Letter to the editor: The surgical treatment of exophthalmos.
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A case of unilateral enophthalmos in a 1-year-old child is presented. This was caused by a meningoencephalocele that originated in the anterior cranial fossa and protruded into the orbit through a bony defect at the junction of the frontal and ethmoid bones at the site of the anterior ethmoid canal. This meningoencephalocele was reduced, and the dura was repaired with a temporalis fascia graft. A split calvarial bone graft was inserted into the floor of the orbit, and lateral canthal ligament elevation completed the operative correction.
The chronologic changes in eyeball position in relation to bony landmarks were studied by CT scans. The results were applied to the preoperative evaluation in 16 craniofacial synostosis patients. Ten subjects from each age group were selected from more than 2000 subjects who underwent CT scanning of the skull without any brain and skull diseases. These age groups ranged from birth to 20 years of age. The following four distances were measured on the CT section incorporating lenses: (1) the distance from the dorsum sellae to the lenses, (2) the distance between the lateral orbital rim and the lenses, (3) the distance from the nasal root to the lenses, and (4) the width between the lenses. These distances also were measured in 16 craniofacial synostosis patients preoperatively, and the results were compared with those of the healthy individuals in the same age group. The distances of the lenses from the nasal root and from the lateral orbital rim were larger than in the healthy individuals in almost all craniofacial synostosis patients. However, the distance from the dorsum sellae to lenses was the same as that in healthy individuals on the whole.
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