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At least 1,459 records · Page 81Linked to original sources
PubMed2001

Repair of orbital floor fractures with bioactive glass implants.

PURPOSE: The ideal management of orbital floor fractures has been highly controversial. Many implants, both autogenous and alloplastic, have been used to span the defects. This study evaluated the use of bioactive glass implants (BAG-implant, S53P4; Abmin Technologies Ltd, Turku, Finland) for the repair of orbital floor defects caused by blunt facial trauma. PATIENTS AND METHODS: This retrospective review of 36 patients was carried out from 1995 to 1999. All patients were diagnosed with an orbital floor fracture or a large orbital blowout fracture. The BAG-implant was placed over the defect, using a subciliary or transconjunctival approach. No screw fixation was used when the implant was the correct size. Follow-up examination was done at 1 and 3 months after surgery. Twenty-eight (82%) of the patients were also seen at one-year follow-up (21 men and 7 women). RESULTS: The implants did not cause a foreign body reaction in the bone or soft tissue. There was no sign of resorption or infection, nor postoperative extrusion, hemorrhage, or displacement of the implant. Diplopia was seen preoperatively in 17 cases (61%) and postoperatively in 5 cases (18%). In 1 patient, the implant was removed 3 months after operation because of diplopia. Infraorbital nerve paresthesia was seen preoperatively in 9 patients (32%) and postoperatively in 5 patients (18%). The functional and cosmetic results were good at the 1-year follow-up. CONCLUSION: The BAG-implant is a well-tolerated material in orbital floor reconstruction. It provides a favorable environment for an uncomplicated healing process because it is bioactive and biocompatible and because it causes new bone formation.

Adult↗
PubMed2001

Effectiveness of operative treatment of internal orbital wall fracture with polydioxanone implant.

Many implants, some made from teflon or silicone, have been used for internal orbital wall reconstruction. Late complications relating to use of such implants have been reported. In this prospective study a polydioxanone (PDS) implant absorbable in vivo was used for internal orbital wall reconstruction. Follow-up involved clinical examination, magnetic resonance imaging (MRI) and computerized tomography (CT). Clinical examinations were undertaken before operation and up to 36 weeks postoperatively. Sixteen consecutive patients (10 pure blow-out fractures, six with associated zygomatic fracture) took part in the study. Prevalences of diplopia, proptosis and enophthalmus were recorded during each follow-up examination. This study revealed no muscle entrapment within the fracture line. Although CT results confirmed bone growth in the internal orbital wall, shape was unsatisfactory, and orbital volume was not reduced. MRI revealed thick scar formations in six cases (37.5%), fibrotic sinuses filled with air or gas in three cases (19%) and a fibrotic sinus with fluid around the PDS in one case (6%). Our results suggest that use of PDS in reconstructing the internal orbital wall is inadvisable.

Absorbable Implants↗
PubMed1994

[Orbital metastasis of kidney carcinoma].

PURPOSE: The case report of a patient with renal cell carcinoma and orbital metastasis is presented and the clinical and histological characteristics are discussed. PATIENT: A 69-year-old man, status post nephrectomy secondary to a renal cell carcinoma, presented with a swelling of the lower lid, reduced visual acuity and visual field defects in the left eye. Ultrasonography and CAT scan revealed a well demarcated orbital tumor. THERAPY: The tumor was excized in toto and the diagnosis orbital metastasis of a renal cell carcinoma verified histologically. The patient showed good postoperative recovery with greatly reduced clinical symptoms. Two years later a recurrence of the orbital tumor was noticed, which was also removed in toto. CONCLUSION: The in toto excision of an orbital metastasis of a renal cell carcinoma is a valid therapeutic approach regarding the tumor morphology and the achievable postoperative symptomatic relief.

Aged↗
PubMed1993

Persistent posttraumatic orbital-antral fistula.

The case of a symptomatic persistent orbital--antral fistula after silicone orbital floor reconstruction is presented. Intermittent diplopia with Valsalva maneuvers was the patient's chief complaint. Periorbital cellulitis was a suspected complication of the fistula. This case emphasizes the importance of an often overlooked goal of orbital floor reconstruction, that is, isolation of the orbital cavity from the maxillary sinus. Greater care in positioning alloplastic implants may improve their function. Autogenous materials may be superior in orbital floor reconstruction.

Adult↗
PubMed1994

Reconstruction of traumatic orbital floor defects using irradiated cartilage homografts.

The important role of orbital shape and volume reconstruction has been studied by many investigators. There is, however, no consensus on the material that should be used in the reconstruction of the orbit. Both biologic and alloplastic materials have been used, each with its advantages and disadvantages. Here we report our experience with irradiated costal cartilage homograft in the reconstruction of the orbital floor. Irradiated cartilage grafts were used in 31 patients with significant traumatic defects in the orbital floor. Long-term follow-up in 21 patients up to 48 months revealed no incidence of graft infections, extrusions, or clinically detectable graft distortion or resorption. Irradiated cartilage homograft appears to be an excellent material for reconstruction of the orbital floor.

Accidents, Traffic↗
PubMed2002

Reverse temporalis muscle flap for the reconstruction of orbital exenteration defects.

Orbital exenteration is a surgical procedure that results in devastating functional and aesthetic losses. Many reconstructive techniques, ranging from spontaneous epithelialization to free flaps, have been described for orbital exenteration defects. The temporalis muscle flap is one of the most frequently used flaps to obliterate the orbital cavity, but only a small portion of the muscle can be used for this purpose because most of the muscle is used as the pedicle. The reverse temporalis muscle flap based on the superficial temporal vessels is a versatile flap by which the entire temporalis muscle can be elevated and carried to defects beyond the midline. The authors have used this flap for orbital reconstruction after exenteration in 6 patients with successful results. This flap enables placement of highly vascularized tissue that provides the reconstructive goals of primary healing, obliterates dead space with separation of the orbit from the nasal cavity or sinuses, provides the potential for early postoperative radiotherapy, and offers possible flaps that can be used in combination for complex, wide defects.

Aged↗
PubMed2006

Surgical resection of locally advanced granular cell tumor of the orbit.

We report a case of locally advanced granular cell tumor of the orbit treated by a multidisciplinary surgical approach. A 49-year-old woman with a recently biopsied granular cell tumor of the orbit was referred to our tertiary care cancer center for evaluation of a right-sided globe ptosis and a palpable mass in the right orbit that had been present for approximately two years. Magnetic resonance imaging showed a large orbital mass that extended posteriorly to the orbital apex and anteriorly to the levator and superior rectus muscle complex. A workup including computed tomography of the chest, abdomen, and pelvis did not show any metastatic foci. Surgical resection of the mass was undertaken via a frontozygomatic craniotomy supplemented by an anterior orbitotomy to repair the levator aponeurosis and the superior oblique tendon, which were partially resected with the mass. Histologic evaluation of the mass revealed solid nests of polygonal cells that had centrally located, round nuclei with abundant eosinophilic granular cytoplasm. The cytoplasmic granules were positive on the periodic acid-Schiff reaction and were diastase-resistant. Immunohistochemical staining was positive for S-100 protein. During the most recent follow-up visit six months after surgery, the patient had no clinical evidence of tumor recurrence, had minimal residual ptosis and exposure keratopathy, and had stable visual function.

Biopsy↗
PubMed1993

Use of demineralized bone as an osteoinductive orbital enucleation implant in the rabbit.

Implanted allogeneic demineralized bone particles (DBP) may be transformed into endochondral bone by inductive or conductive new bone formation. Using a rabbit model, enucleation or evisceration was performed, and DBP was implanted into the socket. Histology confirmed endochondral bone formation in both groups. A morphologic difference existed between enucleation and evisceration: compact bone was produced following evisceration, and cancellous bony spheres were formed following enucleation. Serial quantitative computed tomography (qCT) was performed to monitor mineral density and proved to be an ideal technique to monitor bone mineralization noninvasively in the postoperative orbit. Bone mineral density (BMD, mg/ml) increased approximately 300% in DBP implanted orbits when compared to controls at 6 weeks. The ideal mass/volume ratio of DBP to socket volume was 400 mg/ml. The rapidly formed bone is well vascularized and creates a stable integrated orbital implant, following enucleation and evisceration surgery. DBP implantation into the central orbit results in inductive bone formation with interesting potential in socket and orbit reconstruction.

Animals↗
PubMed1995

Orbital barotrauma.

A 24-year-old man sustained orbital and facial injury when an industrial suction device attached to his face. Hemorrhage and edema within the orbital soft tissues were clinically evidenced by proptosis and restricted ocular motility and confirmed by computed tomography. No retinal hemorrhages or exudates were noted. Orbital soft tissue injury caused by sudden extreme decrease in extravascular atmospheric pressure (i.e., orbital barotrauma) is not well described in the ophthalmic literature. The findings in our case are remarkably similar to those seen with traumatic asphyxia and the ophthalmological hydrostatic pressure syndrome, two conditions attributed to an increase in intravascular pressure. Physiologically, our case and these conditions share a similar increase in transmural pressure at the capillary level that is responsible for fluid transudate and hemorrhage in the orbital soft tissues. Intraretinal hemorrhages and exudates typical of Purtscher's retinopathy were conspicuously absent in our patient.

Adult↗
PubMed1995

Hinged silicone covered metallic implant for repair of large fractures of the internal orbital skeleton.

The objective of this study was to determine the effectiveness of hinged silicone covered metallic implant for the repair of large fractures of the internal orbital skeleton. Twelve patients underwent reconstruction of the orbital floor (and medial wall) with a hinged silicone covered metallic implant that was fixated at or just inside the inferior orbital rim with screws. The surgical technique permits intraoperative graded overcorrection because the implant is secured at the orbital rim and bent at its "hinge" to elevate the entire implant to the desired height. Nine of 12 patients had late repairs (> or = 4 weeks after injury); 3 patients had early repairs < or = 3 weeks of injury. All 12 patients had acceptable results with regards to enophthalmos and hypo-ophthalmos. One patient underwent secondary soft tissue upper eyelid augmentation for a residual superior sulcus deformity. The hinged silicone covered metallic implant is a useful technique for reconstruction of large orbital floor and medial wall defects. Long-term complications of this implant are unknown.

Adult↗
PubMed1996

Use of demineralized bone implants in orbital and craniofacial reconstruction and a review of the literature.

A retrospective study and review of the literature was performed on the use of demineralized bone implants for the correction of orbital and craniofacial defects. Demineralized bone implants heal by endochondral osteogenesis, inducing a transformation of local cells, as well as by osteoconduction, similar to autogenous grafts. They induce the chemotaxis and transformation of mesenchymal cells into chondroblasts, followed by ossification. They also act as a scaffold, with bone resorption taking place simultaneous with bone formation. This study reviewed 21 patients and 31 orbits, in which demineralized bone was used for orbitocranial reconstruction for congenital deformities (nine patients), after surgery for orbital fractures (seven patients: four floor, three roof), and orbital tumors (five patients). The surgical technique is described, and the results are discussed. The follow-up period averaged 15 months (6 months to 33 months). The overall resorption rate of the demineralized bone implants was estimated based on follow-up radiologic studies (facial films, computed tomography scans, and magnetic resonance imaging scans), as well as clinical examinations. All patients had a satisfactory to excellent result. The demineralized bone and Grafton (Osteotech, Shrewsbury, NJ, U.S.A.) was obtained from the Musculoskeletal Transplant Foundation of Holmdel, New Jersey, and it was all processed and reconstituted in a standard manner with Alloprep System. Surgical complications were cerebrospinal fluid leaks (one patient) with infection, transient chemosis, enophthalmos, and hypophthalmos. There were no complications related to demineralized bone alone. Properly prepared demineralized bone is a safe material for orbital reconstruction that eliminates the need for a second operative site to harvest a bone graft.

Adult↗
PubMed1996

Adverse effects of bone wax in surgery of the orbit.

The goal of this article is to establish the incidence and scope of adverse reactions to bone wax in a large orbital surgical series. We report two patients with bone wax granulomas of the orbit as a remote surgical complication. These are the first reported cases of adverse reactions to bone wax in the ophthalmic literature. A chart review was conducted on all patients from the University of British Columbia Orbit Clinic that had surgery with temporary or permanent removal of orbital bone. Two patients with bone wax granulomas were identified. In one case, intraoperative cultures grew Staphylococcus aureus, confirming that the wax may indeed act as a nidus for infection. No cases of pseudoarthrosis have occurred. This syndrome of chronic granulomatous giant cell foreign body inflammation has characteristic clinical, radiologic, and histopathologic features. The literature regarding adverse reactions to bone wax is reviewed, and specific implications for orbital surgery are discussed.

Child, Preschool↗
PubMed1998

Carcinoma of the male breast metastatic to both orbits.

We report the case of a 43-year-old man who presented with painless proptosis of the right eye of 6 weeks' duration. Examination demonstrated a tense right orbit and decreased vision and extraocular motility bilaterally. Diagnostic evaluation included computed tomographic imaging of the head and orbits, a therapeutic trial of high-dose systemic corticosteroids, and orbital biopsy, which revealed the presence of metastatic adenocarcinoma. The primary tumor was found to be an estrogen-receptor-positive, infiltrating ductal adenocarcinoma of the right breast. Therapy included lumpectomy of the breast mass, orbital irradiation, and hormonal therapy. Metastatic carcinoma of the breast should be considered in the differential diagnosis of orbital neoplastic disease in the male patient.

Adult↗
PubMed2001

Sudoriferous cyst of the orbit.

PURPOSE: A case of sudoriferous cyst of the orbit in an adult patient is reported. This unusual cyst in the orbit has heretofore been reported only in congenital cases. METHODS: Case report. RESULTS: A 45-year-old woman sought treatment for an asymptomatic mass of the left lower eyelid. Computed tomography of the orbits showed a cystic lesion in the inferior orbit with bony remodeling. Histopathologic examination showed the lesion to be a solitary cyst lined by two to three layers of cuboidal epithelial cells with eosinophilic cytoplasm. Some of the epithelial cells contained periodic acid-Schiff-positive, diastase-resistant granules. The pathologic diagnosis was a sudoriferous cyst. CONCLUSION: Sudoriferous cysts, although uncommon, should be included in the differential diagnosis of orbital cystic tumors.

Conjunctiva↗
PubMed2001

Bovine pericardium as a wrapping for orbital implants.

PURPOSE: We report the use of bovine pericardium as an alternative wrapping for porous orbital implants after enucleation. METHODS: We retrospectively reviewed the records of all patients who received a bovine pericardium-wrapped orbital implant after enucleation by the authors between August 1, 1996, and December 1, 1999. RESULTS: Eighty patients underwent placement of bovine pericardium-wrapped orbital implants. The average age at the time of implantation was 49.3 years (range, 5 years to 83 years). The mean follow-up interval was 11.8 months (range, 2 to 41 months). There were no intraoperative complications. No patient had secondary systemic infection or showed evidence of rejection. There was no clinical evidence to suggest that vascularization of the porous implant was unusually delayed, and there were no complications after secondary drilling and placement of a coupling post. Four (5%) of 80 patients had complications requiring removal of the spherical implant. All 4 patients had hydroxyapatite implants. Two patients had significant exposure requiring removal of the implant at 2 months after surgery; 1 patient had a chronic fistulous tract with secondary infection 3 years after surgery: and 1 patient had chronic orbital pain requiring removal of the implant at 1 year after surgery. CONCLUSIONS: The incidence of implant exposure was less than 4%. This compares favorably to the incidence of exposure of 9% to 21% reported in recent literature. Other complications were few and of minimal clinical significance. The authors conclude that bovine pericardium is a viable option to sclera as a wrapping for porous orbital implants.

Adolescent↗
PubMed2002

Bilateral infraorbital nerve involvement in idiopathic orbital myositis.

We describe a case of bilateral infraorbital nerve involvement in idiopathic orbital myositis. Computed tomographic scanning of the orbits showed enlargement of extraocular muscles consistent with orbital myositis and enlargement of the ipsilateral infraorbital nerve. With disease progression, infiltration of the contralateral infraorbital nerve also developed. Biopsies of the inferior oblique muscle and infraorbital nerve showed the same inflammatory infiltrate: a mixed population of lymphocytes (B and T) with B cells expressing kappa and lambda light chains. Although orbital myositis may be associated with several conditions, to the best of our knowledge, this is the first time a case of idiopathic orbital myositis with bilateral infraorbital nerve involvement has been described.

Aged↗
PubMedDate not supplied

Orbital lymphoma and subacute or chronic inflammatory pseudotumor: differentiation with two-phase helical computed tomography.

OBJECTIVE: The differentiation between orbital lymphoma and subacute or chronic inflammatory pseudotumor (SCIPT) may be difficult clinically and radiologically. The aim of this study was to evaluate the enhancement characteristics of orbital lymphoma and SCIPT with two-phase helical computed tomography (CT) and delayed coronal CT and to determine whether attenuation measurements on CT can be used to differentiate between the 2 diseases. METHODS: Nineteen histopathologically proven orbital lymphomas and 9 SCIPTs were examined with two-phase helical CT. After injecting 90 mL contrast material at a rate of 3 mL/s, early- and late-phase axial CT scans were obtained with scanning delays of 30 and 90 seconds, respectively. Delayed coronal scans were obtained with delays of 4-9 minutes. Attenuation of the lesions at each phase was measured quantitatively. Relative percentages of contrast enhancement (CE) were calculated to determine the cutoff value for differentiating SCIPT from lymphoma. RESULTS: The CT attenuation change over time was significantly different between orbital lymphoma and SCIPT (P < 0.05). Increased CT attenuation between early- and late-phase axial scans was seen in 42% (n = 8) of lymphoma cases, and decreased CT attenuation was seen in 58% (n = 11). In 17 lymphomas (90%), the CT attenuation decreased between late-phase axial and delayed coronal scans. Conversely, in 7 SCIPTs (78%), the CT attenuation increased gradually over time from early-phase axial to delayed coronal scans. The relative percentage of CE at the delayed coronal scan had a cutoff value of -6.97%, a sensitivity of 84%, and a specificity of 100%. CONCLUSION: Different characteristics of attenuation change on two-phase helical CT and delayed coronal CT can be helpful in differentiating between orbital lymphoma and SCIPT.

Adult↗
PubMed1993

Cranial injury from unsuspected penetrating orbital trauma: a review of five cases.

Penetrating orbital-cranial injury is potentially life threatening. The history of the trauma and ophthalmologic examination may be misleadingly innocent; serious injury may be overlooked. We present five cases of orbital injury in which the diagnosis of intracranial extension was not obvious at the time of initial examination. A thorough history and physical examination should be performed on all patients, even those with apparently trivial injuries. Intracranial extension should be considered in any case where the injury was caused by an instrument small enough to enter the orbit. The threshold for obtaining a coronal CT scan of the orbits should be lowered, since this is the best way to detect an orbital roof fracture.

Adolescent↗