Pterional orbital decompression in traumatic orbital hematomas

The results are presented for pterional orbital decompression in 12 patients with symptomatic traumatic retrobulbar hematoma after various traumatic mechanisms. Pre- and postoperative course, neuroradiological findings, additional brain or facial injuries as well as outcome of eye function are analyzed in detail. Mean time delay between trauma and decompression was 56 h (2.4 days), with a wide range from 2 h to 15 days. Preoperative exophthalmos and pupillary disturbances as well as restrictions of extraocular movements decreased in all patients after orbital decompression and removal of the retrobulbar hematoma if the bleeding was localized. Visual acuity remained normal or showed significant improvement in seven patients, four of whom experienced complete recovery. In three patients the eye remained amaurotic. No complications related to the operation were seen. The pterional orbital decompression described here represents an effective alternative approach for patients with sight-threatening retrobulbar hematoma, especially in cases where it is necessary to gain space for the orbit in addition to evacuating space-occupying blood or bone clots and treating neighbouring lesions. Immediate detection and adequate treatment of orbital hematomas is mandatory to achieve an acceptable outcome of eye function.     

Nasoethmoidal and orbital fractures

It is helpful to consider fractures of the orbit both in terms of their location and fracture pattern. CT scanning is an invaluable aid to the diagnosis and treatment of all orbital fractures. Early operative intervention, wide exposure, and accurate and stable fixation accompanied by immediate bone grafting provide the most successful treatment of fractures of the orbit.     

Extended pterional orbital decompression in severe orbital cellulitis

BACKGROUND: Bacterial orbital cellulitis is a relatively uncommon infective process, which can threaten the function of orbital structures. Apart from antibiotic therapy, sinus surgery with or without abscess drainage via an orbito-otorhinolaryngological approach might be necessary. CASE DESCRIPTION: We present three cases of severe orbital cellulitis, leading to increasing loss of vision, proptosis, afferent pupillary disturbances and restriction of extra-ocular movements, despite antibiotic therapy. After extended pterional orbital decompression and reducing the orbital pressure by removal of the lateral and superolateral orbital walls, all patients showed distinct improvement of initial symptoms, without any complications related to the operation. INTERPRETATION: Extended pterional orbital decompression represents an effective treatment alternative and supplement in cases of a severe, threat to ocular function due to orbital cellulitis, where acute reduction of pressure on orbital, neural and vascular structures is intended.     

Superolateral orbital exposure and reconstruction

Based upon experience with 10 cases of surgical excision of orbital tumors, we describe a modification of the supraorbital and lateral approaches to the orbit. This technique gives a wide superior and lateral exposure of the orbital contents for microsurgical removal of orbital tumors. It is particularly applicable to large orbital neoplasms, tumors in the orbital apex, growths with intra-cranial extension, and medial orbital tumors. Two separate bone flaps are removed: (a) a craniotomy (or cranio-orbital) flap that includes the superior and lateral orbital rim and (b) a smaller, more posterior flap that includes the remainder of the roof and lateral wall of the orbit. After excision of a tumor, the orbital walls can be reconstructed in their entirety or the surgeon can leave out the smaller, posterior flap for orbital decompression. After reconstruction there are no significant anatomic, functional, or cosmetic deficits.     

Mega dose corticosteroid treatment for traumatic superior orbital fissure and orbital apex syndromes

The superior orbital fissure syndrome and orbital apex syndrome are rare complications of craniomaxillofacial traumas. The neurologic symptoms are generally due to reversible neuropathy caused by edema, contusion, and compression of the nerves. Much has been written but no firm conclusions have been reached on the best mode of treatment. Whereas some authors advocate emergency optic nerve decompression, others recommend mega dose corticosteroids alone. We have treated 11 patients with traumatic superior orbital fissure or orbital apex syndromes with mega dose corticosteroids in the last 10 years. No complications attributable to the very high dose of corticosteroids were observed. The long-term follow-up of the patients showed complete recovery. These satisfactory results have led to our recommendation of the mega dose corticosteroid treatment in the management of these patients.     

Emergency orbital decompression

Blindness from orbital hemorrhage following surgery, direct trauma, and remote trauma is not common. Compression cyanosis is a rare condition which may cause blindness. Non-ocular injuries may direct attention elsewhere and emergency surgical procedures may be necessary to save life. Orbital decompression can be carried out simultaneously with the other surgery. One case of blindness from abdominal compression and another with orbital, chest, and arm trauma are presented of patients who had emergency orbital decompression along with their other surgical procedures.     

Membranous nephropathy and orbital malignant tumor

A 7-year-old girl with membranous nephropathy is reported who suffered 16 months later from an orbital rhabdomyosarcoma. Proteinuria disappeared at the time of the remission of the tumor. Membranous nephropathy as paraneoplastic syndrome is exceptional in children, since only two other cases associated with a solid tumor have been reported in the literature. Received: 8 June 1998 / Revised: 5 February 1999 / Accepted: 9 February 1999     

Cranial and orbital epidermoid tumours.

This paper reports on 14 cases of cranial and orbital epidermoid tumours, of which 2 epicranial, 4 extradural intracranial, 4 fronto-orbital-sinusal, 2 orbital and 2 orbito-nasal cases. Referring to these cases and data published in the specialised literature, the authors show that this type of tumour is more frequent in males, and is generally of embryologic but very rarely of mechanical origin. The main symptom is tumefaction in cranial tumours and exophthalmos in orbital tumours. There is very rarely association with a space-occupying process (tumour, cerebral abscess). Evolution is slow and progressive; the only treatment is surgical. After total ablation there were no recurrences and the postoperative course was very satisfactory.     

Treatment of orbital schwannomas and neurofibromas

We present an overview of the treatment and clinical outcome of five orbital peripheral nerve tumours, carried out in our centre from 1999 to 2003. The surgical approach was determined by the location and extension of the lesion. Supraorbital orbitotomy was performed in two superiorly located lesions, a transconjunctival approach in one medial, basal, extraconal lesion. A pterional extradural approach was used in two cases with involvement of the apex, superior orbital fissure and cavernous sinus. Three patients were diagnosed as having schwannoma, one as neurofibroma, and one as cystic mixed neurofibroma and schwannoma. One patient suffered from multiple schwannomas [bilateral acoustic schwannomas, cervical schwannomas (NF2)]. One patient showed bilateral orbital neurofibromas, plexiform cutaneous neurofibroma (NF1) and glaucoma due to a coexisting Marfan's syndrome. Local recurrences were not seen after complete resection in all patients. Surgery is the therapeutic goal.     

Osteoid-producing orbital ethmoid tumor

Fibro-osseus lesions of the paranasal sinuses, especially those that contain multinucleated giant cells, demonstrate a significant histopathologic overlap although they manifest themselves throughout a wide range of clinical behavior. They routinely require a critical clinical and pathologic interpretation. Often, the clinical course of the disease is the only guide to diagnosis and mode of treatment. This study presents the case of a 4-year-old boy with an osteoid-producing tumor of the ethmoid sinus. Despite an original diagnosis of fibrous dysplasia, the lesion followed a relentless course. Eventually, maxillectomy, orbital exenteration, and craniotomy were required to control the disease. The literature of fibro-osseous lesions of the paranasal sinuses is reviewed and an attempt is made to classify these lesions according to their clinical behavior.     

Surgery for orbital lesions

RE: Tsuzuki N, Katoh H, Ohnuki A, Ishihara S, Miyazawa T, Nawashiro H, and Shima K. Cystic schwannoma of the orbit: case report. Surg Neurol 2000;54:385–7.

The authors describe a rare case of a cystic schwannoma of the orbit. The tumor was successfully removed via a lateral approach.     

Blindness following orbital reconstruction

A 20 year old patient who suffered from contusion of the optic nerve due to a complex craniofacial fracture, developed, after orbital reconstruction for sequelae of the fracture, loss of light perception which was transiently improved by drug treatment. The clinical and electrophysiological course suggest the presence of ischaemic optic neuropathy.     

Chronic orbital hematic cyst

A rare case of chronic orbital hematic cyst is reported. A 40-year-old male presented with a mass which displaced the eye downward. The initial symptoms, progression of the disease, the difficulty in clinical and radiological diagnosis are presented and discussed together with treatment. Received: 10 July 1998 / Accepted: 28 October 1998     

Overview of tools for the measurement of the orbital volume and their applications to orbital surgery

There are numerous applications in craniofacial surgery with orbital volume (OV) modification. The careful management of the OV is fundamental to obtain good esthetic and functional results in orbital surgery. With the growth of computer-aided design – computer-aided manufacturing (CAD-CAM) technologies, patient-specific implants and custom-made reconstruction are being used increasingly. The precise measurement of the OV before surgery is becoming a necessity for craniofacial surgeons. There is no consensus on orbital volume measurements (OVMs). Manual segmentation of computed tomography (CT) images is the most used method to determine the OV, but it is time-consuming and very sensitive to operator errors. Here, we describe the various methods of orbital volumetry validated in the literature that can be used by surgeons in preoperative planning of orbital surgery. We also describe the leading software employed for these methods and discuss clinical use (posttraumatic enophthalmos prediction and orbital reconstruction) in which OVMs are important.     

眶肌筋膜韧带提紧眶隔脂肪释放睑袋整复术

目的 探讨应用眶肌筋膜韧带提紧、眶隔脂肪释放移位睑袋整复术的方法 及临床效果.方法 在下睑缘睫毛下1～2mm平行于睑缘处切开皮肤,分离出眶肌筋膜韧带,切开眶隔膜,将释放的眶隔脂肪展平移位填充于眶下缘沟,并提紧眶肌筋膜韧带缝合固定于眶外缘骨膜.结果 本组共135例患者,其中80例获随访1～3年,眶下缘沟消失,外观自然,无并发症发生,美容效果满意.结论 眶肌筋膜韧带提紧、眶隔脂肪移位术适用于中老年睑袋整形的患者,术后效果稳定、持久,可达到较理想的年轻化效果.