Blindness as a Complication of Le Fort Osteotomies: Role of Atypical Fracture Patterns and Distortion of the Optic Canal

Abstract Background Despite the recent advances in skull base surgery, microsurgical techniques, and neuroimaging, yet surgical resection of clinoidal meningiomas is still a major challenge. In this study, we present our institution experience in the surgical treatment of anterior clinoidal meningiomas highlighting the role of extradural anterior clinoidectomy in improving the visual outcome and the extent of tumor resection. This is a prospective observational study conducted on 33 consecutive patients with clinoidal meningiomas. The surgical approach utilized consisted of extradural anterior clinoidectomy, optic canal deroofing with falciform ligament opening in all patients. The primary outcome assessment was visual improvement and secondary outcomes were extent of tumor resection, recurrence, and postoperative complications. Results The study included 5 males and 28 females with mean age 49.48 ± 11.41 years. Preoperative visual deficit was present in 30 (90.9%) patients. Optic canal involvement was present in 24 (72.7%) patients, ICA encasement was in 16 (48.5%), and cavernous sinus invasion in 8 (24.2%). Vision improved in 21 patients (70%), while 6 patients (20%) had stationary course and 1 patient (3%) suffered postoperative new visual deterioration. Gross total resection was achieved in 24 patients (72.7%). The main factors precluding total removal were cavernous sinus involvement and ICA encasement. Mortality rate was 6.1%; mean follow-up period was 27 ± 13 months. Conclusions In this series, the use of extradural anterior clinoidectomy provided a favorable visual outcome and improved the extent of resection in clinoidal meningioma patients.

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The role of postoperative prophylactic antibiotics in the treatment of facial fractures: a randomised, double-blind, placebo-controlled pilot clinical study. Part 3: Le Fort and zygomatic fractures in 94 patients

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2014.01.010 ◽

2014 ◽

Vol 52 (4) ◽

pp. 329-333 ◽

Cited By ~ 19

Author(s):

Poh Luon Soong ◽

Benoit Schaller ◽

Jürgen Zix ◽

Tateyuki Iizuka ◽

Matthias Mottini ◽

...

Keyword(s):

Clinical Study ◽

Prophylactic Antibiotics ◽

Facial Fractures ◽

Double Blind ◽

Le Fort ◽

Double Blind Placebo ◽

Pilot Clinical Study ◽

Zygomatic Fractures

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TRIGEMINO CARDIAC REFLEX IN ORAL & MAXILLOFACIAL SURGERY – A REVIEW

10.36106/ijsr/5912086 ◽

2021 ◽

pp. 1-2

Author(s):

Venu Sameera Panthagada ◽

Ravi Raja Kumar Saripalli ◽

Manoj Kumar Kanta

Keyword(s):

Trigeminal Nerve ◽

Preventive Measures ◽

Pressure Effect ◽

Maxillofacial Surgery ◽

Strabismus Surgery ◽

Effective Management ◽

Le Fort ◽

Le Fort I ◽

Maxillary Tuberosity

Trigemino cardiac reflex (TCR) which was originally called as OCCULOCARDIAC REFLEX is a physiological response due to the pressure effect on the largest cranial nerve, the trigeminal nerve. Oral and maxillofacial procedures can induce the development of this reflex. TCR is a triad of bradycardia , bradypnea and gastric motility changes due to the efferent activation of the vagal nerve in response to the pressure distribution in Trigeminal nerve. TCR may be generated as a result of procedures or conditions that increase intraocular pressure, strabismus surgery, nasal packing after rhinoplasty, the reduction of zygoma and zygomatic arch fractures, elevation of bone flap or osteotomies, reflection of a palatal flap for removal of a mesiodens, during Le Fort I downfractures, sagittal split ramus retraction, midface disimpaction, cutting maxillary tuberosity, and temporomandibular joint arthroscopy. The purpose of this paper is to discuss the pathophysiology and to review the main risk factors , treatment, prevention and management with emphasis on the role of maxillofacial surgeons and attending anesthetist. Maxillofacial surgeons should be familiar with presentations, preventive measures for the effective management of this complication.

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