and discovering trends in evolution and racial differences. These findings may also aid in identifying unclaimed bodies in India, which are found in significant numbers yearly.

Risk Factors of Rhino Orbital Mucormycosis.

To determine the clinical presentation and risk factors associated with rhino orbital mucormycosis. Mucormycosis is a rapidly progressive fungal infection caused by filamentous fungi in the Mucoraceae family. In large numbers, they release spores into the air, and humans get exposed through inhalation. The spores inoculate in the paranasal sinuses and nasopharynx and subsequently spread to the orbit and intracranial cavity. The present COVID-19 pandemic has witnessed a resurgence of rhino-orbital mucormycosis cases, mainly seen in patients with immunocompromised status. Hence, our study evaluated the risk factors and clinical features of rhino orbital mucormycosis. This was a prospective, single-center, cross-sectional study. Patients attending tertiary care centers fulfilling the inclusion criteria were evaluated with a detailed history including sociodemographic profile, occupation, history of fever, COVID-19 infection, steroid or immunosuppressant use, organ transplants, diabetes mellitus and use of oxygen (O2). A complete ophthalmic evaluation was performed, including best-corrected visual acuity, anterior segment evaluation with slit lamp biomicroscopy, and posterior segment evaluation using indirect ophthalmoscopy. Computed Tomography (CT) scan of paranasal sinuses was done for all the patients, and Magnetic Resonance Imaging (MRI) for a few patients if indicated. Intraoperatively, samples were sent for Potassium Hydroxide (KOH) stain while debridement and patients with positive results were included in the study. Forty participants were included, out of which 34 (85%) were males and six (15%) were females. The mean age of the patients was 51.75 years. Out of 40 patients, 29 (72.5%) had h/o COVID-19 infection, 30 (75%) were known type 2 diabetes mellitus, 25 (62.5%) had a h/o steroid intake and 25 (62.5%) had a history of O2 use. 17 (42.5%) patients presented with low vision, out of which 15 had no light perception. 30 (75%) patients had ptosis, 22 (55%) patients presented with proptosis, 15 (37.5%) patients had limited ocular motility, 11 (27.5%) had complete ophthalmoplegia, and 11 (27.5%) patients had central retinal artery occlusion. Rhino orbital Mucormycosis is more prevalent in patients with COVID-19 infection, especially those who have used steroids and oxygen and with type 2 diabetes mellitus. Early presentation with treatment can prevent further ocular morbidity.

Mccune Albright Syndrome/Craniofacial Fibrous Dysplasia and Postcraniectomy Syndrome: Case Report and Literature Review

Introduction: McCune Albright syndrome (MAS) is a rare pathology caused by a genetic mutation of the GNAS1 gene that causes fibrous dysplasia (FD) among other endocrinological and metabolic manifestations (1). Here is presented a case report, in which craniofacial dysplasia (CFFD) produces functional alteration, its treatment, and the management of underlying complications. Case report: A 10-year-old female patient who presented with CFD with progressive involvement of the orbital cavity, compression of the optic nerve and right oculomotor cranial nerves, associated with precocious puberty and the appearance of ‘’café-au-lait’’ spots on the skin and finally, the diagnosis of MAS is made. Right front-parieto-temporal craniectomy and intracanalicular decompression of the optic nerve was performed getting partial improvement of functional alteration. Subsequently, cranioplasty is performed to manage postcraniectomy/trephined syndrome. Discussion: MAS is a genetic postzygotic disease that occurs in early stages of embryonic development, which explains its mosaicism. Among its manifestation is FD, which is explained by the hyperfunctioning nature of the mutation. In the case of DCF, continuous surveillance is required by a multidisciplinary team that includes a neurosurgeon, whose intervention is reserved for cases in which functional alterations occur, following the recommendations given by medical literature regarding the approach and type of surgery. Decompressive craniectomy can be associated with complications such as postcraniectomy/trephined syndrome, which shows improvement or resolution with cranioplasty. Conclusion: The diagnosis of MAS is clinical, and its mosaicism is explained by its early presentation in embryonic development. In the case of FCD with functional compromise, neurosurgical intervention is required, seeking the recovery and preservation of the compromised cranial nerves, avoiding prophylactic decompressions. In case of complications such as postcraniectomy/trephination syndrome, timely cranioplasty should be performed as it turns out to be highly effective as a treatment, however, the need for studies aimed at its characterization and diagnosis arises.

Imaging Spectrum of Coronavirus Disease- 2019 Associated Rhino-Orbital-Cerebral Mucormycosis; From Sinonasal Inflammation to Intracranial Involvement

Rhino‑Orbital‑Cerebral Mucormycosis (ROCM) is a life-threatening opportunistic fungal infection, which mostly affects immunocompromised patients. There has been a notable rise in the incidence of ROCM during the COVID-19 outbreak. In this study we described imaging characteristics of ROCM in detail, from early sinonasal inflammation to late intracranial involvement. In this retrospective study, Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) of 48 patients with proven ROCM in biopsy or culture were evaluated. All the patients had a history of COVID-19 infection within the previous three months. The imaging findings were described and the frequency of different parameters was reported. Paranasal inflammation was detected in all the patients on imaging. The most common involved paranasal sinuses were ethmoid sinuses (97.9%). On diffusionweighted images, restricted diffusion was seen in the paranasal sinuses of 81.1% of the patients. In addition, sinus wall bone involvement was observed in 87.5% of the cases. The most common anatomical sites for extrasinus involvement were the retroantral soft tissue (89.6%) and orbital cavity (87.5%). Dacryocystitis in 50%, optic nerve inflammation in 43.2%, globe involvement in 18.9%, and trigeminal nerve involvement in 16% of the patients were detected. There was extension of inflammation through the cavernous sinuses and alongside the internal carotid arteries in 24% of the patients. Characteristic imaging findings of ROCM not only play a vital role in the early diagnosis of this infection, but they also contribute to the assessment of the extension of inflammation, which is vitally important in surgical planning.

Survival and complication rate of zygomatic implants: a systematic review.

To evaluate the available literature reporting the survival and complication rate of zygomatic implants, assessing factors (such as surgical technique, surgical/restorative plan, population, study design and characteristics, etc.) associated with these outcomes. A comprehensive search was performed in three electronic databases, together with a manual search, to identify clinical studies reporting the survival and/or complication rates following zygomatic implant therapy, to quantify relative rates for both stated outcomes. Results: 101 articles were included: 69 were retrospective in nature, 29 were prospective non-randomized studies and 3 were randomized trials (RCTs).The mean survival rate among retrospective studies was 97.61%, while among prospective non-RCTs and RCTs was 98.53% and 95.92%, respectively. The survival rate was not associated with the surgical technique, nor with the surgical/restorative plan. A trend towards higher survival rate, although not statistically significant (p>0.05), was observed in more recent vs less recent studies.Forty-eight articles reported data on complications related to zygomatic implants, with labial laceration, orbital cavity penetration, hematoma, epistaxis, maxillary sinusitis, infection and oro-antral communication being among the most common adverse event. A lower incidence of maxillary sinusitis was observed for zygomatic implants placed using the extrasinus approach compared to the other surgical approaches (p<0.01). The incidence of maxillary sinusitis and oro-antral communications was found to be less likely in "recent" vs "less recent" studies (p<0.05). Zygomatic implant therapy is a reliable treatment option for rehabilitating the severely atrophic maxilla, with high implant survival rate and relatively low complication rate. Several factors were found to be associated with the incidence of post-operative complications. Nevertheless, the evidence from the literature is mainly based on non-RCTs and therefore these findings have to be interpreted with cautions.

Role of orbital exenteration in management of rhino-orbito-cerebral mucormycosis (ROCM) - A prospective analytical study

Mucormycosis is an uncommon, opportunistic fungal infection. The most crucial decision in the management of rhino-orbital mucormycosis is when to advise exenteration. This study aims at understanding the pattern of cases which progressed and had extensive involvement of the entire orbital cavity with mild intra cranial extension requiring exenteration as life salvage measure in the setting of epidemic of mucormycosis in a pandemic of COVID – 19. Patients suspected or diagnosed with invasive orbital mucormycosis visiting our hospital were admitted and included in the study. CT PNS with orbit were done for all patients and MRI brain with orbit were done in patients in whom intracranial spread and involvement of optic nerve were present. Patients were started on liposomal intravenous amphotericin B (5mg/kg/day) and intraorbital amphotericin B injection when indicated and closely monitored for clinical progression. All patients were taken up for FESS and if positive for mucormycosis on histopathological examination. In cases wherever exenteration was indicated, after confirming that there was no perception of light and obtaining informed consent with psychiatric counselling patient was taken up for orbital exenteration. Lid sparing exenteration was the method of choice. A total of 41 patients out of 696(5.89%) underwent exenteration out of which 21(51.2%) were right sided and 20(48.8%) were left sided. 12 patients (29.2%) of those who had undergone exenteration did not have a history of being tested positive/ been symptomatic for COVID 19. 1 patient (2.4%) was not diabetic. All patients (100%) had sinonasal involvement (Involvement of one or more paranasal sinuses) with involvement of orbital cavity to different degrees. 4 out of 41(9.75%) patients had deteriorated and required ICU care. 1 patient succumbed to death (2.4%) due to multiple comorbidities. On histopathological examination of exenteration specimen, 2(4.87%) patients turned out to be negative for mucormycosis. In 32(78.04%) of them the socket healed well while 5(12.1%) had slough who required 2 or more sittings of sloughectomy. As mucor is angio invasive rapidly progressive highly fatal infection close monitoring for invasion into structures like apex of orbit and intra cranial spread is essential for timely intervention and decision to perform exenteration. This is crucial for arrest of progress and life salvage.

Поражение органа зрения при болезни Вегенера. Клинический случай

The article provides a description of clinical case of patient 53 years old with Wegener's granulomatosis, manifested with necrotizing scleritis of the left eyeball against the background of malignant nose granuloma. The patient underwent sclera plastic surgery twice in order to save the eye. Due to intensive corticosteroid and cytostatic therapy clinical activity of vasculitis was reduced. At the same time was observed further growth of nose granoluma with damage of inferior orbital wall and spread of the tumor to the orbital cavity with the subsequent destruction of the eye. It was performed an enucleation of the left eye with removal of the tumor of the left orbit. The Wegener's granulomatosis diagnosis was confirmed histologically. The problem of treating systemic vasculitis and its complications is very relevant. During 5-year observation period the patient there were noted another complications: septal perforation, oroantral fistula formation, formation of bilateral hearing loss, disintegration of the left lung granuloma. Right eye stayed intact during whole observation period. Prognosis is unfavorable not only for eyesight, but also for patient's life. Keywords: Wegener's disease, granulomatosis with polyangiitis, necrotizing sleritis