1/12. Exposure of expanded polytetrafluoroethylene-wrapped hydroxyapatite orbital implant: a report of two patients.PURPOSE: Hydroxyapatite (HA) spheres used to replace volume after an enucleation are often wrapped with autologous tissue before orbital implantation. Man-made materials are less expensive and pose no risk for viral transmission. The use of expanded polytetrafluoroethylene (ePTFE) to wrap HA spheres was evaluated. methods: The medical records of 2 consecutive patients who underwent uncomplicated implantation of an HA sphere wrapped in ePTFE were reviewed. RESULTS: An unusual reaction to the ePTFE material that was nonresponsive to topical or systemic antibiotic therapy developed in these 2 patients. Eventual wound erosion and bacterial infection of the implant necessitated its removal. CONCLUSIONS: Although well tolerated in other surgeries, ePTFE, when used to wrap HA spheres and placed into the orbit, may cause persistent conjunctival discharge, pyogenic granuloma formation, and eventual wound erosion. Therefore, the use of this material to wrap HA spheres is not recommended.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
2/12. Tarsal switch procedure for the surgical rehabilitation of the eyelid and socket deficiencies of the anophthalmic socket.PURPOSE: To describe a tarsal transfer procedure, which we have named the "tarsal switch," to correct the eyelid malpositions and camouflage the socket defects of acquired anophthalmos. methods: The technique consists of an upper eyelid tarsectomy, with transfer of the autologous tarsoconjunctival graft to the posterior lamella of the lower eyelid. RESULTS: The operation was performed in 21 anophthalmic patients. In 16 patients with eyelid malpositions, excellent results (within 1 mm of the fellow eye) were attained in 100% of the patients with ptosis, and in 88% of patients with lower eyelid retraction. In the remaining 5 patients, orbital volume loss with secondary implant migration, inferior prosthetic displacement and eyelid asymmetry predominated. In these patients the anophthalmic orbital defects and eyelid asymmetry were masked well. patient satisfaction was high and complications were few during an average follow-up interval of 16 months. CONCLUSION: The tarsal switch procedure is useful in managing the eyelid malpositions and masking the orbital deficiencies of the anophthalmic socket.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
3/12. The use of the Naugle orbitometer in maxillofacial trauma.BACKGROUND AND OBJECTIVES: Objective measuring of globe position is not a universal practice in the management of orbital trauma. Few studies in the literature advocate its routine use. methods AND MATERIALS: The Hertel exophthalmometer is the most widely used instrument; however, in trauma involving the lateral orbital rim (e.g., in zygoma fractures), the results are inaccurate because the displacement of the zygomatic bone interferes with its reference point on the lateral orbital rim. A more recent measuring device, the Naugle orbitometer, was introduced in 1992. It uses the superior orbital rim (frontal bar) and inferior orbital rim (malar eminence) as reference points. RESULTS AND/OR CONCLUSIONS: This article reports experience with this instrument in objective measuring the position of the globe in orbital trauma. These measurements are used 1) to monitor fractures that may not require repair but should be followed and observed for dystopia or enophthalmos, 2) to determine the adequacy of fracture repair, and 3) to determine the volume adjustment required for correcting enophthalmos. Future studies will be directed to compare the accuracy of Naugle and Hertel exophthalmometers.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
4/12. Intraosseous hemangioma of the orbit.A case of intraosseous orbital hemangioma is reported to alert surgeons to possible intraoperative hemorrhage during excision of such a lesion. A slowly enlarging mass was excised from the orbital rim of a 49-year-old woman. The clinical diagnosis was not suspected. In retrospect, roentgenographic findings included a focal honeycombed pattern of the zygomatic bone. Surgery was complicated by persistent low-volume bleeding. histology showed endothelial-lined blood-filled channels within the bone. Intraosseous orbital hemangioma is a rare, benign neoplasm that can often be diagnosed clinically by characteristic roentgenographic findings. observation should be considered as a therapeutic alternative when the radiographic diagnosis is established and when ocular function is not compromised.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
5/12. Multimodality imaging for precise localization of craniofacial osteomyelitis.Functional imaging identifies areas of abnormal bone turnover, providing a useful adjunct in the treatment of osteomyelitis and bone tumors. The low resolution and lack of anatomical detail limit the application of bone scans in craniofacial surgery, however. Multimodality image registration addresses this problem by fusing functional images (single photon emission computed tomography [SPECT]) to high-resolution structural images (computed tomography [CT]) for precise anatomical delineation of bone activity. This article describes a technique for spatial registration of CT and SPECT images to provide precise anatomical delineation of abnormal bone turnover, thereby guiding the extent of resection in the management of craniofacial osteomyelitis. Standard CT and SPECT imaging protocols were used in imaging the skull from the vertex to the mentum. Image data were imported into Analyze (Biomedical Imaging Resource; Mayo Foundation, Rochester, MN) on a dedicated Windows NT (Microsoft Corporation, Redmond, WA) workstation. Using the CT data, the craniofacial skeleton, osteotomy segments, and bone grafts were interactively mapped out. Consecutive axial slices were then reconstructed to form a three-dimensional volume of interest. The CT-derived volume of interest was registered to the technetium Tc 99m-methylene diphosphonate SPECT scan using the Analyze program to provide a fused multimodality image. The imaging technique was used to localize osteomyelitis in a complex craniofacial reconstruction. The fused images guided the extent of resection during surgery, and postoperative microbiological and histological testing confirmed the diagnosis. Multimodality image registration provides a readily available method to relate facial skeletal anatomy and physiology. This technique is valuable in planning and monitoring therapeutic interventions in clinical conditions in which bone turnover is abnormal.- - - - - - - - - - ranking = 2keywords = volume (Clic here for more details about this article) |
6/12. Management of the orbital floor in silent sinus syndrome.BACKGROUND: enophthalmos in a patient with an opacified hypoplastic maxillary sinus, without sinus symptomatology, describes the silent sinus syndrome. A current trend is to perform endoscopic maxillary antrostomy and orbital floor reconstruction as a single-staged operation. A two-staged approach is performed at our institution to avoid placement of an orbital floor implant in the midst of potential infection and allow for the possibility that enophthalmos and global ptosis may resolve with endoscopic antrostomy alone, obviating the need for orbital floor reconstruction. methods: A retrospective review identified four patients with silent sinus syndrome evaluated between June 1999 and August 2001. patients presented to our ophthalmology department with ocular asymmetry, and computerized tomography (CT) scanning confirmed the diagnosis in each case. RESULTS: There were three men and one woman, with ages ranging from 27 to 40 years. All patients underwent endoscopic maxillary antrostomy. Preoperative enophthalmos determined by Hertel's measurements ranged from 3 to 4 mm. After endoscopic maxillary antrostomy, the range of reduction in enophthalmos was 1-2 mm. Case 2 had a preoperative CT scan and a CT scan 9 months after left endoscopic maxillary antrostomy. Volumetric analysis of the left maxillary sinus revealed a preoperative volume of 16.85 /- 0.06 cm3 and a postoperative volume of 19.56 /- 0.07 cm3. This represented a 16% increase in maxillary sinus volume postoperatively. Orbital floor augmentation was avoided in two patients because of satisfactory improvement in enophthalmos. In the other two patients, orbital reconstruction was performed as a second-stage procedure. There were no complications. CONCLUSION: Orbital floor augmentation can be offered as a second-stage procedure for patients with silent sinus syndrome. Some patients' enophthalmos may improve with endoscopic antrostomy alone.- - - - - - - - - - ranking = 3keywords = volume (Clic here for more details about this article) |
7/12. Management of spontaneous enophthalmos due to silent sinus syndrome: a case report.Silent sinus syndrome (SSS) is a rare disease exhibiting unilateral enophthalmos and hypoglobus. A 26-year-old white female presented with right side enophthalmos and hypoglobus. There was no history of previous trauma or maxillary sinus diseases. A CT scan showed an opacified right maxillary antrum with decreased volume and downward bowing of the right orbital floor. From clinical and radiological findings the diagnosis SSS was made. Biopsies were collected from the maxillary sinus for the exclusion of malignancy. Two months later orbital floor reconstruction was carried out. Before antrostomy of the affected maxillary sinus, a relative enophthalmos of 4mm was determined. Five days after antrostomy the value reduced to 2.3mm. During the following 2 months the enophthalmos remained constant. At the end of the operation for orbital floor reconstruction it was 0.1mm. Five days after surgery the relative enophthalmos increased to 0.8mm. The value remained constant during the following 3 months. Initial antrostomy of the affected maxillary sinus may lead to a relevant, spontaneous reduction of enophthalmos. After a minimum period of 2 months a re-evaluation should be made, if a reconstruction of the orbital floor is still necessary for the correction of the globe position.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
8/12. Abnormality in the cavernous sinus in three patients with tolosa-hunt syndrome: MRI and CT findings.Three patients with tolosa-hunt syndrome (THS) were examined using computed tomography (CT), orbital venography and magnetic resonance imaging (MRI). CT of the brain showed no definite abnormality in two patients, right optic nerve enlargement and an abnormal area around the orbital apex in one patient. Orbital venography showed an occlusion of the superior ophthalmic vein in one of three patients. MRI showed an abnormal soft tissue area in the cavernous sinus, with intermediate to high signal intensity on T1- or intermediate weighted images. There was clinical improvement following corticosteroid therapy and the abnormal soft tissue on MRI decreased in volume and in signal intensity, although this was equivocal in one patient. Thus MRI proved to be useful in demonstrating lesions in the cavernous sinus in patients with THS.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
9/12. Macrocystic enlargement of orbital dermis-fat grafts.Acquired cysts represent an unusual but significant complication of orbital dermis-fat grafts. We report two cases of late postoperative enlargement of dermis-fat grafts: First, macrocystic enlargement occurring in both orbits with severe microphthalmia; second, cystic enlargement occurring in a dermis-fat graft for anophthalmia following an earlier evisceration. Both graft enlargements were due to epithelial-lined cysts that developed within the graft tissue. These cysts were treated by excising the cysts walls and allowing the resultant cavity to heal spontaneously. light microscopy of the excised tissue revealed that the clear cysts were lined by a non-keratinizing, stratified squamous epithelium. The histogenesis of the cysts is unclear, but most likely they are the result of incompletely removed or implanted conjunctival or corneal epithelium. Several other possibilities are discussed. Due to the difficulty of removing all corneal and conjunctival epithelium, cystic complications of dermis-fat grafts make unattractive their use for volume enhancement in patients with microphthalmia or following evisceration.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
10/12. Spontaneous rupture of an intraorbital hydatid cyst. A rare cause of acute visual loss.A very rare cause of acute visual loss due to the spontaneous rupture of an intraorbital hydatid cyst is presented. Acute onset was thought to be due to volume expansion and inflammatory reaction of orbital structures to ruptured cyst fluid.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
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