Orbital Enlargement Research Articles

Osteology and phylogenetic position of Plagiosaurus depressus (Temnospondyli: Plagiosauridae) from the Late Triassic of Germany and the repeated loss of dermal bones in plagiosaurids

Abstract The skull and postcranium of the Late Triassic plagiosaurid temnospondyl Plagiosaurus depressus from Halberstadt (Germany) are redescribed in detail. Plagiosaurus possesses two autapomorphies, the abbreviated tabular and the broad contact between the postorbital and parietal. A comprehensive phylogenetic analysis of Plagiosauridae finds a clade Plagiosaurinae consisting of Plagiosaurus and Gerrothorax. Among other characters, both taxa share the solid box-like sides of the low pectoral girdle, the short but robust humerus with small deltopectoral crest and well-developed supinator process, and an anterodorsally directed lateral line sulcus close to the mandibular symphysis. Compared with Gerrothorax, the skull of Plagiosaurus is deeper and more slender, and the postfrontal is absent, meaning that the parietal forms the posteromedial margin of the enlarged orbit. This new interpretation of the bone configuration shows that reduction of circumorbital bones associated with orbital enlargement occurred three times independently within Plagiosauridae, albeit probably in different functional contexts. Our phylogenetic analysis further reveals the Plagiosuchinae (Plagioscutum + Plagiosuchus) as the most basal plagiosaurid clade, which, in turn, forms the sister group to Plagiosaurinae and Plagiosterninae (Plagiorophus + (Plagiosternum + Megalophthalma)). The mentioned shared derived characters of Plagiosaurinae in the pectoral girdle, forelimbs, and mandibular lateral lines suggest a similar benthonic lifestyle.

Increased Orbital Muscle Fraction Diagnosed by Semi-Automatic Volumetry: A Risk Factor for Severe Visual Impairment with Excellent Response to Surgical Decompression in Graves' Orbitopathy.

Graves’ orbitopathy (GO) leads to increased orbital tissue and causes symptoms such as exophthalmos, functional complaints, or dysthyroid optic neuropathy. Different GO types with fat and/or muscle enlargement were identified, and increased muscle appears to particularly influence visual status and treatment response. The current study examines visual parameters dependent on orbital muscle volume fraction in a surgically treated GO cohort. After volumetric analysis of the preoperative orbital content, 83 orbits in 47 patients were categorized into predefined groups (increased or not-increased muscle fraction). All cases underwent pterional orbital decompression, and pre- and postoperative visual status was retrospectively analyzed. Forty-one orbits revealed increased and 42 orbits revealed not-increased muscle volume (mean fraction 29.63% versus (vs.) 15.60%). The preoperative visual acuity (VA) was significantly lower in orbits with increased vs. not-increased muscle volume (mean VA 0.30 vs. 0.53, difference 2.5 lines). After surgery, mean VA improved significantly by 1.7 lines in orbits with increased muscle volume. Not preoperative, but postoperative exophthalmos was significantly lower in orbits with not-increased muscle volume. Increased orbital muscle is associated with significantly reduced VA, but can be remarkably improved by pterional orbital decompression. Therefore, surgical therapy should be considered particularly in decreased VA with orbital muscle enlargement.

RETRACTED: The association between metformin therapy and risk of gynecological cancer in patients: two meta-analyses

Contemporary advances in technology have enabled the transfer of industrial laser melting technology to surgery, and its use can improve the accuracy of orbital restoration. The aim of this study therefore was to evaluate the accuracy of primary orbital reconstruction with the use of selective laser melted, patient-specific implants and navigation. A total of 100 patients with complex orbital fractures were included. Planned orbital volumes were compared with those achieved, and angles were compared with the unaffected side. Analysis included the overlay of postoperative on planned images (iPlan® 3.0.5, Brainlab). The mean (SD) orbital volume of the unaffected side was 27.2 (2.8)ml in men and 25.0 (2.6)ml in women. Fractures that involved the posterior third of the orbital floor and comminuted fractures showed significant orbital enlargement (p=0.026). The mean (SD) reconstructed orbital volume was 26.9 (2.7)ml in men and 24.26 (2.5)ml in women. Three-dimensional analysis of the colour mapping showed minor deviations when compared with the unaffected side. The results suggest that a high degree of accuracy can be routinely achieved in these complex cases.

Optic Nerve Glioma : Case Report

Background: Optic nerve gliomas (ONGs) are benign tumors that grow slowly. Clinical Methods: They are most common in females and occur before age of 20 years. This case report of 10 years girl showed right eye loss of vision and proptosis for 2 months with no other medical problem or past medical history. Clinical Findings: A diagnosis of ONG was done using CT scan. The CT scan reported right sided fusiform intra orbital enlargement.

Precision of posttraumatic primary orbital reconstruction using individually bent titanium mesh with and without navigation: a retrospective study

BackgroundThe aim of orbital wall reconstruction is to reestablish anatomically exact orbital volumes to avoid long-term complications. Navigation could facilitate complex reconstructions.MethodsQuality of the orbital reconstruction (n = 94) was measured based on (A) volume changes and (B) on 3D shape deviations compared to the unaffected side. Volume analysis included segmentation of the orbital cavity in the pre- and post-operative 3D data set (VoXim®, IVS Solutions, Germany), and shape analysis was performed by vector-based 3D tools (Comparison®, 3Dshape, Germany).ResultsOrbital volume of the unaffected side ranged from 26.6 ml ± 2.8 ml in male and 25.2 ml ± 2.6 ml in female (CT). Significant orbital enlargement was found in orbital fractures with involvement of the posterior third of the orbital floor and in comminuted fracture pattern. Reconstructed orbital volume ranged from 26.9 ± 2.7 ml in male and 24.26 ± 2.5 ml in female (CBCT). 3D Analysis of the color mapping showed minor deviations compared to the mirrored unaffected side.ConclusionMeasurements demonstrate that even in comminuted orbital fractures true-to-original reconstruction is feasible.

Sunken Eyes, Sagging Brain Syndrome: Bilateral Enophthalmos from Chronic Intracranial Hypotension

To explain the mechanism for acquired enophthalmos after ventriculoperitoneal shunting (VPS). Case series and a case-control study. Four study patients with bilateral enophthalmos after VPS and 10 control subjects. Case description of 4 study patients. Calculated orbital volumes for 2 study patients were compared with controls using the Wilcoxon rank-sum test. Exophthalmometry measurements and total orbital and fat volumes. Patient 1 is a 25-year-old man who presented with progressive enophthalmos 3 years after VPS for traumatic intracranial bleeding. Imaging demonstrated upward expansion of the orbital roof and evidence of intracranial hypotension. The intracranial pressure (ICP) was 20 mm H₂O. The enophthalmos improved after shunt revision. Patient 2 is a 19-year-old man who presented with progressive enophthalmos 18 months after VPS for traumatic intracranial hemorrhage. Patient 3 is a 38-year-old woman who presented with bilateral enophthalmos 15 years after VPS after a ruptured aneurysm. Imaging showed orbital expansion. Patient 4 is a 16-year-old man who presented with severe enophthalmos 5 years after a VPS for aneurysm-related hemorrhage. Imaging demonstrated orbital enlargement and findings of intracranial hypotension. Intracranial pressure ranged between -200 and 0 mm H₂O. Shunt revision improved the enophthalmos. Total orbital volumes were significantly greater in the study patients than in the controls. Control subjects (5 male, 5 female, ages 23-45 years) had an average right orbital volume of 24.6 ± 3.3 cm³ (n = 10). In comparison, the right orbital volumes of patients 1 and 3 were 32.6 and 32.1 cm³. Similar results were found for the left orbits (23.9 ± 2.7 cm³ [control average] vs. 35.9 and 32.6 cm³). In patient 1, the post-shunt volumes increased 14% (right) and 23% (left) from pre-shunt volumes. In contrast, orbital fat volume was not statistically significantly different between the control group and enophthalmic patients (right orbit control mean 7.94 ± 3.1 cm³ [n = 10] vs. 7.9 and 9.8 cm³; left orbit control mean 7.88+3.1 cm³ vs. 9.2 and 10.0 cm³). Enophthalmos after VPS results primarily from chronic intracranial hypotension. Low ICP causes expansion of orbital volume with no fat atrophy. In such patients, shunt revision with a pressure-regulating valve to correct intracranial hypotension should be considered. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Influence of Orbit Size on Aspects of the Tarsier Postorbital Septum

Explanations invoking the complex mechanical effects of orbital enlargement in Tarsius have been extended to several areas of the skull, including the conformation of the postorbital septum. The strong cline in the degree of relative orbital enlargement across tarsier species groups presents an unexploited opportunity to test such scenarios. Our goal is to evaluate hypotheses concerning the impact of orbital hypertrophy on the size of specific components of the postorbital region including the frontal, zygomatic, alisphenoid, and maxillary bones. The frontal process is almost always viewed as a functional projection whose bracing role requires a positive morphometric association with orbital hypertrophy. Conversely, the periorbital expansion of the zygomatic is often perceived as functionally unrelated to orbital enlargement and therefore is not expected to track increases in relative orbit size. Interpretations of the alisphenoid and maxillary periorbital processes range from vestigial remnants of once larger structures reduced because of ocular enlargement to structures large in tarsiers because of their functionally relevant role in supporting the enlarged ocular apparatus. We measured these attributes in an extensive sample of 4 tarsier species groups including Tarsius bancanus, T. syrichta, T. spectrum, and T. pumilus. In contrast to proposed functional interpretations, our results indicate that variation in most linear parameters might be better explained by differences in body size than intrageneric differences in orbit size. As expected, width of the zygomatic postorbital contribution does not parallel intrageneric variation in orbit size. However, morphometric relationships between relative orbit size and other parts of the septum are complex but not clearly associated with orbit size differences within Tarsius.

MRI findings of nasopharyngeal carcinoma in patients presenting with ocular signs

Objective To study the MRI features of nasopharyngeal carcinoma (NPC) in patients who presented with ocular abnormalities. Methods The clinical signs and MRI features of Ⅲ, Ⅳ and/or Ⅵ cranial nerve involvement in 22 cases of histologically proved nasopharyngeal carcinoma were retrospectively analyzed. Results All 22 cases showed perineural tumor spread along the course of Ⅲ, Ⅳ and Ⅵ cranial nerve. Diplopia was the most common sign, occurred in 14/22 patients. The incidence of incomplete palsy of Ⅲ, Ⅳ and Ⅵ cranial nerve were 16/44, 7/44 and 4/44, respectively. There were four types of abnormal MRI findings: cavernous sinus thickening (10/44) and mass ( 16/44), superior orbital fissure enlargement (4/44) and abnormal signals (9/44), thickened oculomotor muscles with obscured adjacent fatty space and abnormal enhancement (10/44). The dynamic contrast enhancement patterns of the masses in cavernous sinus and orbital were the same as that of nasopharynx lesions; all appeared as rapid initial enhancement followed by a plateau phase. Conclusion Oculomotor nerve involvement can be the first clinical signs of NPC, and MRI can show the perineural extension along the Ⅲ, Ⅳ and Ⅵ cranial nerve in NPC. Key words: Nasopharyngeal neoplasms; Eye diseases; Cranial nerve diseases; Magnetic resonance imaging

Reconstruction of skull base defects in sphenoid wing dysplasia associated with neurofibromatosis I with titanium mesh

Sphenoid wing dysplasia occurs in 3–7% of patients with neurofibromatosis type 1 (NF1). The typical radiological features are partial or complete absence of the greater wing of the sphenoid. This condition is slowly progressive and may result in temporal lobe herniation into the orbital cavity, producing pulsating exophthalmos and gross facial deformity. Thus, reconstruction of the orbit is important for both cosmetic and functional reasons. Traditional surgical treatment of sphenoid dysplasia involves split bone grafting and repair of the anterior skull base defect. However, several reports have demonstrated complications of graft resorption and recurrence of proptosis and pulsating exopthalmos. In this case series, we present two patients suffering from pulsating exophthalmos due to sphenoid dysplasia. Radiological and MRI studies demonstrated orbital enlargement and complete absence of the greater wing of the sphenoid. Surgical management of these patients involved dural defect repair, and the use of titanium mesh in conjunction with bone graft to act as a barrier between the orbit and the middle cranial fossa. The mesh was fixed by fine screws. Proptosis improved markedly post-operatively and resolved within a few weeks. Ocular pulsation subsided and remained quiescent with at least 1-year follow-up.

CT evaluation of orbital blowout fracture.

Objective To analyzed and summarized clinical situations and CT signs of orbital blowout fracture, deeply investigate CT signs of old orbital blowout fracture. Methods 239 patients with orbital blowout fracture proved by CT scan from December 2004 to October 2006 were retrospectively analysed their CT signs and clinical sings and symptoms. Results In the study of 239 eases （241 eyes）, the orbital blowout fracture of simple medial wall,simple inferior wall and multi walls were respectively in 130 cases （132 eyes）, 31 eases （31 eyes） and 63 eases （63 eyes）, Complicated fracture were identified 15 cases, extraoeular muscles thickening were 182 eases, orbital content hernia into accessory nasal cavity were 28 eases, intraorbit hemorrhage were 43 eases, intraorbit pneumatosis were 39 cases, accessory nasal cavity hydrops were 142 cases, soft tissue where surrounding of orbit and eyelid engorgement were 176 cases. Diplopia,muscular apparatus dyscinesia,and endophthalmos were respectively in 86 cases, 125 cases, and 27 cases. Injured above three months in these study were 22 cases, orbital wall hollowed 22 eyes 30 orbital cavity enlargement accompany enophthalmos were 13 cases, extraocular muscles thickening were 16 cases 21 strips. Conclusion CT scan was the first election for examine method that to evaluate orbital blowout fracture and prognosis. Medial orbital wall fracture was the most common orbital blowout fracture; orbital wall became hollow in old orbital blowout fracture; orbital cavity enlargement accompany enophthalmos were resulted in severity fracture; extraocular muscles thickening may exist a long term. Key words: orbit ; blowout fracture ; tomography, X- ray computed

Management of congenital glaucoma in neurofibromatosis type 1: a report of two cases

The most frequent ophthalmic lesions associated to neurofibromatosis type 1 include iris Lisch nodules, optic nerve gliomas, and neurofibromas located on the eyelid, conjunctiva or orbit. Glaucoma is much less frequent, and it may be difficult to diagnose and treat. We present two patients with neurofibromatosis type 1 and associated congenital glaucoma. In case 1, the glaucoma was present at birth, and was the first symptom of the disease. It was surgically treated by means of an Ahmed glaucoma valve implantation, with good intraocular pressure (IOP) control after 13 months of follow-up. In case 2, the glaucoma appeared at 5 months old, and a trabeculectomy was initially performed; it failed 2 years later and an Ahmed glaucoma valve was then implanted, with adequate IOP control after 7 years of follow-up. Both children were males, and in both cases there were orbital neurofibromas and a dysplasia of the greater wing of the sphenoid of the same side. In case 2, orbital enlargement surgery was also performed at 4 years old. Congenital glaucoma management in the context of neurofibromatosis is very complex due to the frequent association of orbital and eyelid tumors and bone dysplasia, and its prognosis is usually poor. We present two cases in which good control of IOP has been achieved with Ahmed glaucoma valve implantation after 13 months and 7 years of follow-up.

Variations of Maxillary Sinus and Accompanying Anatomical and Pathological Structures

Hypoplasia and aplasia of maxillary sinus, maxillary sinus septae, ethmomaxillary sinus, superior meatus-draining maxillary sinus, and over-pneumatization are the variations of maxillary sinuses. Findings such as uncinate process abnormality, orbital enlargement, sphenomaxillary plate, canine fossa elevation, infraorbital fissure enlargement, thickening of the sinus wall and mucosal pathologies can be seen together with these variations. The aim of this study is to determine the incidence and morphology of the anatomical variations of maxillary sinus and accompanying structures. A total of 330 consecutive paranasal sinus computed tomography scans of the patients presenting with sinonasal complaints at our ENT department were assessed for maxillary sinus anatomical variations and related structures. There were 134 (20.3%) anteriorly and 17 (2.5%) posteriorly localized maxillary sinus bony septa. The position of antral septa was frequently vertical at anterior, and horizontal at posterior. We found significant correlation between the anteriorly localized maxillary sinus septa and infraorbital fissure enlargement. Maxillary sinus hypoplasia was found in 31 (4.6%) maxillary sinuses. Seven (1.0%) ethmomaxillary sinuses were assessed. Significant correlation was found between maxillary sinus hypoplasia and orbital enlargement. Presence of mucosal pathology was significant in patients with maxillary sinus septa, but there was no difference when it was compared with the mucosal pathology in the nonseptated group. There was no significant correlation between other anatomical variations and mucosal pathologies. Determining the anatomical variations of maxillary sinus and accompanying structures in patients planning endoscopic sinus surgery will significantly help with providing surgical orientation and preventing possible complications.

Factors affecting orbital abnormal development and its relevant treatments

Orbital development is associated with the growth of the eyeball. During the development period, congenital or acquired changes of volume of the eyes and radiation treatment in ocular region influence the development of the orbit. Abnormal development of the orbit influences craniomaxillofacial growth and person's overall aesthetics of the face afterwards. Reconstruction of contracted sockets and shrunken orbits poses significant difficulties and obstacles that often results in universal frustration and disappointment results. Various methods have been used to improve these abnormalities. There are substantial different opinions regarding which method offers the best outcome. Traditional methods involve using progressively enlarging conformers, static spherical orbital implants, demis-fat grafts, and inflatable balloon expanders for orbital enlargement. Recently, the self-expander hydrogel tissue expander is available that expanders our option. This article reviews the influence of ocular abnormalities on the development of the orbit, as well as the advantages and disadvantages of various treatments for promoting the development of the orbit.

Reconstruction of the anophthalmic orbit by orbital osteotomy and free flap transfer

It is challenging to perform an adequate reconstruction of the post enucleation irradiated orbit of patients with rentinoblastoma. Rebuilding of the orbital structure, reconstruction of the eye socket and restoration of periorbital volume are required. We reviewed 12 patients with hypoplastic orbital deformities, who have undergone orbital osteotomy and free flap transfer. Reconstruction of the orbital cavity was achieved using 'C' osteotomy of the lateral portion of the orbit in mild and moderate cases or transverse 'U' osteotomy of lateral wall, roof, and floor by intra-cranial approach in severe cases. Socket reconstruction and periorbital volume restoration was achieved using dorsalis pedis free flap transfer. From our experience the combination of orbital osteotomy and free flap transfer could meet the multi-requirements for the anophthalmic orbital reconstruction, including both orbital bony enlargement and soft tissue restoration.

Use of self-expanding, hydrophilic osmotic expanders (hydrogel) in the reconstruction of congenital clinical anophthalmos

Rehabilitation of the congenitally anophthalmic orbit is frustrating to both the parents and physician. Traditional methods involve using progressively enlarging static acrylic conformers to expand the conjunctival socket, followed by placement of conventional static spherical orbital implants, dermis-fat grafts, or inflatable balloon expanders for orbital enlargement. Limitations of these methods typically result in less-than-optimal cosmetic outcomes, with retardation of bony orbital and overlying soft tissue growth adversely affecting midfacial growth and symmetry. Recent advances in tissue expansion technology may offer additional, novel alternatives to conventional therapies. Hydrogel tissue expanders were recently adapted for use in congenital anophthalmia. The expanders are placed in their dry, contracted states, and expand gradually to their full size via osmosis of surrounding tissue fluid, with up to a 10-fold increase in volume. Offering the benefit of predictable and controllable self-expansion, hydrogel expanders may offer yet another alternative or adjunctive therapy to the early rehabilitation of the contracted socket. Separate appliances are used for conjunctival and orbital reconstruction. Initial results appear promising. Tempering the enthusiasm for their use, however-particularly in terms of implanted orbital expanders-is the recent spate of long-term complications reported from previous uses of hydrogels as scleral buckling material. Self-expanding hydrogel tissue expanders appear to offer an intriguing reconstructive alternative to the frustrating condition of congenital anophthalmia. Long-term safety of the material as an orbital implant has not yet been demonstrated, but early results are promising.

The surgical management of childhood orbito-temporal neurofibromatosis

Purpose. (1) To describe the natural history, changing manifestations and new signs of orbito-temporal neurofibromatosis (NF) during childhood and puberty. (2) To describe the surgical treatment and recommend guidelines for management of this condition in children compared to adults. Methods. Retrospective case note and serial photographic review Results. There were 9 patients (5M, 4F) with orbito-temporal NF who were children (<16 years) at the time of first presentation with a minimum of 5 years follow up. All the patients had unilateral periorbital neurofibromatosis with blepharoptosis, orbital enlargement and hypoglobus. All nine patients underwent blepharoptosis surgery. Eight patients underwent neurofibroma debulking (and lid shortening) and lateral canthal reattachment. Three had enucleation of their blind eyes. Seven patients had two or more operations for their orbito-palpebral deformities. New signs included conjunctival and lacrimal gland infiltration with a secondary dry eye. Conclusion. Blepharoptosis surgery is indicated if the visual axis is compromised and there is a chance of limiting amblyopia. Definitive surgery for appearance is best delayed until the age of 18 years, or when the disease progression has stabilised, unless there are compelling social reasons for earlier surgery.

Rotation advancement of the midface by distraction osteogenesis.

A wide variety of disease processes produce alteration of midfacial skeletal growth, resulting in moderate-to-severe midface deficiency presenting as retrusion associated with Angle's class III malocclusion. Le Fort III osteotomies with advancement can provide an excellent tool for correction of this deformity. Recently, the corrective procedure of choice for advancement of midfacial segments has been distraction osteogenesis after osteotomy. Straight linear advancement is the most common choice for corrective movement of the midfacial segment, whether accomplished through acute surgical advancement or through the progressive distraction technique. Unfortunately, linear advancement can produce abnormal configurations, both at the nasal root and lateral orbits, regardless of the technique used. Enophthalmos, caused by orbital enlargement, may limit the advancement necessary to achieve class I occlusion. The authors have extended the utility of the Le Fort III procedure and have improved the final outcome by creating a controlled rotation advancement of the midfacial segment using distraction. The application of an existing internal distraction device is modified to control the movement of the midfacial segment in a rotation advancement path. Included in the series were 10 patients with severe midface retrusion secondary to multiple congenital syndromes, along with cleft lip and palate. The ages of the patients ranged from 6 to 14 years. An internal distraction system was used in all cases. Application of the distractor was substantially modified to simplify both fixation and removal and to produce controlled rotation advancement. The team orthodontist determined the final occlusal relationship. Percutaneous distractor drive rods were removed 4 to 6 weeks after active distraction to increase patient comfort. The distractors and all associated hardware were removed after 12 to 16 weeks of consolidation; follow-up periods ranged from 1 to 3 years. By using the modified distractor application to produce rotation advancement, the contour abnormalities at the nasal root and lateral orbit and the enophthalmos produced by linear advancement were eliminated. Significant improvement in facial contour and class I occlusion was obtained in all cases. Complications consisted of near exposure of the device in one patient. Stability has been excellent, with no relapse reported by the orthodontist. Rotational advancement of facial segments by distraction allows successful early intervention in patients with significant midface retrusion. The abnormal nasal root and lateral orbital configurations produced by direct linear advancement are avoided, and a stable and normalized facial configuration is produced.

A new approach to the classification of maxillary sinus hypoplasia with relevant clinical implications.

The purpose of this study was to discover the prevalence of maxillary sinus hypoplasia (MSH) and associated malformations. A total of 490 consecutive axial and coronal computerized tomographic (CT) scans of the paranasal sinuses were obtained from patients with chronic sinusitis. CT scans were assessed for the presence of MSH and associated anatomic variations. A new classification of MSH was made, and the diagnostic criteria listed. The frequency of anatomic variations coexisting with MSH was also estimated. MSH was encountered in 21 (4.2%) of the 490 patients. Unilateral types I, II and III MSH were seen in 7 (1.4%), 6 (1.2%) and 8 (1.6%) respectively. MSH was bilateral only in 3 (0.6%) patients, one of which was a bilateral type II. In the remaining two bilateral MSH cases, there was a type II MSH on one side and type III MSH on the other in each patient. Middle conchal pneumatization was the most common coexisting anatomic anomaly in MSH, followed by agger nasi cell, secondary middle concha, paradoxical middle concha and superior conchal pneumatization. A patient with MSH should be carefully evaluated prior to any sinus surgery in order to avoid surgical complications. With precise CT assessments, an MSH can be diagnosed and distinguished from other maxillary sinus anomalies. With the additional criterion of orbital enlargement, and the help of reproducible measurement techniques explained in this study, an objective diagnosis and classification can be made in further investigations of MSH.

Orbital enlargement secondary to chronic foreign body

Orbital enlargement secondary to a chronic intraorbital foreign body is rare. However, a case where this did occur is presented and a possible mechanism for the phenomenon discussed.

Pulsatile expansion therapy for orbital enlargement

Experimental and clinical investigations have documented the modulatory role of the globe in the development of the orbit. In cases of absence or early loss of the globe, severe hypoplasia of the orbit and midface has been reported by several authors. Statical conformers and orbital osteotomies have been used to correct the resulting facial asymmetry. When replacing such conformers by increasingly larger ones, orbital structures are negatively influenced by the repeated trauma of surgical interventions. Simulating the modulatory role of the globe on orbital growth was the objective when developing a pulsatile device for orbital enlargement in cases of anophthalmia and microrbitism. The design, application and preliminary experience with a dynamic, pulsatile expanding system are presented.