Factor Influencing Postoperative Enophthalmos After Reconstruction of Orbital Wall Fracture

Abstract Rating patients with head trauma and multiple neurological injuries can be challenging. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, Section 13.2, Criteria for Rating Impairment Due to Central Nervous System Disorders, outlines the process to rate impairment due to head trauma. This article summarizes the case of a 57-year-old male security guard who presents with headache, decreased sensation on the left cheek, loss of sense of smell, and problems with memory, among other symptoms. One year ago the patient was assaulted while on the job: his Glasgow Coma Score was 14; he had left periorbital ecchymosis and a 2.5 cm laceration over the left eyelid; a small right temporoparietal acute subdural hematoma; left inferior and medial orbital wall fractures; and, four hours after admission to the hospital, he experienced a generalized tonic-clonic seizure. This patient's impairment must include the following components: single seizure, orbital fracture, infraorbital neuropathy, anosmia, headache, and memory complaints. The article shows how the ratable impairments are combined using the Combining Impairment Ratings section. Because this patient has not experienced any seizures since the first occurrence, according to the AMA Guides he is not experiencing the “episodic neurological impairments” required for disability. Complex cases such as the one presented here highlight the need to use the criteria and estimates that are located in several sections of the AMA Guides.

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A Case of Acute Orbital Abscess following Repair of Orbital wall Fracture with Alloplastic Implant

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2007.48.12.1706 ◽

2007 ◽

Vol 48 (12) ◽

pp. 1706 ◽

Cited By ~ 1

Author(s):

Sang Moon Jeong ◽

Jae Seok Yim ◽

Do Hoon Park ◽

Ju Yeong Kwak

Keyword(s):

Orbital Abscess ◽

Orbital Wall

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Outer Table Frontal Bone Fracture: When Need Surgical Intervention?

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v2i3.49 ◽

2018 ◽

Vol 2 (3) ◽

pp. 167

Author(s):

Adam Mohamad ◽

Irfan Mohamad ◽

Khairulzaman Adnan ◽

Syed Yusoff Alzawawi Syed Abdul Fattah

Keyword(s):

Bone Fracture ◽

Open Reduction ◽

Surgical Intervention ◽

Rectus Muscle ◽

Frontal Bone ◽

Facial Bone ◽

Orbital Roof ◽

Orbital Wall ◽

Outer Table ◽

Superior Rectus Muscle

Frontal bone fracture is a common facial bone fracture which commonly involved the outer table part. Most of the time outer table fracture is treated conservatively. However, when there is involvement of orbital wall fracture, as well as entrapment of extraocular muscle, surgical intervention via open reduction and internal fixation is needed. We described a case of outer table frontal bone fracture with left orbital roof fracture complicated with superior rectus muscle entrapment which was successfully treated via open reduction and internal fixation.International Journal of Human and Health Sciences Vol. 02 No. 03 July’18. Page : 167-169

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Endoscopic transnasal approach and intraoperative navigation for the treatment of isolated blowout fractures of the medial orbital wall

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2015.10.007 ◽

2015 ◽

Vol 43 (10) ◽

pp. 1974-1978 ◽

Cited By ~ 10

Author(s):

C. Copelli ◽

A. Manfuso ◽

A. d'Ecclesia ◽

S. Catanzaro ◽

L. Cassano ◽

...

Keyword(s):

Intraoperative Navigation ◽

Transnasal Approach ◽

Orbital Wall ◽

Endoscopic Transnasal Approach ◽

Medial Orbital Wall

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Ethnic variation in medial orbital wall anatomy and its implications for decompression surgery

BMC Ophthalmology ◽

10.1186/s12886-021-02009-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Minhui Amy Chan ◽

Farah Ibrahim ◽

Arjunan Kumaran ◽

Kailing Yong ◽

Anita Sook Yee Chan ◽

...

Keyword(s):

Relative Position ◽

Ethmoid Sinus ◽

Decompression Surgery ◽

Ethnic Variation ◽

Sinus Wall ◽

Orbital Wall ◽

Mean Width ◽

Significant Difference ◽

The Mean ◽

Medial Orbital Wall

Abstract Background To describe the inter-ethnic variation in medial orbital wall anatomy between Chinese, Malay, Indian and Caucasian subjects. Methods Single-centre, retrospective, Computed Tomography (CT)-based observational study. 20 subjects of each ethnicity, were matched for gender and laterality. We excluded subjects younger than 16 years and those with orbital pathology. OsiriX version 8.5.1 (Pixmeo., Switzerland) and DICOM image viewing software CARESTREAM Vue PACS (Carestream Health Inc., USA) were used to measure the ethmoidal sinus length, width and volume, medial orbital wall and floor angle and the relative position of the posterior ethmoid sinus to the posterior maxillary wall. Statistical analyses were performed using Statistical Package for Social Sciences version 25.0 (IBM, USA). Results There were 12 males (60 %) in each group, with no significant difference in age (p = 0.334–0.994). The mean ethmoid sinus length in Chinese, Malay, Indian and Caucasian subjects, using the Chinese as reference, were 37.2, 36.9, 38.0 and 37.4mm, the mean width was 11.6, 10.5, 11.4 and 10.0mm (p = 0.020) and the mean ethmoid sinus volume were 3362, 3652, 3349 and 3898mm3 respectively. The mean medial orbital wall and floor angle was 135.0, 131.4, 131.0 and 136.8 degrees and the mean relative position of posterior ethmoid sinus to posterior maxillary wall were − 2.0, -0.2, -1.5 and 1.6mm (p = 0.003) respectively. Conclusions No inter-ethnic variation was found in decompressible ethmoid sinus volume. Caucasians had their posterior maxillary sinus wall anterior to their posterior ethmoidal walls unlike the Chinese, Malay and Indians. Awareness of ethnic variation is essential for safe orbital decompression.

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Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient

BMJ Case Reports ◽

10.1136/bcr-2020-241540 ◽

2021 ◽

Vol 14 (5) ◽

pp. e241540

Author(s):

Jaekyoung Lee ◽

Dong Cheol Lee

Keyword(s):

Elderly Patient ◽

Cerebrospinal Fluid ◽

Gold Standard ◽

Standard Treatment ◽

Nasolacrimal Duct ◽

Intravenous Antibiotic ◽

Duct Obstruction ◽

Orbital Wall ◽

Silicone Intubation ◽

Endoscopic Dcr

Dacryocystorhinostomy (DCR) is the ‘gold standard’ treatment for nasolacrimal duct obstruction (NLDO). However, despite its recent technical advancements, complications are possible. Herein, to the best of our knowledge, we present the first reported case of delayed unilateral pneumocephalus after bilateral endoscopic DCR. An 85-year-old man with bilateral NLDO underwent endoscopic DCR with silicone intubation. After 1 month, he became lethargic and was admitted to emergency room. Brain CT demonstrated left pneumocephalus and a suspected microfistula in left orbital wall. Intravenous antibiotic therapy was started, and cerebrospinal fluid studies showed no evidence of meningitis. After 13 days of antibiotic treatment, his mental state recovered with no signs of pneumocephalus. Although DCR has high success rate and is relatively safe, surgeons should be aware of the risk, although low, of pneumocephalus, especially in elderly patients who are vulnerable to fractures and who exhibit headache or mental status changes after endoscopic DCR.

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Bony landmarks of the medial orbital wall: An anatomical study of ethmoidal foramina

Clinical Anatomy ◽

10.1002/ca.22303 ◽

2013 ◽

Vol 27 (4) ◽

pp. 570-577 ◽

Cited By ~ 8

Author(s):

Maria Piagkou ◽

Georgia Skotsimara ◽

Aspasia Dalaka ◽

Eftychia Kanioura ◽

Vasiliki Korentzelou ◽

...

Keyword(s):

Anatomical Study ◽

Bony Landmarks ◽

Orbital Wall ◽

Medial Orbital Wall

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Sphenoorbital meningioma: surgical technique and outcome

Journal of Neurosurgery ◽

10.3171/2010.10.jns101128 ◽

2011 ◽

Vol 114 (5) ◽

pp. 1241-1249 ◽

Cited By ~ 37

Author(s):

Soichi Oya ◽

Burak Sade ◽

Joung H. Lee

Keyword(s):

Surgical Technique ◽

Visual Outcome ◽

Sphenoid Bone ◽

Wide Resection ◽

Tumor Control ◽

Subtotal Resection ◽

Total Resection ◽

Anterior Clinoid Process ◽

Orbital Wall

Object The aim of this study was to describe the surgical technique used for removal of sphenoorbital meningiomas in the authors' practice and to review the operative outcome. Methods Review of the senior author's practice between 1994 and 2009 revealed 39 patients (mean age 48 years) eligible for this study. Clinical presentation, surgical technique, postoperative outcome, and follow-up data are presented. Surgical technique is detailed, with an emphasis on aggressive removal consisting of drilling of the hypertrophied sphenoid bone, orbital wall, and anterior clinoid process, followed by tumor removal and a wide resection of the involved dura. A simple dural closure without reconstruction of the orbital roof or the lateral wall of the orbit is also described. Results Gross-total resection was achieved in 15 cases (38.5%), near-total resection with small residual in the cavernous sinus or periorbita in 20 cases (51.3%), and subtotal resection in 4 cases (10.3%). Postoperative complications included trigeminal hypesthesia in 9 patients, oculomotor palsy in 3 patients, and seizure in 2 patients. Seven patients had recurrence within the mean follow-up period of 40.7 months. Preoperative visual deficits were present in 21 patients (53.8%). Of these, 14 (66.7%) experienced visual recovery to normal levels postoperatively. Statistical analyses revealed preoperative severe visual deficit and sphenoid bone hypertrophy as an independent risk factor and an independent favorable factor, respectively, for a favorable visual outcome. Proptosis was resolved (≤ 2 mm) in 73.5% of the authors' patients. No patient had postoperative enophthalmos. Conclusions In the authors' practice, surgery for sphenoorbital meningiomas consists of resection of the orbital/sphenoid intraosseous, intraorbital, and intradural tumor components. The authors believe that aggressive removal of the orbital/sphenoid intraosseous tumor is critical for a favorable visual outcome and tumor control. Furthermore, satisfactory cosmetic results can be achieved with simple reconstruction techniques as described.

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