1/6. Management of traumatic optic neuropathy.Visual loss caused by trauma to the optic nerve is a well-recognized sequela to cranio-maxillofacial trauma. The authors reviewed their experience with 90 patients with pure traumatic optic neuropathy and optic nerve trauma with concomitant maxillofacial injuries. All patients were treated with intravenous steroids. Those not improving underwent extracranial optic canal decompression. patients with initial visual acuity of 20/100 or better all responded favorably with improvement in visual acuity or visual field to a course of intravenous megadose corticosteroids. patients with initial vision of 20/200 or worse who failed to respond to corticosteroids may have improved visual function after undergoing extracranial optic canal decompression. Preoperative and postoperative computed tomography scans on 6 patients enhanced with intrathecal iopamidol indicate the site of optic nerve compression to be at the optic canal. This article discusses the diagnosis and the medical and surgical treatment of pure and complex optic nerve injuries.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/6. Computer-assisted secondary reconstruction of unilateral posttraumatic orbital deformity.Until now, computer-assisted surgery has not been practiced as part of the surgical routine of posttraumatic orbital reconstruction. The purpose of this study was to investigate the use of a navigation system for computer-assisted preoperative planning with virtual reconstruction to obtain symmetry of the orbits and intraoperative control of virtual contours in comparison with the clinically achieved surgical results. A further objective of the computer-assisted orbital analysis was to use an ideal measurement for the two-dimensional and three-dimensional changes following orbital reconstruction and to check the equality of the postoperative values for the affected orbits in comparison with those of the unaffected sides. patients with unilateral posttraumatic orbital defects (n = 18) underwent computer-assisted surgery and preoperative planning using a spiral computed tomography database. Surgical procedures were preplanned with virtual correction by mirroring an individually defined three-dimensional segment from the unaffected side onto the deformed side, creating an ideal unilateral reconstruction. These computer-models were intraoperatively used as virtual templates to navigate the preplanned contours and the globe projection using the Stryker-Leibinger navigation system. Individual noninvasive registration with an overall inaccuracy of approximately 1 mm was achieved by using a maxillary occlusal splint with four markers. The mirroring of the unaffected side allowed an ideal virtual reconstruction. A mean decrease in enlarged orbital volume of 4.0 (SD /- 1.9) cm was achieved, as was a mean increase in the sagittal globe projection of 5.88 (SD /- 2.98) mm. With a paired Student test, the decrease between the preoperative and postoperative differences of the affected and unaffected sides was proved significant for orbital volume, globe projection, and computed tomography-based Hertel scale changes (p < 0.01). In 15 of 18 cases, simultaneous malar bone advancement resulted primarily in an additional increase in orbital volume before intraorbital augmentation with calvarial split-bone grafts could be performed. Intraorbital bony augmentation included one (n = 1), two (n = 7), three (n = 8), and all four (n = 2) orbital walls. Computer-assisted preoperative planning enables the surgeon to predict reconstructive surgical steps before the operation. Highly vulnerable structures such as the optic nerve can be detected and avoided intraoperatively, and virtually preplanned bone graft positions and/or orbital frame contours can be checked. Computer-assisted preoperative planning and surgery thus advance the difficult surgical field of orbital reconstruction, particularly through a greater exploitation of radiologic information without additional radiation to the patient.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
3/6. Naso-orbital-ethmoid injury: report of a case and review of the literature.Trauma to the midface severe enough to cause nasal fractures will often result in fractures of the bony naso-orbital-ethmoid (NOE) complex. Extensive damage may be encountered in the interorbital area because of the fragility of the bony framework. The medial orbital walls, ethmoid sinuses, and cribriform area of the anterior cranial fossa can resist a maximum compressive force of only 30 g. NOE injuries are usually the result of either a direct blow sustained during an altercation or of a high-velocity motor vehicle accident. Quite often multiple systemic injuries serve to complicate treatment. NOE fractures present the surgeon with numerous challenges during repair. The delicate bony architecture, anatomic framework, and cosmetic expectations indicate comprehensive, thorough treatment. Damage to the eye, which is basically an extension of the brain, is of major concern. Pupillary discrepancies, retrobulbar hematoma, and damage to the optic nerve must be ruled out. Early surgical management is indicated because delayed repair or inadequate treatment prediposes the patient to defects that may be extremely difficult if not impossible to correct with secondary procedures. Numerous articles have been published describing the NOE injury. The multifaceted array of fractures seen in NOE injuries has been formulated into a comprehensive classification by Gruss.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
4/6. Bilateral microneurosurgical reconstruction of inferior alveolar nerves via autogenous sural nerve transplantation.Microneurosurgical operative techniques permit satisfactory restoration of sensation in many lesions of the inferior alveolar nerve. Therefore, restoration of the sensory deficit is becoming increasingly more important in the total functional rehabilitation of individuals with mandibular continuity defects involving transection of or permanent damage to the inferior alveolar nerve. This article reviews the case history of a young man who underwent bilateral osseous mandibular reconstruction and microneurosurgical reconstruction of his inferior alveolar nerves following severe maxillofacial trauma. A new technique for isolating the sural nerve is introduced to facilitate harvesting of the graft. Scanning electron microscopic examination of the resected proximal inferior alveolar nerve is recommended to determine the prognosis for regeneration across the proximal anastomosis and to decide whether secondary resection and reanastomosis of the distal anastomosis is indicated when anesthesia persists 9 to 12 months after initial transplantation of a long donor nerve.- - - - - - - - - - ranking = 3.5keywords = nerve (Clic here for more details about this article) |
5/6. Computed tomography in maxillofacial trauma.Computed tomography (CT) has become the key diagnostic modality in the evaluation of head trauma. Experience with CT in the operative assessment of maxillofacial injuries is limited, however. Plain films and multidirectional tomography have been used until now to define fractures in the facial region. We examined 27 patients sustaining maxillofacial trauma with CT scans. Ten patients were studied in the coronal plane, 12 in the axial plane, and the remaining 5 in both the axial and coronal planes. Polycycloidal tomography in the coronal and/or sagittal plane was obtained in 18 patients for comparison with the CT scan. Fracture lines, bony fragments, and associated skeletal deformities were clearly identified by CT scan in all 27 patients permitting the diagnosis of zygomatic, orbital floor, nasoethmoidal complex, LeFort, temporal bone, frontal sinus, and mandible fractures. More importantly, concomitant intracranial injuries including epidural and intracerebral hematomas, traumatic encephalocoele, and pneumocephalus were readily seen. In addition, facial and orbital soft tissue structures including the globe, optic nerve, orbital fat, and extraocular muscles were easily examined by adjusting the CT level and window settings. overall, CT yielded additional information not available from polytomography in 15 of 18 cases when both modalities were used. Multidirectional tomography is currently superior to CT scanning if fine, intrinsic bone detail is required. However, we have found that complex fractures with fragmentation are more easily identified on CT scans than conventional tomography because of superior contrast resolution of computed tomography. With improved spatial resolution, CT scanning may totally supplant multidirectional tomography in the evaluation of maxillofacial trauma.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
6/6. Eagle's syndrome caused by traumatic fracture of a mineralized stylohyoid ligament--literature review and a case report.Eagle's syndrome is the common name for a series of clinical symptoms arising from an elongated styloid process of the temporal bone. The syndrome is named for Watt W. Eagle, M.D., who described its occurrence in a series of articles beginning in 1937. Common presentations of Eagle's syndrome are a post-tonsillectomy, nerve irritation and an impingement on either the external or internal carotid artery. The styloid process is the first section of the stylohyoid chain, formed by the stylohyoid ligament. Sections of this structure have the ability to mineralize, forming a rigid segment. This mineralized segment is then subject to fracture due to traumatic injury. The literature is reviewed for examples of traumatic fracture of the mineralized stylohyoid ligament, and a clinical case is presented.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |