Orbital cholesterol granuloma: a retrospective case series

Background To review the clinical features, radiographic features, therapy, pathological features and prognosis of orbital cholesterol granuloma(CG). Methods Twelve patients with orbital CG who were referred to Tianjin Eye Hospital between January 2002 and December 2020 were include in this retrospective case series study. Data collected included patient ophthalmic manifestations, imaging finding, treatment strategies, pathological features and prognosis were retrospectively reviewed. Results The patients comprised 10 males and 2 females. The mean age was 34.5±8.9 years(range 16 to 45 years). Four patients had a history of orbital trauma. The clinical manifestations at first visit were proptosis ( 7/12, 58.3%), periorbital or eyelids swelling (6/12,50%), limitation of eye displacement (4/12,33.3%), ptosis(2/12,16.7%), decreased visual acuity (1/12,8.3%).CT showed a non-enhancing,well-circumscribed lesion in the orbit with extensive erosion of the adjacent frontal bone and temporal bone.MRI showed a non-enhancing mass with intermediate to high signal intensity on T1- and T2-weighted imaging. Ten patients underwent lateral orbitotomy, and two patient underwent supraorbital orbitotomy,.All patients had aggressive bone erosion. Histopathologic evaluation of the cyst contents and wall revealed cholesterol clefts,multinucleated giant cells,histiocytes, foamy macrophages,and altered blood pigments. The median recurrence time of 79.6±49.8 months (range 19 month to 193 months). Three patients were lost to follow-up. No postoperative diminution of vision was noted,and no recurrence was observed. Conclusions Cholesterol granulomas can present as superiotemporal or temporal orbital lesions. The diagnosis can be established based on CT and MRI. Most of patients can have no history of orbital trauma.

Radiological characteristics of mixed composition intraorbital foreign body

Orbital trauma is commonly complicated by retention of intraorbital foreign bodies. A 39-year-old man presented following a penetrating injury to the right orbit, with CT evidence of foreign bodies in the right anterior and posterior medial orbit. The foreign bodies were found to be a mixed composition of metal and wood. Characterising wood on CT imaging is difficult due to its radiolucency and low density, which can be mistaken for air in the setting of traumatic orbital emphysema. Increasing the window width on bone window settings can be used to distinguish wood from air, which is crucial for facilitating its complete surgical removal.

Introduction of 3D Printing in a German Municipal Hospital—Practice Guide for CMF Surgery

Study Design: This study aimed to introduce 3D printing in a municipal hospital to improve the treatment of craniomaxillofacial patients and optimize costs and operating time. Thus we describe the implementation of low-cost in-house 3D printing to facilitate orbital- and mandible reconstruction in CMF surgery. Moreover, we address legal requirements, safety at work, fire- and data protection. Finally, we want to share our experiences using 3D printing and point out its advantages in providing better patient care. Methods: We outline the setup of in-house 3D printing and focus on obeying German health care regulations. We based our approach on a fused deposition modeling 3D printer and free software. As proof of concept, we treated 4 cases of severe orbital trauma and 1 case of mandibular reconstruction. We printed a 3D patient-specific model for each case and adapted a titanium mesh implant, respectively, a titanium reconstruction plate before performing the surgery. Results: Our approach reduced costs, duration of anesthesia, operating time, recovery time, and postoperative swelling and increased the revenue. Functional outcome in orbital reconstruction like eye movement and double vision, was improved compared to the conventional technique. No severe complications like loss-of-vision or surgical revision occurred. Likewise, mandibular reconstruction showed no plate loosening or plate fracture. Conclusion: The implementation of cost-efficient 3D printing resulted in successful patient treatment with excellent outcomes. Our practice guide offers a 3D printing workflow and could be adapted to fit the needs of other specialties like neurosurgery, orthopedic surgery as well.

Epidemiology of Orbital Fractures in a Large Hospital in the Netherlands: Results of Implementation of a Multidisciplinary Orbital Trauma Team

Introduction: This study aims to describe the epidemiology, aetiology and therapy of orbital fractures in a large municipal hospital in The Hague, the Netherlands, and to demonstrate the effectiveness of an integrated approach of orbital trauma care with a team consisting of an ophthalmologist, an orthoptist and an oral and maxillofacial (OMF) surgeon. Methods: We obtained data from patients with an orbital fracture between June 2015 until July 2018. Primary outcomes were the classification of orbital fractures and treatment (conservative or surgical). Results: 182 patients were included in this study. The most common type of orbital fracture was an isolated orbital floor fracture (n=56, 30.8%). In most cases, therapy was conservative (69.2%). When surgical repair was indicated, a polydioxanone (PDS) plate was most commonly used (11.5%). The main cause of an orbital fracture was a fall accident (38.5%), followed by assault (32.4%). 32.4% of the patients were intoxicated with alcohol. Conclusion: In our study population, almost 70% (69.2%) of the patients were treated conservatively in our study. Compared to the international literature, this percentage is considerably higher than in other studies. In our opinion, our integrated approach to orbital trauma has led to a justifiable reduction of the proportion of cases receiving surgical intervention in orbital fractures. We would like to advocate the implementation of a similar team in other hospitals to improve the quality and cost-effectiveness of treatment in patients with orbital fractures.

Incidence of Ocular, Adnexal and Orbital Trauma at Different Tertiary Care Centers of Karachi.

Purpose:To assess the incidence of ocular trauma resulting from various inciting agents presenting at three large centers of Karachi, Pakistan.Method:Patients with ocular trauma were recruited at the three centers over a period of three months, in this study. Any other ocular disease was excluded. After informed consent, history and examination was done. A proforma was filled for every patient. The various inciting agents were identified and incidence of the different types of ocular damage found. Trauma scoring was also done according to the Ocular Trauma Score.Results:A total of 343 patients with trauma presenting at different tertiary centres including DIMC 38 (11%), JPMC 150 (44%) and IPIO 155 (45%). Male predominance was found overall. Patients presented with different forms of injuries at the three centers. Commonest presentation at IPIO was of keratitis, at JPMC of road traffic accidents and at DIMC of corneal and conjunctival foreign body impaction. Most of the patients fell at grade 5 of Ocular Trauma Score.Conclusion:This study showed that the type of inciting agents were different at the three centers respective to their location, surrounding workplaces and the authority of the hospital to attend to medicolegal cases.

Influence of the Neural Crest Derived Stem Cells to Optic Nerve Regeneration After Its Experimental Injury

Purpose: Orbital trauma is a challenging problem due to such severe sequel as diplopia, decrease of vision or eye motility disorder. However, the conditions of orbital soft tissue content still become underestimated. The aim of this study was to investigate structural changes in the rat optic nerve after experimental injury followed by treatment with stem cells. Materials and Ьethods: An experimental model of injury to the orbital soft tissue content in the rat was developed. Forty Wistar rats maintained under daylight were divided into two equal experimental groups. Unlike the rats of Group I, in rats of Group II, the site of injury to the orbital soft tissue mass received postnatal multipotent stem cells, epidermal neural crest stem cells (NCSCs) derived from the bulge of hair follicles. Results: Comparing the number of glial cells per certain area of the slice (NC) between group І and site without injury (control) after 3 week of observation, it was higher in group I more than 258.8% (p < 0.0001) and on 272.4% in group II (p < 0.0001). After 6 weeks NC in group I was higher than at previous terms: more then 128.9% (р < 0.0001). At the same, NC in group II was higher comparing with previous terms only on 17.1% (р = 0.0212). Between the animals of group I at terms of 12 and 24 weeks NC high and wasn’t significantly differ between this terms of observation (ANOVA p = 0.4379). In contrast, NC in group II stopped rising between 6 and 12 weeks demonstrating statistical equality (p = 0.4563). Conclusions: It can be assumed that the application of mesenchymal stem cells, derivates of the neural crest, after the experimental orbital trauma, stimulates a recovery of the optic nerve. Further studies should be performed to more deeply discover the neural crest derived stem cell populations, ivoleved into recovery of damaged optic nerves.