Microsurgical reconstruction of the skull base and midface after orbitomaxillary resections for malignant tumors

Background. Orbitomaxillary resection includes exenteration of the orbital contents with resection of the inferior orbital and medial walls. The main goals are: reconstruction of soft tissue and bone structure defects, tamponade of the orbital cavity and/or its preparation for further ocular prosthetics, and reconstruction of the skull base defect. The purpose of the study to present the immediate results of orbitomaxillary resections in patients with malignant neoplasms of the skull base and midface. Material and methods. Between 2014 and 2020, 6 patients who previously underwent surgery for primary cancer (n=3) and recurrent cancer (n=3) were treated at the Head and Neck cancer department of N.N. Blokhin National medical Research center of oncology. To reconstruct defects after resection of bone structures (maxilla, frontal and nasal bones) and skin, a musculocutaneous alt-flap was used in 3 (50 %) cases and a fascial skin radial flap in 3 (50 %) cases. Results. The aesthetic result was assessed in 6 patients. In all cases, a satisfactory result was obtained. None of the patients who underwent resection of the dura mater followed by reconstruction had no symptoms of liquorrhea in the postoperative period. Conclusion. Flap selection depends on the defect size. In cases with a small defect size (up to 70 cm3), reconstruction with the radial fascial skin flap can be performed. If the defect size is more than 71 cm3, reconstruction with musculocutaneous alt flap can be the method of choice.

Displaced Orbital Fractures with Concurrent Orbital Compartment Syndrome: A Case-Based Systematic Review

Orbital compartment syndrome (OCS) is an emergency that complicates intra-orbital, retrobulbar hemorrhage in most cases. Bony orbital decompression is an effective treatment for OCS, and displaced orbital fractures are protective. Nevertheless, in rare cases, OCS occurs despite a displaced orbital fracture. The aim of the current review is to present its pathophysiology and management based on what is published in the medical literature, and our center's experience. A systematic review of literature was conducted through PubMed, Medline, Embase, and Cochrane from inception through February 2021. The following search query was used: “orbital fracture” and “trauma” and “orbital compartment syndrome.” Studies tackling the pathophysiology and management of concurrent displaced orbital fracture with OCS were included and a cohort of patients was constituted. A cohort of 18 cases reported in the literature were included (49.3 ± 30.6 years, 50% M). Given that OCS occurs with or without orbital fracture, pathophysiology of OCS is mostly explained by the division of the orbital fat into many compartments, due to the presence of Koorneef's fibrous septa. Management of OCS in such circumstances consisted of inferior-lateral canthotomy and cantholysis in 50% of cases, subperiosteal drainage with myringotomy in 22.2% of cases, subperiosteal drainage in 16.7% of cases, and complete lateral cantholysis in 16.7% of cases. Two cases who presented to our tertiary care center were also added to this review. Physicians should be aware that OCS can occur even with displaced fractures of the orbital cavity. When clinical suspicion is present, an emergent management is needed.

MR IMAGING OF RHINO-ORBITAL-CEREBRAL MUCORMYCOSIS IN POST COVID PATIENT: CASE SERIES

Rhino-orbital-cerebral Mucormycosis also known as orbital zygomycosis. It is a life-threatening deadly complication in post covid patient presenting as pathological involvement of nasal cavity and paranasal sinuses with extension into orbital cavity and intracranial compartment as a result of fungal infection caused by fungi in the order Mucorales, mainly Rhizopus oryzae. MATERIAL AND METHOD We present a case series of 5 patient who were biopsy/culture proven invasive rhino cerebral Mucormycosis in post covid-19 patient who were reviewed on MR imaging. MR imaging were recovered from PACS in PMCH Patna and the data was analyzed. RESULT Involvement of para nasal sinuses with adjacent fat standing was present in 100%, orbital involvement was seen in 80%, intracerebral involvement was seen in 60%, mastoiditis was present in 40% of the patient selected in our case series. CONCLUSION MR imaging is helpful in early diagnosis when there is involvement of nasal, paranasal sinus and varying degree of orbital and cranial extension and associated with varying complication

Cavernous Hemangioma in the Orbital Cavity: Case Report

Cavernous hemangiomas are benign malformations of vascular origin, usually well circumscribed and slow to grow. These lesions can be asymptomatic, being discovered unintentionally in imaging exams or symptomatic, indicated mainly by the presence of proptosis, diplopia, and visual disturbances by optic nerve compression. The complementary exams involve computed tomography associated with contrast, color Doppler, magnetic resonance, and angiography. Treatment can be conservative or surgical depending on the case, and the open therapy usually involves lateral, supraorbital, transconjunctival, transantral, pterional, transnasal, and extradural endoscopic orbitotomy. The present study aims to report a recurrent case of hemangioma in the orbital cavity signaled by ocular proptosis, hyperemia, and ocular pain.The lesion was achieved through the Weber-Ferguson access with zygomatic osteotomy and preservation of the infraorbital nerve. The excision of the lesion was performed, and the previously displaced fragments were fixed with 1.5 mm mini plates. The patient has a chance of progressing with visual impairment due to considerable manipulation of the optic nerve and is being followed up.The reported case showed a successful diagnosis and therapeutic conduct, remaining now in the evolution and follow-up scenario.

Oculocerebrocutaneous Syndrome (Delleman Syndrome): A Case with a Novel Presentation of Orbital Involvement

Oculocerebrocutaneous syndrome (OCCS), also known as Delleman syndrome (DS), is a rare congenital anomaly featuring focal skin defects, orbital anomalies, and central nervous system malformations. Diagnosis of Delleman syndrome is based on the triad of eye, central nervous system (CNS), and cutaneous defects and confirmed by magnetic resonance imaging. A 23-day-old girl was referred to our department for brain imaging. The infant had multiple cutaneous appendages on the right side of her face. There also was a fleshy mass measuring about 12 mm over her right eye. Brain MRI demonstrated the evidence of colpocephaly, agenesis of the corpus callosum, nodular subependymal heterotopias adjacent to the right lateral ventricle, aplasia of the cerebellar vermis, hypoplasia of the right cerebellar hemisphere, and widening of CSF space in the posterior fossa. There was also an exophytic skin lesion on her right cheek, measuring about 13 × 12 mm in size. In the orbital MRI, there was a mixed cystic solid mass measuring about 25 × 20 mm in her right orbital cavity. The orbital content was abnormal and suggestive of rudimentary orbit. Considering the findings, diagnosis of oculocerebrocutaneous syndrome (Delleman syndrome) was established for the patient. Because of the variations in orbital and CNS manifestations, all patients with clinical suspicion of DS should be assessed by brain and orbital MRI and managed by a pediatric neurologist and ophthalmologist.

Frontoethmoid mucocele: a case report

<p>Mucoceles are cystic lesions of the paranasal sinuses that develop as a result of mucous secretion accumulation due to sinus ostium obstruction, Mucoceles are most common in the frontal and ethmoidal sinuses, and they affect both men and women equally in may become infected and spread to the orbital cavity, compressing the orbit by eroding the orbital cavity's bony walls. In surgical treatment, endoscopic approach we are used, we present a case of a complicated ethmoid mucocele that eroded the orbital wall and spread into the orbital cavity, and we discuss surgical treatment options in light of the existing literature.</p>

Post Natal Gross Anatomical Studies on the Harderian Gland of Pati Duck (Anas platyrhynchos domesticus) of Assam

Background: The agro-climatic condition of Assam is suitable for duck rearing. Duck rearing contributes a major part to uplift the socio-economic condition of the rural poor people of Assam as well as others states located in the coastal regions of India. The Pati duck (Anasplatyrhynchos domesticus) population constitutes a major indigenous non-descript economically important duck variety in the state of Assam. The Harderian gland acts as a part of the Head Associated Lymphoid Tissue (HALT) Olah et al. (1992) and provides local innate immunity to the upper respiratory system, to the eye and oral cavity. Since literature on the postnatal development of Harderian gland of Pati duck is scant, hence the present study was designed to establish the basic anatomical details on Harderian gland at different stages of postnatal development of Pati duck of Assam. Methods: The present study was conducted on total forty five (45) numbers Pati duck of Assam at different stages of postnatal development. The experimental birds were brought to the Department of Anatomy and Histology, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati-22 and was sacrificed according to the method of Gracy (1986). After slaughter, the birds were placed on a clean dissecting table and skin and fascia were reflected carefully without disturbing the other organs of the head region. The Harderian gland was collected by opening the orbital cavity. Thereafter, length, breadth and thickness of the Harderian gland of all age group were recorded with the help of the Vernier Callipers (McCance, 1974) and topographical location of the gland was observed. The weight of the Harderian gland of all age group was also recorded with the help of electronic balance. Result: The Harderian gland of Pati duck (Anas platyrhynchos domesticus) was located within the orbit. The gland was flat, oval and coma shaped with irregular border. The gland had two surfaces i.e. the parietal and visceral surfaces, two borders and two blunt poles. The parietal surface was found convex and attached to fascia covered by the nasal bones and interorbital septa. The visceral surface was concave and it was attached loosely to the eye ball with fascia. The lobes of the Harderian gland became more prominent with the advancement of the age. The gland was light pink in colour. The arterial blood and the venus drainage was by provided by the ophthalmic artery and vein, respectively. The slender branch of oculomotor nerve innervated the Harderian gland. The result reflected an ascending trend from 0 week age group to 42 week age group in regard to all the gross parameters. There were slight difference between left and right glands for all the gross parameters but such variations were not statistically significant (P greater than 0.05). Each lobe of the Harderian Gland of Pati duck (Anas platyrhynchos domesticus) had a single short duct which opened into the conjunctival sac at the base of the 3rd eyelid.

THE USE OF ALLOTRANSPLANT FROM THE SUBCUTANEOUS FAT WITH PLANTAR APONEUROSIS FOR THE MUSCULOSKELETAL STUMP FORMATION DURING ENUCLEATION

Objective. To develop a method for the formation of a musculoskeletal stump for an ocular prosthesis during enucleation using an allograft from subcutaneous fat with a plantar aponeurosis was developed Methods. The study included patients with the diagnosed choroid melanoma (n=15), and retinoblastoma (n=2). The orbital cavity was replenished with the section of subcutaneous adipose tissue with the sole aponeurosis, preserved by cryopreservation. The orbital cavity was filled with a section of subcutaneous adipose tissue with plantar aponeurosis, preserved by cryopreservation. The immediate effect was assessed 3 and 6 months after the treatment according to the following criteria: the presence of the orbital tissues edema, the mobility of the supporting stump with the prosthesis, the position of the stump with the prosthesis in the orbit, and the position of the upper eyelid. Results. In all cases, a positive result was obtained: after 3 months, the orbital tissue edema was absent in 7 patients, in 7 - it was mild, in 3 - it was moderately pronounced. After 6 months, the orbital tissue edema was absent in all patients. After 3 months the mobility of the supporting stump was moderately marked in 10 patients, and in 7 - it was feeble marked. After 6 months, the mobility of the stump was marked moderately in all patients. After 3 months in 7 patients, the position of the stump with the prosthesis had a symmetrical position; there was hypereffect in 10 patients. By 6 months, all patients had a symmetrical arrangement of the healthy eye and prosthesis. Conclusion. The designed method for the formation of the functional stump for an ocular prosthesis during enucleation using the allograft from subcutaneous fat with the plantar aponeurosis makes it possible to obtain good anatomical, cosmetic and functional results of the operation due to the achievement of a sufficient rangeofprosthetic movement of the ocular prosthesis. The introduction of the designed method of the functional stump formation into clinical practice increases the medical, social, economic efficiency of the rehabilitation of patients with malignant neoplasms of the eyeball membranes. What this paper adds For the first time, a method for the formation of a musculoskeletal stump for an ocular prosthesis during enucleation using an allograft from subcutaneous fat with a plantar aponeurosis was developed. It is shown that the allograft application makes it possible to obtain a good anatomical, cosmetic and functional result by achieving a sufficient rangeofprosthetic movement of the eye prosthesis.

Juvenile ossifying fibroma of the orbit: a rare location

<p class="abstract">Osseous tumors in the craniofacial skeleton of young patients are not very frequent, and tumors involving the walls of the orbital cavity are even more infrequent. Despite being usually slow-growing, even small neoformations can have a local aggressive behavior, displacing and compressing vital structures, and so it is important to perform an early diagnosis in order to avoid the tumor to pose problems on the optic nerve and threaten vision. The case that we are presenting shows an ossifying fibroma in a 19-year-old male from Ethiopia, a benign lesion whose progressive growth caused proptosis and downward displacement of the left eye. Following an adequate radiological diagnosis, we were able to delimit the fibroma existence and location. The surgery was conducted in a conservative form, allowing the patient not to suffer from post-surgery malformations. Histopathological diagnosis was compatible with juvenile ossifying fibroma, psammomatoid variant, arising from an uncommon location – the roof of the orbit. </p>