1/19. aspergillus mycetoma in a secondary hydroxyapatite orbital implant: a case report and literature review.OBJECTIVE: The authors describe the first case report of a fungal abscess within a hydroxyapatite orbital implant in a patient who had undergone straightforward secondary hydroxyapatite implant surgery. DESIGN: Case report and literature review. INTERVENTION: Four months postoperatively after pegging and 17 months after original implant placement, chronic discharge and socket irritation became evident. Recurrent pyogenic granulomas were a problem, but no obvious area of dehiscence was present over the implant. The peg and sleeve were removed 31 months after pegging (44 months after original placement of the implant). The pain and discharge did not resolve, and the entire hydroxyapatite orbital implant was removed 45 months after sleeve placement and 58 months after initial implant placement. The pain and discharge settled rapidly. MAIN OUTCOME MEASURES: Cultures and histopathology. RESULTS: Results of bacterial cultures were negative. Results of histopathologic examination of the implant disclosed intertrabecular spaces with multiple clusters of organisms consistent with aspergillus. CONCLUSIONS: Persistent orbital discomfort, discharge, and pyogenic granulomas after hydroxyapatite implantation should cause concern regarding potential implant infection. The authors have now shown that this implant infection could be bacterial or fungal in nature. This is essentially a new form of orbital aspergillus, that of a chronic infection limited to a hydroxyapatite implant.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/19. Non-randomized comparison of surgical modalities for paranasal sinus mycoses with intracranial extension.Mycotic infections of paranasal sinuses are frequently reported in southern asia. aspergillus and Mucor species are the predominant ones. Intracranial extension of paranasal sinus mycoses is a difficult problem to manage. We report 18 cases of paranasal sinus mycoses with intracranial extensions. The commonest manifestations were nasal discharge (67%), nasal obstruction (50%), ocular symptoms such as proptosis (44%), telecanthus (39%) and ophthalmoplegia. Computerized tomography scans were found to be quite informative regarding the nature and extent of the disease (100% sensitivity and 78% specificity). A combined intracranial-extracranial approach (six cases) gave a distinct advantage over only adopting an extracranial approach (12 cases). A 17% incidence of CSF leak was noted by adopting only an extracranial approach as well as a recurrence in four cases out of the 12 that were treated using this method (P < 0.05). A slight increase in morbidity was associated with the combined intracranial-extracranial treatment, but no recurrence or significant complications were noted in this approach.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/19. Fatal rhino-orbito-cerebral mucormycosis in an apparently normal host: case report and literature review.Fungal infections of the central nervous system (CNS) are fortunately rare but remain challenging problems occurring mostly in immunocompromised individuals, with protean manifestations, unpredictable course and unfavorable outcome in many cases despite aggressive neurosurgical intervention and recent antifungal drugs. Rhino-orbito-cerebral mucormycosis is a potentially lethal opportunistic fungal infection with rapid progression and high mortality. Its pathogenic nature becomes evident when the patient's general resistance is compromised. We present a case of an invasive rhino-orbito-cerebral mucormycosis in an apparently normal adult who initially developed mild paranasal sinusitis and later developed status epilepticus and despite an aggressive management died. Interesting clinical, neuroimaging and histological findings are described, and the possibility of fatal mucormycosis in an apparently normal host is highlighted.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/19. Invasive streptococcal infection of the periorbita and forehead.Recent epidemiological reports suggest an increased frequency of invasive streptococcal infections linked to the appearance of a dominant group A streptococcus serotype. Necrotizing streptococcal infections involving the skin and soft tissues of the face are uncommon. This case demonstrates the aggressive and invasive nature of these infections. The patient presented with symptoms of angioedema and was treated with corticosteroids. Her condition worsened and plastic surgery was consulted. There was extensive necrosis of the periorbital and forehead soft tissue, requiring extensive debridement to control the invasive process. Multiple reconstructive procedures were performed to close the defects and to preserve function of the facial muscles and eyelids. The literature indicates less than 50 reported cases of necrotizing streptococcal infections limited to the periorbita. This case reflects the importance of rapid diagnosis, and emphasizes the need for prompt and appropriate surgical treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/19. Clinical applications of color Doppler imaging in the management of orbital lesions.PURPOSE: To present the clinical applications of color Doppler imaging (CDI) as an adjunctive study in the diagnosis and treatment of orbital lesions. methods: Retrospective noncomparative case series. medical records of 17 patients with orbital lesions who underwent orbital CDI were reviewed, and their orbital CDI results, diagnosis, and treatment were studied. The main outcome measures were detection of abnormal orbital vascular flow and presence or absence of blood flow within orbital lesions by CDI. RESULTS: Absence of intralesional flow was associated with an orbital lesion considered benign. Tumors in which flow was present were more frequently malignant or had malignant potential. Reversal of flow in the superior ophthalmic vein was observed in patients with carotid-cavernous fistula and orbital varix. CONCLUSIONS: CDI is a useful adjunctive imaging study for evaluating the vascularity of orbital tumors. The absence or presence of intratumoral blood flow as demonstrated by CDI can help determine the nature of the orbital mass and can assist with surgical planning.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/19. MRI artifact masquerading as orbital disease.OBJECTIVES: To describe the diagnostic challenge associated with magnetic resonance imaging (MRI) artifact and to describe methods of minimizing this artifact. methods: gadolinium enhancement was demonstrated to be artifact by using an inversion recovery pulse sequence technique. RESULTS: A patient with complaints of painless loss of vision also had radiologic abnormalities that led to subsequent referral to a tertiary care facility. Increased signals on the fat-suppressed contrast enhanced MRI was demonstrated to be artifact by using an inversion recovery technique which produced a normal MRI of the orbit. CONCLUSIONS: Clinical confusion leading to unnecessary and costly evaluation may be avoided if one considers the possibility of artifact when reviewing magnetic resonance studies. When magnetic susceptibility is suspected, the use of an inversion recovery sequence can better delineate the true nature of the abnormality.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/19. eosinophilic granuloma: resolution of maxillofacial bony lesions following minimal intervention. Report of three cases and a review of the literature.INTRODUCTION: Langerhans' cell histiocytosis is a collective term used to describe a group of enigmatic proliferative disorders. The natural history of the disease varies from a slow, benign, localized symptomatic bony or soft tissue lesion, to a rapidly progressive widespread multiple organ disorder which is often fatal. eosinophilic granuloma accounts for 60-70% of all cases of Langerhans' cell histiocytosis and can present as solitary (50-75%) or multifocal defects in bone. It occasionally presents as a localized soft tissue lesion. There are multiple treatment options but the response is unpredictable. AIMS: We present three separate cases, of the maxillofacial skeleton where the lesions of eosinophilic granuloma resolved following incisional biopsy only. patients AND RESULTS: Three patients presented with solitary lesions of the maxillofacial skeleton. All were diagnosed as Langerhans' cell histiocytosis following open curettage, which also resulted in resolution of the lesions. Follow-up has thus far been disease free. CONCLUSION: For some solitary Langerhans' cell histiocytosis lesions, simple curettage is the only treatment required. The paper discusses the need to confirm the solitary nature of the disease and the need for follow-up. Reviewing the literature on the disease, the authors suggest that perhaps cellular immaturity holds the cells of the lesion in a disease state until pushed to maturity by the trauma of open curettage surgery, resulting in a complete resolution of the disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/19. Rhino-orbito-cerebral mucormycosis: a treatment dilemma.A case of rhino-orbito-cerebral mucormycosis is presented showing its aggressive nature and progression of disease. The typical clinical features, neuroimaging and histological findings are highlighted in this report. amphotericin b and surgical debridement remain the mainstay of treatment. However, associated co-morbidities need to be addressed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/19. Ependymal tissue in microphthalmia with cyst.PURPOSE: To report the nature of the contents of a cyst associated with microphthalmia and optic nerve coloboma in a male infant. DESIGN: Clinicopathologic report. CASE REPORT: A male infant in good general health presented with a massively swollen, protruded left lower eyelid since birth. The globe was not identifiable. MRI disclosed a microphthalmic globe in the upper nasal orbit and an orbital cystic mass consisting of various compartments. Examination of the fellow eye showed a large optic nerve coloboma. As the protrusion of the left lower eyelid was progressive, aspiration of the cyst was performed twice. Finally, the cyst was removed surgically due to repeated filling. RESULTS: Examination of the aspirated fluid showed resemblance to cerebrospinal fluid (CSF). During surgery, the cyst was not found to communicate with the cerebrospinal fluid system. However, tissue resembling choroidal plexus lined the wall of the cyst that was adherent to the optic nerve. Histological evaluation of the tissue revealed ependymal cells. DISCUSSION: The presence of CSF in microphthalmic cysts does not necessarily imply a connection to the CNS, but may be due to local CSF production by ectopic ependymal cells.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/19. Orbital cyst formation associated with Gelfilm use.Two patients developed cystic lesions in the anterior orbit 21 and 26 months after repair of blow-out fracture with orbital floor Gelfilm implants. Both patients had associated motility disturbances. Both lesions were surgically excised and found to be cystic in nature and filled with glistening gelatinous material consistent with partially absorbed, encysted gelatin film (Gelfilm). Histologically, a fibrous capsule was present; the contents of the cyst were not pathologically identifiable since they dissolved during fixation. Postoperatively, the motility disturbances improved in each patient.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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