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At least 991 records · Page 55Linked to original sources
PubMed1985

[An unusual form of isolated fracture of the orbital floor: "valve fracture". Therapeutic problems].

Among isolated fractures of the orbital floor, the authors are pointing out an unusual clinical type characterized by the irreducibility of the orbital contents ruptured in the maxillary sinus by using classical procedures. This primary failure is due to a bone fragment dropped in the sinus and being attracted by the herniated collar when trying to integrate the hernia in the orbit. To name this type of lesion, the word "valve fracture" is proposed because of the analogy of the one way function of a valve and its different mechanism from the classical trapdoor fracture. The different concepts of the pathogenesis of isolated fractures of the orbital floor and the physiopathology of the frequently associated ocular disturbances are briefly exposed. The authors report the case which confronted them to the valve fracture. Following a direct trauma to the right orbital area a 13-year-old child presented a limitation of the upwards movements of the right eye with diplopia and a positive forced duction test. The surgical exploration shows an orbital hernia in the sinus which is impossible to reposition either with a higher incision (under the orbital rim) or with a lever incision, upper vestibular incision (through maxillary sinus). Only the infraorbital marginotomy described by P. Tessier exposes completely the lesions and allows understanding of the mechanism of this primary irreducibility related to the valve movement of the fractured bone fragment. Above all, marginotomy allows an atraumatic set. If is performed combining gentle handles of pulling and forcing back on the ruptured pieces while keeping opened the valve.

Adolescent↗
PubMed1978

[Changes in the indications and techniques in the surgery of retrobulbar orbital tumours (author's transl)].

In the past 3 decades, surgery of retrobulbar tumours was mainly done by neurosurgeions (transfrontal orbital approach) or ENT surgeons (transethmoidal approach), especially in Europe. More recently, especially in USA this has changed and the majority of these cases, in an increasing number of hospitals, are now treated by a modified Krönlein operation, usually performed by ophthalmic surgeons. In this paper we tried to elucidate the background of this development. Ultrasound exophthalmometry (Fig. 3), ultrasound A- and B-scans of the orbital tissues (Fig. 4 and 5) and computerized axial X-ray-tomography of the orbits (Fig. 6) improved the preoperative diagnoses markedly. In the most cases it is now possible to decide preoperatively on the existence, size and location (and sometimes even on the nature) of a spaceoccupying lesion in the orbit. The technic and the instruments for Krönlein's operation have been improved (Krönlein-Berke, Fig. 8-11). The oscillating saw (Stryker) facilitates the resection of the bone, and microsurgical technics are now preferred for removal of the tumour from the orbit. The modified Krönlein operation is also recommended for orbital decompression in severe endocrine exophthalmos, provided the lateral orbital wall is removed to the described extent.

Exophthalmos↗
PubMed1984

[Blow out fracture of the medial orbital wall--plastic repair with tantalum mesh].

Two cases of blow out fracture of the medial orbital wall were reported. The one was a 14 year-old boy and the other was a 32 year-old man. After hitting the eye against another man or a hard object, the patients felt diplopia, especially on lateral gaze toward the injured side. The blow out fracture was able to be diagnosed by plain roentgenography or tomography. The fractured bone as well as the entrapped soft tissue were clearly detected by CT scan. The fractures occurred at the thinnest part of the Lamina orbitalis ossis ethmoidalis (Lamina papyracea) in both cases. Objects with diameter larger than that of the bony orbit pressed the eye ball and other soft tissue into the orbital cavity, and the blow out fracture occurred in the medial orbital wall in each case. The skin was incised along the supero-medial margin of the orbit and subperiostial dissection was done. The entrapped medial rectus muscle was observed in one case and unverified in the other. Entrapment of the orbital soft tissue other than medial rectus muscle may also have caused diplopia. Tantalum mesh, used for repair is quite thin material. It has much plasticity and little possibility of damaging the orbital tissue and of causing postoperative bleeding. No complication occurred after operation and diplopia disappeared completely or nearly completely in the cases reported.

Adolescent↗
PubMed1995

[The adipose tissue of the orbit. Anatomic classification, therapeutic deductions].

There are two types of adipose tissue in the orbit. The yellow fat and the more abundant white, or orbital fat. Orbital fat cannot be dissociated from the contents of the orbit and plays an important role in ocular physiology and oculomotricity. Orbital fat is essential for aesthetic orbits. Graves' disease and anophthalmia. Adipose tissue in the orbit is particularly important in protecting the ocular globe from lateral wall trauma.

Adipose Tissue↗
PubMed1995

Transforming growth factor-beta induces plasminogen activator inhibitor type-1 in cultured human orbital fibroblasts.

PURPOSE: The level of constitutive plasminogen activator inhibitor type-1 (PAI-1) expression in cultured human orbital fibroblasts is considerably lower than that found in dermal fibroblasts. This divergence in PAI-1 expression implies differences in the pericellular proteolytic environment and, therefore, in the turnover of extracellular matrix. In this article, the authors examine the effect of transforming growth factor-beta (TGF-beta) on PAI-1 expression in orbital fibroblasts. METHODS: Human orbital and dermal fibroblasts were grown in culture. Confluent monolayers were treated with TGF-beta. PAI-1 in the extracellular matrix was quantitated by radiolabeling the cultures and electrophoresing the cellular material on SDS-PAGE. Medium content was determined by immunoprecipitation of [35S]PAI-1 with a rabbit, anti-human, polyclonal antibody. PAI-1 mRNA was determined by Northern hybridization. RESULTS: TGF-beta increased PAI-1 levels in orbital fibroblasts in a dose-dependent manner, up to 35-fold. The induction was maximal after 16 hours of treatment. The increases in extracellular matrix PAI-1 paralleled those observed in the medium. The steady state levels of the mRNA encoding the protein were upregulated by TGF-beta up to 60-fold 8 hours after the addition of TGF-beta. The fractional increase in PAI-1 expression in orbital fibroblasts was consistently greater than that observed in dermal strains. CONCLUSIONS: Exposure to TGF-beta consistently induces PAI-1 expression in orbital fibroblasts, cells that do not express the polypeptide constitutively at high levels. The effects are mediated at the pretranslational level and involve the upregulation of PAI-1 mRNA. These results suggest that TGF-beta may exert a profound regulatory influence on the pericellular proteolytic environment in orbital connective tissue.

Blotting, Northern↗
PubMed1994

Orbital wall fractures. Conventional views and CT.

In order to evaluate the benefit derived by conventional views in the initial diagnosis of fractures of the orbital walls, a clinical study was designed to compare the results of evaluations by plain films and coronal CT scans. The conventional Caldwell's and Waters' views will provide a fairly reliable result as to the presence of orbital fractures: orbital floor (anterior in 78%, posterior in 73%), medial orbital wall (anterior in 71%, posterior in 72%), and ethmoid-maxillary plate in 64%. False-negative diagnosis was seen at the anterior portion of the floor in 13%, at the anterior portion of the medial orbital wall in 7%, and at the ethmoid-maxillary plate in 11%. False-negative diagnosis was seen at the orbital floor (anterior in 9%, posterior in 10%), at the medial orbital wall (anterior in 21%, posterior in 29%), and at the ethmoid-maxillary plate in 21%. Our results agree well with those of the past reports.

Adult↗
PubMed1994

[Computed tomography in acute inflammation of the orbit].

Acute orbital infection, which is usually secondary to sinusitis, requires prompt diagnosis and timely treatment to prevent the infection from spreading and to avoid severe complications, such as osteomyelitis, orbital and cerebral abscesses, meningitis and cavernous sinus thrombophlebitis. Fifteen young patients with orbital cellulitis were examined: they were 13 men and 2 women, whose mean age was 23 years, with orbital cellulitis secondary to fronto-ethmoidal sinusitis (10 cases), to maxillary sinusitis (4 cases) and to craniofacial trauma (1 case). On the basis of CT findings the patients were divided into two groups according to whether the inflammatory process involved the preseptal (4 cases) or the postseptal (11 cases) space; postseptal cellulitis was classified as orbital cellulitis and subperiosteal abscesses. The site of the inflammatory process must always be accurately located because orbital septum integrity does affect treatment choice, which in our series was medical in preseptal cellulitis and always surgical in subperiosteal abscess. After describing the CT patterns of cellulitis and its possible complications, the authors emphasize the role of CT as the method of choice to confirm clinical diagnosis and to demonstrate the site, the extent and the complications of acute orbital cellulitis.

Acute Disease↗
PubMed1996

Leukoregulin induction of prostaglandin-endoperoxide H synthase-2 in human orbital fibroblasts. An in vitro model for connective tissue inflammation.

Several proinflammatory cytokines can increase prostaglandin E2 (PGE2) synthesis in a variety of cell types, constituting an important component of the inflammatory response. We demonstrate here that leukoregulin, a 50-kDa product of activated T lymphocytes, dramatically increases PGE2 synthesis in cultured human orbital fibroblasts. This up-regulation is mediated through an induction of prostaglandin-endoperoxide H synthase-2 (PGHS-2), the inflammatory cyclooxygenase. Steady-state levels of PGHS-2 mRNA are increased within 1.5 h of leukoregulin addition and are near maximal by 6 h, when they are 50-fold or higher above basal levels. The increase in PGHS-2 mRNA levels is partially blocked by cycloheximide, suggesting de novo synthesis of an intermediate protein may be required for a maximal leukoregulin response. Nuclear run-on studies indicate PGHS-2 gene transcription is up-regulated by leukoregulin 2-fold after 2 and 6 h. PGHS-2 protein, as assessed by Western blotting and two-dimensional protein gel analysis, is increased dramatically in orbital fibroblasts. This lymphokine-dependent expression of PGHS-2 is blocked by dexamethasone, and the increase in PGE2 and cAMP levels following leukoregulin treatment is also blocked by indomethacin and by SC 58125, a newly developed PGHS-2-selective cyclooxygenase inhibitor. The dramatic increase in cAMP levels causes marked alteration in orbital fibroblast morphology. PGHS-2 expression in dermal fibroblasts is also increased by leukoregulin; however, the response is considerably less robust, and these cells do not undergo a change in morphology. Both orbital and dermal fibroblasts express high levels of PGHS-1 mRNA and protein, the other abundant form of cyclooxygenase. In contrast to its effects on PGHS-2 expression, leukoregulin fails to alter PGHS-1 levels in either orbital or dermal fibroblasts, suggesting that PGHS-1 is not involved in cytokine-dependent prostanoid production in human fibroblasts. The increased PGHS-2 expression elicited by leukoregulin in orbital fibroblasts may be a consequence of both transcriptional and post-transcriptional effects. These observations help clarify the pathogenic mechanism relevant to the intense inflammation associated with Graves' ophthalmopathy. Lymphocytes trafficked to orbital tissues have a putative role, through the cytokines they release, in the activation of fibroblasts in this autoimmune disease.

Blotting, Northern↗
PubMedDate not supplied

[Reconstruction of the lower orbital wall in the remote posttraumatic period].

The authors share their experience gained in the treatment of 11 patients with different fractures of the lower orbital wall in remote periods after the injury (1 month to 4 years). A specific feature of late injury in all the patients we observed were disorders of binocular vision presenting as diplopia due to cicatricial changes in the orbit. X-Ray examinations showed deep fractures of the lower orbital wall involving the posterior half of the orbital space in all cases. An operation had to be performed in all the patients: inferior orbitotomy via a transcutaneous access combined with anterior highmorotomy and submucosal refracture of the upper wall of the maxillary sinus within the framework of improperly consolidated fracture along the borders of the orbital hernia. The choice of this operation was dictated by specific localization of the fractures (zones difficult to access), solidity of scar growth at the site of the fracture (because of long period elapsed after the injury), and by limited possibility of intervention via an isolated transorbital access. An accessory element: refracture of the lower deformed wall and its reposition in the proper state helped repair the defect in the wall with a homocartilage on the side of strips and the orbit. Binocular vision and mobility of the eyeball in the orbit were repaired in all the patients, the degree of posttraumatic enophtalmos was appreciably decreased.

Adult↗
PubMedDate not supplied

Computerized axial transverse tomography in the diagnosis of orbital tumors.

CT scanning demonstrated orbital tumors in 15 patients with progressive unilateral proptosis in whom the diagnosis was confirmed by surgery or biopsy. The CT scan was the only abnormal study in 13 patients. In two patients, standard roentgenogram studies and CT scan were both abnormal, but the CT scan was of greatest value in identifying the tumor. Orbital structures are clearly demonstrated when scans are performed at lower level than those used in standard cerebral studies. The large fat content of the orbit is of low density and appears dark on the cathoderay tube. The tumors were of higher densities and appeared as white homogenous or speckled masses against the dark background. Surgical findings confirmed the accuracy of CT scanning in determining the tumor size and location. A new 160X160 grid provides remarkable resolution of orbital structures such as the optic nerve and extraocular muscles. Moreover, it is now possible to visualize ten consecutive ventral to dorsal slices of orbital tissue providing greater detail of orbital pathology. CT scanning will probably be an indispensable tool in the diagnosis of orbital tumors.

Adolescent↗
PubMed1998

Iodine-131-metaiodobenzylguanidine uptake in metastatic carcinoid tumor to the orbit.

Metastatic tumor is one of several etiologies of space-occupying masses in the orbit that accounts for 1%-13% of all orbital masses (1). In the adult patient population, breast cancer is the most common tumor to metastasize to the orbit followed by metastases from the lung, prostate and gastrointestinal tract (2). It is rare for carcinoid tumors to metastasize to the eye or to the orbit. Carcinoid tumors arise from Kulchitsky cells that originate in the neural crest. Histologically, these tumors resemble, but are not as aggressive as, adenocarcinomas. Most carcinoids arise in the gastrointestinal tract or the lung. The most common site for carcinoid metastases is the liver. On anatomical imaging studies, such as CT and magnetic resonance imaging, metastatic orbital carcinoid tumors appear as nonspecific tumor masses. Carcinoid tumors have an affinity for uptake of the radiopharmaceutical 131I-metaiodobenzylguanidine (MIBG) (3). We report a case of a patient with a known carcinoid tumor who developed a left orbital mass that demonstrated abnormal uptake of 131I-MIBG indicative of metastatic carcinoid tumor to the orbit.

3-Iodobenzylguanidine↗
PubMed1996

[Diagnostic significance of CT in the orbital inflammatory lesions].

OBJECTIVE: To analyze and summarize the CT signs of orbital inflammatory lesions. METHOD: HITACH-W, or EXEL 2400 pattern of CT was applied for the orbital scanning of 52 cases with orbital inflammatory lesions proved by clinicopathology. RESULTS: The CT signs of orbital inflammatory lesions in our series included exophthalmos, orbital mass, ill-marginated mass, multiple space involvement, extraocular muscle enlargement, scleral thickening, eyelid thickening, optic nerve thickening, orbital fat density increasing, lacrimal gland enlargement, sinusitis, subperiosteal abscess, ring-enhancement in masses, etc. CONCLUSION: All these findings on CT are of important significance for the diagnosis of orbital inflammatory lesions.

Adolescent↗
PubMed1998

Studies of the anatomy and pathology of the orbit in carcinoma of the maxillary sinus and their impact on preservation of the eye in maxillectomy.

BACKGROUND: The periorbita has been traditionally regarded as the decisive layer whose involvement in carcinoma of maxillary sinus indicates orbital exenteration. Anatomic texts depict that the orbital fat rests on the periorbita. Our experience at surgical dissections has been different. METHODS: Twenty-five patients underwent total maxillectomy for advanced (T3-T4) carcinoma of the maxillary sinus with postoperative radiotherapy during a 15-year period between 1981 and 1995. In 11 patients, despite radiologic evidence of orbital invasion, and in 5 patients with infiltration of the periorbita, the eye could be preserved without evidence of recurrence. In 6 patients who in addition underwent orbital exenteration, histopathologic evidence of tumor invasion of the orbit was present in only one surgical specimen. RESULTS: Clinicoanatomic studies have clearly shown the presence of a thin, distinct fascial layer which surrounds the periocular fat and separates it from the periorbita. Neither clinical examination nor imaging could predict orbital invasion with absolute accuracy. Histopathologic examination of the surgical specimens shows that tumor infiltration of the eye is rare. CONCLUSION: Periocular fat is surrounded by a thin fascial layer and is not in direct contact with the periorbita. Intraoperative decision making with respect to preservation of the eye is sometimes essential.

Combined Modality Therapy↗
PubMed1999

Acute orbital compartment syndrome after lateral blow-out fracture effectively relieved by lateral cantholysis.

PURPOSE: To report the observation of an acute traumatic orbital compartment syndrome in an 80-year-old man. METHODS: Lateral canthotomy and cantholysis. Computed x-ray tomography. RESULTS: Unilateral proptosis, blindness, a frozen globe and a dilated pupil developed within one hour after a blunt trauma to the left orbital region. Surgery two hours later resulted in normal orbital tension and near-complete recovery of functions. An orbital hematoma was found overlying a lateral blow-out fracture. CONCLUSION: Under favorable conditions, the orbital compartment syndrome can be effectively relieved by lateral canthotomy and cantholysis. The present and previous reports suggest that two hours of orbital ischemia is near the critical time limit for recovery of full visual function.

Accidental Falls↗
PubMed1996

[Orbital hematomas].

BACKGROUND: Orbital hematomas may occur spontaneously, as a result of vascular anomalities, or they may be induced by trauma or occur following paranasal sinus surgery. The retrobulbar hematoma requires special attention because of its potential compression of the optic nerve may compromise vision or cause blindness. PATIENTS AND METHODS: We report on four cases: two subperiostal orbital hematomas, a spontaneous retrobulbar hematoma, and one orbital hematoma due to trauma. RESULTS: In one case a vascular anomality was detected by angiography. Though temporary blindness occurred in this case, it was possible to preserve 30% vision by surgery. An infected subperiostal hematoma was successfully treated using an endonasal approach. Two cases (a traumatic and a subperiostal orbital hematoma) required no operative treatment. CONCLUSIONS: The diagnosis of an orbital hematoma should be made as quickly as possible to permit adequate early therapy. Decrease of vision or blindness caused by orbital hematoma may be improved through a lateral canthotomy as emergency measure and subsequently by draining the hematoma to relieve compression of the optic nerve.

Adult↗
PubMed2002

The use of autologous autoclaved bone in orbital reconstruction after exenteration for invasive cutaneous carcinoma.

PURPOSE: To describe a technique for reconstructing the orbital bony architecture after invasion by tumour. METHODS: Orbital bone invaded by tumour was osteotomized (post-exenteration), autoclaved to remove tumour cells, and then refixated in order to re-establish the normal orbital anatomy. RESULTS: Despite some shrinkage of the bone fragment in the autoclaving process, after refixation the contour and topography of the bony orbit was essentially normal. CONCLUSION: Autoclaved bone can be used to reconstruct the exenterated orbit; it is a fast and technically simple strategy for maintaining orbital anatomy when faced with bony invasion by tumour.

Aged↗
PubMed2005

[Rabbit orbital measure evaluations after enucleation and evisceration].

PURPOSE: To assess orbital volume in weaned rabbits, submitted to enucleation and evisceration, with orbital volume reconstitution using porous polyethylene (PP) spheres, analyzed by computed tomography, by the water displacement test and external orbital measures using Image-J software. METHODS: This experimental randomized study consisted of 48 albino rabbits, with 42 days of life, submitted to enucleation (EN) and evisceration (EV), with (WI) or without (NI) implantation of a 10 mm PP sphere. After 1 month (M1), 3 months (M2) and 6 months (M3), 4 animals of each group were sacrificed. The skulls were prepared for dry bone study using the maceration technique. The orbital volume was calculated by computed tomography and by the water displacement test. The results suggest that orbital development in rabbits above 42 days of life is not different regarding evisceration or enucleation, or when an orbital implant is used. The water displacement test showed similar results compared with computed tomography, making a morphometric method in experimental studies worthwhile.

Animals↗
PubMed1996

[Rhinosurgery in diseases of the orbits].

The rhinosurgical procedures in different orbital diseases are discussed. Special attention is directed to the application of endoscopic and microsurgical techniques. We describe the different stages of orbital involvement in 106 patients. Computer-tomography has proven to be most effective informing the extent of sinus disease as well as orbital inflammation, because of this an immediate stage-dependent therapy can be commenced. Indications for endonasal, extranasal or for combined approaches are given. In two patients with blindness due to mycosis we performed an exenteration of the orbit. The advantages of extranasal and endonasal techniques for decompression of the orbit are discussed. Successful approaches for the extranasal microsurgical removal of orbital tumors are described. The results demonstrate that the surgically decompressed optic nerve has a favourable prognosis. Pathogenesis, diagnostic procedures, indications and microsurgical techniques of the traumatized optic nerve are discussed. The long-term follow up results of our optic nerve decompression cases are presented.

Endoscopy↗