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At least 1,279 records · Page 71Linked to original sources
PubMed1989

[Post-operative cyst and orbital walls: a CT image analysis].

A set of coronal CT images obtained by 118 side (109 cases) of post-operative cysts of maxilla, seen from 1982 to 1988, was analyzed as to the orbital wall affections. Coronal images were grouped into five consecutive planes, i.e. the first plane being the one which is 5mm posterior to the nasion, and the other planes in successive orders each being 5mm apart. The orbital walls were classified into inferior, medial, and transition of these two. The orbital wall affections were classified into dehiscence, thinned-out (less than 1mm), and normal. The orbital signs and symptoms (epiphora, pain, asthenopia, visual loss, diplopia, and exophthalmos) were analyzed based upon the questionnaires by patients. The inferior wall affections (dehiscence and thinned-out) were seen most often (57%) at the third plane (2cm posterior to the nasion). The orbital signs and symptoms in general were seen in half of the cases of which 20% were of grave (visual loss, diplopia and exophthalmos). These signs and symptoms were the more often, the more anterior the site of affections located. Grave signs and symptoms were seen at 2 to 2.5cm posterior to the nasion when the orbital floor was affected and the inferior rectus were either pushed up or in direct contact with the cysts.

Adolescent↗
PubMed1999

Surgical reconstruction of the contracted orbit.

Anophthalmic patients and patients afflicted with retinoblastoma incur severe deformity of the orbit. Treatment of the severely contracted orbit is very difficult, and patient satisfaction is often poor. Since 1988, we have performed temporalis muscle transfer and surgical expansion of the contracted bony orbit in 26 patients. Satisfactory results were obtained. Gradual expansion of the orbit was performed in case of congenital anophthalmic patients. The treatment should be established in multiplicity, among many methods available for contracted eye sockets, according to the degree of orbital deformity and the amount of residual conjunctiva. In case of severe deformity, volume expansion surgery and temporalis muscle transfer are necessary. If augmentation is required in the periorbital region, rib bone onlay graft must be performed. We were able to shorten the operative time by modifying the three-wall orbital expansion technique of Tessier and Wolfe to a more simplified method. Our observations show that our procedures achieved symmetry in both eyes in all patients, and there have been no remarkable complications.

Adult↗
PubMed1999

[Non-traumatic orbital diseases in Lausanne from 1965 to 1996].

PURPOSE: Describe our series of patients with non-traumatic orbital diseases. PATIENTS AND METHODS: A series of patients with non-traumatic orbital diseases seen in Lausanne from 1965 to 1996. RESULTS: Inflammatory conditions and infections were the most frequently observed diseases. Pseudotumors were the most representative. Orbital involvement in systemic diseases (for example Graves' disease), vascular tumors and malformations, as well as orbital involvement in rhinological diseases were also often observed. Orbital cysts, particularly dermoid and epidermoid cysts, and orbital diseases of nervous origin were exceptional. Finally, diseases of the lacrimal gland, metastases, secondary tumors from adjacent structures and diseases of mesenchymal origin were more rare. DISCUSSION: This study also reports the proportion of male and female patients and the percentage of proptosis.

Adolescent↗
PubMed1998

Removal of tumours of the orbital apex via a postero-lateral orbitotomy.

BACKGROUND: The surgical management of pure apical tumours of the orbit may be problematic with traditional approaches. A postero-lateral approach, specifically designed for apical growths, provides a more favourable angle of vision through a relatively small bone opening. METHODS: A series of 103 consecutive cases of intraorbital tumours, operated on in a community-based institution, was retrospectively reviewed. Out of this series, 8 patients, harbouring lesions located in the posterior intraconal space, underwent a postero-lateral orbitotomy. This approach, through a small opening on the orbital and temporal portions of the greater wing of the sphenoid, with the lesser sphenoidal wing, the orbital plate of the frontal bone, the lateral rim of the orbit being maintained intact, allowed adequate exposure of the orbital apex and successful extirpation of the tumours. In four patients the histological examination disclosed a cavernoma; the other patients had, respectively, a dermoid cyst, a lymphoma, a hemangiopericytoma and a metastatic melanoma. RESULTS: No recurrences were observed in a follow-up period ranging from 1 to 7 years postoperatively (the patient with melanoma died 16 months after operation for systemic complications of her illness). One patient showed transient weakness of lateral rectus muscle due to surgical manipulation, which subsided in few months. CONCLUSIONS: The postero-lateral orbitotomy represents a reliable alternative to other traditional surgical approaches when dealing with tumours of the orbital apex, providing excellent exposure of this region with a low rate of operative morbidity.

Adult↗
PubMed1999

Extensive, traumatic fractures of the orbit in war and peace time.

Traumatic fractures of the orbit are fairly frequent injuries both in wartime and in peacetime. Most often they are part of facial injuries but they can also be isolated. They are followed by numerous symptoms such as eye dislocation, enophthalmos, double vision, and often by various injuries of eye accessory organs. The conservative treatment of these injuries has been mostly abandoned. Surgical therapy--that is, the reconstruction of the original orbital shape and volume as well as repositioning of orbital contents to their previous position--has to be performed as soon as possible. In cases of neglected fractures it is necessary to refracture the bone, reposition and fix the broken orbital fragments, and then, concomitantly, reconstruct the orbital shape and volume as well as reposition the orbital contents in their original position. In patients with neglected injuries, results of surgical treatment (i.e., correction of eye position, enophthalmos, and double vision) are considerably poorer than those achieved after the surgical treatment of fresh injuries.

Adult↗
PubMed2000

Ectopic lacrimal gland cyst of the orbit.

Lacrimal duct cysts are not common. It is extremely rare when a lacrimal duct cyst and an ectopic lacrimal gland develop in the orbital cavity. A unique case of an ectopic lacrimal gland cyst of the orbit is presented. A 33-year-old man had a palpable mass above the inferior medial orbital rim for nearly two years. An ocular examination was normal except for a movable, firm mass found in the anterior nasal inferior orbit of the right eye. An echogram revealed a homogeneous, hypoechoic cystic mass. Computed tomography of the orbit showed a well-encapsulated lesion in the lower orbit of the right eye near the inferior rectus muscle, without bony erosion. A tense, thin-walled, clear fluid-filled cyst measuring 15 x 12 x 13 mm in size was completely enucleated without rupture by anterior orbitotomy. Pathologic examination disclosed a small nest of normal gland tissue surrounded by a cystic lesion lined with two layers of lacrimal duct epithelium cells. No recurrent signs were noticed during a 12-month period of follow-up.

Adult↗
PubMed2000

Pulsatile expansion therapy for orbital enlargement.

Experimental and clinical investigations have documented the modulatory role of the globe in the development of the orbit. In cases of absence or early loss of the globe, severe hypoplasia of the orbit and midface has been reported by several authors. Statical conformers and orbital osteotomies have been used to correct the resulting facial asymmetry. When replacing such conformers by increasingly larger ones, orbital structures are negatively influenced by the repeated trauma of surgical interventions. Simulating the modulatory role of the globe on orbital growth was the objective when developing a pulsatile device for orbital enlargement in cases of anophthalmia and microrbitism. The design, application and preliminary experience with a dynamic, pulsatile expanding system are presented.

Anophthalmos↗
PubMed2000

Incidence and clinical significance of frontal sinus or orbital entry during pterional (frontotemporal) craniotomy.

BACKGROUND AND PURPOSE: Frontal sinus entry, orbital entry, or both may occur during pterional craniotomy for microsurgical clipping of aneurysms. We sought to determine the incidence and clinical significance of these findings on postoperative CT scans. METHODS: Eighty-two postoperative CT scans of the head obtained from 81 patients (64 women, 17 men; age range, 25-80 years) were retrospectively reviewed over a 1-year period. These scans were reviewed independently by two blinded neuroradiologists for the presence and degree of orbit and frontal sinus entry that may have occurred during craniotomy. Clinical charts, operative notes, and discussions with the patients' neurosurgeons were reviewed to determine the clinical management and significance of these findings. RESULTS: Of the total 82 craniotomies reviewed, 77 (94%) had been performed via the pterional approach (43 right, 34 left). Twenty-three (30%) of these 77 studies revealed some evidence of penetration into the orbit or frontal sinus (orbit=65.2% [15/23]; frontal sinus=30.4% [7/23]; both=4.4% [1/23]). Only five of 16 patients with radiographic orbital penetration had evidence of involvement of intraorbital contents (ie, thickened lateral rectus, fat herniation, intraorbital air). Chart review revealed no complication or change in management. Of the seven patients with frontal sinus entry, three had mucosal exenteration and packing with antibiotic-coated gelfoam. No delayed complications (ie, persistent fever, mucocele, cerebrospinal fluid leak, air leak, or meningitis) were identified (follow-up period, 18-29 months). CONCLUSION: Frontal sinus or orbital entry is not uncommon after pterional craniotomy, but the incidence of immediate complications is rare.

Adult↗
PubMed2000

Transcaruncular approach for reconstruction of medial orbital wall fracture.

Medial orbital wall fractures can cause horizontal diplopia and enophthalmos. Therefore, reconstruction of displaced medial wall fractures should be considered. We used a transcaruncular approach in five male patients to reconstruct the medial orbital wall after acute injuries and also as a secondary procedure for enophthalmos correction. Four of these patients had a concomitant orbital floor fracture. The incision was made in the caruncule and extended in the conjunctiva superior and inferior into the fornices for 10-12 mm. The tissue was bluntly dissected in an anteroposterior direction. The periosteum was incised dorsal of the posterior lacrimal crest and after elevation of the periosteum, the fractured orbital wall was visible. Transplants up to a height of 2 cm could be inserted for reconstruction of the medial orbital wall. In the cases of acute trauma, the medial wall was reconstructed using a resorbable polydioxanone plate. Cortical bone was used for the reconstruction of late enophthalmos. No postoperative complications were found. The transcaruncular approach gave a rapid entry to the fractured medial orbital wall without a visible scar.

Adult↗
PubMed2001

[A case of orbital MALT lymphoma in which 67Ga scintigraphy was useful for evaluating the radiation therapy response].

A 67-year-old man was hospitalized at our institution complaining with epiphora and exophthalmos on the left side. Magnetic resonance imaging (MRI) showed an ill demarcated retrobulbar mass in the left orbit. 67Ga scintigraphy revealed avid uptake in the left orbital region. The patient was treated with radiation therapy. One month after the radiation therapy, the size of the mass decreased remarkably on MRI. 67Ga planar imaging after treatment showed no uptake, but 67Ga SPECT showed slightly increased uptake in the left orbital region. One year after the radiation therapy, MRI showed residual mass in the left orbital region. Both 67Ga planar imaging and SPECT showed no uptake in the left orbital region. 1.8 years after the radiation therapy, MRI showed the residual mass with no interval change in size. Both 67Ga planar imaging and SPECT showed no uptake in the left orbital region. The patient remains well with no evidence of local recurrence. 67Ga scintigraphy is useful in assessing the response to radiation therapy of MALT lymphoma in this case.

Aged↗
PubMed2000

Three-dimensional magnetic resonance imaging of the orbit in craniofacial malformations and trauma.

Craniofacial malformations and trauma often lead to changes in orbital soft tissues, requiring surgical correction of both hard and soft tissues. Computed tomographic scans and 3-dimensional reconstructions are the optimal tools for evaluation of the bony structures. However, there is no equivalent method for the orbital soft tissues. The aim of this study was to establish a 3-dimensional magnetic resonance imaging (3-D MRI) technique that allows a differentiated visualization of the different types of soft tissue in the orbit. A total of 8 patients with different pathologic conditions of the orbit was examined. Five of these patients underwent secondary correction after trauma, and 3 had craniofacial malformations. The 3-D reconstruction was performed in the volume-rendering technique after acquisition of 3-mm axial slices. It was shown that a differentiated visualization of the orbital soft tissues is possible. Although the thin bony structures have a weak signal and, therefore, the imaging is poor, reliable reconstruction of the globe was achieved by different radiologists because of its circular delimitation from the bone. This technique is an additional support in the planning of orbital surgery.

Craniofacial Abnormalities↗
PubMed2000

[Human umbilical cord used for wrapping hydroxyapatite orbital implant--animal experiment and clinical observation].

OBJECTIVE: Hydroxyapatite (HA) sphere is admitted to be the best orbital implant today, but it can cause some complications, such as conjunctival erosion and implant exposure. The causes of these complications include HA's mechanical and chemical stimulation to the conjunctiva. In order to protect conjunctiva against HA's invasion, most authors suggest wrapping the HA sphere with some material. The wrapping materials usually are autogenous or heterogeneous sclera or fascia. These materials are either unavailable or unaccepted by patients. This study was made on human umbilical cord tissue as the wrapping material of HA sphere. METHOD: Hydroxyapatite spheres enveloped in human umbilical cord tissue were inserted in ten rabbits' orbits. At 1, 2 weeks and 1, 2, 3, 6, 8, 10, 12 and 14 months after implantation, the conjunctival sac was examined. Then the HA sphere was removed and examined with a scanning electron microscope. Fifteen patients received HA orbital implants enveloped in human umbilical cord from September 1996 To December 1997. The pre- and post-operative photographs of the sockets, the implant motility were analysed. RESULTS: The animal experiment showed that the umbilical cord was tightly adherent to the HA sphere and orbital tissue. The fibro-vascular tissue gradually invaded the interconnecting pores of the sphere after implantation. None of the 15 patients had orbital infection or implant extrusion during an average follow-up of 10 months (range of 8-12 months). Three patients had conjunctival erosion, which was well treated. All patients have cosmetically satisfactory motility of the prosthesis. CONCLUSION: Human umbilical cord tissue can be used as wrapping material of hydroxyapatite orbital implant.

Adolescent↗
PubMed2002

Chromosomal imbalances in lymphoid tumors of the orbit.

PURPOSE: To identify chromosomal gains and losses in lymphoid tumors of the orbit and to examine whether such abnormalities are related to orbital presentation, disease severity, or risk for recurrent disease. METHODS: Biopsy specimens from 26 patients were examined by histomorphologic and immunohistochemical analysis. Lymphomas were classified according to the Revised European-American Lymphoma Classification. Chromosomal imbalances were detected by high-resolution comparative genomic hybridization (CGH). Clinical data were obtained by retrospective evaluation of medical records. RESULTS: Chromosomal imbalances were detected in 0 of 6 patients with idiopathic orbital inflammation, 0 of 2 with benign reactive lymphoid hyperplasia, 3 of 3 with highly malignant diffuse large B-cell lymphoma, 4 of 10 with marginal zone B-cell lymphoma, 0 of 1 with chronic lymphatic leukemia lymphoma, and 1 of 4 with immunocytoma. Among the low-grade malignancies, chromosomal imbalances were seen in 1 of 9 at stage IAE, 2 of 3 at stage IIE, and 2 of 3 at stage IVE. Chromosomal imbalances were observed in all primary tumors from the five patients that later developed recurrent disease. In 14 of 23 imbalances with intrachromosomal breaks outside the centromere region, the breaks were present at bands with known fragile sites. No chromosomal imbalances specific for orbital presentation were detected. CONCLUSIONS: Chromosomal imbalances were seen mainly in orbital lymphomas that were either highly malignant or at an advanced stage. CGH analysis of orbital lymphomas could be prognostically relevant, but further studies are required to confirm this notion.

Adult↗
PubMed1999

Concomitant ocular injuries with orbital fractures.

BACKGROUND AND OBJECTIVES: The orbital floor may fracture alone, and the fracture is then defined as "pure"; when there is a rim involvement, the fracture may be defined as "impure". Controversy exists as to the pathophysiology of orbital floor fractures and the incidence of orbital rim involvement. The purpose of this retrospective review was to determine the incidence of purity in orbital floor blowout fractures and the rate of ocular injuries in pure and impure floor fractures. METHODS AND MATERIALS: The charts of 250 patients with orbital fractures, treated at a primary trauma center between 1992 and 1996, were reviewed. All fractures had been examined by the Ophthalmology Service and confirmed by high-resolution computerized tomography scans. The average age of the patients was 45 years; more than 90% were male. Motor vehicle accidents were the most commonly documented mechanism of injury, followed by interpersonal violence and falls. Almost 50% could not be categorized for mechanism of injury. RESULTS AND/OR CONCLUSIONS: The incidence of ocular injuries in pure fractures (n = 54; 5.6%) was higher than in impure fractures (n = 26; 2.0%) (p = 0.05). Serious visual injuries following orbital fractures occurred in 17.1% of the patients; they were more common in patients with pure fractures.

Accidental Falls↗
PubMed1999

Orbital floor repair with titanium mesh screen.

BACKGROUND AND OBJECTIVES: Surgical repair of the acutely fractured orbit strives to restore appearance, preserve ocular and orbital function, and avoid enophthalmos or hypoglobus. Repair is achieved with autologous bone graft, synthetic substitutes, or both. The purpose of this article is to present an alternative procedure--use of implants, cut from a titanium mesh screen, without bone graft. METHOD AND MATERIALS: A total of 51 orbital floor fractures in 43 patients were repaired with titanium mesh screen implants. In three patients with bilateral orbital floor fractures repaired with titanium mesh, intraoperative symmetry was improved with bone graft added to the mesh on one side. RESULTS AND/OR CONCLUSIONS: Follow-up was available for 42 orbits in 35 patients and averaged 9 months. The transconjunctival approach with lateral canthotomy yielded better results than the subciliary approach, which often caused transient scleral show or ectropion. One patient underwent surgery for ectropion following a subciliary approach, and one patient developed a 4-mm enophthalmos. Routine bone grafting is unnecessary, even in large floor defects. Titanium mesh implants are a simple and reliable option for orbital floor repair.

Bone Transplantation↗
PubMedDate not supplied

Orbital melanoma metastatic from contralateral choroid: management by complete surgical resection.

We discuss a clinicopathologic correlation of orbital metastasis from a contralateral choroidal melanoma wherein the orbital tumor was removed completely by surgical resection. In October 1982, a 29-year-old woman was treated with cobalt-60 plaque radiotherapy for a choroidal melanoma in her right eye. The tumor responded well but recurred after 9 years, necessitating enucleation. In August 1999, 17 years after initial presentation, metastatic melanoma to liver, lung, and brain were found and the patient had a favorable response to chemotherapy and brain irradiation. Five months later, in November 2000, an enlarging orbital mass was documented to be compressing the left optic nerve. Complete surgical removal of the tumor was achieved by a superotemporal orbitotomy. Histopathologically, the tumor was a malignant melanoma with features similar to the choroidal tumor. The contralateral orbit can be the site of late metastasis from choroidal melanoma. In rare instances, an orbital metastasis can be completely removed surgically without subjecting the patient to orbital irradiation.

Adult↗
PubMedDate not supplied

[Features of treating patients with combined damage to the orbit and eye in the late period in peacetime and war conditions].

Analysing the diagnosis and treatment of 100 patients with combined injuries of the organ of vision and orbital zone of the face provided clinical features of lesions in peace-time or battle accidents. Battle accidents were found to be prognostically worse for visual functions. The use of immunotherapy for inflammatory complications of a traumatic process is demonstrated to be advisable. A program of stepwise treatment of combined lesions of the eye and the orbit with the priority of preserving the function of the vision organ. At stage 1 it is necessary to take measures for restoration of visual functions to avoid their decline or loss. At stage 2 reconstructive interventions in the orbit and visceral cranium, directed to the provision of topographic and trophic conditions for further restoration of eye functions should be performed. One-stage surgical intervention may be used if there are no real danger of vision loss. The peculiarities of reconstructive treatment of multifractional fractures of the orbit in the battle accident and fragmental fractures of the orbit in peace-time accident are described. Patients with combined injuries of the vision organ and the orbit in specialized institutions should be cared.

Adolescent↗
PubMed2000

Gene rearrangement analysis of orbital lymphoid infiltrating disorders.

PURPOSE: To determine whether the use of polymerase chain reaction for B-cell gene rearrangement in patients with orbital lymphoid infiltrate disorders could be useful in the diagnosis of lymphoma, especially, in differentiating benign lesion from malignant one. METHODS: In addition to clinical, pathological, and immunohistochemical evaluations, 48 cases of orbital lymphoid infiltrate disorders were examined for immunoglobulin heavy (IgH) gene rearrangement by means of PCR to amplify the FR3 region with formalin-fixed and paraffin-embedded tissues. RESULTS: Gene rearrangement in the third frame-work of the IgH region was detected in specimens obtained from 15 cases of malignant lymphoma, 4 of reactive lymphoid hyperplasia and 3 of orbital pseudotumor. All of these patients showed a discrete band (100 bp) which reflected monoclonal proliferation of B lymphocytes. 5 cases of malignant lymphoma, 6 of reactive lymphoid hyperplasia and 15 of orbital pseudotumor did not show a discrete band on PCR. CONCLUSIONS: The FR3 region gene rearrangement of Ig heavy in patients with orbital lymphoid infiltrate disorders may be an additional diagnostic tool in differentiating benign from malignant lymphoid diseases and in offering a useful adjunct for diagnosis in difficult or unclear cases. It is a reliable and practical method of gene diagnosis in orbital lymphoid infiltrate disorders and helps to identify the molecular mechanism of malignant lymphoma.

Carrier Proteins↗