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PubMed1996

Prognosis of orbital lymphoid hyperplasia.

BACKGROUND: Orbital lymphoid hyperplasia can be associated with systemic non-Hodgkin lymphoma (NHL), even when polyclonal proliferation is found in the orbit. Although irradiation is recommended, some orbital lymphoid hyperplasias are treated by steroids (when inflammation is clinically presumed) or left untreated. METHODS: The incidence of concurrent NHL and the incidence of future NHL after oral prednisone, radiotherapy, or no treatment were retrospectively evaluated in 33 cases of lymphoid hyperplasia (22 benign lymphoid hyperplasias, BLH, and 11 atypical lymphoid hyperplasias, ALH), after follow-up of 2-13 years. RESULTS: NHL occurred in 12 of 33 cases (36.4%). In seven patients it was concurrent; in five patients it occurred 2-6 years later. In the actuarial curve, at 5 years 55% of patients were free of lymphoma, at 10 years, 46%. NHL was more commonly observed when the lacrimal gland was involved (57% vs 21%; P = 0.03). Of the 13 patients treated with oral steroids, 46% had complete response, 39% partial response, and 15% future NHL. Of the seven irradiated patients, five (71%) had complete response, two (29%) partial response, and none future NHL. Of the eight untreated patients, five (63%) had partial response and three (37%) future NHL. Irradiated lacrimal gland BLHs only achieved partial response, one having radiation-induced orbital inflammation. CONCLUSION: Because of a high risk of NHL, in all orbital lymphoid tumors systemic staging and follow-up are mandatory. The advised management is irradiation, except for Sjögren syndrome, an initially inflammatory lacrimal gland BLH, where a course of steroid is suggested before considering radiotherapy.

Anti-Inflammatory Agents↗
PubMed1988

Orbital cellulitis due to mucormycosis. A case report.

A case of orbital cellulitis caused by mucormycosis developed in a patient subsequent to cataract extraction and during systemic steroid treatment for postoperative complications. Fatal mucormycosis is a rare disease usually beginning with a subcutaneous inflammatory lesion. As the subsequent development of orbital cellulitis is very rare, little has been published on this subject. In cases of subcutaneous mucormycosis, the diagnosis can easily be made by means of histologic examination of the lesion. However, early diagnosis is difficult in cases with orbital involvement, because the most common cause of orbital cellulitis is bacterial. Thus, orbital cellulitis caused by mucormycosis is often wrongly treated with antibacterial agents only, as histologic examination is neither easy nor part of any routine investigation. Therefore, a combined treatment using antibiotics and antifungal agents in immunusuppressed patients with this disease is advocated.

Aged↗
PubMed2000

[Therapeutic facial surgery possibilities for orbital tumors].

Based on a large experience of more than 400 orbital tumours which were treated operatively, the surgical strategies are described in detail. A surgical approach including the temporary removal of one or more bony orbital walls provided excellent exposure of the intraorbital structures. Using microsurgical techniques for tumour removal the surgical morbidity could be minimized. Subsequent refixation of the osteotomized orbital bones with microplates and screws and skin incisions within the hair bearing parts of the skull resulted in excellent postoperative function and cosmesis. For many malignant orbital tumours definitive cure can only be achieved by an orbital exenteration procedure. An individually tailored surgical and reconstructive strategy (if possible preservation of eyelid skin, tarsal and bulbar conjunctiva) gives a significant benefit, as well with respect to function as to the esthetic outcome of the patient.

Follow-Up Studies↗
PubMed2008

[MALT lymphoma of the orbit].

MALT lymphomas of the orbit are rare orbital tumors; the differential diagnosis needs to exclude inflammatory pseudotumors of the orbit, but also benign lymphoproliferations, pseudolymphomas, and other orbital neoplasms. After histological confirmation of the diagnosis staging is necessary, and - as long as the disease is localized exclusively in the orbit - radiation therapy should be started. The clinical picture of MALT lymphoma and its differential diagnosis and treatment are discussed with reference to an actual case.

Aged↗
PubMed2001

[Orbital space-occupying lesions. Practical aspects of imaging].

During the period 1992-1998,we diagnosed orbital tumors in 23 cases at the MLU Halle-Wittenberg. In the intraconal compartment we mostly saw cavernous hemangiomas and neurogenic tumors. Lymphomas and a primary meningioma were located in the extraconal space. Beneath the periosteum, bony processes, tumors of the sinuses, dermoid-and epidermoid-cysts normally occur, but we only observed metastases and hematomas. Furthermore,tumors of the lacrimal gland and inflammatory lesions were diagnosed. Orbital tumors are uncommon lesions, whose location in the orbit gives an important hint to differential diagnosis, because a high percentage of various pathologies is located in special compartments of the orbit. According to our results,the MRI-scan is usually sufficient for differentiation and for preoperative planning in order to reduce the X-ray dose of the lens. CT-scans with contrast are sometimes necessary for examining bone destroying processes and for planning the surgical approach to removing the tumor. X-rays of the skull widely lost their importance in the exact diagnostic of orbital tumors. B-scan ultrasonic imaging is reserved for screening and follow-up examination. Despite the use of MRI and CT scanning, the histological examination remains necessary.

Combined Modality Therapy↗
PubMed2003

Aggressive management of orbital meningeal melanocytoma.

OBJECTIVE: Meningeal melanocytoma generally occurs in the posterior fossa. Orbital manifestation is rarely encountered. METHODS: A thirty-five year-old man presented with progressive proptosis of his right eye. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) of the brain showed an expansive intraconal mass lesion occupying the superior orbital compartment, the entire orbital apex, and the optic foramen. Histological analysis and Immunohistochemical staining for S-100 and HMB-45 monoclonal antibodies confirmed melanocytoma. FINDINGS: Microsurgical removal was accomplished through a fronto-orbital craniotomy. Chemotherapy and irradiation followed the initial intervention. The patient returned for follow up two years after surgery, complaining of headache and right visual loss. A subfrontal tumor with massive edema was found on follow up CT scan. INTERPRETATION: Meningeal melanocytomas are rare benign pigmented tumors of the central nervous system. They are predominant in the posterior fossa and spinal cord and frequently mistaken for melanomas, especially on frozen sections. Orbital presentation is rare. The natural history is poorly defined.

Adult↗
PubMed2004

[Interobserver variation of the sonographic diagnosis of orbital floor fractures and fractures of the infraorbital margin].

PURPOSE: The aim of the study was to evaluate the interobserver variation of the ultrasound diagnosis of orbital floor fractures and fractures of the infraorbital rim. MATERIAL AND METHODS: A total of 25 patients with a clinical diagnosis of an orbital trauma were investigated prospectively by computed tomography (CT) and ultrasonography (US). Inter-observer variation was calculated using the lambda coefficient (lambda). The US images were reassessed by two inexperienced investigators. RESULTS: The lambda value for the US investigation of the orbital floor showed poor reliability comparing the US findings with the results of the re-investigators. The comparison between the two re-investigators showed a good reliability for the US evaluation of the orbital floor. The lambda for the US investigation of the infraorbital margin showed a good reliability comparing the US findings with the results of the both re-investigators. The comparison of the two re-investigators showed a good reliability as well. CONCLUSION: Ultrasound is not yet an alternative method for the evaluation of orbital floor fractures and fractures of the infraorbital margin. To replace CT which is accepted as the current gold standard, further studies have to be done to reach a better diagnostic quality of the method and to achieve a better calibration of the investigations.

Adolescent↗
PubMed2001

[Reconstruction of the orbits with polylactate implants: animal experimental results after 12 months and clinical prospects].

In earlier experiments healing of large orbital wall defects in sheep occurred undisturbed by osteoconductive bone growth along biodegradable membranes when there was no interference with additional bone grafts or titanium miniplate osteosynthesis. In this experiment similar bilateral defects were reconstructed with poly(L/DL 80/20) lactide implants using a microporous membrane 0.5 mm thick without further support on one side, an 0.25 mm microporous membrane supported by solid polylactide buttresses and stabilized by polylactide dowels on the opposite side. After 12 months we found a symmetrical reconstruction of the normal anatomy of the orbits in CT and X-ray examinations. In contrast, histologic investigations revealed massive foreign-body reactions around degrading buttress implants and dowels especially. Milder reactions occurred in some orbits along the membranes as well, in contrast to our earlier experiments with 4-month follow-up. None of the implants had degraded completely 12 months after surgery. In our 12-month long-term survey, polylactide microporous membranes confirmed their osteoconductive potential in orbital wall reconstruction. Nevertheless, massive polylactic implants should not be considered for clinical application in the orbit because of significant late foreign-body reactions.

Animals↗
PubMed2003

Role of routine nonenhanced head computed tomography scan in excluding orbital, maxillary, or zygomatic fractures secondary to blunt head trauma.

The purpose of this paper is to determine the necessity of a dedicated facial bone/orbital computed tomography (CT) scan for fracture surveillance in patients who have suffered blunt head trauma and whose routine nonenhanced head CT scan is negative. It is based on a retrospective review of 115 patients presenting to the Emergency Department at a level I trauma center after blunt head trauma. Included patients underwent both a nonenhanced head CT scan and a dedicated facial bone or orbit CT. Standard nonenhanced head CT protocol was followed for each patient as per department protocol. A positive head CT scan is defined to include either an air-fluid level within the paranasal sinuses or fracture of the maxillary, orbital, or zygomatic osseous structures. A negative scan demonstrates none of these findings. Intracranial/parenchymal pathology was not evaluated in this study. Sixty-five of the 115 patients had a negative head CT scan as defined above. Of these 65 patients, none subsequently had a positive facial bone or orbit CT scan. The sensitivity and negative predictive values of a negative routine nonenhanced head CT scan for fracture surveillance are both 100%. In the setting of blunt trauma, a negative nonenhanced head CT scan precludes the need for a dedicated facial bone or orbital CT scan in the evaluation for orbital, maxillary, or zygomatic fractures. This saves the patient unnecessary radiation exposure, health care costs, and time spent in the emergency radiology department.

Adult↗
PubMedDate not supplied

Histopathological study of orbital lymphangioma in an infant.

BACKGROUND: There has been controversy over whether orbital lymphangioma is a true entity in the orbit or various venous malformations. CASE: A 1-year-old girl was referred to us with subcutaneous induration of the right upper eyelid. Rapid enlargement of the eyelid mass with blepharoptosis and dislocation of the eyeball were noted within 1 week. A diagnosis of an orbital lymphangioma was made from the clinical course and findings of magnetic resonance imaging. Surgical resection of the tumor was performed to prevent amblyopia. OBSERVATIONS: Histopathologically, the lumen of the expanded cystic tumor consisted of a single layer of endothelium and was filled with erythrocytes as well as lymph. Immunohistochemical study revealed positive staining for factor VIII-related protein and CD 31, weak positive staining for thrombomodulin, and negative staining for CD 34 at the endothelium of the lymphangioma. The endothelium of the capillary vessels around the lymphangioma was positive for factor VIII-related protein, CD 31, and CD 34. Although a part of the tumor remained in the orbit postoperatively, orthophoria was achieved and no recurrence was observed for 2 years. CONCLUSION: Immunohistochemical study suggested that the cellular composition of the endothelium of the orbital lymphangioma was different from that of the surrounding capillary vessels.

Female↗
PubMed1992

Lateral canthotomy transconjunctival approach to the orbit.

Multiple surgical approaches to the orbits with the use of the eyelids have been used. The orbital rim incision fell into disfavor because of esthetic considerations. A subciliary approach supplemented by the lateral brow incision is currently the most popular method of approach to the orbital rim. It provides adequate access to the orbit, but it is not without inherent complications, such as unfavorable scarring, ectropion, and entropion. This article describes an alternate approach to the orbit by means of a transconjunctival incision with lateral canthotomy.

Bone Plates↗
PubMed1990

Orbital complications of sickle cell disease.

Swelling and pain of the peri-orbital tissues in patients with sickle cell disease has been described. This has most often been ascribed to orbital apex syndrome, but there are recent reports in the literature of frontal bone infarctions compounding this syndrome. We will present a case report of a child with sickle cell disease with bilateral orbital abscesses and frontal bone infarctions. The literature pertaining to the diagnosis and treatment of the orbital complications of sickle cell disease is reviewed. We stress that intravenous antibiotics are not adequate therapy for orbital abscesses and that these must be drained surgically.

Abscess↗
PubMed2006

Reconstruction of orbital wall defects with calcium phosphate cement: clinical and histological findings in a sheep model.

The aim of this pilot study was to investigate the potential of calcium phosphate cement in the treatment of orbital wall defect fractures in an adult sheep model, and to compare this alloplastic material to autologous calvaria split-bone grafts. Clinical, volumetric and histological examinations were carried out of both reconstruction materials. The use of cement made intraoperative corrections easier to perform, and increased the precision of reconstruction of the orbital volume. This material also proved to be osseoconductive. The two materials were used successfully in combination. Regions of most intensive remodelling were the anterior orbital floor and the adjacent orbital rim. The preliminary results of this study demonstrate the potential of calcium phosphate cement as a useful biomaterial in the reconstruction of the anterior orbital region. Further animal and clinical trials are necessary to investigate its ability as a carrier for mediators where bone healing requires influence or support.

Animals↗
PubMed2006

A comparative study of 2 implants used to repair inferior orbital wall bony defects: autogenous bone graft versus bioresorbable poly-L/DL-Lactide [P(L/DL)LA 70/30] plate.

PURPOSE: The purpose of this study was to compare our clinical findings on the use of autogenous bone grafts and bioresorbable poly-L/DL-Lactide [P(L/DL)LA 70/30] implants to repair inferior orbital wall defects. PATIENTS AND METHODS: Thirty-nine patients who suffered orbital blow-out fractures with >or=2 cm2 bony defect in the inferior orbital wall took part in the study. Each inferior orbital wall was reconstructed using either an autogenous bone graft or a triangle form plate of P(L/DL)LA 70/30. Computed tomography scans were taken before the operation and at 2 and 36 weeks postoperatively. To describe the distribution of complications and facilitate statistical analysis, we categorized our findings into diplopia, enophthalmos, numbness, gaze restrictions, size of bony defect after treatment, bone growth, and implant resorption. A comparative study was carried out using chi2 test and the Fisher exact test. We considered P < .05 to be statistically significant. RESULTS: The clinical outcome was excellent in 19 of the 24 (79%) cases treated with autogenous bone grafts and in 13 of the 15 (87%) cases treated with P(L/DL)LA 70/30. No statistically significant differences were found between the 2 groups in overall type or number of complications. The most frequent type of complication found in both groups was enophthalmos, with 5 cases (bone graft, 3; P(L/DL)LA plates, 2). Diplopia was the second most frequent type of complication; however, both complications caused no need for the removal of the implants in either group. CONCLUSION: Autogenous bone grafts and P(L/DL)LA 70/30 implant plates do not present statistically significant differences in the parameters studied. Taking into account the availability and the advantages of P(L/DL)LA 70/30 implants when compared with autogenous bone grafts, our results allow us to conclude that there is no compromise regarding successful bridging of orbital floor defects using biodegradable P(L/DL)LA 70/30 osteosyntheses.

Absorbable Implants↗
PubMed2005

Osseointegrated craniofacial implants in the rehabilitation of orbital defects: an update of a retrospective experience in the United States.

STATEMENT OF PROBLEM: Since their introduction, craniofacial implants have been used in prosthetic rehabilitation of facial defects. The literature, however, indicates marked variability in outcomes using implants for the retention of orbital prostheses. PURPOSE: A multicenter report updating the experience in the United States with the use of craniofacial implants for prosthetic rehabilitation of orbital defects is presented. MATERIAL AND METHODS: Surveys were sent to clinicians at 25 centers where maxillofacial prosthetic treatment is provided to obtain retrospective data regarding patients who completed implant-retained orbital prosthetic rehabilitation. Data on implant placement location, radiation treatment history, and use of hyperbaric oxygen therapy were collected and assessed in relationship to implant survival over time. The Kaplan-Meier life table and Wilcoxon analyses (alpha = .05) were used to assess the significance of the findings. RESULTS: Ten centers responded, providing data suitable for statistical analysis on 153 implants placed to retain 44 orbital prostheses and followed for a mean period of 52.6 months. Forty-one implant integration failures occurred during this follow-up period, resulting in an overall integration survival rate of 73.2%. No significant relationship was found between radiation treatment history, hyperbaric oxygen therapy history, or implant placement location and implant survival. Individual responses revealed large variability between reporting centers in treatment outcomes. CONCLUSION: Craniofacial implants may offer marked benefits in the prosthetic rehabilitation of orbital defects when compared to conventional adhesive retention designs. However, questions remain regarding long-term predictability and the impact specific factors may have on treatment outcomes. Insufficient data is currently available from which to draw statistically meaningful conclusions. The establishment of a national database designed to acquire adequate data to assess treatment outcomes is recommended.

Adolescent↗
PubMed1999

Giant cell reparative granuloma of the orbit.

PURPOSE: To report a case of giant cell reparative granuloma occurring in the orbit and to discuss its clinical, radiologic, and histopathologic characteristics in contrast with other similar lesions. METHODS: A 38-year-old man developed pain and mild proptosis of the left eye. Computed tomography and magnetic resonance imaging demonstrated an intraosseous cystic orbital mass. Excisional biopsy disclosed giant cell reparative granuloma of the orbit. RESULT: At 11 months' follow-up, the patient had normal vision, with no tumor recurrence. CONCLUSION: Giant cell reparative granuloma of the orbit is a rare benign fibro-osseous proliferation that is generally seen in young adulthood. It should be considered in the differential diagnosis of orbital fibro-osseous proliferation. Surgical excision and curettage is the therapeutic method of choice.

Adult↗
PubMed1999

Clinical findings in a patient with spontaneous arteriovenous fistulas of the orbit.

PURPOSE: To report clinical and radiologic findings of a patient with spontaneous arteriovenous fistulas of the orbit. METHOD: Case report. RESULTS: A 73-year-old woman was initially examined with a 1-year history of mild proptosis of the right eye. She had no history of trauma. Neuro-ophthalmologic examination disclosed dilatation of conjunctival vessels, increased intraocular pressure, mild proptosis and bruit in the right eye, and ocular signs suggestive of carotid-cavernous sinus fistulas or orbital arteriovenous malformations. The patient exhibited dilation of the superior ophthalmic vein in enhanced computed tomography of the orbit. Selective cerebral angiography disclosed communications between branches of both ophthalmic and facial arteries and the superior ophthalmic vein in the orbit. CONCLUSION: Arteriovenous fistulas of the orbit must be considered in the differential diagnosis of carotid-cavernous sinus fistulas and arteriovenous malformations, although they are quite rare.

Aged↗
PubMed2003

Strain gauge biomechanical evaluation of forces in orbital floor fractures.

Since the first description of orbital blow-out fractures, there has been much confusion as to their aetiology. Two principal mechanisms have been proposed to explain these fractures, the buckling and hydraulic mechanisms, caused by trauma to the orbital rim and the globe of the eye, respectively. Previous experimental and clinical studies have aimed to support one or other of these two theories. However, these studies have failed to provide quantifiable data to objectively support their conclusions. We present the results of a study of these two proposed mechanisms under identical conditions, using quantifiable intraocular pressure, variable and quantifiable force, and quantifiable bone strain distribution with strain gauge analysis in fresh intact human post-mortem cadavers. Both qualitative and quantitative findings suggest that efforts to establish one theory over the other as the primary mechanism have been misplaced. Both mechanisms produce orbital floor fractures, although these fractures differ fundamentally in their size and location. We have objectively demonstrated that it is easier to fracture the orbital floor by the hydraulic mechanism than by the buckling mechanism, and provided quantitative data for the average force required to displace the orbital floor.

Aged↗