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PubMed2001

Congenital orbital cyst detected and monitored by prenatal ultrasonography.

PURPOSE: High-resolution prenatal ultrasound can allow for early detection and monitoring of many fetal anomalies, including those involving the globe and orbit. We describe a case of a congenital orbital cyst detected and monitored by prenatal transvaginal ultrasonography. METHODS: After detection of a congenital orbital cyst, serial transvaginal ultrasound examinations were performed through the remainder of the pregnancy to monitor the growth and development of the fetus and the orbital cyst. RESULTS: A large retrobulbar orbital cyst causing extreme proptosis was detected at 23 weeks of gestation and monitored through the remainder of the pregnancy. Lack of growth, benign behavior, and appropriate interval fetal growth without destruction of adjacent structures was noted. After birth, early surgical intervention allowed for complete surgical excision of the cyst without the need for enucleation or exenteration. Fifteen months after excision, the patient wore a scleral shell and had a good cosmetic appearance with good ocular motility. CONCLUSIONS: Prenatal ultrasound may allow for early detection of orbital masses. To our knowledge, this report describes the first case of a congenital orbital cyst detected and monitored by prenatal ultrasonography.

Adult↗
PubMed2002

The quasi-integrated porous polyethylene orbital implant.

PURPOSE: To describe a new quasi-integrated porous polyethylene orbital implant that combines the advantages of host tissue incorporation and improved motility with a single-stage surgery. METHODS: Twenty-four consecutive patients undergoing primary or secondary orbital implantation received the quasi-integrated porous polyethylene implant. Approximately 6 weeks after implantation, a custom-fitted prosthesis was made by an impression technique to provide a "lock-and-key" fit with the orbital implant. Postoperative complications and motility of the prosthetic shell were evaluated. RESULTS: During the 27-month period between December 1998 and March 2001, 24 patients received the quasi-integrated porous polyethylene implant as a buried orbital implant. Thirteen patients received the implant as a primary orbital implant after either evisceration or enucleation and 11 patients received the implant as a secondary orbital implant. Follow-up ranged from 3 months to 30 months, with an average of 16.9 months. All patients were considered to have good motility of their prosthetic shell at their final follow-up visit. No cases of implant extrusion or migration were noted. Two patients required deepening of their inferior fornix to accommodate the increased motility of their prosthesis. CONCLUSIONS: The new quasi-integrated porous polyethylene orbital implant provides improved motility without the need for secondary placement of pegs or screws. It has the advantage of biocompatibility, allowing host tissue incorporation to resist implant migration and extrusion. The implant is available in three sizes: small, medium, and large, approximating the volume of a 16-, 18-, and 20-millimeter sphere, respectively.

Adolescent↗
PubMed2003

Treatment of prominent eyes with orbital rim onlay implants: four-year experience.

PURPOSE: Different approaches have been proposed to address the aesthetic or reconstructive challenge associated with relatively prominent eyes. Operations that address the soft tissues alone are prone to failure if the underlying orbital bony relationships are not addressed. Orbital rim advancement can serve as a supplement to orbital decompression in this setting or as an alternative for patients who may not maximally benefit from decompression surgery. METHODS: We report our 4-year experience with porous polyethylene orbital rim onlay grafts used to address relative proptosis in 24 patients. RESULTS: All patients had some degree of subjective and objective improvement. Proptosis decreased an average of 4.65 mm, with a range of 3 to 9 mm, based on single-observer Hertel exophthalmometry measurements (5.2 mm in those with concomitant decompression). Lagophthalmos was also improved in all patients with preoperative inadequacy in eyelid closure. Interpalpebral fissure size was reduced 1.3 mm on average, with a range of 0.5 to 6 mm (2 mm in those with concomitant decompression). Average follow-up was 41 months, with a range of 7 to 70 months. In 3 cases, we noted postoperative lower eyelid retraction with eyelid adhesion to the implant; possible risk factors for this complication included reoperative cases and simultaneous eyelid reconstruction with hard palate grafts. CONCLUSIONS: The porous polyethylene orbital rim onlay implant offers a relatively simple and effective surgical technique for the treatment of symptomatic relative proptosis. It can be used alone or in combination with other techniques including midface lift, lower eyelid retractor recession, and orbital decompression. To be effective, the implant should be placed so that it is flush with or overlapping the orbital rim; lateral displacement negates the effect of the implant in improving the eyelid/globe relationship. Postoperative eyelid retraction with tethering to the implant is a potential risk of the onlay implant, and although it may not be possible to avoid this in all cases, surgeries should be designed to minimize postoperative eyelid retraction.

Anthropometry↗
PubMed2003

Echography as a useful adjunct in the diagnosis of orbital solitary fibrous tumor.

PURPOSE: To describe the echographic features of solitary fibrous tumor of the orbit. METHODS: A retrospective review of 3 patients with solitary fibrous tumor of the orbit and a literature review were performed. RESULTS: Three patients with orbital solitary fibrous tumor were studied with standardized echography and 3 other cases of orbital solitary fibrous tumor with ultrasound descriptions were identified in a literature review. Consistent echographic features of the 6 orbital solitary fibrous tumors included firmness, low to medium internal reflectivity, regular internal structure, moderate sound attenuation, and some degree of vascularity. CONCLUSIONS: Standardized echography is a useful adjunct in the evaluation of orbital solitary fibrous tumors and can help differentiate these tumors from other orbital lesions.

Adolescent↗
PubMed2002

Wegener's granulomatosis of the orbit: a clinicopathological study of 15 patients.

OBJECTIVES: Wegener's granulomatosis is a granulomatous and necrotizing vasculitis that classically involves the respiratory and renal systems. The goal of the study was to define clinical and pathological characteristics in a subgroup of patients with the changes of Wegener's granulomatosis involving the orbit. STUDY DESIGN: Retrospective study. METHODS: A database search identified 15 patients with the histological changes of Wegener's granulomatosis of the orbit presenting over a 23-year period. A review of the histological specimens, radiological studies, and patient charts was performed. Additional follow-up data were obtained through patient interviews. RESULTS: Of 15 patients (median age, 54 y) with Wegener's granulomatosis of the orbit identified, the disease was limited to the orbit in 12 patients; 3 patients had additional sinonasal involvement. All patients underwent various surgical procedures followed by medical treatment (cyclophosphamide and prednisone). Specimens showed characteristic histopathological features of Wegener's granulomatosis. Follow-up data were available for 12 patients with a median period of 5 years. In the group with only orbital involvement, none of the patients developed systemic progression of Wegener's granulomatosis. Only one patient had multiple local recurrences and later developed contralateral orbital Wegener's granulomatosis. CONCLUSIONS: Wegener's granulomatosis limited to the orbit is a localized form of the disease without systemic progression. Diagnostic surgical procedures followed by aggressive medical treatment results in good outcome, although local recurrence may occur.

Adolescent↗
PubMed2003

Orbital complications in endoscopic sinus surgery using powered instrumentation.

OBJECTIVES/HYPOTHESIS: Powered dissection is increasingly used in endoscopic sinus surgery. Although it has certain clear advantages over conventional instrumentation, powered dissection also presents special liabilities. The objectives of the report are to highlight the special dangers of powered instrumentation near the orbit, to suggest techniques that might minimize these risks, and to review the management of orbital injuries. STUDY DESIGN: Case series. METHODS: A retrospective review was performed of patients who were referred to our institution with orbital injury complicating endoscopic sinus surgery in which powered instrumentation had been used. Patient demographics, status as revision or primary surgery, degree of intraoperative blood loss, indications for surgery, intraoperative findings, the complication sustained, time of recognition of the complication, immediate and delayed treatment, and clinical course were obtained from the clinical records. RESULTS: Three patients had medial rectus muscle injuries. In addition to the medial rectus injury, one patient also had blindness, probably from an orbital hemorrhage. One patient underwent orbital exploration in an unsuccessful attempt to reattach the ends of the medial rectus muscle. One patient had continuing diplopia, but declined orbital exploration or strabismus surgery. CONCLUSIONS: Intraoperative orbital complications that might be of minor consequence with conventional instrumentation can have dramatic sequelae when powered dissection is used. Special care must be exercised in using powered instrumentation.

Adult↗
PubMed1996

The concept of the sagittal orbital-globe relationship in craniofacial surgery.

Euophthalmos, the normal relationship of the orbital rims to the eyes, is critical to planning and to surgical correction of craniofacial deformities. The four most easily localized anthropometric (soft tissue) landmarks for the sagittal orbital-globe relationship are orbitale superius (os), orbitale inferius (oi), orbitale laterale (ol), and nasion (n), all referenced to apex corneae (acor). The normal adult values for os, oi, ol, and n were extracted from the literature. Age-specific anthropometric landmarks were computed from age-specific Bolton cephalometric templates. A vernier caliper was used to measure preoperatively the surface orbital landmarks in patients with various syndromic and nonsyndromic craniosynostotic disorders. Preoperative measurements were compared with the derived normative data to determine the necessary sagittal orbital translocation for frontal advancement (n=19) and frontal-midfacial advancement (n=2). Postoperative orbital anthropometry documented the degree of normalization of the sagittal orbital-globe relationship. The problems with current instrumentation for orbital anthropometry are discussed.

Adolescent↗
PubMed2001

Morphometry of the orbital region: a soft-tissue study from adolescence to mid-adulthood.

The objective of this study was to gain information about normal sex-related linear and angular dimensions of the orbital region; left-right symmetry; and growth changes between adolescence and mid-adulthood. The three-dimensional coordinates of several soft-tissue landmarks on the orbits and face were obtained by an electromagnetic digitizer in 40 male and 33 female adolescents aged 12 to 15 years, 73 female and 89 male young adults aged 19 to 30 years, and 41 male and 38 female adults aged 31 to 56 years. From the landmarks-binocular and intercanthal widths; paired height and inclination of the orbit relative to both the true horizontal (head in natural head position) and Frankfurt plane; length and inclination of the eye fissure; and the orbital height to eye fissure length ratio were calculated and averaged for age and sex. Comparisons were performed by factorial analysis of variance. Both the linear dimensions and the angular values were significantly larger in male subjects than in female subjects of corresponding age (p < 0.05). A significant effect of age was found (p < 0.05): while the linear distances and the orbital height-to-length ratio were greater in older people of the same sex, the inclination of the eye fissure decreased as a function of age. Both orbital inclinations were larger in the young adult group than in the adolescent and middle-aged groups. On average, the paired measurements were symmetrical, with similar values within each sex and age group. Data collected in this investigation could serve as a database for the quantitative description of human orbital morphology during normal adolescent and adult growth.

Adolescent↗
PubMed2004

Orbital apex syndrome.

PURPOSE OF REVIEW: Visual loss from optic neuropathy and ophthalmoplegia involving multiple cranial nerves are the hallmarks of an orbital apex syndrome. Historically, the terms superior orbital fissure, orbital apex, and cavernous sinus have been used to define the anatomic locations of a disease process. However, the diagnostic evaluation and management is similar for each of these entities. The authors reviewed the literature on the diagnosis and evaluation of disorders involving the orbital apex. RECENT FINDINGS: High-resolution MRI is the preferred modality for evaluating most lesions involving the orbital apex. CT is a useful tool in the setting of trauma, to evaluate bone involvement, or when MRI is contraindicated. Although laboratory studies may be useful adjuncts in the diagnostic evaluation of lesions involving the orbital apex, surgical biopsy is often required for definitive diagnosis. SUMMARY: Orbital apex syndromes may result from a variety of inflammatory, infectious, neoplastic, iatrogenic/traumatic, and vascular conditions. A detailed history with review of systems is important in narrowing the differential diagnosis. Management is directed at the underlying cause and may be guided by surgical biopsy. Corticosteroids may be useful if an inflammatory etiology is suspected, but should be used with caution.

Cranial Nerves↗
PubMed2004

Orbital radiotherapy for thyroid-related orbitopathy.

PURPOSE OF REVIEW: Orbital radiotherapy has been one of the primary treatment modalities for moderate to severe thyroid-related orbitopathy. In this review the authors discuss the role of orbital radiotherapy in this disease with particular emphasis on questions raised by recent studies. RECENT FINDINGS: Despite its widespread use, until recently there have been few well-designed, randomized clinical trials on the role of orbital radiotherapy for thyroid-related orbitopathy. Although most the literature points to a favorable effect of orbital radiotherapy, recent studies have provided us with conflicting results. SUMMARY: Orbital radiotherapy remains a safe and a widely used treatment option for severe and progressive thyroid-related orbitopathy. More randomized clinical trials are needed, especially to examine the role of orbital radiotherapy for severe thyroid-related orbitopathy characterized by severe congestion and/or compressive optic neuropathy with and without the use of corticosteroids. There is a wide consensus among clinicians that this subgroup of patients is the most frequent one to which orbital radiotherapy is offered.

Chemotherapy, Adjuvant↗
PubMed2006

Orbital cellulitis in children.

BACKGROUND: To review the epidemiology and management of orbital cellulitis in children. METHODS: The medical records of children < or = 18 years old and hospitalized from June 1, 1992, through May 31, 2002, at the Brenner Children's Hospital, with a discharge ICD-9 code indicating a diagnosis of orbital cellulitis and confirmed by computed tomography scan were reviewed. A literature search for additional studies for systematic review was also conducted. RESULTS: Forty-one children with orbital cellulitis were identified. The mean age was 7.5 years (range, 10 months to 16 years), and 30 (73%) were male (male:female ratio = 2.7). All cases of orbital cellulitis were associated with sinusitis; ethmoid sinusitis was present in 40 (98%) patients. Proptosis and/or ophthalmoplegia was documented in 30 (73%), and 34 (83%) had subperiosteal and/or orbital abscesses. Twenty-nine (71%) had surgical drainage and 12 (29%) received antibiotic therapy only. The mean duration of hospitalization was 5.8 days. The mean duration of antibiotic therapy was 21 days. CONCLUSIONS: Orbital cellulitis occurs throughout childhood and in similar frequency among younger and older children. It is twice as common among males as females. Selected cases of orbital cellulitis, including many with subperiosteal abscess, can be treated successfully without surgical drainage.

Abscess↗
PubMed2003

Potential utility of radiofrequency-induced thermal lesions in the orbit.

PURPOSE: Although rare, primary orbital neoplasms are a cause of significant morbidity. For the most part, the proximity of orbital tumors to delicate ocular neural and microvascular structures renders their surgical excision challenging. We investigated the utility of radiofrequency-induced thermal lesions in a rabbit model as potential means of less invasive therapy for benign orbital tumors. METHODS: A small radiofrequency (RF) probe was inserted through the conjunctiva at the fornix and guided along the orbital rim toward the apex of rabbit orbits. The exact location of the probe was ascertained using magnetic resonance (MR) imaging before heating. RF currents at a frequency of 500,000 Hz were conveyed through the exposed tip of a thin RF probe, causing a steady tissue temperature of 90 degrees C for 120 seconds. RESULTS: By using this technology, we induced targeted, localized, and reproducible elliptical thermocoagulative lesions in the rabbit orbit. CONCLUSIONS: We believe this technology has promise as a less invasive alternative or adjunct to open surgical debulking of difficult orbital tumors.

Animals↗
PubMed2003

Orbital inflammatory syndromes with systemic involvement may mimic metastatic disease.

Physical examination of a 9-year-old girl with a 2-month history of swelling of the left orbit demonstrated an orbital mass, blepharoptosis, and proptosis. Computed tomography revealed a 2 x 3-cm mass in the superior left orbit that expanded orbital dimensions. Radiography showed abnormalities in the parietal and frontal bones and distal right tibia. Magnetic resonance imaging demonstrated an 8.5-cm abnormality of the marrow space of the right mid-tibia. Bone marrow biopsy was unremarkable. Orbital and tibial biopsies showed a nonspecific chronic inflammation. Idiopathic inflammation that involves the orbit (orbital pseudotumor) and that has systemic manifestations may mimic more serious conditions, such as metastases from rhabdomyosarcoma or Ewing sarcoma, chronic recurrent multifocal osteomyelitis (CRMO), and SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis). Accurate diagnosis requires careful clinical and pathologic examinations.

Blepharoptosis↗
PubMedDate not supplied

Preliminary study of positron emission tomography in the detection and management of orbital malignancy.

PURPOSE: To determine the clinical efficacy of positron emission tomography (PET) in the treatment of patients with orbital malignancy. METHODS: Prospective, consecutive case series to assess the ability of PET to (1) identify lesions previously demonstrated on CT or MRI; (2) characterize the metabolic activity of these lesions; and (3) determine the presence of metabolically active metastases elsewhere in the body. RESULTS: Eighteen patients with suspected orbital malignancies, ages 32 to 78 years, underwent PET in addition to CT and/or MRI. Sixteen of 18 also underwent orbital biopsy. Histopathologic diagnosis included lymphoma (55%), carcinoma (22%), melanoma (11%), sarcoma (5.5%), and lymphoid hyperplasia (5.5%). All orbital lesions were seen on conventional imaging. Overall, 61% of orbital lesions were demonstrated on PET, including 55% of tumors that were lymphoproliferative and 100% (n = 5) of other malignancies. PET was useful in ruling out tumor recurrence after exenteration in 2 patients. CONCLUSIONS: In this small clinical series, PET proved effective in demonstrating nonlymphoproliferative orbital malignancy. This series is too small to study any correlation between histopathologic aggressiveness and PET findings in orbital lymphoma.

Adult↗
PubMed2004

Coronoid-temporalis pedicled rotation flap for orbital floor reconstruction of the total maxillectomy defect.

OBJECTIVES: Total maxillectomy creates a significant defect in the supporting framework of the orbit. Successful reconstruction of the deficit requires repair of the orbital floor to prevent early and late complications. This paper describes the recreation of the orbital floor using a coronoid-temporalis sling. STUDY DESIGN: Retrospective review of two patients who underwent total maxillectomy and subsequent coronoid-temporalis sling reconstruction of the surgical defect. METHODS: The charts of two patients who underwent coronoid-temporalis reconstruction of the orbital floor were retrospectively reviewed. The outcomes were evaluated. The authors present a method for reconstruction of the orbital floor and discuss the advantages and disadvantages of this method. RESULTS: Two patients underwent successful reconstruction of the orbital floor with a coronoid-temporalis sling procedure. Both patients display acceptable functional and cosmetic results. CONCLUSION: Coronoid-temporalis sling is a readily available and easily modified tissue for reconstruction of the orbital floor. It offers similar results to those previously described techniques in this area without need for further extensive surgery.

Aged↗
PubMed2006

Air bag-induced orbital blow-out fractures.

RATIONALE: Although air bags have decreased the risk of serious injury from motor vehicle crashes, their deployment is not innocuous and can result in injury. The force of the deploying air bag can cause orbital blow-out fractures. We investigated the circumstances that predispose a crash occupant to this particular injury. STUDY DESIGN: The authors conducted a case series. METHODS: A total of 150 orbital fractures occurred among 2,739 occupants in crashes included in the Crash Injury Research and Engineering Network (CIREN) database from January 1997 to July 2005. Ten orbital blow-out fractures attributed solely to air bag deployment were extracted and four reported in depth. Occupant, vehicle, and crash characteristics were reviewed for predisposing similarities and to investigate the mechanism of injury. RESULTS: All crashes had air bag deployment and a frontal or near-frontal principle direction of force. Nine of 10 injured occupants were positioned within the air bag's deployment zone at the time of impact as a result of a forward seat track position, falling asleep at the wheel, being unrestrained, or having decelerated before impact. Six of 10 occupants experiencing orbital blow-out fractures were of shorter than average height. Based on rigorous crash reconstructions, the orbital blow-out injuries were felt to be causally related to air bag deployment. CONCLUSION: Air bag deployment may result in orbital blow-out fractures. Occupants positioned in close proximity to the air bag during its deployment phase appear to be at increased risk for orbital blow-out fractures.

Accidents, Traffic↗
PubMed2006

Repair of traumatic orbital wall defects using conchal cartilage.

BACKGROUND: The authors' aim was to investigate the efficiency of conchal cartilage grafts in defective orbital wall fractures, which are encountered isolated or in combination with other orbitozygomatic fractures. The authors assessed, for this purpose, the follow-up results of patients treated by using conchal cartilage grafts. METHODS: Ten patients who had defective orbital wall fractures and were treated by using conchal cartilage graft among those treated for facial fractures in the authors' clinic were included in the study. The wall defects in the patients were detected either with preoperative radiologic images or with orbital exploration performed to look for a possible defect accompanying the fracture with orbital extension during the operation. In all patients (four isolated and six combined orbital fractures), who had defects varying from 100 to 400 mm, conchal cartilage grafts were adapted to the defect. In the postoperative follow-up, Hertel exophthalmometry was also performed together with clinical examination so that enophthalmos that might develop as a complication could be assessed. RESULTS: In the postoperative period, cartilage graft was palpated slightly in two patients at the edge of the infraorbital rim. Limitation in eye movement, diplopia, and enophthalmos did not occur in our patients, except for one who reported to us 1 year after the primary trauma. No complication in the donor area was observed. CONCLUSIONS: Conchal cartilage could be considered one of the autogenous materials among those materials suitable for the repair of defective orbital wall fractures that are not oversized. It has the advantages of being adequate for reconstruction of the fracture, easy to obtain, easily adaptable to the orbital walls, and having minimum morbidity at the donor site.

Adolescent↗
PubMed2006

Reconstruction of internal orbital wall fracture with iliac crest free bone graft: clinical, computed tomography, and magnetic resonance imaging follow-up study.

BACKGROUND: The purpose of this study was to clinically and radiologically assess the outcome of internal orbital reconstruction with an iliac bone graft. METHODS: Twenty-four consecutive patients with unilateral orbital wall fractures were enrolled in this prospective study. A medial cortical wall from the anterior ilium was used for reconstruction. At each follow-up visit, globe posture, diplopia, and eye movements were assessed. Coronal and sagittal computed tomography and magnetic resonance imaging were used to observe graft posture, bone defects, and intraorbital soft-tissue changes. RESULTS: Most fractures (46 percent) were pure orbital floor fractures. The mean follow-up was 7.8 months. One patient with medial wall and floor fractures required reoperation because of insufficient bone graft. At the last follow-up, this was the only patient (4 percent) with both enophthalmos (2 mm) and hypophthalmos (3 mm). Five patients (21 percent) had hypophthalmos (> 1 mm) at the end of the study. Resorption and remodeling were detected in all grafts, but no grafts were totally resorbed. Sagittal or coronal bone graft postures were assessed as good in 18 orbits (75 percent). Bone defects (> 10 mm) at reconstructed areas were detected in 13 orbits (54 percent). Scar tissue was observed only in three reconstructed orbits (13 percent). Diplopia in central field of vision was registered in seven patients preoperatively but in none at the end of the study. CONCLUSIONS: The resorption rate was high, but most of it was advantageous remodeling. Overall outcome was good. Secondary operations led to poor outcomes. Thin computed tomography and magnetic resonance imaging sections (< or = 2 mm) are needed to evaluate accurately bone graft placement and posture and orbital volume.

Adult↗