A case of blowout fracture of the orbital wall with eyeball entrapped within the ethmoid sinus

Blowout fractures, fractures of an orbital wall, are a common result of orbital injury. The author has experienced a case of a 66-year-old man who sustained a blowout fracture of the orbital wall with his intact eyeball entrapped within the ethmoid sinus. After undergoing a successful reduction surgery, the eyeball was repositioned to its original position, but the patient lost extraocular motility as well as vision. The final visual acuity was perception of light as a result of traumatic optic nerve injury and secondary retinal ischemia.     

鼻窦黏液囊肿87例的临床特征及治疗分析

目的探讨鼻窦黏液囊肿的临床特征、诊断及治疗方法。方法分析本院2005年12月-2013年12月收治的87例鼻窦黏液囊肿患者的临床表现、影像学特点、鼻内镜检查特点及手术治疗效果。结果 87例鼻窦黏液囊肿患者的主要表现为头痛、眼球突出、视力下降、面部隆起等非鼻部症状。影像学检查见鼻窦占位;病理检查示囊肿发生于蝶窦9例、筛窦14例、蝶-筛窦26例、额窦15例、额-筛窦9例、上颌窦14例。结论鼻窦黏液囊肿的鼻部症状不明显。CT、磁共振成像和鼻内镜检查有助于鼻窦黏液囊肿的诊断。根据病变特点选择合适的手术方法,早期诊断、早期治疗对预防严重并发症有着重要的意义。     

视神经管周围结构解剖的实验研究

目的 了解视神经管周围结构的解剖并为临床视神经管减压术及鼻窦手术提供解剖学依据.方法 实验研究.(1)成人干性颅骨标本50个,观察和测量筛窦和蝶窦的形态和大小;(2)甲醛溶液固定的成年湿性头颅标本15个,观察和测量蝶窦中部外侧壁与颈内动脉的距离、眼动脉起始处与颈内动脉的夹角,测量视神经颅内段的长度、视神经于视交叉前方之间的夹角、视神经颅内段颅口处两侧视神经内侧缘之间的距离,测量眼动脉在视神经管内的长度和直径;(3)选取6例经甲醛溶液防腐固定的完整成年无明显病变的成年湿性头颅标本,应用CT对筛、蝶窦进行轴位和冠状位扫描,观察视神经管与筛、蝶窦的关系;然后将CT扫描后的湿性头颅标本利用工业用钢锯行筛、蝶窦的断面(6例)、水平断面(3例)、冠状断面(3例)解剖,层厚均为6 mm.将筛窦、蝶窦、视神经管的CT扫描图像和相对应的解剖断面标本进行对比、观察.采用SPSS 13.0统计学软件进行数据处理.男性与女性湿性颅骨标本的测量值比较,采用两组独立样本的t检验.结果 全筛窦前后径(39.02±4.89)mm,前部横径(12.26±2.12)mm,前筛窦上下径(11.89±2.56)mm;蝶窦前后径(24.08±4.87)mm,蝶窦中部外侧壁与颈内动脉的距离(1.23±0.56)mm;眼动脉起始处与颈内动脉的夹角54.33°±7.89°;视神经颅内段的长度(9.91±2.89)mm,两侧视神经于视交叉前方之间的夹角59.89°±4.79°,视神经颅口处两侧视神经内侧缘之间的距离(14.26±3.23)mm;眼动脉在管内段的长度(5.38±1.87)mm,眼动脉外径(2.18±0.37)mm.男性与女性间的视神经颅内段长度(t=0.25)、两侧视神经于视交叉前方之间的夹角(t=0.71)、视神经颅口处两侧视神经内侧缘之间的距离(t=0.57)、蝶窦中部外侧壁与颈内动脉的距离(t=0.29)、眼动脉起始处与颈内动脉的夹角(t=0.99)、眼动脉在视神经管内段的长度(t=0.50)、眼动脉外径(t=0.52)测量值比较,差异均无统计学意义(P>0.05).结论 (1)切开视神经管内侧壁时,在蝶窦内切开的深度不宜超过13 mm,否则有可能损伤颈内动脉并引起大出血;(2)在进行视神经管减压术时,穿破前部筛窦的左右深度不宜超过15 mm,上下不宜超过12 mm,否则易穿破到对侧筛窦或向上穿破颅底进入颅内;(3)应特别注意保护眼动脉,防止眼部缺血和失明.     

泪囊鼻腔吻合术中前筛窦过度发育的处理

目的 探讨泪囊鼻腔吻合术(dacryocystodlinostomy，DCR)中前筛窦过度发育的处理方法。方法 147例泪囊鼻腔吻合术中发现前筛窦过度发育44例(50眼)。以弯蚊式钳插入患侧中鼻道探查、捏鼻鼓气、向骨孔中注水等方法予以识别。发现单层骨板36例(42眼)，双层骨板8例(8眼)；薄骨板29例(35眼)，厚骨板15例(15眼)。薄骨板以剥离子剥离取出，厚骨板以咬骨钳咬除。结果 术后随访3月～2年，全部患者术后溢泪症状消失，泪道冲洗通畅。结论 在泪囊鼻腔吻合术中正确识别和处理过度发育的前筛窦对提高手术成功率具有重要意义。     

鼻内窥镜下经筛窦行眶内壁骨折整复术

探讨应用鼻内窥镜下经筛窦行眶内壁折整复术。方法前鼻孔入路,内窥镜观察下将嵌入筛房的眶脂肪及内直肌还纳回眶内,硅胶板修补充填孔洞。结果１６例患者,平均术后观察８个月,复视消失,眼球内陷矫正,无硅胶排异。结论内窥镜下经筛窦行眶内壁骨折整复术,具有无皮肤瘢痕,手术损伤小,并发症少,且手术安全可靠。     

Massive juvenile ossifying fibroma of maxillary sinus with orbital involvement.

A 14-year-old black girl had painless, progressive proptosis and upward displacement of the left eye for approximately six months. Computed tomography showed a massive tumour involving the maxillary sinus with extension into the sphenoid sinus, ethmoid sinus, and orbit. The mass was excised surgically and proved histopathologically to be a juvenile ossifying fibroma. The clinical and histopathological features of this uncommon orbital tumour are discussed and its place in the spectrum of fibro-osseous tumours of the orbital region is considered.     

泪囊瓣与前组筛窦黏膜瓣吻合的内镜下泪囊鼻腔吻合术治疗前组筛窦过度气化的慢性泪囊炎

目的：探讨前组筛窦气化至上颌骨额突时的成年慢性泪囊炎患者采取泪囊瓣与前组筛窦黏膜瓣吻合 的内镜下泪囊鼻腔吻合术（En-DCR）的可行性。方法：前瞻性研究。收集2017年7月至2019年3月在 温州医科大学附属眼视光医院,通过泪道CT造影（CT-DCG）确诊的前组筛窦气房气化至上颌骨额突 的成年慢性泪囊炎并接受En-DCR的患者。手术步骤：切开鼻黏膜的同时开放并扩大前组筛窦,再进 行常规En-DCR手术,最后将泪囊瓣与前组筛窦黏膜瓣进行吻合。对随访超过12个月的患者,记录 手术的成功率及并发症。结果：纳入前组筛窦气房气化至上颌骨额突并接受En-DCR的成年慢性泪 囊炎患者84例（90眼）。En-DCR的成功率为87%（78/90）。术后出现再次泪道阻塞12眼,其中肉芽阻 塞造瘘口7眼,瘢痕闭锁造瘘口4眼,泪总管阻塞1眼。术后均未出现眼眶脂肪脱垂、脑脊液漏、鼻窦炎、 视力损害等严重并发症。结论：开放前组筛窦完整暴露泪囊窝行En-DCR,通过泪囊瓣与前组筛窦黏 膜瓣的吻合方法,对前组筛窦气房气化至上颌骨额突的慢性泪囊炎患者是可行且有效的。     

前筛窦过度发育的泪囊炎两种手术效果评价

目的 评价伴前筛窦过度发育的慢性泪囊炎在行泪囊鼻腔吻合术(dacryocystorhinostomy,DCR)时的两种手术方式的效果.方法 167例(1 82只眼)泪囊鼻腔吻合术中发现前筛窦过度发育61例(62只眼),按手术方式不同而随机分为两组,试验组将泪囊及鼻黏膜后唇切除,吻合泪囊、鼻黏膜前唇,并留置凡士林纱条33例(33只眼).对照组是单纯将泪囊前后唇与鼻粘膜前后唇分别进行吻合28例(29只眼).结果 试验组治愈31例(31只眼).好转2例(2只眼),无效0例,有效率93.9%;对照组治愈20例(21只眼),好转3例(3只眼),无效5例(5只眼),治愈率72.4%.两组比较,手术效果差异有统计学意义(P＜0.05).结论 实验组明显优于对照组.     

Endoscopic dacryocystorhinostomy with mucosal anastomosing in chronic dacryocystitis with three categories of ethmoid sinuses

AIM: To evaluate the outcome of endoscopic dacryocystorhinostomy (En-DCR) with mucosal anastomosis in chronic dacryocystitis patients, with various categories of ethmoid sinuses. METHODS: Between July 2015 and September 2019, 1439 adult patients, representing 1623 affected eyes, presented with chronic dacryocystitis and were scheduled for En-DCR. The categories of ethmoid sinuses were preoperatively determined, using computed tomography-dacryocystography (CT-DCG), and were classified as category 1 (C1), category 2 (C2), and category 3 (C3). No sinuses anterior to the posterior lacrimal crest defined as C1. Sinuses found between the anterior edge of the lacrimal bone and the posterior lacrimal crest defined as C2. Sinuses found anterior to the lacrimal bone suture defined as C3. At the end of surgery, the dacryocyst and nasal mucosa were anastomosed in C1, and the dacryocyst mucosa and anterior ethmoid sinus were anastomosed in C2 and C3 ethmoid sinus patients. The surgical success rate and related complications, in patients with 3 categories of ethmoid cells, were monitored and documented. RESULTS: Postoperative data was obtained for 179 C1 affected eyes, 878 C2 affected eyes, and 432 C3 affected eyes. The overall success rate of En-DCR was 93.0% (1385/1489). Additionally, the success rates were comparable among the different ethmoid categories at 12mo post operation. We demonstrated that the major reason for surgical failure was intranasal ostial closure, due to granulation or scar tissue. CONCLUSION: En-DCR is a feasible and highly effective primary treatment for chronic dacryocystitis. To ensure surgical success, the surgery protocol must be designed in accordance with the category of ethmoid sinuses present in individual patient.     

鼻内窥镜下经筛窦治疗爆裂性眶内壁骨折

目的探讨鼻内窥镜下经筛窦治疗爆裂性眶内壁骨折的临床疗效。方法25例爆裂性眶内壁骨折在鼻内窥镜下切除筛窦房隔及外伤损伤的眶纸板，将制备好的多孔硅胶片，凸面向外填塞进筛窦术腔，对眶纸板进行施压复位。结果随访3月-2年，治愈22例，占88．00％。2例术后残留周边复视，总有效率为96．00％。术后无眶内感染或其他并发症。结论鼻内窥镜下经筛窦治疗眶内壁骨折是有效的方法，疗效稳定，创伤小、手术时间短而且面部不留瘢痕，硅胶片可以长期存留。     

An unusual case of a retained metallic arrowhead in the orbit and sphenoidal sinus

A case of retained metallic arrowhead in orbit and sphenoidal sinus through an unusual route is reported. The eyeball was removed because of a possible risk of sympathetic ophthalmia.     

Ethmoidal involvement in "imploding" (silent) sinus syndrome

A 32-year-old woman presented with mild enophthalmos of her right eye of recent onset. A CT scan revealed characteristic findings of silent sinus syndrome, involving not just the maxillary but the less frequently reported ethmoid sinus as well. A clinically and radiologically noted shrunken and lateralized middle turbinate was a strong pointer to the suspected cause. The symptoms resolved with endoscopic sinus drainage.     

大鼠眼球标本石蜡切片的改良制作方法

目的探讨改良固定液固定大鼠眼球的效果。方法将大鼠眼球投入到由多聚甲醛、冰醋酸和丙酮组成的改良固定液中固定后制成石蜡切片，经HE染色后在显微镜下观察。结果眼球不变形，外观收缩不明显。镜下视网膜无脱落，眼球全层结构完整．视网膜各层细胞排列整齐，染色鲜艳。虹膜、睫状体、巩膜静脉窦和角膜等组织结构清楚。结论此改良方法明显优于其他方法，是适合大鼠眼球固定的一种有效方法。     

Precursor B-cell lymphoblastic lymphoma presenting as an orbital mass

A previously healthy 12-year-old boy presented with acute onset of proptosis of his left eye. CT scan demonstrated a mass involving the left orbit, left maxillary sinus, and left ethmoid sinus with extension through the cribriform plate into the anterior cranial fossa. Incisional biopsy of the mass revealed a precursor B-cell lymphoblastic lymphoma. Precursor B-cell lymphoblastic lymphoma is a rare type of non-Hodgkin's lymphoma seen exclusively in children and young adults. This is the first reported case of precursor B-cell lymphoblastic lymphoma presenting in the orbit. Treatment is primarily by systemic chemotherapy and is potentially curative. The principal role of the ophthalmologist is in diagnosis and monitoring of such patients. The clinical features and multidisciplinary diagnosis and management of childhood non-Hodgkin's lymphomas are reviewed.     

Ethmoid sinus osteoma presenting as epiphora and orbital cellulitis: case report and literature review.

Paranasal sinus osteoma is a slow-growing, benign, encapsulated bony tumor that may be commonly asymptomatic, being detected incidentally in 1% of plain sinus radiographs or in 3% of sinus computerized tomographic scans. In a patient presenting with orbital cellulitis and epiphora, computed tomography disclosed a large osteoma of the ethmoid sinus. Excision of the osteoma allowed recovery of vision, return of extraocular muscle function, and resolution of choroidal folds. Proptosis, diplopia, and visual loss are other frequent presenting signs of paranasal osteomas. Epidemiology, diagnosis, treatment, and pathologic findings in paranasal sinus osteoma are reviewed.     

Ethmoid osteoma, orbital cellulitis and orbital emphysema

A possibly unique association of an osteoma of the ethmoid sinus with orbital emphysema and orbital cellulitis is described. The osteoma, which had eroded through the orbital periosteum, was removed; the orbital periosteum was grafted with fascia lata and a partial external ethmoidectomy performed.     

Idiopathic orbital inflammation with bone destruction and extension into the paranasal sinuses

Idiopathic orbital inflammation developed in the right orbit of a woman in her mid-thirties, causing tearing, photophobia, diplopia, altered depth perception, proptosis, and pain on eye movements. Computed tomography disclosed a mass involving the intraconal and extraconal nasal right orbit, extending to the orbital apex with anterior displacement of the globe, effacement of the medial rectus muscle, portions of the fat plane, and the superior oblique muscle, and bone destruction with extension of the mass through the orbital floor into the superior maxillary sinus and through the lamina papyracea into the ethmoid sinus. Orbital biopsy disclosed dense fibrous connective tissue with numerous lymphocytes and macrophages. Immunohistochemical stains supported a diagnosis of idiopathic inflammatory pseudotumor involving the orbit and sinus mucosa. Treatment with a prednisone taper and a retrobulbar injection of triamcinolone acetonide have relieved her symptoms and diminished her proptosis. This patient highlights the rare potential of idiopathic orbital inflammation to erode though bone into adjacent cranial structures.     

Precursor B-cell lymphoblastic lymphoma presenting as an orbital mass

A previously healthy 12-year-old boy presented with acute onset of proptosis of his left eye. CT scan demonstrated a mass involving the left orbit, left maxillary sinus, and left ethmoid sinus with extension through the cribriform plate into the anterior cranial fossa. Incisional biopsy of the mass revealed a precursor B-cell lymphoblastic lymphoma. Precursor B-cell lymphoblastic lymphoma is a rare type of non-Hodgkin's lymphoma seen exclusively in children and young adults. This is the first reported case of precursor B-cell lymphoblastic lymphoma presenting in the orbit. Treatment is primarily by systemic chemotherapy and is potentially curative. The principal role of the ophthalmologist is in diagnosis and monitoring of such patients. The clinical features and multidisciplinary diagnosis and management of childhood non-Hodgkin's lymphomas are reviewed.     

ETHMOID OSTEOMA, ORBITAL CELLULITIS AND ORBITAL EMPHYSEMA

A possibly unique association of an osteoma of the ethmoid sinus with orbital emphysema and orbital cellulitis is described. The osteoma, which had eroded through the orbital periosteum, was removed; the orbital periosteum was grafted with fascia lata and a partial external ethmoidectomy performed.     

Orbital trauma inflicted by a butcher's knife without any injury of the eyeball

We present a 25 year old man, who suffered from an apparently serious orbital injury inflicted by a butcher's knife during a fight. The knife perforated the upper lid of the right eye, and than penetrated the orbita along its medial wall into the right maxillary sinus, the ethmoid sinus, finally reaching the left maxillary sinus. The eye bulb, as well as the optic nerve and the muscles remained intact. A major hemorrhage from the nasal cavity, which occurred immediately after the extraction of the knife, was managed successfully by means of anterior and posterior nasal packing. Intranasal synechias developed in the days following the injury, leading to obstruction of the nasal cavities. The synechias were later almost entirely eliminated through appropriate treatment, leaving the patient with practically no complications of this dramatic injury.