眼眶瘘管分析

眼眶瘘管是一种少见病。我院从1978—1992年间共收治11例眶部瘘管,都因对原发病的诊断和治疗不当而形成的。临床资料1.概况:11例眼眶瘘管,其中2例病变恶化脑转移死亡;9例经彻底手术,除去病因而痊愈。男性6例,女性5例。年龄最小6岁,最大57岁。病程最短1年,最长30年。2.瘘管位置:眶外上缘7例,眶上缘偏内1例,眶内缘2例,眶外缘及耳前多发瘘管1例。3.痿管原因:①外伤异物6例(木质异物3例,脏玻璃异物1例,金属异物1例,弹伤1例)。②囊肿5例(皮样囊肿4例,粘液囊肿1例)。     

改良美蓝染色法在眼眶复杂性皮样囊肿摘除术中的应用

分析改良美蓝染色法在眼眶复杂性皮样囊肿摘除术中的应用及病例随访结果。方法：回顾性分析。收集2014年6月至2017年12月在复旦大学附属眼耳鼻喉科医院采用改良美蓝染色法进行复杂性（表）皮样囊肿摘除的患者8例（8眼），详细阐述该方法的操作步骤及注意事项。结果：8例患者中首次手术7例、外院术后复发1例。肿块均位于眼眶外上方，其中1例有瘘管形成，1例有眶内外沟通。就诊时症状包括复视（2例）、眼位偏移（5例）和眼球突出（6例）等。术中行改良美兰染色，囊壁均清晰着色并完全剥离。术后平均随访2.9年，CT检查示囊肿无复发，8例患者均无复视、眼位偏移。病理证实表皮样囊肿2例，皮样囊肿6例。结论：改良美蓝染色法有助于完全剥离囊壁，是眼眶复杂性皮样囊肿摘除术的重要辅助手段。     

眼眶囊肿手术治疗探讨

目的分析眼眶囊肿的手术进路、效果及并发症。方法总结我院2003-2006年病理学证实的眼眶囊肿49例，对其临床表现，影像学检查及治疗结果进行分析。手术方法包括前路开眶37例，前路开眶联合鼻腔引流术4例，外侧开眶8例。结果病理学检查证实皮样囊肿34例，表皮样囊肿7例，粘液囊肿4例，皮脂腺囊肿4例，与术前诊断一致。根据CT检查结果进行手术，49例手术均顺利完成，未出现手术意外。术后1例出现上睑下垂，1月后复诊恢复正常；2例外侧开眶术后出现眼睑肿胀，眼球活动受限，术后半年恢复正常。全部病例术后随访未发现复发。结论眼眶囊肿以皮样囊肿、表皮样囊肿最为多见，后天性囊肿以粘液囊肿多见。CT检查对眼眶囊肿有定性及定位诊断价值。手术的关键是完全摘除囊壁。     

眼眶病变中PACS图像系统的应用

目的 探讨眼眶病变中PACS图像系统的诊断价值.方法 对70例眼眶病变患者行眼眶CT检查,部分行MRI,DSA检查.结果 在70例眼眶疾病中眼眶骨折38例,海绵状血管瘤4例,皮样囊肿3例,眼眶异物2例,其他23例.PACS图像系统能有效提高诊断率.结论 PACS图像系统在眼眶病变中的诊断中具有重要价值,并能指导手术方案的设计.     

眼眶木质异物遗留二例报告(摘要)

笔者报告2例较大木质异物遗留在眼眶组织中,由此引起慢性炎症形成瘘管,造成患者极大的痛苦和失明。本文2例伤后都有严重的眼眶挫裂伤及眼球挫伤,当时都进行清创缝合。例1由于跌在草地上,病人及医师都没有发现异物存在而按一般外伤处理,对严重的眼球及眼肌损伤未作进一步检查,致异物遗留形成瘘管,一年后手术切除瘘管时,于瘘管上方发现并取出树枝异物一枚,术后伤口愈合。例2木块刺入眼眶,即日在原创口取出大块木质异物,术后不久形成瘘管,先后3次在原创口取出大小不一木质异物,直到异物取净,伤口才愈合。     

眼眶瘘管临床分析

临床上眼眶瘘管较少见，大多数是由于对原发病的诊断和处理不当所造成的，本文总结了我院1979年至1993年共收治的10例眼眶层管，现分析报告如下。临床资料1．一般资料：本组共10例，男性8例，女性2例；年龄最大47岁，最小10岁；病程最长18年，最短4个月；9例经彻底手术后治愈，l例因故未手术。1例手术多达8次。2．瘘营位置及长度：眶外上线处5例，眶内下缘3例，眶内上缘2例。渗管最长5cm，最短4mm。3．瘘管原因：①外伤异物6例（植物性异物4例，金属异物1例，玻璃1例）。②鼻窦炎2例。③皮样囊肿2例。4．并发眼症：①脸闭合不全3例，脸外翻1…     

小儿眼眶皮样囊肿的临床分析

目的　探讨小儿眼眶皮样囊肿的临床特点。方法　对8例小儿眼眶皮样囊肿患者进行临床分析。结果　8例均单眼发病,囊肿多位于颞上方眶缘。结论　术中避免囊壁破裂及彻底去除肿瘤的囊壁、囊蒂是关键。     

眼眶皮样囊肿临床分析

目的评价各种影像学检查对眼眶皮样囊肿的诊断价值，总结眼眶皮样囊肿的手术经验。方法利用15年期间诊治的眼眶皮样囊肿17例做回顾性分析，对比各种检查结果的特征，分析不同部位囊肿的手术方式和术中处理。结果X线检查能粗略反映眼眶骨骼改变。超声多普勒反映肿瘤的血流情况。B超、CT、MRI均可确定病变位置并提示病变的性质，但B超能较好显示病变内结构和动态，CT发现病变及确定空间位置较准确，MRI上信号高低与脂质、H^4含量有关。表浅囊肿易分离、摘除；深部囊肿需复杂的手术方案。囊肿壁的完整摘除是手术成功的关键。结论上述影像检查均对眼眶皮样囊肿诊断有帮助，CT检查最有价值。超声、MRI与CT检查相结合，能得出最佳定性、定位诊断，术中必须彻底清除囊肿，防止复发。     

眶区皮样囊肿的CT表现

目的 分析眶区皮样囊肿及表皮样囊肿的CT表现,揭示该病的特殊性CT征,作为诊断依据.方法 复习经手术及病理组织学证实的皮样及表皮样囊肿CT片共55例,分析其所在位置、范围、形状、边界、密度、CT值及继发改变.结果 55例病变均被CT发现,53例提示病理组织学诊断,2例眶缘有瘘管者缺乏特征性CT表现.病变位于眶内者44例:内上象限2例、外上象限36例、内下象限3例、外下象限3例;按所在间隙分析,中央间隙(肌锥内)1例、周围间隙9例、骨膜下间隙24例、眶骨壁内10例.眶缘者5例均位于眶上缘.颞窝者6例均位于颞肌下.囊肿密度不均,CT值-158.67Hu～+62.00Hu.典型的骨壁改变45例.结论 CT能够在术前对皮样囊肿作准确定性、定位诊断,对制定手术方案有很大帮助.     

原发性眼眶肿瘤120例临床病理分析

目的:探讨原发性眼眶肿瘤的发病情况及组织学来源,为原发性眼眶肿瘤的诊断提供参考.方法:回顾性分析我院近5a来原发性眼眶肿瘤患者的病历资料,记录患者的性别、年龄、眼别、病理结果.结果:原发性眼眶肿瘤共120例,血管源性肿瘤32例(26.7%),泪腺源性肿瘤28例(23.3%),眼眶囊肿22例(18.3%),神经源性肿瘤19例(15.8%),淋巴瘤6例(5.0%),炎性假瘤5例(4.1%),肌源性肿瘤3例(2.5%),骨源性肿瘤2例(1.7%),其它未明确诊断的3例(2.5%).其中良性肿瘤93例(77.5%),依次为海绵状血管瘤、皮样囊肿、多形性腺瘤、毛细血管瘤、神经鞘瘤、脑膜瘤、炎性假瘤、表皮样囊肿、视神经胶质瘤、骨瘤、血管平滑肌瘤、淋巴管瘤、皮脂腺瘤、血囊肿、泪腺囊肿.恶性肿瘤24例(20.0%),依次为泪腺腺样囊性癌、淋巴瘤、多形性腺癌、横纹肌肉瘤、泪腺腺癌、恶性黑色素瘤.结论:眼眶肿瘤种类繁多,海绵状血管瘤和泪腺腺样囊性癌仍是最常见的良性和恶性原发性眼眶肿瘤.     

Osteomyelitis of the orbit. A case report

With the advent of the antibiotic era, the incidence of osteomyelitis has decreased remarkably. However, cases of trauma-induced orbital cellulitis, abscess, fistula formation, and osteomyelitis may still occur. The following case is illustrative of the chronicity of problems (8-year course) caused by retained orbital wooden foreign bodies.     

眶内非金属异物25例临床分析

目的 总结眶内非金属异物的临床特征及诊治方法.方法 回顾性系列病例研究.收集2002至2009年经手术证实的眶内非金属异物患者资料25例,总结临床表现、影像学征象、治疗与随访结果.结果 外伤性异物23例,包括:植物性异物11例,玻璃、油脂和石块各3例,塑料笔头2例,爆竹残渣1例.另2例为医源性异物.特征性临床表现为眶周皮肤或结膜瘘道,共11例,发生率为44%,以植物性异物最为多见.CT征象因异物性质不同而各异.植物性异物在外伤早期呈低密度,随时间延长密度逐渐增高,压缩窗宽,异物显示更加清晰.油脂异物表现为与脂肪相近的低密度,石块和玻璃表现为高密度块影.植物性异物在MRI的T1和T2加权像均呈低信号,周围的脓液在T2加权像呈环形高信号影,异物周围的炎性组织强化明显.油脂异物在T1和T2加权像均呈高信号,脂肪抑制显像呈低信号.所有患者均在全身麻醉下接受眶内异物清除术,均经一次手术清除全部异物及周围腐烂组织,感染伤口一期不予缝合.术后半年随访,伤口愈合良好,症状改善,未见与手术相关并发症.结论 眶内非金属异物种类较多,病情复杂各异,处置不当易眶内残留.CT为首选检查方法.正确认识病史及临床表现,运用恰当的手术技巧,彻底清除异物,预后良好.

Abstract：

Objective To evaluate the clinical features,diagnostic methods and treatment of intraorbital nonmetallic foreign body injuries. Methods In a retrospective study,the records of 25 consecutive cases with nonmetallic foreign bodies in the orbit confirmed by surgery were analyzed with special attention to the types of injury,history,clinical manifestations,imaging findings,treatment and follow-up results. Results Among 25 cases with nonmetallic foreign bodies,23 cases were caused by trauma,including 11 cases with wooden bodies,3 cases with glass,grease,or stone,2 cases with plastic pen point,and one case with firecrackers. The remaining two cases had iatrogenic foreign bodies. The distinctive clinical manifestation was the periorbital fistula recorded in 11 (44%) cases,mostly in patients with wooden foreign bodies. The CT findings were different in various foreign bodies. The wooden foreign bodies showed low density in the acute stage and the density increased gradually from the acute to the chronic stage. CT images with lower windows could distinguish a wooden foreign body better. The grease was seen as low density mimicking orbital fat on CT. The stone or glass showed as masses with high density. Wooden foreign bodies displayed low signals on both MRI T1- and T2-weighted images. The surrounding pus was seen as a ring with high signal on T2-weighted images. The inflammatory infiltration showed marked enhancement. The grease displayed high signal on both T1- and T2-weighted images and showed lower signal than that of the fat. All patients underwent surgical removal of retained foreign bodies and the surrounding decomposed tissues. The infected wounds were not sutured at one stage operation. After follow-up for 6 months,all wounds healed normally and all patients recovered well No complications were encountered.Conclusions There are various types of intraorbital nonmetallic foreign bodies. The clinical manifestations of these different foreign bodies are complex. CT is the preferred examination for this condition. With the combination of correct diagnosis,proper surgical skills,and complete removal of foreign bodies and surrounding decomposed tissues,nonmetallic foreign bodies can be treated efficiently.     

Differentiating intradiploic orbital dermoid and epidermoid cysts utilizing clinical features and machine learning

Purpose:The purpose of this study was to characterize intradiploic dermoid and epidermoid orbital cysts to determine any differences in clinical, radiographic, or surgical features.Methods:A retrospective review was performed of patients presenting with intradiplopic dermoid or epidermoid cysts. Additionally, a complete review of the literature was performed to identify cases of intradiplopic orbital dermoid and epidermoid cysts. Data collected included age, sex, presenting symptoms, location of intradiplopic cyst, ophthalmic findings, treatment, and follow-up. Clinical features of dermoid versus epidermoid cyst were compared. Additionally, machine-learning algorithms were developed to predict histopathology based on clinical features.Results:There were 55 cases of orbital intradiploic cysts, 49 from literature review and six from our cohort. Approximately 31% had dermoid and 69% had epidermoid histopathology. Average age of patients with dermoid cysts was significantly lesser than that of patients with epidermoid cysts (23 vs. 35 years, respectively; P = 0.048). There was no difference between sex predilection, presenting symptoms, radiographic findings, or surgical treatment of dermoids and epidermoids. The majority of patients (64%) underwent craniotomy for surgical removal. Machine-learning algorithms KStar and Neural Network were able to distinguish dermoid from epidermoid with accuracies of 76.3% and 69%, respectively.Conclusion:Orbital intradiploic cysts are more commonly epidermoid in origin. Dermoid cysts presented in younger patients; however, there were no other significant differences in features including ophthalmic or radiographic findings. Despite similar features, machine learning was able to identify dermoid versus epidermoid with good accuracy. Future studies may examine the role of machine learning for clinical guidance as well as new surgical options for intervention.     

眼眶复发性皮样囊肿的临床特征与治疗

目的 总结复发性皮样囊肿的临床特征及诊治方法.方法 回顾性系列病例研究.收集30例经病理学确诊的复发性皮样囊肿患者资料,总结病史特点、复发因素、临床表现及影像学征象、治疗与预后.结果 患者初次手术距最后就诊时间间隔1个月至36.0年,中位数时间2.5年.既往有1、2、3次手术史的例数分别为:20例、9例及1例.特征性临床表现有:眶周肿物,伴红肿及触痛16例;眶周皮肤瘘管4例;上睑皮肤与眶缘骨膜粘连,眼睑外翻4例.常见导致复发的因素有:部分切除囊壁或未清理残存在眶骨缝中的囊壁16例;误诊为皮下肿物盲目手术11例;术前未行影像学检查8例等.所有患者行CT检查,显示囊肿可呈低或中等密度,常见征象有:囊肿发生在颧额缝附近,呈哑铃形8例,骨内隧道盲端细长迂曲6例,眶壁大面积骨质呈波浪状压迹6例.28例行手术治疗,彻底清除囊壁和内容物后,随访1至9年,均无再次复发,保守观察2例,所有患者无严重并发症.结论 眼眶皮样囊肿复发与术者经验不足、手术不彻底等因素有关,具有典型的临床表现和影像学特征.根据影像学检查精确定位,术中综合运用多种手术技巧,可有效避免复发.     

Diagnosis and management of orbital inflammation and infections secondary to foreign bodies: a clinical review

Orbital inflammation and secondary infections may be caused by many types of foreign bodies, including organic and inorganic matter, non-autogenous surgical implants and allografts, and surgical hardware and materials utilized in reconstructive surgery. In penetrating injury patients, the nature of the foreign body determines the clinical behavior; inert objects such as steel and glass may not cause significant inflammation to warrant their removal. Removal of organic foreign bodies, however, is mandatory since these objects usually lead to secondary infection with abscess and fistula formation. This paper reviews salient points related to history-taking and physical examination, diagnostic workup, and medical and surgical treatment in foreign body-induced orbital inflammation and infections. It is emphasized that practically every case of orbital trauma should be approached with a high index of suspicion for penetrating injury with possible intraorbital foreign body. The investigational tools to detect orbital foreign bodies, including ultrasonography, computed tomography and magnetic resonance imaging, are reviewed. The principles of the management, including antimicrobial therapy, surgical indications and techniques, are also discussed.     

Diagnosis and management of orbital inflammation and infections secondary to foreign bodies: a clinical review

Orbital inflammation and secondary infections may be caused by many types of foreign bodies, including organic and inorganic matter, non-autogenous surgical implants and allografts, and surgical hardware and materials utilized in reconstructive surgery. In penetrating injury patients, the nature of the foreign body determines the clinical behavior; inert objects such as steel and glass may not cause significant inflammation to warrant their removal. Removal of organic foreign bodies, however, is mandatory since these objects usually lead to secondary infection with abscess and fistula formation. This paper reviews salient points related to history-taking and physical examination, diagnostic workup, and medical and surgical treatment in foreign body-induced orbital inflammation and infections. It is emphasized that practically every case of orbital trauma should be approached with a high index of suspicion for penetrating injury with possible intraorbital foreign body. The investigational tools to detect orbital foreign bodies, including ultrasonography, computed tomography and magnetic resonance imaging, are reviewed. The principles of the management, including antimicrobial therapy, surgical indications and techniques, are also discussed.     

Orbital foreign bodies]

Orbital foreign bodies are found in a variety of instances according to the foreign body, its volume, its nature and its location. Clinical cases are variable. In an emergency, the suspicion of an orbital foreign body in case of an orbital wound is studied as well as the surgical indications for extraction of this foreign body. Later, a misdiagnosed orbital foreign body can lead to infectious complications such as cellulitis, orbital abscess, fistula, or cerebral abscess with possible mortality. The different cases are presented with their surgical indications.     

Multilobular dermoid cyst of the orbit

Dermoid cysts are histologically defined as surface epithelium encapsulating an inner lumen. They are well described in the literature as discrete, single masses, either circumscribed or dumbbell-shaped, with or without a longstanding fistula. Chronic granulomatous inflammation is often a feature of dermoid cysts, contributing to local soft tissue and bony destruction. Isolated multicystic dermoids are not well described. We present a case of a multilobular dermoid characterized both radiographically and histopathologically. These findings may be attributed to repeated rupture and reformation of the dermoid cyst. When possible, our experience favours early excision of orbital dermoid cysts to minimize morbidity.     

Atypical choristomatous cysts of the orbit

Background: The commonest choristomatous cysts of the orbit are dermoid and epidermoid cysts, which are lined by kerantinizing seuamous epithelium. They typically occur in the superior orbit, most commonly superotemporally. Other types, lined by different epithelia, and other orbital sites are much less common. Methods: Five cases of atypical orbital cystic choristomas that presented over the past 6 years are reported. The clinical and radiological features, surgical approach and findings, and histology are described. Similar cases from the literature are reviewed, and possible aetiology discussed. Results: Four of the cysts were lined by a non-keratinizing epithelium resembling conjunctiva; two had adnexal structures in their walls. Compared with typical dermoid and epidermoid cysts, these ‘conjunctival dermoids’ and ‘conjunctival cysts’ of the orbit tended to present later in life, none were associated with bony defects, and three of the four occurred in the superomedial quadrant. One case occurred inferiorly, a rare site for orbital conjunctival dermoids and cysts, or typical dermoids and epidermoids. The fifth case, also inferior; is an example of a cyst within choristomatous lacrimal tissue. Conclusion: Choristomatous cysts of the orbit may occur with non-keratinizing epithelial linings, and such cysts tend to differ clinically from the commoner dermoids and epidermoids. They may also occur in atypical sites such as the inferior orbit.