scholarly journals ACESSO TRANSCONJUNTIVAL NA ABORDAGAGEM DE FRATURA DO ASSOALHO ORBITAL: RELATO DE CASO

2017 ◽  
Vol 8 (1) ◽  
pp. 6
Author(s):  
Bruna Pedral Sampaio de Souza Dantas ◽  
Alana Del’Arco ◽  
Daniel Freitas ◽  
Roberto Almeida de Azevedo ◽  
Laise Tourinho
Keyword(s):  
Bone Structure ◽  
Complication Rates ◽  
Facial Bone ◽  
Nasal Bones ◽  
Recommended Treatment ◽  
Orbital Wall ◽  
Lower Complication ◽  
The Face ◽  
Medial Orbital Wall ◽  
Infraorbital Rim

Objective: Fractures in the face require approaches with predictable esthetic results, seeking access to minimize scars and to lower complication rates. Among the extraoral access to approach the infraorbital margin there are cutaneous accesses (subciliary, subtarsal and infraorbital) and Transconjunctival with some variations. The transconjuntivais access enable orbital floor display, infraorbital rim and medial orbital wall for placement of grafts, osteotomies and osteosynthesis, leaving imperceptible scars in the conjunctiva. The zygomatic complex is anatomically located in the midface and due to its anterior projection it is quite affected by trauma, and facial bone structure, after the nasal bones, more prone to fractures. Case Description: This paper discusses a clinical case on the transconjunctival access to orbitozygomatic fracture approach of a female patient JJC, 30, discussing their indications, techniques and complications. Conclusion: From the diagnosis, the recommended treatment was the transconjunctival access to approach orbitozygomatic fracture.

Safety of Ethmoid Sinus Drug-Eluting Catheter Insertion

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P108-P108
Author(s):  
Christopher T Melroy ◽  
Frederick A Kuhn
Keyword(s):  
Skull Base ◽  
Topical Therapy ◽  
Topical Drug Delivery ◽  
Lamina Papyracea ◽  
Post Procedure ◽  
Orbital Wall ◽  
The Face ◽  
Drug Eluting ◽  
Medial Orbital Wall ◽  
Ethmoid Sinuses

Problem The objective is to develop an instrument which allows a drug-eluting catheter to be safely and reproducibly inserted into the ethmoid sinuses. Methods A trochar-based insertion device was designed to allow delivery of a drug-eluting catheter into the anterior and posterior ethmoid sinuses. It was inserted into 12 cadaveric ethmoid sinuses under endoscopic and fluoroscopic guidance. CT scans were performed pre-, intra-, and post-procedure. The device's position was analyzed and the proximity to the skull base, lamina papyracea, and ethmoid face was measured. The specimens were then dissected and evaluated for skull base, sphenoid face, or lamina papyracea injury. Results The drug eluting catheter system was successfully inserted into the ethmoid sinuses of all 12 cadaver sides without injury to either the medial orbital wall or the skull base as confirmed by post-procedure CT scan and dissection. The final position of the distal tip of the stent averaged 8.1mm (RMS = 3.3) from the skull base, 5.6mm (RMS=3.5) from the sphenoid face, and 5.0mm (RMS=3.5) from the lamina papyracea; the proximal tip was at the face of the ethmoid bulla and 17.1mm (RMS=3.5) below the skull base. Conclusion This study demonstrates that a trochar-based instrument can safely and reproducibly introduce a drug-eluting catheter into the ethmoid sinuses without skull base or lamina papyracea injury. This device may allow safe topical drug delivery into the ethmoid sinuses and provide chronic ethmoid sinusitis patients an alternative to ethmoidectomy. Significance The primary surgical therapy for chronic ethmoid sinusitis is ethmoidectomy; topical therapy has been widely used in the management of chronic ethmoid sinusitis only after ethmoidectomy. This study shows a drug-eluting catheter can be safely and reliably inserted into virgin ethmoid sinuses in order to allow the topical elution of medications into the ethmoids without ethmoidectomy. Support Acclarent supplied cadaveric specimens.

scholarly journals Cephalometrically analysis of the convexity angle

2003 ◽  
Vol 50 (3) ◽  
pp. 124-128
Author(s):  
Ljiljana Strajnic
Keyword(s):  
Bone Structure ◽  
Class I ◽  
Complete Dentures ◽  
Facial Bone ◽  
Facial Profile ◽  
Skeletal Class ◽  
Clinical Methods ◽  
The Face ◽  
Natural Teeth ◽  
Edentulous Patients

The convexity angle of facial bone structures ( N-A: A-Pg) expresses the sagittal protrusion of the maxillary part of the face compared to facial profile (the convex or concave face).The convexity angle is defined as the angle colligated by the lines N-A and A-Pg. The aims of the present study were: to analyse the convexity angle in participants with natural teeth skeletal class I, to cephalometrically evaluate the reconstructing angle of hard facial profile structures of edentulous patients skeletal class I, to compare examined variables between individuals with natural teeth and edentulous patients. The control group consisted of 30 lateral cephalometric radiographs of participants with natural teeth skeletal class I. The experimental group consisted of 30 lateral cephalometric radiographs of edentulous patients, with models of complete dentures after clinical methods of determining the vertical and horizontal intermaxillary relation. Analysis of the convexity angle was done in cephalometric radiographs by Downs metod. The results showed the facial bone structure convexity angle span a range between -13? and 10? (X= 0.45?) in subjects with natural teeth. In edentulous patients the values of facial bone structure convexity angles span a range between -5? and 10? (X=1.7?). The results of t-test proved that there were no statistically significant differences in examined variables between persons with natural teeth and edentulous patients (p>0.05). The conclusion is that clinical methods of determining the sagittal protrusion of the maxillary part of the face against the facial profile of edentulous patients used in the designing procedures of complete dentures were reliable enough in reconstruction of examined angles of hard facial profile structures.

Endoscopic Orbital Decompression: Technical Pearls and Pitfalls of an Evolving Technique

2020 ◽  
pp. 194589242096547
Author(s):  
Janki Shah ◽  
Jonathan Ting ◽  
Raj Sindwani
Keyword(s):  
Middle Turbinate ◽  
Infraorbital Nerve ◽  
Orbital Floor ◽  
Anatomical Landmarks ◽  
Orbital Decompression ◽  
Orbital Wall ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Medial Orbital Wall ◽  
Bag Mask Ventilation

Background First described in the early 1990s, endoscopic orbital decompression has become increasingly popular and has been shown to be a safe and effective approach for surgical decompression of the medial and inferior orbit. Methods We present our preferred technique for performing an endoscopic orbital decompression, highlighting key pearls and pitfalls. Results An endoscopic wide maxillary antrostomy and sphenoethmoidectomy is performed in standard fashion. We prefer to resect the middle turbinate for optimal exposure and access. The medial orbital wall is skeletonized and the lamina papyracea is carefully elevated, preserving the underlying periorbita. The orbital floor medial to the infraorbital nerve is resected. Once the periorbita is fully exposed, parallel axial incisions along the medial orbit and orbital floor are made from posterior to anterior using a sickle knife, taking care not to bury the tip to avoid injuring underlying orbital contents. The remaining fibrous bands are incised and prolapse of orbital fat is observed. Post extubation bag mask ventilation is limited to avoid subcutaneous emphysema. Conclusion Compared to open techniques, endoscopic orbital decompression provides superior visualization of critical anatomical landmarks, assures healthy sinus functioning post procedure, offers a lower complication rate, and avoids external incisions.

Resources: Internet Resources for the Independent Medical Evaluator – 2007

2007 ◽  
Vol 12 (4) ◽  
pp. 4-7
Author(s):  
Christopher R. Brigham ◽  
Jenny Walker
Keyword(s):  
Head Trauma ◽  
Clonic Seizure ◽  
Acute Subdural Hematoma ◽  
Orbital Fracture ◽  
Orbital Wall ◽  
First Occurrence ◽  
One Year ◽  
The One ◽  
Neurological Injuries ◽  
Medial Orbital Wall

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.

Outer Table Frontal Bone Fracture: When Need Surgical Intervention?

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

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

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.

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

2013 ◽  
Vol 27 (4) ◽  
pp. 570-577 ◽  
Author(s):  
Maria Piagkou ◽  
Georgia Skotsimara ◽  
Aspasia Dalaka ◽  
Eftychia Kanioura ◽  
Vasiliki Korentzelou ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Bony Landmarks ◽  
Orbital Wall ◽  
Medial Orbital Wall

scholarly journals Partially Thrombosed Internal Maxillary Pseudoaneurysm after Gunshot Wound

2016 ◽  
Vol 9 (4) ◽  
pp. 335-337 ◽  
Author(s):  
Menachem Gold
Keyword(s):  
Gold Standard ◽  
Gunshot Wound ◽  
Bone Fractures ◽  
Maxillary Artery ◽  
Digital Subtraction ◽  
Fat Pad ◽  
Facial Bone ◽  
Artery Pseudoaneurysm ◽  
Ct Angiogram ◽  
The Face

A 29-year-old man arrived in our emergency department after being shot on the face. Computed tomography (CT) revealed multiple facial bone fractures along the bullet trajectory. On day 10 of admission, CT angiogram of the neck revealed a partially thrombosed pseudoaneurysm in the parapharyngeal fat pad. The pseudoaneurysm was successfully treated with coil embolization. This report discusses diagnosis and treatment of a partially thrombosed internal maxillary artery pseudoaneurysm. Although digital subtraction angiography is the gold standard for pseudoaneurysm diagnosis, CT angiography may provide complimentary information, as seen in this case.

scholarly journals Non-target digital ischemia in an ulnar artery distribution following transradial access: Case report and review of best practice techniques

2021 ◽  
pp. 112972982110008
Author(s):  
Patrick Kennedy ◽  
Darren Klass ◽  
John Chung
Keyword(s):  
Best Practice ◽  
Artery Aneurysm ◽  
Ulnar Artery ◽  
Complication Rates ◽  
Endovascular Interventions ◽  
Transradial Access ◽  
Digital Ischemia ◽  
Aneurysm Embolization ◽  
Lower Complication ◽  
Access Complications

Transradial access is a safe approach for visceral endovascular interventions, with lower complication rates compared to transfemoral access. This report describes an unusual case of ulnar artery thrombosis following splenic artery aneurysm embolization via left transradial approach, resulting in non-target digital ischemia and eventual amputation of the ring and little finger distal phalanges. Technical considerations to reduce the incidence of access complications are also reviewed, along with practice modifications undertaken at our institution following this case to improve outcomes.

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