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At least 739 records · Page 41Linked to original sources
PubMed2002

Treatment of orbital floor blowout fractures with conchal auricular cartilage graft: a report on 14 cases.

PURPOSE: We sought to present follow-up on 14 cases in which conchal cartilage graft was used to span small orbital floor defects (up to 2 x 2 cm). MATERIALS AND METHODS: Fourteen patients with orbital floor blowout fractures were included in the study; in 8 cases, there was associated fracture of the inferior orbital rim. The decision to proceed surgically was based on the presence of at least one of the following conditions: diplopia, enophthalmos, herniation of orbital tissues through gaps in the orbital floor bone, and concomitant displacement of bone fragments of the inferior orbital rim. Auricular cartilage was used in all cases. Access to the orbital floor was via subtarsal incision unless a laceration was present and useable. RESULTS: The incidence of clinical signs during follow-up and the surgical complications found (1 case of entropion, 1 case of palpebral edema) are fully comparable with those reported in the literature; they do not appear to be correlated to the use of a cartilage graft. CONCLUSIONS: The use of auricular cartilage has wide application for small orbital floor defects. The conchal graft is easy to harvest. It provides an optimal support function for the globe with minimum donor-site morbidity. A graft of adequate size ensures adequate stability.

Ear Cartilage↗
PubMed1994

Superolateral approach to orbital tumors.

The conventional lateral approach to the orbit (Krönlein) does not allow a satisfactory view of the superior part of the orbit and the operative field is rather narrow. Therefore, large tumors which have developed not only laterally but also superiorly are usually approached transcranially. The craniotomy and exposure of the dura may be avoided when the tumor does not extend too far posteriorly and medially, by turning a larger orbital bone flap than the Krönlein's one. This technique was described by Nakamura as "type I orbitotomy" and can be referred to as a superolateral approach. After a bicoronal skin incision, a free orbital bone flap is cut. It includes the lateral orbital rim, a large external part of the superior orbital rim, and the lateral orbital wall. From 1985 to 1990 this approach was performed on 23 patients presenting with lacrimal gland tumors in 14 cases (11 pleomorphic adenomas, 2 adenoid cystic carcinomas, 1 adenocarcinoma), schwannomas in 2 cases, dermoid cyst in 1 case, hydatic cyst in 1 case, cavernous hemangiomas in 2 cases, inflammatory pseudotumor in 1 case, and mucoceles in 2 cases. This superolateral approach provides a wider exposure to the superolateral orbit than the classical Krönlein's approach and avoids the drawbacks of a craniotomy. A direct incision through the eyebrow can be used for bald people or for patients in poor condition.

Follow-Up Studies↗
PubMed2002

Metastatic orbital tumors in Japan: a review of the literature.

A review of reports on metastatic orbital tumors published from 1903 to 1998 in Japan revealed 128 patients, 74 males, 52 females and 2 whose sex was not recorded. The average age was 44.8 years, but varied depending on the primary tumor. Since 1980, metastatic orbital tumors have increased in Japan, especially those from the lung, liver and adrenal gland, while metastasis from the stomach has decreased slightly. Metastasis from the breast is still common. Most metastatic orbital tumors were from the lung, followed, in order, by breast, liver, adrenal gland and stomach. Males had four times as many metastatic orbital tumors from lung cancer than did females; only females had metastases from breast cancer; almost 90% of metastases from hepatoma were in males; metastasis from renal carcinoma was 2-3 times more common in males than in females. Metastasis from the liver and stomach is seen more frequently in Japan than in the United States and Europe. Ocular signs due to orbital metastases from hepatoma, neuroblastoma and gastric cancer were apt to appear earlier than the signs of the primary lesion. Metastases to the orbit were frequently bilateral in patients with neuroblastoma and malignant lymphoma. Specific ocular signs such as ecchymosis and conjunctival hemorrhages were seen in orbital metastasis from neuroblastoma and seminoma, while ocular pain was characteristic of malignant lymphoma. Orbital metastasis was very rare in patients with carcinoma of the uterus, ovaries, bladder, pancreas, colon or rectum in both Japan, the United States and Europe.

Adult↗
PubMed1996

Localization and clinical significance of thyrotropin receptor mRNA expression in orbital fat and eye muscle tissues from patients with thyroid-associated ophthalmopathy.

We have studied the cellular localization of thyrotropin receptor (TSH-R) mRNA in orbital fat and extraocular muscle tissues from patients with thyroid-associated ophthalmopathy (TAO) using Northern blot, reverse transcriptase polymerase chain reaction (RT-PCR), and in situ hybridization, and we correlated the findings with clinical estimates of ophthalmopathy. Although we failed to detect TSH-R mRNA in orbital tissues by Northern blot, TSH-R cDNA was amplified in orbital fat tissue from 13 of 25 patients with TAO and from 2 of 4 control subjects, in eye muscle tissue from 2 out of 7 patients with TAO, and in cultured orbital fibroblasts and subcutaneous fibroblasts from TAO patients. In situ hybridization showed that TSH-R mRNA was detected in cultured orbital fibroblasts as well as skin fibroblasts obtained from the patient. Furthermore, the expression of TSH-R mRNA in orbital fat tissue from patients with TAO significantly correlated with the orbital fat volume and the severity of ophthalmopathy, especially the extent of eye muscle dysfunction. These results suggest that the expression of TSH-R in the orbit, especially fibroblasts, may play a role in the pathogenesis and clinical manifestations of the ophthalmopathy in patients with TAO, although a secondary effect, involving fibroblasts in TAO is also possible.

Adipose Tissue↗
PubMed1990

Exploration of the orbital floor: an indicated procedure?

Fractures to the middle third of the facial skeleton continue to increase in frequency secondary to motor vehicle accidents and interpersonal violence. Orbital floor fractures can occur either independently or may be associated with other facial bone fractures. Controversy has persistently surrounded the treatment of fractures to the floor of the orbit. We will present our investigation of 296 patients who sustained a total of 396 traumatic injuries to the orbit and were treated at the University of California, Davis Medical Center, Sacramento, California, during the period July 1, 1988 to June 30, 1989 to determine whether surgical exploration of the orbital floor is necessary or adds potential serious risks. In the 38 patients (46 orbits) who did not undergo surgical exploration of the orbital floor, 31 (82%) suffered serious residual complications. In the remaining group of 258 patients who underwent orbital floor exploration, there was a 7 percent incidence (18 patients) with residual sequelae. We conclude that exploration of the orbital floor has the potential to decrease the incidence of serious post-traumatic complications significantly, primarily enophthalmos.

Adult↗
PubMed1990

Magnetic resonance imaging and computed tomographic scanning of fresh (green) wood foreign bodies in dog orbits.

Wooden foreign bodies in the orbit can extend into the intracranial cavity without diagnostic clues from the small eyelid entrance wound, from neurologic examination, and from imaging studies such as ultrasound, plain x-rays, or computed tomography (CT) scans. In cadaver magnetic resonance imaging (MRI) studies, dry wood in the orbit can be seen as a negative or hypointense image in contrast to orbital fat. We studied fresh, green wood in dogs to determine the reliability of CT and MRI scans to image hydrated wood. Wood was placed into each orbit of two dogs. After 24 h the wood was removed from one orbit, but not the other. The dogs were then scanned with CT and MRI. Radiologists were asked to determine if any wood had been left in either or both orbits. The fresh wooden foreign bodies could not be detected despite an intensive effort. MRI does not appear to reliably demonstrate fresh wood in the orbit. MRI can show dry wooden foreign bodies that have not become hydrated, but has not yet been reliable in the clinical situation to rule out the presence of wood in the orbit.

Animals↗
PubMed1998

Prediction of late enophthalmos by volumetric analysis of orbital fractures.

The purpose of this study was to determine whether orbital volume assessment by computerized tomography (CT) could provide additional information for the initial evaluation of orbital blowout fractures and guide optimal treatment. The medical records of 30 patients with orbital blowout fractures, either surgically or conservatively managed, were retrospectively reviewed. Orbital volumetric analysis was then determined from digitized CT scans. Fracture-related volume expansion relative to the unaffected fellow orbit was correlated with motility deficits and location and degree of enophthalmos. Early Hertel's measurements (< 4 weeks) were available in 21 patients and did not correlate with the computer volumetric values or with subsequent late enophthalmos. Late Hertel's measurements (> 4 weeks) were obtained in 13 of 15 nonrepaired fractures and in 5 of 15 surgically repaired patients (late presentation; 18 patients). When seen at more than 4 weeks, 11 (92%) of 12 patients with > or = 13% orbital volume expansion manifested significant enophthalmos (> 2 mm) compared with 1 (17%) of 6 patients with < 13% orbital expansion (p = 0.004). Fractures presenting with enophthalmos on initial examination had extensive medial wall involvement in addition to the floor fracture (p = 0.003). CT measurements of orbital volume can predict the final degree of late enophthalmos and may facilitate the planning of surgical intervention.

Adolescent↗
PubMed1999

Role of local amphotericin B therapy for sino-orbital fungal infections.

PURPOSE: Sino-orbital fungal infections are serious complications of diabetes and immunosuppression. Standard treatments include surgical debridement of the involved tissues with possible orbital exenteration, intravenous antifungal therapy, and improvement of the host's immunocompetence and metabolic state, when possible. The role of conservative orbital debridement combined with local amphotericin B irrigations in the treatment of these patients was evaluated. METHODS: The records of seven consecutive patients with sino-orbital fungal infections, who were treated with limited surgical debridement and local and systemic amphotericin B therapy, were reviewed. The underlying disorders of these patients included acute lymphoblastic leukemia, immunosuppression after renal transplantation, diabetes mellitus, and acquired immunodeficiency syndrome. The fungal species identified included Rhizopus, Mucor, and Aspergillus. RESULTS: Follow-up ranged from 4 months to 4 years. All patients retained their preoperative visual acuities. Only one patient ultimately underwent an orbital exenteration for progressive orbital fungal infection. The remaining patients had either complete or incomplete (without further progression) resolution of their fungal infection. Two of the seven patients died of unrelated causes, and no patient died of uncontrolled fungal spread. CONCLUSIONS: Conservative orbital debridement with local amphotericin B irrigations is an effective adjunct in the control of sino-orbital fungal infections, especially in patients with reversible immunosuppression and good preoperative visual acuities.

Adult↗
PubMed1999

The effect of cigarette smoke constituents on the expression of HLA-DR in orbital fibroblasts derived from patients with Graves ophthalmopathy.

PURPOSE: Numerous studies have established a strong association between smoking and Graves disease, but the underlying mechanism of Graves ophthalmopathy has not been elucidated. Recent studies of Graves ophthalmopathy have focused on the orbital fibroblast as an integral component in the pathogenesis of this disorder. This investigation focuses on the effect of cigarette smoke constituents, nicotine and tar, to alter the expression of human leukocyte antigen (HLA-DR) in cultured orbital fibroblasts from patients with Graves disease. METHODS: HLA-DR expression was quantified by scanning densitometry of whole cell lysates subjected to sodium dodecyl sulfate--polyacrylamide gel electrophoresis with immunoblotting and also by direct immunofluorescence. RESULTS: Cultured orbital fibroblasts, obtained from patients undergoing orbital decompression for severe Graves ophthalmopathy, failed to express HLA-DR as analyzed by both immunoblotting and direct immunofluorescence when treated with nicotine alone (25-300 ng/ml). The expression of HLA-DR increased three-fold when nicotine (25 ng/ml) in combination with interferon-gamma (500 U/ml) was added to the cultured orbital fibroblasts (p < 0.0001). Cultured orbital fibroblasts treated with tar alone (60-600 ng/ml) failed to exhibit HLA-DR expression as assessed by direct immunofluorescence and immunoblotting. A greater than two-fold increase in HLA-DR expression occurred when tar (600 ng/ml) combined with interferon-gamma (500 U/ml) was added to the cultured orbital fibroblasts (p < 0.0001). CONCLUSION: The results suggest a possible molecular mechanism for the more severe ophthalmopathy observed in Graves patients who smoke cigarettes. These findings could prove useful for possible medical interventions to decrease or even inhibit the interaction between cigarette constituents, cytokines, and orbital fibroblasts.

Cells, Cultured↗
PubMed2000

Clinical features predictive of orbital exenteration for conjunctival melanoma.

PURPOSE: Conjunctival malignant melanoma can sometimes be difficult to control locally, and orbital exenteration may be necessary. To our knowledge, the risk factors that portend exenteration have not been previously identified. The purpose of this study was to review patients who underwent orbital exenteration for advanced disease and to identify retrospectively the clinical factors predictive of ultimate exenteration. METHODS: The records of patients with conjunctival melanoma who were managed on the Oncology Service at Wills Eye Hospital from 1974 to 1997 were reviewed. Factors predictive of orbital exenteration were analyzed using Cox proportional hazards regression models. RESULTS: Of 151 consecutive patients with conjunctival melanoma, 20 (13%) required orbital exenteration for advanced disease. The number of melanoma excisions performed before referral ranged from 0 to 11, with a mean of 2. The clinical factors predictive of orbital exenteration on multivariable analysis were visual acuity of 20/200 or worse, lack of tumor pigmentation, and extralimbal tumor location. All exenterations were performed using an eyelid-sparing technique. At mean follow-up of 51 months after exenteration, 4 patients (20%) had died of metastasis, 3 (15%) were alive with metastasis, and 13 (65%) had not developed metastasis. CONCLUSIONS: Conjunctival melanoma can show aggressive local behavior, and orbital exenteration is necessary in up to 13% of cases at a tertiary referral center. Patients with risk factors such as poor visual acuity, amelanotic tumor, and extralimbal tumor location may require wider excision and radiation therapy to control the tumor and avoid orbital exenteration. It is hoped that modern surgical approaches will decrease the need for orbital exenteration.

Adult↗
PubMed2001

Orbital lipogranulomatous inflammation harboring Mycobacterium abscessus.

PURPOSE: A case of iatrogenic Mycobacterium abscessus orbital infection is presented to call attention to its distinct histopathologic appearance, mechanism of organism, virulence, and clinical management. METHODS: Clinicopathologic analysis of an orbital infection caused by M. abscessus is described. Detailed histologic analysis is performed to provide insight into the mechanism of infection and correlate the features of the orbital infection with that of atypical mycobacteriosis at other body sites. RESULTS: A 71-year-old woman had an orbital mass in the supranasal orbit after a blepharoplasty. The mass consisted of a dimorphic inflammatory reaction with a superficial purulent reaction and a deeper granulomatous process consisting of epithelioid tubercles, each centered about a lipid vacuole. Acid-fast bacilli were found in the lipid vacuoles but not elsewhere in the specimen. Each tubercle was surrounded by a zone of lymphocytes and a desmoplastic reaction. Microbiologic culture studies identified M. abscessus. A combination of surgical intervention and antibiotic therapy for 4 weeks eliminated the infection. CONCLUSIONS: Acid-fast stains should be performed on any orbital lesion showing an apparent lipogranulomatous reaction. Although clinical management of orbital atypical microbacteriosis is difficult, the combination of surgical and specific antimicrobial intervention is effective. Our study contributes to an evolving understanding of the mechanism of human infectivity of these low-virulence organisms by suggesting that the orbital fat is a source of lipid material that can harbor the organisms, allowing them to escape host immunosurveillance.

Aged↗
PubMed2001

The use of a computer-assisted image-guided system (InstaTrak) in orbital surgery.

PURPOSE: To assess the usefulness of a computer-assisted image-guided system (CAIGS) as an intraoperative anatomical guide in performing orbital surgery. METHODS: Noncomparative interventional case series of 30 consecutive orbital procedures performed by one surgeon (J.G.C.) using the CAIGS (InstaTrak) for intraoperative anatomical guidance. RESULTS: The series consisted of 8 cases of orbital decompression, 8 cases of orbital fracture, 11 cases of tumor excision, 2 cases of orbital reconstruction for severe enophthalmos, and 1 case of drainage of an orbital abscess. The CAIGS (InstaTrak) was useful in providing adjunctive intraoperative guidance in all 30 orbital cases. CONCLUSION: The CAIGS (InstaTrak) system is a useful adjunctive tool in providing intraoperative anatomic guidance in a consecutive series of varied orbital operations.

Adult↗
PubMed2003

The use of vicryl mesh in 200 porous orbital implants: a technique with few exposures.

PURPOSE: To report the results of a wrapping technique for porous orbital implants by using polyglactin 910 (Vicryl) mesh (Ethicon Inc., Somerville, NJ, U.S.A.). METHODS: We retrospectively reviewed the records of 200 consecutive patients from one author's practice who received a polyglactin 910 mesh-wrapped porous orbital implant after enucleation or as a secondary implant between October 1, 1996, and April 15, 2001. We recorded potential problems that might be attributed to polyglactin 910 mesh both before pegging (excessive inflammatory response to the material, conjunctival thinning, and implant exposure) and after pegging (exposure of the implant around the sleeve, conjunctival thinning, and implant exposure other than adjacent to the peg). RESULTS: One hundred twenty-two men and 78 women underwent placement of a polyglactin 910 mesh-wrapped porous orbital implant. The average age at the time of implantation was 48.9 years (range, 11 to 85 years). The average follow-up interval in the 200 patients was 19.4 months (range, 2 to 80 months). Thirteen of the 200 patients had less than 6 months of follow-up, leaving 187 patients with an average follow-up of 20.5 months (range, 6 to 80 months). There were 76 primary enucleations and 124 secondary orbital implants. Thirty-seven patients received a Bio-Eye hydroxyapatite implant (HA) (Integrated Orbital Implants, San Diego, Calif), 97 received a synthetic FCI hydroxyapatite implant (FCI, Issy-Les-Moulineaux, France), and 66 received a Bioceramic implant (aluminum oxide-Al2O3) (FCI, Issy-Les-Moulineaux, France). One hundred fourteen patients (57%) underwent peg placement. The average time to pegging was 9.9 months (range, 6 to 16 months). Before pegging, 4 of 187 patients (2.1%) had implant exposure. Three of these exposures followed secondary orbital implant placement (2 Bio-Eye HA, 1 synthetic FCI3 HA) and one followed an enucleation (synthetic FCI3 HA). Two patients required a temporalis fascia graft and one required a scleral patch; the remaining defect closed spontaneously. One patient had conjunctival thinning 6 months after orbital implantation, which remained stable with no frank exposure for 36 months. No patient had excess socket inflammation. After peg placement, 3 additional patients had exposure of the implant around the peg site. There were no cases of conjunctival thinning or exposure of the implant other than adjacent to the peg site. CONCLUSIONS: Polyglactin 910 mesh is an excellent option as a wrapping material for porous orbital implants. It is simple to use, readily available, eliminates the need for donor tissue, does not require a second operative site, and it is less expensive than other currently available wrapping materials. We attribute our high success rate to our technique, which emphasizes proper placement of the implant within the Tenon space, suturing the extraocular muscles anterior to their normal anatomic sites, and meticulous closure of the Tenon capsule and conjunctiva in separate layers.

Adolescent↗
PubMed2003

Diplopia following porous polyethylene orbital rim onlay implant.

An 81-year-old man with ocular irritation associated with lower eyelid retraction, horizontal laxity of the lower eyelids, and hypoplastic inferior orbital rims underwent bilateral placement of porous polyethylene orbital rim onlay implants. Two weeks after surgery, he developed vertical binocular diplopia on downgaze. Examination of extraocular motility demonstrated limited infraduction OD. Surgical exploration revealed scarring in the anterior orbit between the inferior rectus pulley and the orbital implant. The orbital implant was found to lie higher than the inferior orbital rim. After surgical lysis of the scar and reduction of the vertical height of the implant, the patient's diplopia resolved. Orbital connective tissues critical to ocular motility may be abnormally superficial in orbital rim hypoplasia. Onlay grafts must be carefully placed so that they do not interfere with these tissues.

Aged↗
PubMed2003

Results of orbital preservation for advanced malignant maxillary sinus tumors.

OBJECTIVE: The purpose of the study was to examine the oncological and functional outcomes of multimodality therapy for patients with advanced malignant maxillary sinus tumors that invaded the orbit. STUDY DESIGN: Retrospective study. METHODS: The medical records of 26 patients with orbital invasion were retrospectively analyzed. The patient group consisted of 16 men and 10 women, with a median age of 58 years. The mean follow-up period was 73 months. The most common disease was squamous cell carcinoma. Seven patients had nodal disease. All patients underwent simultaneous combined therapy consisting of conservative surgery through a sublabial incision, radiotherapy, and regional chemotherapy. Patients with nodal disease were treated with either irradiation or selective neck dissection. RESULTS: The 5- and 10-year overall survival rates were 68% and 51%, respectively. The 5- and 10-year local control rates were 66% and 51%, respectively. Overall survival rates and local control rates were significantly worse in patients with disease other than squamous cell carcinoma. Local control rates were significantly worse in patients with orbital apex disease than in patients without orbital apex disease. All 26 patients, despite orbital involvement, retained their orbital contents. Nineteen of these patients demonstrated adequate ocular function. CONCLUSIONS: Combined therapy with conservative surgery, radiotherapy, and regional chemotherapy is an effective method for local control and preservation of ocular function. However, performing orbital conservation procedure in patients with disease other than squamous cell carcinoma and with orbital apex disease must be considered carefully.

Adult↗
PubMed1998

Reconstruction of total maxillectomy defects with preservation of the orbital contents.

Reconstruction after total maxillectomy with preservation of the orbital contents is technically more challenging than when the maxillectomy is combined with orbital exenteration. Reconstruction of such defects should (1) provide support to the orbital contents, (2) obliterate any communication between the orbit and nasopharynx, (3) reconstruct the palatal surface, and (4) achieve facial symmetry and a good aesthetic result. We report our experience in performing reconstructive surgery on 14 patients who had a total maxillectomy and preservation of the orbital contents using nonvascularized bone grafts for reconstruction of the orbital floor and maxilla, in conjunction with a soft-tissue free flap or pedicled muscle flap. The orbital floor was reconstructed using split ribs in six cases (42.9 percent), split calvaria in six cases (42.9 percent), and iliac crest graft in two cases (14.3 percent). A myocutaneous rectus abdominis free flap was used for soft-tissue reconstruction and resurfacing of the palatal mucosa in twelve patients (85.7 percent), and a temporalis muscle transposition was used in two elderly patients (14.3 percent). One patient died 2 days after surgery. Mean follow-up and aesthetic and functional results were assessed in the remaining 13 patients a minimum of 6 months postoperatively. In 9 of these 13 patients (69.2 percent), postoperative radiotherapy was administered. No reexplorations or free flap failures were observed. One rectus flap developed partial necrosis of the skin island intraorally without affecting the final result. All patients had adequate functional vision. One patient had a mild vertical dystopia; there were no cases of enophthalmos. Ectropion was the most common undesirable result and was present in 10 of 13 cases (76.9 percent). It was graded as mild in four cases (40.0 percent), moderate in four cases (40.0 percent), and severe in the remaining two cases (20.0 percent). Speech was considered normal in six cases (46.2 percent), near normal in six cases (46.2 percent), and intelligible in one case (7.7 percent). Chewing function was considered good (soft to unrestricted diet) in all cases except for one patient who was only able to eat a pureed diet. Aesthetic results after immediate reconstruction were considered good in nine cases (69.2 percent) and fair in four cases (30.8 percent). Primary reconstruction of total maxillectomy defects with orbital content preservation remains a complex problem without a perfect solution. The combination of nonvascularized bone grafts for orbital/maxillary reconstruction with a soft-tissue free flap is a safe, reliable, and effective method of maximizing postoperative functional and aesthetic results.

Adult↗
PubMed2000

Analysis of fronto-orbital advancement for Apert, Crouzon, Pfeiffer, and Saethre-Chotzen syndromes.

The purposes of this study were (1) to document outcome after primary fronto-orbital advancement for the four major eponymous craniosynostotic syndromes (Apert, Crouzon, Pfeiffer, and Saethre-Chotzen) and (2) to identify factors that might influence need for primary and secondary fronto-orbital advancement or foreheadplasty. Also tested was the hypothesis that coincident sagittal synostosis could modulate brachycephaly and affect whether a primary or secondary frontal operation was necessary. Data were collected on age and indications for initial operation, type of primary and secondary frontal procedures, and concomitant sagittal synostosis. Patients initially managed by subcranial Le Fort III were included in the study group but excluded from analysis of fronto-orbital advancement. Patients treated by monobloc advancement or Le Fort III osteotomies with frontal grafting or Anderl modification were assessed as having had primary fronto-orbital advancement. Minimum time to follow-up was 5 years. A total of 126 patients met inclusion criteria. Lateral photographs were examined to assess preoperative and postoperative sagittal position of supraorbital rims-to-globes. Frontal re-advancement was indicated if the corneal apex was anterior to the supraorbital rim. Foreheadplasty was indicated for unacceptable frontal contour and normal supraorbital rim-to-globe relationship. Primary correction for frontal retrusion was not required in 4 percent of Apert (1 of 25), 16 percent of Crouzon (7 of 44), 6 percent of Pfeiffer (2 of 31), and 19 percent of Saethre-Chotzen (5 of 26) patients. Of those infants who had a primary fronto-orbital advancement, reoperation for either supraorbital retrusion or frontal deformity was necessary in all 16 Apert patients and in 5 of 19 Crouzon (26 percent), 10 of 26 Pfeiffer (38 percent), and 13 of 20 Saethre-Chotzen (65 percent) patients (p < 0.001). Age at initial fronto-orbital advancement did not influence reoperative rate. No correlation was found between concomitant sagittal synostosis and necessity for primary or secondary frontal correction (p = 0.22). In summary, phenotypic diagnosis was determinant for outcome as defined by need for secondary fronto-orbital advancement, foreheadplasty, or both. Apert patients had the highest incidence of reoperation for frontal retrusion or forehead contour. Crouzon and Saethre-Chotzen patients were most likely to express a minor phenotype and not require fronto-orbital correction. Coincident sagittal synostosis did not influence frontal projection, as reflected in need for either primary or secondary frontal advancement.

Acrocephalosyndactylia↗
PubMed2001

A current 10-year retrospective survey of 199 surgically treated orbital floor fractures in a nonurban tertiary care center.

This study characterizes the surgically treated patient population suffering from orbital floor fractures by use of current data from a large series consisting of 199 cases taken from a nonurban setting. Data were gathered through a retrospective chart review of patients surgically treated for orbital floor fractures at the University of Michigan Health System, collected over a 10-year period. Data regarding patient demographics, signs and symptoms of presentation, cause of injury, nature of injury, associated facial fractures, ocular injury, and associated nonfacial skeleton trauma were collected. In total, there were 199 cases of orbital floor fractures among 189 patients. Male patients outnumbered female patients by a 2:1 ratio and were found to engage in a wider range of behaviors that resulted in orbital floor fractures. Motor vehicle accidents were the leading cause of orbital floor fractures, followed by physical assault and sports-related mechanisms. The ratio of impure to pure orbital floor fracture was 3:1. The most common signs and symptoms associated with orbital floor fractures, in descending order, were periorbital ecchymosis, diplopia, subconjunctival hemorrhage, and enophthalmos. Associated facial fractures were found in 77.2 percent of patients, the most prevalent of which was the zygoma-malar fracture. Serious ocular injury occurred in 19.6 percent of patients, with globe rupture being the most prevalent, accounting for 40.5 percent of those injuries. There was a 38.1 percent occurrence of associated nonfacial skeletal trauma; skull fracture and intracranial injury were the most prevalent manifestations. Associated cervical-spine fractures were rare (0.5 percent). Statistical examination, using odds ratios and chi-squared analysis, demonstrated significant associations that have not previously been reported. Impure and pure orbital floor fractures revealed striking differences in several demographic aspects, including mechanism of injury, signs and symptoms of presentation, spectrum of associated trauma, and the severity of concomitant trauma.

Accidents, Traffic↗