Orbital Support Device Via Intranasal Approach – An Unconventional Design

2021 ◽  
Vol 10 (29) ◽  
pp. 2221-2224
Author(s):  
Kasim Mohamed ◽  
Maheshwaran K.S
Keyword(s):  
Maxillary Sinus ◽  
Primary Treatment ◽  
Orbital Floor ◽  
Surgical Reconstruction ◽  
Resection Margins ◽  
Malignant Tumours ◽  
Suspensory Ligament ◽  
Primary Treatment Modality ◽  
Close Relationship ◽  
Visual Apparatus

Maxilla can be considered a hexahedrium with close relationship to surrounding critical anatomic structures, and thereby invariably involved in the resection process of tumours that arise from maxillary sinus, palate, nasal cavity, orbital contents, or intro-oral mucosa.1 Maxillary defects created after tumour ablation can cause severe functional and aesthetic deficits. Orbital floor defects with displacement of the eyeball results in deformities with possible consequences of enophthalmos, diplopia and impaired visual acuity. The eyeball can become displaced either due to alteration in the position of the orbital walls caused by trauma, or due to loss of support of the orbital floor during resection of a lesion. The role of the suspensory ligament of Lockwood in maintaining the superio - inferior position of the visual apparatus is recognized. The preservation of this ligament, which acts like a hammock holding the eyeball in position, prevents any drastic downward displacement except for the small limit which the slack of the ligament allows. Surgical reconstruction of orbital floor defects is the primary treatment modality, but remains nonetheless a challenge for surgeons. Currently various types of materials such as titanium meshes, hydroxyapatite, silica gel, Teflon, Medpor and autogenous bones are used for orbital reconstruction.2,3 Prosthetic rehabilitation of maxillary surgical defects is so predictable and effective that reconstructive surgery is not indicated in most instances.4,5 Prosthetic management of defects with orbital floor resection is usually obturators with extensions to support the visual apparatus.6 In clinical situations involving the resection of the orbital floor and maxillary sinus, without the sacrifice of the floor of maxilla, no oro-antral communication is created. This eliminates the need for an obturator prosthesis. In this scenario the support for the visual apparatus will be solely dependent on surgical reconstruction. However, when dealing with invasive and progressive diseases of fungal and bacterial origin, immediate surgical reconstruction is not generally recommended till complete resolution of the disease is achieved. The potential for recurrence of tumours varies from 10 - 30 % with benign tumours and over 50 % with malignant tumours. This creates a need for long term follow up, to assess the resection margins for signs of recurrence.4

STEREOTACTIC RADIOSURGERY FOR CAVERNOUS SINUS OR ORBITAL HEMANGIOMAS

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. 914-918 ◽  
Author(s):  
Aftab A. Khan ◽  
Ajay Niranjan ◽  
Hideyuki Kano ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Tumor Regression ◽  
Target Volume ◽  
Symptomatic Improvement ◽  
Primary Treatment ◽  
Vascular Tumors ◽  
Presenting Symptoms ◽  
Primary Treatment Modality

Abstract OBJECTIVE Hemangiomas are rare but highly vascular tumors that may develop in the cavernous sinus or orbit. These tumors pose diagnostic as well as therapeutic challenges to neurosurgeons during attempted removal. We analyzed our increasing experience using stereotactic radiosurgery (SRS). METHODS Eight symptomatic patients with hemangiomas underwent SRS between 1988 and 2007. The presenting symptoms included headache, orbital pain, diplopia, ptosis, proptosis and impaired visual acuity. The hemangiomas were located in either the cavernous sinus (7 patients) or the orbit (1 patient). Four patients underwent SRS as primary treatment modality based on clinical and imaging criteria. Four patients had previous microsurgical partial excision or biopsy. The median target volume was 6.8 mL (range, 2.5–18 mL). The median prescription dose delivered to the margin was 14.5 Gy (range, 12.5–19 Gy). The dose to the optic nerve in all patients was less than 9 Gy (range, 4.5–9 Gy). RESULTS The median follow-up period after SRS was 80 months (range, 40–127 months). Six patients had symptomatic improvement; 2 patients reported persistent diplopia. Follow-up imaging revealed tumor regression in 7 patients and no change in tumor volume in 1 patient. All the patients improved after SRS. CONCLUSION Our extended experience confirms that SRS is an effective management strategy for symptomatic intracavernous and intraorbital hemangiomas. Our study is the first long-term report on the safety and efficacy of SRS.

Management of the Orbital Floor in Silent Sinus Syndrome

2003 ◽  
Vol 17 (2) ◽  
pp. 97-100 ◽  
Author(s):  
Robert D. Thomas ◽  
Scott M. Graham ◽  
Keith D. Carter ◽  
Jeffrey A. Nerad
Keyword(s):  
Ct Scan ◽  
Maxillary Sinus ◽  
Current Trend ◽  
Ct Scanning ◽  
Volumetric Analysis ◽  
Orbital Floor ◽  
Second Stage ◽  
Silent Sinus Syndrome ◽  
Orbital Floor Reconstruction ◽  
Preoperative Ct

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.

scholarly journals Case-based review: conservative management of appendicitis – are we delaying the inevitable?

2012 ◽  
Vol 94 (4) ◽  
pp. 232-234 ◽  
Author(s):  
S Davies ◽  
A Peckham-Cooper ◽  
A Sverrisdottir
Keyword(s):  
Acute Appendicitis ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Primary Treatment ◽  
Spontaneous Resolution ◽  
Primary Treatment Modality ◽  
Uncomplicated Appendicitis ◽  
Recurrent Appendicitis ◽  
Appendiceal Inflammation ◽  
Surgical Presentation

Acute appendicitis is a common surgical presentation for which surgical intervention, an appendicectomy, has remained a largely unchallenged primary treatment modality. Traditionally, it has been felt that the pathophysiological progressive nature of appendicitis ultimately leads to perforation. A number of recent studies, however, suggest that the process of appendiceal inflammation may follow a more remitting nature with evidence indicating spontaneous resolution. It is hypothesised that the treatment of uncomplicated appendicitis may therefore be amenable to conservative management with antibiotics. This article aims to highlight some of the issues and challenges relating to the conservative management of acute appendicitis and further demonstrates potential diagnostic and treatment difficulties involved in managing the more unfamiliar condition of recurrent appendicitis.

scholarly journals Role of Adjuvant Radiosurgery after Thoracoscopic Microsurgical Resection of a Spinal Schwannoma

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Toba N. Niazi ◽  
Christian A. Bowers ◽  
Meic H. Schmidt
Keyword(s):  
Stereotactic Radiosurgery ◽  
Treatment Modality ◽  
Surgical Excision ◽  
Primary Treatment ◽  
Benign Tumors ◽  
Noninvasive Treatment ◽  
Thoracic Spinal ◽  
Primary Treatment Modality ◽  
Microsurgical Resection ◽  
Spinal Schwannoma

Stereotactic radiosurgery to benign tumors of the spine has not been advocated as a primary treatment modality because of the favorable prognosis for these lesions after gross-total resection. There is even less evidence regarding its use as an adjuvant to neurosurgical resection of benign recurrent spinal disease. We describe the case of a 30-year-old man with a thoracic spinal schwannoma who had an interval increase of his lesion five months after thoracoscopic microsurgical resection. The patient opted for noninvasive stereotactic radiosurgery in lieu of additional surgical excision and has had stable disease 15 months after radiosurgical treatment with the linear accelerator (LINAC) system. In this setting, stereotactic radiosurgery provided a useful adjunct to thoracoscopic microsurgical resection. Future Class I and II evidence should be sought to evaluate the utility of stereotactic radiosurgery as a primary treatment modality or as an adjuvant for microneurosurgical resection of benign spinal lesions in patients who want noninvasive treatment after disease recurrence or who harbor medical comorbidities that would preclude them from being safe surgical candidates.

Prolapse of the globe into the maxillary sinus after orbital floor fracture

1981 ◽  
Vol 68 (3) ◽  
pp. 459
Author(s):  
Richard A. Mladick ◽  
R. A. Berkowitz ◽  
A. M. Putterman ◽  
D. B. Patel
Keyword(s):  
Maxillary Sinus ◽  
Orbital Floor ◽  
Orbital Floor Fracture

Maxillary Sinus Atelectasis with Enophthalmos

1998 ◽  
Vol 107 (1) ◽  
pp. 34-39 ◽  
Author(s):  
James H. Boyd ◽  
Karen Yaffee ◽  
John Holds
Keyword(s):  
Bone Resorption ◽  
Maxillary Sinus ◽  
Maxillary Sinusitis ◽  
Endoscopic Technique ◽  
Orbital Floor ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Middle Meatal Antrostomy ◽  
Chronic Maxillary Sinusitis ◽  
Sinus Ostium

Chronic maxillary sinusitis may present as atelectasis of the sinus with changes to surrounding structures. Several mechanisms have been proposed for this problem. Chronic obstruction of the sinus ostium, with resultant retention of secretions and osteitic bone resorption, may account for these changes. Enophthalmos is one manifestation that may require corrective treatment. Titanium micromesh reconstruction of the orbital floor, with or without onlay concha cartilage, has reliably resolved the enophthalmos. Reconstruction of the orbital floor and ventilation of the obstructed sinus ostium may be carried out relatively safely in a single operation. The standard endoscopic technique of uncinate removal and middle meatal antrostomy should be modified to prevent orbital penetration. This report reviews our series of 6 patients with this problem, as well as a comprehensive review of the literature. Recommendations for management of both the obstruction and the secondary orbital manifestations are presented.

Enophthalmos secondary to maxillary sinus disease: single-stage operative management

1995 ◽  
Vol 109 (9) ◽  
pp. 868-870 ◽  
Author(s):  
N. J. P. Beasley ◽  
N. S. Jones ◽  
R. N. Downes
Keyword(s):  
Maxillary Sinus ◽  
Endoscopic Sinus Surgery ◽  
Operative Management ◽  
Single Stage ◽  
Sinus Surgery ◽  
Orbital Floor ◽  
Sinus Disease

AbstractMaxillary sinus disease can lead to dehiscence of the orbital floor. Using endoscopic sinus surgery it is possible to simultaneously reconstruct the orbital floor and to assess and treat underlying sinus disease.

Diagnostic utility of (18)f-fluciclovine positron emission tomography (FACBC) in biochemically recurrent (BCR) prostate cancer (PCa) based on prior primary treatment modality for localized disease and the impact of FACBC findings on treatment selection.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 34-34
Author(s):  
Marina Nasrin Sharifi ◽  
Petra Lovrec ◽  
Jens C. Eickhoff ◽  
Aria Kenarsary ◽  
David Frazier Jarrard ◽  
...  
Keyword(s):  
Median Time ◽  
Treatment Guidelines ◽  
Recurrent Disease ◽  
Primary Treatment ◽  
Prostate Bed ◽  
Primary Treatment Modality ◽  
Positron Emission ◽  
Treatment Data ◽  
Detection And Localization ◽  
The Impact

34 Background: Management of BCR PCa requires accurate assessment of location and extent of recurrent disease. FACBC has been shown to be a sensitive modality for detection and localization of recurrent disease but treatment guidelines are based on the findings of conventional (conv) imaging, including computed tomography, magnetic resonance imaging, or bone scintigraphy, and little is known about how prior treatment impacts FACBC findings and concordance with conv scans. Methods: This single-center retrospective study included 137 patients (pts) who had FACBC for BCR at the University of Wisconsin-Madison from 10/2017-10/2019. Clinical, pathological, imaging, and treatment data were collected by chart review. Pts were classified by type of primary treatment for localized PCa, either radical prostatectomy (RP) or radiation therapy (RT). Findings of conv scans performed within 4 weeks prior or any time after FACBC were collected. Results: 105 pts had RP and 32 pts had RT as their primary PCa treatment. Gleason score and PSA at diagnosis were similar between groups. Median PSA at time of FACBC was higher in the RT compared to RP group (3.3 vs 0.7 ng/dL) and median time from initial diagnosis to FACBC was longer (70 vs 55 months). Frequency of (+) FACBC findings was higher in the RT group (66% vs 47%); only 3% of pts in the RT group had a (-) FACBC compared to 29% in the RP group. The rate of (+) lesions in the prostate/prostate bed was higher in the RT group (41% vs 22%), while the rate of (+) lesions in pelvic nodes and distant sites was similar between groups. Of 69 pts who also had conv imaging, 61% had concordant conv imaging findings. In the RT group, conv and FACBC findings were similar in 47% of pts and not similar in 28%. In the RP group, conv and FACBC findings were similar in 26% of pts and not similar in 17%. Management after FACBC is listed in table. Median time from FACBC to first (+) conv scans was 6 (range: 0-18) and 5 (range: 0-17) months for RT and RP groups, respectively. Conclusions: In this large retrospective cohort, pts treated with initial RT had a longer median time from diagnosis to FACBC and higher median PSA at the time of FACBC compared to the RP group. RT patients had a higher rate of (+) FACBC findings but were more likely to continue on observation. The median time from FACBC to first (+) conv scan was 5-6 months, supporting the role of FACBC in earlier detection of recurrent disease in both groups of patients. Further analysis of concordance between FACBC and conv imaging is in process. [Table: see text]

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