Periorbital Hematoma Research Articles

Dental Rehabilitation of Patients with Extreme Resorption of the Alveolar Process of the Upper Jaw with the Use of Zygomatic Implantation

The innovative method of zygomatic implantation is a rational method of dental rehabilitation for extreme resorption of the alveolar ridge. However, like any method, it is associated with certain disadvantages. These include: difficult surgical access requiring significant experience, risk of orbital injury, prolonged speech dysfunction, postoperative sinusitis, oroantral fistula, periorbital and conjunctival hematoma. The aim of the study was to evaluate the long–term results of maxillofacial and dental rehabilitation using zygomatic implantation. A comparative analysis of the obtained data revealed a significantly lower frequency of early postoperative complications with the use of zygomatic implantation 3 (2,6 % p = 0,112) compared with classical implantation 8 (11,5 % p < 0,002). There were no cases of zygomatic implants rejection, unlike traditional implantation, 8 (11,5 % p < 0,002). Conclusion. Rehabilitation of patients with extreme alveolar process resorption using zygomatic implants has shown high efficiency, with a significantly lower frequency of local complications and fewer lost implants compared with traditional implantation.

SPECTRUM OF ZYGOMATIC COMPLEX FRACTURE AT A TERTIARY CARE CENTER OF NEPAL

Background: Zygomatic bone is complex bilaterally located bone of face contributing to aesthetic and function. Zygomatic complex fracture is common type of facial bone fracture in young male with periorbital ecchymosis, flattening of cheek being common clinical presentation and Road Traffic Accident (RTA) being common etiology. Its treatment depends upon various factors like demographics, clinical findings, socioeconomics, fracture type and available resources. Present study is aimed to evaluate various clinical and other preoperative spectrums of ZMC fracture. Methods: This was a descriptive cross-sectional study conducted at Department of Oral and Maxillofacial Surgery in a tertiary center for 1 year, after taking consent in 86 patients. Convenience sampling was used after confirmation of ZMC fracture by CT scan. Data was collected, assembled, analyzed by SPSS and presented in table and graphs. Results: Mostly male 74(86%) of age group 20-39 years 42(48.8%) were involved in ZMC fracture. RTA was most common etiology accounting for 68.6%. Common presentations were subconjunctival hemorrhage, periorbital hematoma, trismus, flattening of cheek and orofacial laceration accounting for 90.1%, 84.9%, 54%, and 58.1% respectively. Nasal fracture was associated in 33.7% cases and extremity fracture in 20.9% cases. 84.9% cases were of displaced type and 48.8% were of tetrapodal fracture. Conclusions: This study in different preoperative parameters of ZMC fracture would be helpful in educating society regarding etiologies and precautions to be taken, for policy makers to make and enforce regulations to minimize incidences and for health workers to evaluate, diagnose and better multidisciplinary management.

Maxillofacial haemorrhagic symptoms in emergency department patients: impact of antithrombotics

PurposeTo investigate the effect of antithrombotics on the occurrence of maxillofacial haemorrhagic symptoms, and to determine if these haemorrhagic symptoms are predictors of maxillofacial fractures.MethodA prospective cohort study was conducted of consecutive patients with maxillofacial trauma who had been admitted to the emergency department of four hospitals in the Netherlands. This study compared five haemorrhagic symptoms (peri-orbital haematoma, raccoon eyes, epistaxis, subconjunctival ecchymosis, and intra-oral haematoma) between patients not-using (NUA) and using (UA) of antithrombotics, and whether these maxillofacial haemorrhagic symptoms served as predictors for maxillofacial fractures.ResultsOut of the 1005 patients, 812 (81%) belonged to the NUA group, and 193 (19%) to the UA group. UA patients exhibited higher frequencies of peri-orbital hematoma (54% vs. 39%, p < 0.001), raccoon eyes (10% vs. 5%, p = 0.01), and subconjunctival ecchymoses (16% vs. 7%, p < 0.001). In NUA, peri-orbital hematoma (OR = 2.5, p < 0.001), epistaxis (OR = 4.1, p < 0.001), subconjunctival ecchymosis (OR = 2.3, p = 0.02), and intra-oral hematoma (OR = 7.1, p < 0.001) were significant fracture predictors. Among UA, peri-orbital hematoma (OR = 2.2, p = 0.04), epistaxis (OR = 5.4, p < 0.001), subconjunctival ecchymosis (OR = 3.7, p = 0.008), and intra-oral hematoma (OR = 22.0, p < 0.001) were significant fracture predictors.ConclusionMaxillofacial haemorrhagic symptoms were observed more frequently in the UA group than in the NUA group. However, in both groups, maxillofacial haemorrhagic symptoms appear to be predictors of maxillofacial fractures. Caution is warranted in attributing these symptoms solely to antithrombotic use during emergency department assessments.

Характеристика множественной и сочетанной офтальмотравмы у детей на современном этапе

Aim: to identify the medical and epidemiological hallmarks of eye damage in children with complex and multiple injuries in a specialized surgical department. Patients and Methods: this study included 403 children aged 1 month to 18 years with eye injuries associated with multiple or complex injuries of varying severity on the day before hospital admission. All children were admitted between 2014 and 2020. The following data were evaluated: patient's age, gender, severity of complex trauma based on the ISS score, cause of trauma, combination of anatomical areas involved. Results: among children with mechanical complex eye injuries, 255 (63%) were boys and 148 (37%) were girls. The mean age of boys was 10.2±0.34 years, and the mean age of girls was 8.5±0.42 years. Furthermore, more than half (67.5%) of those included in the study were school-aged children and adolescents. The most common types of injuries were those resulting from falls from height, school, sports, gunshot/mine blast, and street incidents. In more than half of the children (n=227, 56.4%), orbital traumas affecting the walls and/or content were reported. The most common type of eye damage was a complex damage to the orbit and ocular adnexa (most often as a periorbital hematoma). The percentage of children with multiple fractures of the orbital walls increases with an increase in the severity of polytrauma. Conclusions: children most often received mechanical complex eye injuries as a result of road traffic accidents. The percentage of children with minor, moderate, and severe complex injuries (assessed by the ISS) was 47.1%, 18.4%, and 33.5%, respectively. Orbital fractures are the most common surgical entities in children with complex mechanical eye injuries. Unilateral orbital fractures were diagnosed in 56.4% of cases, while bilateral orbital fractures were diagnosed in 17.9%. In the majority of instances, mechanical complex eye injuries are associated with traumatic brain injury (99%). KEYWORDS: complex eye injuries, multiple injury, combined injury, mechanical complex eye injury, orbital fracture, orbital injury, morbidity pattern, damage to eye. FOR CITATION: Arzhimatova G.Sh., Karaseva O.V., Koroleva E.A., Chernakova G.M. Multiple and complex eye injuries in children. Russian Journal of Clinical Ophthalmology. 2024;24(2):78–82 (in Russ.). DOI: 10.32364/2311-7729-2024-24-2-6.

Orbital blowout fractures: manifestations and missed diagnoses in 207 surgically treated patients.

We aimed to retrospectively measure the incidence of missed orbital blowout fracture diagnosis in primary examinations of patients with surgically treated fractures, to identify the causes of the diagnostic oversight, and to describe the clinical manifestations of the fractures. A retrospective cohort of all patients with unilateral orbital blowout fractures who underwent subsequent surgical fracture reduction at the Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, from January 2011 to July 2021, was gathered. Demographics, fracture type, associated injuries, clinical manifestations, reconstruction indication, diagnostic delay, and causes of fractures were analysed. For statistical analysis, Fisher's exact test, unpaired t-test, and the Wilcoxon Rank Sum were used. Significance was set at P˂0.05. Fracture diagnosis was missed in 26 (13%) of 207 patients: in 40% of patients aged under 18 years and in 10% of patients aged 18 years or over (P=0.005). Suboptimal eye examination was found in 62% of patients with missed fracture and in 13% of those with timely diagnosis (P<0.001). Adjusted odds ratios for missed diagnosis in patients aged under 18 years versus patients aged 18 years and over was 9.3 (95% CI 2.4-35) and in patients with suboptimal versus sufficient eye examination 13.6 (95% CI 5.1-37). More common clinical manifestations in patients aged under 18 years were diplopia or restricted eye movements (P=0.005), pain in eye movements (P=0.010), nausea and/or vomiting (P<0.001), and bradycardia (P=0.014); periorbital haematoma was rarer (P<0.001). Suboptimal eye examination was involved in 62% and misinterpretation of computed tomography images in 50% of missed fractures, together explaining 85% of cases. Orbital blowout fractures are often missed in primary examination, especially in children and adolescents, who also present with subtler clinical manifestations. While the diagnosis can be difficult, appropriate clinical and radiological examination will reveal most cases.

Characteristics of pediatric ocular trauma in a tertiary hospital in Israel 2011-2020 - How can public prevention policy be improved?

To describe and analyze characteristics and trends of pediatric ocular trauma during 2011-2020. Retrospective descriptive study. Data were collected on all pediatric ocular trauma cases that presented to a Rambam Health Care Campus during 2011-2020. Data included age, gender, visual acuity, diagnosis, injury mechanism and surgical repair. Median BCVA at presentation was 0.96 (logMAR). Males and non-adolescent males specifically were the most prominent groups (70.6% and 44.7%, respectively). The ratio of ocular trauma cases to total pediatric emergency department (ED) visits was stable during 2011-2020 (p = 0.714) regardless of gender (p = 0.832 and p = 0.545 for boys and girls, respectively). The leading causes were partial thickness eyelid laceration, periorbital hematoma, and extraocular muscle contusion, all of which were stable over the study period (p = 0.678, p = 0.203 and p = 0.398, respectively). Falls and children play were the most common mechanisms (25.8% and 18.4%, respectively), but differed between age groups. Most patients did not require consecutive operation and were treated conservatively (p < 0.01). Pediatric ocular injuries to pediatric ED visits ratio remained stable during 2011-2020, regardless of gender. Non-adolescent males accounted for nearly half of all cases, with different mechanisms for each age group. Consecutive surgery was rarely necessary.

Evaluating the Olfactory Fossa Depth and KEROS Classification in Kashmiri Population

Background: KEROS classification is a means of classifying the depth of the olfactory fossa The olfactory fossa is shallow depression in the anterior cranial fossa whose floor is formed by medial lamella of cribriform plate located within ethmoid bone, lateral boundary by lateral lamella which is a thin plate like bone and is susceptible to injury during functional endoscopic sinus surgery, especially when fossa is deep/asymmetric. Functional endoscopic sinus surgery (FESS) although considered the gold standard technique to treat various nasal and paranasal sinus disorders but detailed anatomical study of the paranasal sinuses, olfactory fossa and adjacent anatomical structures during surgery is the necessity to avoid the complications like cerebrospinal fluid leak, periorbital and orbital hematoma, and blindness. Computed tomography(CT) is a frequently used imaging method in the evaluation of the paranasal sinuses, nasal cavity and nasopharynx. Objective: The purpose of the study was to evaluate the depth of olfactory fossa and ethmoid bone using computed tomography in kashmiri population and distributing Kashmir people on the basis of KEROS classification. Methods: In this observational study, PNS CT scan images of 396 patients including 234 males and 162 females between the age group of 17 and 75 years were examined in the Department of Radiodiagnosis, GMC Srinagar. Results: The average depth of the total 792 olfactory fossa (OF) examined was 5.05 mm with a standard deviation (SD) calculated of ±1.51. Statistically, no significant difference was found between males and females in mean OF depth (p&gt;0.05). According to KEROS classification in kashmiri population, 192(24.2%) had type I, 518 sides (65.50%) had type II and 82 sides (10.30%) had type III among 792 olfactory fossa.

Double vision due to lateral rectus injury after cosmetic botulinum toxin injections.

Facial intramuscular injections of Botulinum toxin (BoNT) injections are among the most common cosmetic procedures in dermatology. Rarely, serious adverse reactions such as blepharoptosis, diplopia and periorbital hematoma may occur with improper administration technique. Here we report a case of painless diplopia 5 weeks post-BoNT injection for 'crow's feet' likely due to inadvertent BoNT diffusion into the lateral rectus muscle causing a temporary palsy. This case aims to raise awareness of proper cosmetic BoNT injection techniques in the periorbital area to avoid ophthalmic complications.

Study of Clinicoepidemiology and Surgical Complications in Acute Invasive Fungal Rhinosinusitis.

To study clinicoepidemiology and surgical complications in acute invasive fungal rhinosinusitis. Retrospective observational study carried in GMC Akola from February 2021 to April 2022. Detailed history and clinical examination, nasal endoscopic biopsy or swab for KOH and fungal culture was taken. CECT/MRI PNS + Orbit + Brain was done. All patients underwent surgery and tissue sample send for histopathological examination. Total 146 patients included in study with M:F ratio 1.7:1. Most affected age group was between 40 and 60years. 107 (78.6%) patients had history of COVID-19.Mucorale is most commonly found fungal species (90.4%) followed by aspergillus (2.7%) & mixed species (6.8%). Diabetes Mellitus is most common comorbidity. Intraoperative complications were bleeding (72.60%), CSF leak (4.1%), orbital hematoma (0.68%), nasolacrimal duct trauma (2.05%), periorbital hematoma (0.68%). Post operative complications like synechiae (56.16%), OAF (45.89%), hypoesthesia (25.34%), decreased vision (16.43%), facial pain (20.54%), facial deformity (20.54%), diplopia (6.8%), headache (30.13%), anosmia (39.72%), dental pain (20.54%), earache (9.58%), hyposmia (45.89%), periorbita ecchymosis (0.68%), residual disease (16.10%), recurrence (2.05%), death (2.05%) was observed. Prompt surgical debridement of devitalized tissue and early adequate dosage of antifungal (inj. Amphotericin-b) treatment are necessary as delay in surgical debridement and treatment can worsen the prognosis of disease. Among all complications faced maximum were manageable with early interventions but few of them were inevitable due to extensive nature of disease.

Fatal blast injuries in tyre blowouts: two autopsy case reports

BackgroundFatal blast injuries are generally reported as a consequence of explosions, mainly in terrorist events, work-related detonations, or domestic settings. Although quite rare, blast injuries of high kinetic energy can be seen in tyre blowouts and are very dangerous and potentially lethal because of their unpredictability. This phenomenon is rarely reported in the existing forensic literature.The aim of this study was to report two cases of fatal truck tyre bursts and to discuss the mechanisms leading to the burst and the pattern of injuries.Case presentationsCase 1 was of a 58-year-old truck driver man who was standing nearby a detached tyre that was being inflated in a repair shop when the burst occurred. The tyre struck him in the face and threw him. The medicolegal autopsy showed a right periorbital haematoma, a large wound of the left parietal scalp, a diffuse subarachnoid haemorrhage, an atlanto-occipital dislocation, a fracture of the hyoid bone, multiple rib fractures, and lacerations of the ascending aorta and the pulmonary arteries. Case 2 involved a young man of 24-year-old, a worker in a tyre repair shop, who was inflating a truck’s tyre when it burst violently. The injuries sustained included bleeding from the right ear, fractures of the facial bones, a left hemispheric subdural haematoma associated with the fracture of the skull base, a rib fracture, and diffuse areas of contusions to the lungs. Toxicological analyses were negative in both cases.ConclusionFatalities related to tyre blowout accidents are uncommon. The mechanisms leading to a blowout can be mechanical or chemical in origin, and the main danger of a burst often occurs when air enters the tyre during inflation. Internal damage caused by the pressure waves of the blast often exceeds what would be expected based on external signs alone.

A clinical decision aid for patients with suspected midfacial and mandibular fractures (the REDUCTION-I study): a prospective multicentre cohort study

PurposeTo assess physical examination findings related to maxillofacial trauma to identify patients at risk of midfacial and mandibular fractures and then to construct a clinical decision aid to rule out the presence of midfacial and mandibular fractures in emergency department patients.MethodsWe performed a prospective multicentre cohort study in four hospitals in the Netherlands, including consecutive patients with maxillofacial trauma. Each patient received a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular traumas, respectively. Consequently, clinical decision aids were constructed with the focus being on ruling out the presence of midfacial and mandibular fractures, and diagnostic accuracy was calculated.ResultsA total of 993 consecutive patients were identified of whom 766 and 280 patients were suspected of midfacial and mandibular fractures, respectively. Midfacial fractures were diagnosed in 339 patients (44.3%), whereas mandibular fractures were observed in 66 patients (23.6%). The decision aid for midfacial trauma consisting of peri-orbital hematoma, epistaxis, ocular movement limitation, infra-orbital nerve paresthesia, palpable step-off and tooth mobility or avulsion, produced a sensitivity of 89.7 (86.0–92.5), a specificity of 42.6 (38.0–47.4), and a negative predictive value of 83.9% (78.4–88.2). The decision aid for mandibular trauma consisting of the angular compression test, axial chin pressure test, objective malocclusion, tooth mobility or avulsion and the tongue blade bite test resulted in a sensitivity of 98.5 (91.9–99.7), a specificity of 34.6 (28.5–41.2), and a negative predictive value of 98.7% (92.8–99.8).ConclusionThe constructed clinical decision aids for maxillofacial trauma may aid in stratifying patients suspected for midfacial and mandibular fractures to reduce unnecessary diagnostic imaging.Clinical Trial RegistrationThe study was registered at ClinicalTrials.gov with the identifier NCT03314480.

An Optic Nerve Avulsion Due to A Gun Shot Injury: A Case Report

Purpose: To present a rare case of optic nerve avulsion due to gun shot injury. Case Report: A 30-year-old man presented with sudden visual loss on the Right Eye (RE) after a gun shot on his left frontal bone. On examination of the RE, he had periorbital hematoma and edema, and also conjunctival chemosis. There was no light perception of the RE, and his pupil was dilated and nonreactive to light. There’s also an eye movement resistance. On the examination of the Left Eye, he had periorbital hematoma and edema, visual acuity was 1.0 and other examinations was within normal limit. B-scan USG of the RE showed a hyperechoic image on the retinal projection in front of the optic nerve. CT-scan showed multiple metal density fractions in the subcortical cortical left frontal lobe and right retrobulbar. On funduscopic examination, there was bleeding in the inferior vitreous originating from the optic nerve papilae. The patient underwent craniotomy, debridement, and corpus alienum extraction by neurosurgeon and plastic surgeon. The patient was treated with high dose steroid (methyl prednisolone 4 x 250 mg iv). After a week of therapy, there was no improvement of his RE visual acuity. Conclusion: Optic nerve avulsion is a rare case with devastating results because there’s still no definite therapy to improve the outcome.

Blow-in Fracture of Orbital Roof. A Case Report

Orbital fractures may be accompanied with severe damage of the eye bulb and other intraorbital tissues. Early clinical findings can be very mild, therefore it is vital to actively seek not only for any damage done to the soft tissues of the orbit, but also for extraorbital complications such as liquorrhea or meningitis. We report a relatively rare case of blow-in fracture of orbital roof in eleven years old boy. Patient was admitted to the emergency care after falling off a bicycle without impaired consciousness. During admission ophthalmologist evaluated the condition as severe contusion of the left bulb, with hemophthalmia and retinal comotosis. Due to significant swelling of eye lids and periorbital hematoma, it was not possible to perform specific tests to objectify possible oculomotor disorder and diplopia. CT scan findings show dislocated fracture of orbital roof with fragments reaching into the musculus rectus superior. For high risk of bulbus penetration and muscle damage a surgical intervention with bone fragments removal was performed using endoscopic assisted frontal orbitotomy. After operation patient had no signs of functional eye disorder.

Hemostasis Disorders in Patients with De Novo Acute Leukemias

Aim. To study hemostasis disorders in patients with de novo acute leukemias (AL) prior to chemotherapy. Materials &amp; Methods. The study enrolled 107 patients with newly diagnosed AL, aged 18-80 years and treated at the National Research Center for Hematology. Acute lymphoblastic leukemia (ALL) was identified in 37 patients, acute myeloid leukemia (AML) was diagnosed in 46 patients, and acute promyelocytic leukemia (APL) was reported in 24 patients. Hemorrhagic and thrombotic complications were analyzed; platelet count, APPT, prothrombin and fibrinogen concentration were determined; thromboelastography (TEG; native tests, functional fibrinogen tests) and rotation thromboelastometry (ROTEM; EXTEM, INTEM, FIBTEM, APTEM) were performed. The data were statistically processed using SAS 9.4 software. Results. At AL onset hemorrhagic syndrome was detected in 34 (32 %) out of 107 patients. It was manifested by petechia (n = 16), subcutaneous hematomas (n = 12), gingival (n = 10) and nose (n = 6) bleeding, uterine bleeding (n = 2), hematuria (n = 2), gastrointestinal bleeding (n = 1), brain hemorrhage (n = 6), and periorbital hematoma (n = 1). According to TEG and ROTEM hypocoagulation was more common in APL patients. Hyperfibrinolysis could be detected using only ROTEM in 54 % of APL patients, in 8 % of ALL and 4 % of AML patients. Compared to other AL patients those with APL showed different parameters of fibrinogen concentration of &lt; 1.75 g/L (sensitivity 83.3 %, specificity 83.13 %), D-dimer concentration of &gt; 2686 pg/L (sensitivity 72.73 %, specificity 64.79 %), MCF&lt;sub&gt;FIBTEM&lt;/sub&gt; &lt; 12.5 mm (sensitivity 80 %, specificity 80 %), and MA&lt;sub&gt;FF&lt;/sub&gt; &lt; 9.7 mm (sensitivity 86.96 %, specificity 90.12 %). Conclusion. The parameters that distinguish APL from other categories of AL patients are hypofibrinogenemia, higher D-dimer concentration, ROTEM changes, and hyperfibrinolysis.

Lipectomia bucal: relato de complicação cirúrgica mediata

O coxim adiposo bucal é descrito como um tecido gorduroso localizado na face e a sua remoção é conhecida como lipectomia bucal ou bichectomia, podendo ser indicada com finalidade estética e funcional. Esse trabalho tem como objetivo relatar um caso de complicação mediata após a lipectomia bucal. Paciente, 33 anos, sexo feminino, buscou tratamento por apresentar morsicatio bilateral. Foi realizada cirurgia de lipectomia bucal e após três horas do fim do procedimento, a paciente relatou edema na face desproporcional e unilateral direito, com presença de dor leve e latejante, havendo evidente formação de hematoma periorbitário e equimose no olho direito. A paciente necessitou de nova intervenção para explorar a ferida, necessitando de drenagem do hematoma, seguida de manobras de compressão e cauterização com bisturi elétrico monopolar. Diante da estabilização do sangramento, a paciente foi orientada a fazer uso de antibiótico, bem como controlar a dor com analgésicos e crioterapia, sendo monitorada diariamente até que a regressão do edema fosse evidente. O hematoma regrediu com 30 dias, não havendo prejuízo funcional e estético. A cirurgia de lipectomia bucal deve ser realizada por um profissional qualificado com experiência em ambiente ambulatorial e hospitalar, com capacidade de intervir precocemente nas possíveis intercorrências, minimizando a possibilidade de evolução para complicações mais significativas.

Ultrasound Examination of the Pupil - A New Tool for the Neuro-Ophthalmological Assessment.

Pupil examination represents a diagnostic and prognostic test in the management of several neurological diseases. Infrared video pupillometry (IVP) is the gold standard, since it is not routinely available, a noninvasive bedside ultrasound assessment has been proposed as an alternative. The aim of this study was to assess the feasibility and reproducibility of ultrasound pupillometry (UP) in comparison with IVP. 81 subjects (43 men and 38 women, mean age: 52 ± 20 years and 49 ± 19 years, respectively) with no history of neurophthalmologic disease were enrolled. UP was performed with a 12-MHz linear probe according to current guidelines for orbital insonation. Light and painful stimuli were applied to test pupillary light reflex (PLR) and ciliospinal reflex (CR). In 30 of these subjects IVP examination was performed additionally to obtain intra-observer and inter-observer agreement. Increasing age was associated with a decreased pupillary diameter (PD) at rest, after PLR and CR (R -0.728, p < 0.01, R -0.643, p < 0.01, R 0.674, p < 0.001 respectively), while no association was noticed with time to constriction/dilation. UP measurements were reproducible (rate of inter- and intra-observer agreement: R 0.979, p < 0.01, R 0.946, p < 0.01 respectively) and concordant with IVP (PLR R 0.831, p < 0.01; CR R 0.879, p < 0.01). According to our study, ultrasound pupillometry is a feasible and reliable technique for bedside pupillary function assessment, and is a good alternative to infrared video pupillometry. Moreover, it represents the only way for functional pupillary assessment in patients with periorbital hematoma.

A misleading Periorbital Hematoma..Case Report

Periorbital ecchymosis or hematoma is due to extravasations or collections of blood into the periorbital skin and the subcutaneous tissues around the eyes. ‘Spectacle hematoma’ ‘raccoon eyes’ or ‘panda sign’ is a distinctive type of periorbital hematoma. A six year old girl brought in the casualty accompanied by her mother with complain of severe cough, left periorbital blackening, running nose, nose block and mild fever for 7 days. Keywords: Periorbital hematoma, Spectacle hematoma, Sub-conjunctival hemorrhage

Catastrophic optic canal fracture

Isolated orbital roof fractures are raremost of these fractures heal without any complications. Traumatic optic neuropathy (TON) is one of the rare but catastrophic complications of orbital roof fractures. A 37-year-old gentleman was admitted in our emergency department following road traffic accident. He fell down from a motocycle, on presentation to the emergency department he felt a little drowsy, had vomited twice, and complained of pain around his right eye. His Glasgow Coma Scale was 15/15. Clinical examination revealed right periorbital hematoma with edematous lids closing the right eye and ecchymosis, and pupils were equal in size. Eye movements was normal but visual acuity in the right eye was 2/10 and in left 9/10.

TRAUMATIC SUPERIOR ORBITAL FISSURE SYNDROME - A CASE REPORT

The superior orbital apex syndrome is a relatively uncommon complication of midface maxillofacial trauma. The clinical symptoms consist in ophthalmoplegia, palpebral ptosis, exophthalmia, fixed mydriasis, retrobulbar pain and supraorbital nerve hypoesthesia by involvement of the third (oculomotor nerve), fourth (trochlear), fifth (trigeminal) and sixth nerve (abducens). If there is involvement of the optical nerve, the syndrome is termed - orbital apex syndrome. In this article, we will present the case of a 33-years old male, victim of human aggression with traumatic superior orbital apex syndrome. We discuss details of diagnosis and surgical treatment. We will make, also, a review of literature on this subject. Even if the actual therapeutic algorithm is currently a matter of controversy, the generally accepted therapy plane initiated with a high dose of corticosteroids. Fine slice CT scan examination is mandatory for the correct planning. If the CT scan reveals a highly displaced maxillo-zygomatic complex fracture with or without orbital blow-out fracture, we recommend early surgical intervention after the resolving of the periorbital hematoma within 5 to 10 days ideally if concomitant intracranial injury or other conditions permit it. The early restoration of the orbital anatomy and volume will create the basis for cranial nerve decompression and function at the level of superior orbital fissure.

Functional blindness: Blepharospasm with apraxia of eyelid opening

Purpose: The purpose was to evaluate the effectiveness of protractor myectomy surgery in patients with severe blepharospasm whose daily life is severely impaired. Materials and Methods: Records of fifty patients with benign, essential blepharospasm were examined retrospectively and seven were included in the study. All patients underwent a complete ophthalmological and neurological examination. The severity and frequency of spasm was determined by Jankovic Rating Scale, ranging from 0 to 4, and six daily activities were determined by Blepharospasm Disability Index. The primary indication for protractor myectomy was poor response to serial botulinum toxin injections. The main outcome measure was based on whether the spasms were fully healed or the need for additional botox application. Results: Fourteen eyes of seven patients with significant functional disability were included in the study. Excessive blinking and visual disability were the most common symptoms seen in all patients, and all had previously used one or more medications. Myectomy surgery was performed in all patients who were resistant to serial botulinum toxin injections. Of the 14 eyelids, 85.7% showed resolution of spasms and no longer required botulinum toxin treatment following surgery. One patient with keratitis sequelae and dry eye was given botulinum 1 month after the surgery. One patient with residual blepharospasm in the lower eyelid underwent lower eyelid myectomy and blepharoplasty. Transient periorbital edema, hematoma, and echymosis developed following surgery. The patients were followed up for 2 years, and excellent cosmetic result with no contracture was observed in all patients. Conclusion: Protractor myectomy is an effective treatment modality in cases of blepharospasm with severe functional disability.