scholarly journals Alterações funcionais como consequências de traumatismo orbitário: revisão da literatura

2020 ◽  
Vol 9 (5) ◽  
pp. 464-467
Author(s):  
Ernest Cavalcante Pouchain ◽  
Vanessa Anastacio Pimentel ◽  
Roque Soares Martins Neto ◽  
Francisco Wylliego de Holanda Maciel ◽  
Kelvin Saldanha Lopes ◽  
...  
Keyword(s):  
Surgical Repair ◽  
Rectus Muscle ◽  
Fracture Repair ◽  
Orbital Floor ◽  
Orbital Fracture ◽  
Comparison Analysis ◽  
Inferior Rectus ◽  
Orbital Trauma ◽  
Orbital Floor Fractures ◽  
Inferior Rectus Muscle

Os traumas de face ocorrem por forças externas lesionando o corpo, podendo eles ser locais, gerais ou concomitantes. A etiologia do traumatismo orbitário é diversificada como: quedas, queimaduras e agressões, sendo considerada uma das principais causas de morte no mundo de acordo com Organização Mundial da Saúde (OMS). As fraturas faciais podem se dividir em fraturas dos terço superior, terço médio e terço inferior. As fraturas do tipo Blow-outmantêm as margens orbitais integra, envolvendo apenas parede orbital inferior e ou média. Diplopia e enoftalmia são complicações bem características de traumas orbitais. O objetivo do artigo é identificar as principais lesões ocasionadas por fraturas orbitárias e apontar o diagnóstico e tratamento das lesões. Trata-se de uma revisão de literatura do tipo descritiva, com os dados colhidos nas bases de dados PubMed, SciElo, Lilacs, Google Acadêmico, selecionando artigos entre o ano de 2008 – 2018, de língua inglesa, portuguesa e espanhola, disponíveis para download nas bases de dados citadas. Os exames de imagem como a Tomografia Computadorizada é de suma importância para o diagnóstico devido seu detalhamento. Alguns sinais clínicos são: diplopia, enoftalmia, hipoftalmia ou mobilidade muscular ocular prejudicada. O tratamento ainda varia muito entre os cirurgiões.Descritores: Diplopia; Fraturas Ósseas; Órbita; Traumatismo do Nervo Abducente; Nervo Óptico.ReferênciasRamos JC, Almeida MLD, Alencar YCG, de Sousa Filho LF, Figueiredo CHMC, Almeida MSC. Estudo epidemiológico do trauma bucomaxilofacial em um hospital de referência da Paraíba. Rev Col Bras Cir. 2018;45(6):e1978.Affonso PRA, Cavalcanti MA, Groisman S, Gandelman I. Etiologia de trauma e lesões faciais no atendimento pré – hospitalar no Rio de Janeiro. Rev UNINGÁ. 2010;23(1):23-34.Scolari N, Heitz C. Protocolo de tratamento em fraturas orbitárias. RFO UPF. 2012;17(3):365-69.Polligkeit J, Grimm M, Peters JP, Cetindis M, Krimmel M, Reinert S. Assessment of indications and clinical outcome for the endoscopy-assisted combined subciliary/transantral approach in treatment of complex orbital floor fractures. J Craniomaxillofac Surg. 2013;41(8):797-802.Mendonça JCG, Freitas GP, Lopes HB, Nascimento VS. Tratamento de fraturas complexas do terço médio da face: relato de caso. Rev Bras Cir Craniomaxilofac 2011;14(4):221-24.Jung H, Byun JY, Kim HJ, Min JH, Park GM, Kim HY, Kim YK, Cha J, Kim ST. Prognostic CT findings of diplopia after surgical repair of pure orbital blowout fracture. J Craniomaxillofac Surg. 2016;44(9):1479-84.Ellis E 3rd, Perez D. An algorithm for the treatment of isolated zygomatico-orbital fractures. J Oral Maxillofac Surg. 2014;72(10):1975-83.Nilsson J, Nysjö J, Carlsson AP, Thor A. Comparison analysis of orbital shape and volume in unilateral fractured orbits. J Craniomaxillofac Surg. 2018;46(3):381-87.  Yu DY, Chen CH, Tsay PK, Leow AM, Pan CH, Chen CT. Surgical Timing and Fracture Type on the Outcome of Diplopia After Orbital Fracture Repair. Ann Plast Surg. 2016;76 Suppl 1:S91-5.Morotomi T, Iuchi T, Hashimoto T, Sueyoshi Y, Nagasao T, Isogai N. Image analysis of the inferior rectus muscle in orbital floor fracture using cine mode magnetic resonance imaging. J Craniomaxillofac Surg. 2015;43(10):2066-70.He Y, Zhang Y, An JG. Correlation of types of orbital fracture and occurrence of enophthalmos. J Craniofac Surg. 2012;23(4):1050-53. Roth FS, Koshy JC, Goldberg JS, Soparkar CN. Pearls of orbital trauma management. Semin Plast Surg. 2010;24(4):398-410. Palmieri CF Jr, Ghali GE. Late correction of orbital deformities. Oral Maxillofac Surg Clin North Am. 2012;24(4):649-63. Tavares SSS, Tavares GR, Oka SC, Cavalcante JR, Paiva MAF. Fraturas orbitárias: revisão de literatura e relato de caso. Rev Cir Traumatol Buco-Maxilo-Fac. 2011;11(2):35-42.Long JA, Gutta R. Orbital, periorbital, and ocular reconstruction. Oral Maxillofac Surg Clin North Am. 2013;25(2):151-66.Wolff J, Sándor GK, Pyysalo M, Miettinen A, Koivumäki AV, Kainulainen VT. Late reconstruction of orbital and naso-orbital deformities. Oral Maxillofac Surg Clin North Am. 2013;25(4):683-95.  Dean A, Heredero S. Alamillos F.J, García-García B. Aplicación clínica de la planificación virtual y la navegación en el tratamiento de las fracturas del suelo de la órbita. Rev Esp Cir Oral Maxilofac. 2015; 37(4):220-28.Damasceno NAP, Damasceno EF. raumatic orbital fracture with intact ocular globe displacement into the maxillary sinus. Rev bras oftalmol. 2010;69(1):52-4.

scholarly journals STRABISMUS MANAGEMENT AFTER ORBITAL BLOWOUT FRACTURE

2021 ◽  
pp. 36-40
Author(s):  
Reena Gupta ◽  
Chekitaan Singh ◽  
Rohan Madan ◽  
Suma Ganesh
Keyword(s):  
Road Traffic ◽  
Motor Nerve ◽  
Rectus Muscle ◽  
Orbital Floor ◽  
Inferior Rectus ◽  
Presumptive Diagnosis ◽  
Blowout Fracture ◽  
Post Surgery ◽  
Orbital Floor Fractures ◽  
Inferior Rectus Muscle

Orbital floor fractures (OBF) account for 40% of mid-facial injuries and are therefore the most common of all trauma injuries in this region. The post-treatment complication that often follows orbital floor repair is residual diplopia or 1 persistent diplopia and is seen in 86% of the OBF cases. The causes for persistent diplopia can be varied and is often related to the degree of inflammation, trauma to 2 musculature, fat or nerves and surgical timing. Some of the common causes of the same are - malpositioning of the globe, fibrosis of the inferior fibro fatty muscular complex following trauma, direct damage to an extraocular muscle (commonly inferior rectus muscle), local injury to a motor nerve, ischemia (or compartment syndrome), iatrogenic damage during reconstructive surgery or entrapment under improperly placed alloplastic material. Our case report mentions a rare case of persistent vertical diplopia even after successful repair of orbital blowout fracture. A 15-year-old male patient following a road traffic accident presented with persistent headache and vertical diplopia. The patient was evaluated by a oral maxillofacial surgeon and a presumptive diagnosis of a case of large orbital floor fracture with entrapment of inferior rectus muscle was made which was confirmed on CT Scan. He was managed surgically by reduction of the fracture and fixation with a titanium mesh. 2 weeks post-surgery he reported to the squint clinic with complaints of persistent double vision. On comprehensive ocular examination, it was found that patient had vertical diplopia with limitation of infraduction in the left eye with negative FDT, on re-evaluation of MRI scans with 1 mm cuts, a partial left inferior rectus tear was seen and documented as the cause of persistent diplopia. Patient was treated conservatively by prescribing prismatic glasses with fusional exercises. After 6 months of follow up, the patient was relieved of diplopia in primary position but there was a residual hypotropia in downgaze for which he was prescribed prisms only for downgaze.

Surgical repair of traumatic isolated inferior rectus muscle avulsion

2018 ◽  
Vol 29 (1) ◽  
pp. 106-109
Author(s):  
Xuhong Zuo ◽  
Lei Gao ◽  
Lewei Bao ◽  
Lv Chunyan
Keyword(s):  
Muscle Force ◽  
Surgical Repair ◽  
Rectus Muscle ◽  
Proximal Portion ◽  
Inferior Rectus ◽  
Orbital Trauma ◽  
History Of ◽  
Type Of Injury ◽  
Inferior Rectus Muscle

Purpose: To report our experience in the management of avulsion of the inferior rectus muscle. Methods: We describe the approach we have used for surgical repair of isolated avulsion of the inferior rectus muscle in two patients who suffered orbital trauma. Results: In both cases, the proximal portion of the inferior rectus muscle was located successfully by the generated muscle force duction test and sutured back into its original insertion point. Infraduction was normal and orthotropia was present in all directions of gaze during 1 year of postoperative follow-up in both cases. These favorable outcomes are attributed in part to the inferior rectus muscle pulleys system and the natural history of this type of injury, which allows the lost proximal portion to be identified by generated muscle force duction test. Conclusion: Generated muscle force duction test can be used to locate the proximal portion of a lost inferior rectus muscle and restore its function in patients with traumatic avulsion injury involving an extraocular muscle.

scholarly journals Resolution of Vertical Gaze Following a Delayed Presentation of Orbital Floor Fracture With Inferior Rectus Entrapment: The Contributions of Charles E. Iliff and Joseph S. Gruss in Orbital Surgery

2020 ◽  
Vol 13 (4) ◽  
pp. 253-259
Author(s):  
Arvind U. Gowda ◽  
Paul N. Manson ◽  
Nicholas Iliff ◽  
Michael P. Grant ◽  
Arthur J. Nam
Keyword(s):  
Rectus Muscle ◽  
Gaze Following ◽  
Orbital Floor ◽  
Vascular Compression ◽  
Delayed Presentation ◽  
Inferior Rectus ◽  
Orbital Surgery ◽  
Orbital Floor Fracture ◽  
Orbital Floor Fractures ◽  
Inferior Rectus Muscle

Introduction: Orbital floor fractures occur commonly as a result of blunt trauma to the face and periorbital region. Orbital floor fractures with a “trapdoor” component allow both herniation and incarceration of contents through a bone defect into the maxillary sinus as the bone rebounds faster than the soft tissue, trapping muscle, fat, and fascia in the fracture site. In children, the fractured floor, which is often hinged on one side, tends to return toward its original anatomical position due to the incomplete nature of the fracture and elasticity of the bone. The entrapment of the inferior rectus muscle itself is considered a true surgical emergency—prolonged entrapment frequently leads to muscle ischemia and necrosis leading to permanent limitation of extraocular motility and difficult to correct diplopia. For this reason, prompt surgical intervention is recommended by most surgeons. In adults, true entrapment of the muscle itself is not as common because the orbital floor is not as elastic and fractures are more complete. Methods: We present an adult patient with an isolated orbital floor fracture with clinical and radiologic evidence of true entrapment of the inferior rectus muscle itself. Results: Despite the delayed surgical repair (4 days after the injury), the patient’s inferior rectus muscle function returned to near normal with mild upward gaze diplopia. Conclusions: Inferior rectus entrapment in adults may more likely be associated with immobilization of the muscle without total vascular compression/incarceration significant enough to lead to complete ischemic necrosis.

scholarly journals Accelerated Osteomesh Resorption: A Case Report

2010 ◽  
Vol 3 (3) ◽  
pp. 115-117 ◽  
Author(s):  
Samuel Y.M. Ho ◽  
Vigneswaran Nallanthamby ◽  
Marcus T.C. Wong
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Significant Proportion ◽  
Rectus Muscle ◽  
Orbital Floor ◽  
Surgical Reconstruction ◽  
Inferior Rectus ◽  
Orbital Floor Fractures ◽  
Orbital Content ◽  
Inferior Rectus Muscle

Facial fractures occur commonly as a result of blunt trauma from road traffic accidents, assaults, and sporting injuries. Orbital floor fractures form a significant proportion of these and when large enough, the defect often requires surgical reconstruction of the floor to prevent orbital content herniation. Here, we present a case of a 28-year-old gentleman, who sustained an orbital floor fracture from a soccer-related injury. The resulting floor defect was surgically repaired using an osteomesh that was hand-cut to size. He developed delayed enophthalmos and entrapment of the inferior rectus muscle due to early resorption of the osteomesh, requiring revision surgery.

scholarly journals Persistent Upgaze Restriction after Orbital Floor Fracture Repair

2016 ◽  
Vol 9 (3) ◽  
pp. 268-270
Author(s):  
SarahWillcox DeParis ◽  
F.Lawson Grumbine ◽  
M.Reza Vagefi ◽  
Robert C. Kersten
Keyword(s):  
Conservative Management ◽  
Rectus Muscle ◽  
Fracture Repair ◽  
Orbital Floor ◽  
Inferior Rectus ◽  
Radiographic Evidence ◽  
Orbital Floor Fracture ◽  
Postoperative Findings ◽  
Inferior Rectus Muscle

Here we present two cases of marked postoperative upgaze restriction after successful repair of orbital floor fracture and release of inferior rectus entrapment. In both cases, follow-up imaging showed enlargement of the inferior rectus, and gradual resolution of gaze limitation was observed over several months of conservative management. Thus, in patients with postoperative findings suggestive of residual inferior rectus entrapment, follow-up imaging is indicated prior to returning to the operating room. With a markedly swollen inferior rectus muscle but no radiographic evidence of residual muscle entrapment in the fracture, a trial of conservative management may be warranted.

New Extraocular Muscle Entrapment after Facial Fracture Repair

FACE ◽  
2021 ◽  
pp. 273250162110154
Author(s):  
Lucas A. Dvoracek ◽  
Jonathan Y. Lee ◽  
S. Tonya Stefko ◽  
Jesse A. Goldstein
Keyword(s):  
Extraocular Muscle ◽  
Rectus Muscle ◽  
Fracture Repair ◽  
Orbital Fracture ◽  
Facial Fracture ◽  
Inferior Rectus ◽  
Orbital Floor Fracture ◽  
Careful Assessment ◽  
Inferior Rectus Muscle ◽  
New Onset

Extraocular muscle entrapment is a well-recognized complication of orbital fracture, wherein the inferior rectus muscle becomes lodged within the fracture fragments at the time of the initial trauma. New onset entrapment cannot occur without new force applied to the orbit, displacing the fragments and the inferior rectus. Theoretically, in complex orbital fractures, manipulation of disjunct fragments may apply pressure to the orbital contents and induce new entrapment in an otherwise non-operative orbital floor fracture. Here we present the only described case of new extraocular muscle entrapment after open reduction and fixation of a supraorbital rim and frontal sinus fractures and emphasize the need for careful assessment after repair of such a fracture to ensure that new entrapment has not occurred.

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