1/17. Surgical removal of orbital osteoma; case report.Thr authors report a patient with a large orbital osteoma causing marked physical deformity and diplopia but with preservation of visual acuity. A combined transorbital and transcranial operative approach was used for total tumor removal and cosmetic repair.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/17. Temporoparietal fascial flap in orbital reconstruction.OBJECTIVE: To evaluate the success of the temporoparietal fascial flap (TPFF) in the primary or secondary reconstruction of difficult orbital defects and to review the surgical techniques. DESIGN: Retrospective analysis. SETTING: Tertiary medical center. patients: Nine patients with diverse orbital cavity or periorbital soft tissue and bony defects due to trauma, benign or malignant neoplasms, and radiation treatment. INTERVENTIONS: Temporoparietal fascial flap anatomy and techniques of harvest and inset are reviewed in detail. Four cases are presented to illustrate possible variables in orbital reconstruction. Variables examined include the location of defects, the success of flap survival in orbital cavities after primary or secondary reconstruction, the effects of prior irradiation on flap survival, and the possibility of concurrent osteointegrated implant placement with TPFF reconstruction. MAIN OUTCOME MEASURES: Functional and aesthetic outcomes were determined by physical examination and preoperative and postoperative photographs. RESULTS: All patients had successful transfer of TPFF grafts without flap compromise. Temporoparietal fascial flap was a viable option for subtle orbital and malar contour defects. In chronically inflamed wounds such as with osteoradionecrosis and orbitoantral fistula, TPFF successfully restored vascularity, obliterated the defects, and enabled the placement of osteointegrated implants. The TPFF also supported the concurrent placement of a free calvarial bone graft. Finally, split-thickness skin grafted onto a pedicled TPFF showed 100% survival. CONCLUSIONS: The TPFF is one of the most reliable and versatile regional flaps in the head and neck for orbital reconstruction. This study presents the use of TPFF in a variety of orbital defects, from lateral bony rim defects to total exenteration. Timing of repair in this study spans from immediate reconstruction to reconstruction delayed more than 50 years after the initial injury. In all cases, reconstruction with TPFF resulted in improved bony and soft tissue contours, and incurred minimal morbidity.- - - - - - - - - - ranking = 9.2931410313834keywords = physical examination, physical (Clic here for more details about this article) |
3/17. Melanotic neuroectodermal tumour of infancy involving the orbit and maxilla: surgical management and follow-up strategy.Melanotic neuroectodermal tumour (MNET) of infancy is a rare benign but locally aggressive tumour. We describe our surgical treatment of MNET of the orbital region. There was osteogenic relapse involving the bone of the orbit, 20 days after macroscopically complete excision of the primary tumour when the patient was 12 weeks old. This is only the second report of osteogenic relapse in MNET. The relapse was treated by excision of the involved orbital floor, preserving the orbital periosteum. The tumour has not recurred in 23 months of follow-up. Residual tumour islets may regress spontaneously after incomplete excision of MNET, but the relapse rate is between 15% and 45%. In our opinion, excising a safety margin of a few mm of apparently healthy bone reduces the risk of relapse. In contrast, the orbital contents should be preserved if they are macroscopically normal. Follow-up consisted of frequent physical examinations and CT scans.- - - - - - - - - - ranking = 9.2931410313834keywords = physical examination, physical (Clic here for more details about this article) |
4/17. July 2002: 66-year-old female with a one-year history of progressive left proptosis.The July 2002 Case of the Month (COM). This 66-year-old Caucasian female presented with gradually increasing protrusion of her left eye over a one-year period. She complained of increased tearing and foreign body sensation. The physical examination revealed a visual acuity of 20/20, normal color testing, full vision field with motility of her left eye limited in lateral gaze. Pupils were round, symmetric, with no afferent pupillary defect noted. On external examination, her left eye was grossly proptotic with resistance to retropulsion. She had 4 mm proptosis of the left eye. Computed tomography and MR imaging demonstrated a left retro-orbital mass with gadolinium enhancement and focal remodeling of orbital bones. She underwent surgical resection of tumor with a diagnosis of solitary fibrous tumor, and postoperatively she was symptom free. The histopathological differential diagnoses of spindle cell neoplasms of the orbit are discussed. Five months after surgery, no evidence of tumor recurrence was seen on neuroimaging and her vision was 20/20.- - - - - - - - - - ranking = 9.2931410313834keywords = physical examination, physical (Clic here for more details about this article) |
5/17. A rapidly fatal case of T-cell lymphoma presenting as idiopathic orbital inflammation.A 41-year-old Caucasian woman presented with a painful, red right eye with minimal systemic symptomatology, and was initially diagnosed with right idiopathic orbital inflammation. Ten days later, she developed abdominal and respiratory symptoms; this led to her demise within a further week. Post-mortem examination demonstrated widespread extranodal NK/T- cell lymphoma (nasal type), involving the right posterior orbit, lungs, uterus, left adrenal gland, pericardium and meninges. Thorough physical examination with early orbital biopsy should be considered to exclude underlying treatable pathology in managing patients with presumed idiopathic orbital inflammation.- - - - - - - - - - ranking = 9.2931410313834keywords = physical examination, physical (Clic here for more details about this article) |
6/17. Selective carotid angiography in the diagnosis of fibrous histiocytoma. A case report.Selective carotid angiography is of value in the diagnosis of an orbital fibrous histiocytoma, an uncommon tumor with a high local recurrence rate and frequent distant metastases. The angiogram shows the physical extent of the tumor and also suggests its general microscopic anatomy. Comparison is made with similar angiographic presentations seen in cerebellar hemangioblastomas, glomus tumors, meningiomas, and hemangiopericytomas.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/17. Orbital infiltration by eyelid skin carcinoma.This paper presents 5 patients seen in the eye Clinic, Royal victoria Hospital, Belfast with orbital infiltration of malignant eyelid tumours. The physical features and natural progression of the disease are described. The value of CT scans in determining the extent of the disease and patient management are described.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/17. Computerized tomography of the orbit.The potential for using CT to diagnose orbital lesions is clearly demonstrated in this chapter. The patients discussed were all suffering from proptosis and had other complaints such as visual disturbances, pain, or ophthalmoplegia. CT is superior to ultrasonography in its ability to reproduce anatomical structures, including the retroocular space, bony walls of the orbit, and extraorbital regions, such as ethmoid sinuses and the cranial cavity. Such reproduction helps distinguish lesions arising within the orbit from those invading the orbit from outside. CT not only defines the extent of a lesion but also provides information about the physical properties of the tissue. The remarkable difference on CT between proptosis caused by thyrotoxic disease and that caused by intraorbital tumor or pseudotumor is a striking example of the way in which CT may contribute to more accurate diagnosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/17. Ultrasonic evidence of inflammatory thickening and fluid collection within the retrobulbar fascia: the T sign.A case of nonfebrile and nonpyogenic but inflammatory exophthalmos in a 60-year-old woman is presented in illustration of a diagnostic enigma which has previously eluded physical and roentgen examination. With painful limitation of rotation, a less than satisfactory diagnosis of tenonitis or, less commonly, orbital pseudotumor usually has been made. The convenient assistance of contact (nonimmersion) B-scan ultrasound gives objective evidence of fluid within Tenon's space and communicating into the vaginal spaces beneath the optic nerve sheath appearing as homogeneous and echolucent areas. Concurrently there is thickening of the posterior bulbar complex and muscle sheaths evidenced by increased echo density. A definitive finding as the echolucent "T sign" lends substantial and specific basis for clinical management. Rapid improvement in exophthalmos, rotations, and discomfort following oral steroids (without antibiotics) further supports the etiologic concept of both noninfectious and nonendocrine ophthalmopathy. The T sign is suggested as a specific finding, rather than an artifact, differentiating this exophthalmos from neoplastic invasion or thyroidopathy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/17. Pseudorheumatoid nodule involving the orbit.We report a clinicopathologic study of an unusual case of pseudorheumatoid nodule involving the right orbit of a child. Pathologically, the orbital lesion was similar to subcutanous nodules of rheumatoid arthritis and rheumatic fever. The physical findings and laboratory studies in our case did not reveal any evidence of systemic disease. Based on a review of reported cases involving other locations, this lesion appears clinically benign in children.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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