Transcaruncular orbital decompression: an alternative procedure for graves ophthalmopathy with compressive optic neuropathy.
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Biomedical subjects
Publications and source records attributed to C Robert Bernardino.
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OBJECTIVE: To describe a simplified technique of zygomatic fracture repair. DESIGN: Retrospective, noncomparative case series with description of a surgical technique. PARTICIPANTS: Twenty consecutive patients with zygomatic fractures undergoing repair with the described technique. INTERVENTION: Fracture repair was accomplished with a technique that used a T-bar screw for reduction through a transconjunctival approach. MAIN OUTCOME MEASURE: Successful fracture reduction. RESULTS: Twenty patients with zygomatic fractures underwent successful reduction with the simplified technique. No complications were observed. CONCLUSIONS: The use of the T-bar through a transconjunctival approach is a simplified and effective technique for zygomatic fracture repair.
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PURPOSE: To report a case of unilateral proptosis and chronic pansinusitis in which the diagnosis of pneumocele was made. DESIGN: Observational case report. METHODS: A retrospective chart review was made. RESULTS: A 52-year-old man with chronic pansinusitis presented with a 5-mm proptosis and a larger palpebral fissure in the left eye. Computed tomography imaging demonstrated an air-filled mass originating from the frontal sinus and protruding into the orbit. After endoscopic sinusotomy and excision of the mucosal sac through anterior orbitotomy, proptosis improved to 3 mm and palpebral fissures became symmetric. CONCLUSIONS: A pneumocele is a rare lesion of the paranasal sinuses that may expand into the orbit and may present with proptosis or motility deficit to the ophthalmologist. Through proper diagnosis and surgical management, the orbital symptoms will resolve.
PURPOSE OF REVIEW: To evaluate the recent developments in the evaluation and treatment of orbital trauma from April 2003 to March 2004. The scope of orbital trauma included a MEDLINE search under the keywords of zygoma and orbital fracture, and traumatic optic neuropathy. RECENT FINDINGS: Preoperative volume assessment with computed tomography of orbital fractures can help surgical planning of volume replacement. Ultrasonography can visualize anterior orbital fractures, including rim and zygoma trauma. Orbital trauma has a high incidence of concurrent ocular trauma. Fractures in the presence of the oculocardiac reflex, persistence nausea/vomiting, or entrapped soft tissue require urgent repair. Endoscopic-assisted repair of orbital fractures offers an alternative approach to orbital fracture repair. SUMMARY: Advances in ultrasonography and computed tomography allow better visualization of orbital fractures for better preoperative evaluation and intraoperative repair. Progress in endoscopic techniques offers alternatives in orbital fracture repair. New materials allow for options in orbital reconstruction. Unfortunately, few advances in the management of traumatic optic neuropathy were found in this review.
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PURPOSE: Hydrogel is a biocompatible osmotic expansile material used in contact lenses, scleral buckles, and orbital expanders. Three unique complications from hydrogel scleral buckle use are presented: orbital cellulitis mimicry, fornical shortening with orbital prosthetic intolerance, and orbital pseudotumor. METHODS: A retrospective chart review was conducted on three subjects with unknown hydrogel scleral buckle complications at a tertiary care oculoplastics practice. Demographics, imaging studies, and pathologic specimens were reviewed. RESULTS: All three patients had a history of encircling hydrogel scleral buckle placed for retinal detachment. The mean time from implantation to presentation was 10.7 years (range, 7 to 15 years). One patient had an onset of presumed orbital cellulitis caused by an enlarged buckle and no abscess. The second patient had inability to wear an evisceration prosthesis as the result of a shortened fornix from an enlarged hydrogel scleral buckle implant. The third patient presented with an orbital mass caused by the enlarged implant. In all cases, surgical removal of the expanded buckle relieved the patient's symptoms. CONCLUSIONS: Although the hydrogel scleral band is designed to expand in a controlled fashion, overexpansion can occur. Expansion can cause buckle extrusion, prosthetic intolerance, a pseudo-orbital cellulitis, or orbital pseudotumor and may be due to a chemical change in the hydrogel polymer. Patients with hydrogel scleral buckles should be followed long-term for possible complications. Patients with newer uses of hydrogel, such as orbital expanders, should also be observed for long-term complications.