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The orbital branch of the infraorbital artery is an important surgical landmark but is frequently omitted from texts that discuss orbital anatomy and surgical technique. This report reviews the anatomy of this artery to familiarize the reader with its existence and location to reduce the risk of intraoperative hemorrhage from this vessel.
A method of lateral orbital rim advancement is described for periorbital deformities associated with coronal and metopic synostosis in infants. The technique offers the advantages of a smooth lateral rim contour and improvement in accompanying malar recession. In 13 patients with follow-up periods of up to 2 years following surgery, improved orbital contour has been appreciated. Further observation is warranted to determine whether this improvement will last into adulthood.
A case with orbital dermoid adherent to a tooth in the frontal bone is discussed. The X-ray exam showed dental abnormalities in the same patient. Because of the presence of true bone we considered the correct diagnosis is orbital teratoma.
Micro-orbitism which follows the very early arrested development of the optic vesicles hinders the fitting of a prosthesis. A total enlargement of the orbit is proposed which restores the normal dimensions and enables facial symmetry to be re-established. The risks and advantages of this procedure are discussed.
54 years old male presented with an injury to the face. As a result of this incident, some pieces of glass were penetrating into the left orbit. Total ophthalmoplegia and hematoma with exophthalmus in the left orbit were observed. The difficulties of radiology and clinical diagnosis was described. The circumstances of accident were wrong reported by the patient. Radiograms and computed tomography (CT) were misdiagnosed. As a result of theses, it was necessary to perform two times operation. The best useful but not ideally in diagnostic was NMR. Consultation and collaboration with oculist, radiologist, neurologist and maxillofacial surgeon is often useful.
The zygomatic bone plays an important role in keeping an esthetic and functional balance of the midface. A high number of traumas in the region induces a continuous improvement of diagnostic and therapeutic methods used in fracture management. The material for the studies constituted of 61 patients, treated between 1996 and 2001 at the 1st Department of Maxillofacial Surgery of Silesian Medical University in Zabrze. Zygomatico-orbital and zygomatico-maxillo-orbital fractures were the reasons for hospitalization. All fractures were managed by open reduction and plate fixation. There were 4 women and 57 men aged 14-66 in this group. The analysis was carried out in two stages. Case histories from the hospital and outpatient department were analyzed retrospectively during the first stage. Early therapeutic results were estimated. Prospective analysis was carried out during the second stage of the research. Patients were called for the routine control postoperative examination. Forty three patients came forward. Their subjective ailments after operation were collected. Possible abnormalities were determined in clinical and roentgenological examination. Remote therapeutic results were estimated. On the basis of the analysis it has been found that the use of possibly the least number of plate osteosynthesis, larger than four holed ones, assures the optimal therapeutic result in follow-ups and shortens the time of hospitalization. The place of osteosynthesis application affects the final therapeutic result. High stability of plate osteosynthesis results in fact that bone fragments reduced and fixed with plates do not change the initial location. The efficacy of the method was proved by the results obtained in remote observations.
Aspergilloma is a fungal ball that usually forms in a preformed stationary cavity, mostly in lung and paranasal sinuses. We report a rare case of primary orbital Aspergilloma following exenteration for an invasive ocular surface squamous neoplasia, clinically mimicking a recurrence of the tumor. The fungal ball showed the presence of conidiophores with a globular head and a complete row of uni and biserrate phialides, suggestive of Aspergillus flavus species. The exposure to air in the orbit, possibly promoted the formation of conidiophores, which are normally seen when the organism is located in air cavities.
The author's experience, limited to some twenty operations, mirrors the great experience of other clinics. The need to be aware of compressive optic neuropathy (CON) in endocrine-related orbital disease (EROD) is outlined. The value of orbital decompression in CON, severe corneal exposure and cosmetically unacceptable proptosis is mentioned. The author's technique is outlined. Three illustrative cases are briefly described.
In severe cases of microphthalmos or anophthalmos, the bony orbital cavity is often too small to allow one to create a satisfactory socket for a prosthesis. An omnidirectional expansion of the orbit, by osteotomies done in a step-like fashion, allows the creation of a larger bony cavity and improves the symmetry of the face. The risks of the craniotomy and of the mobilization of the free bone pieces are discussed.
A case of 72 years old man, diabetic, suffering from phlegmonous cellulitis with orbital veins and sinus cavernous thrombophlebitis as a nasal vestibule furuncle complication is presented. Apart from the application of antibiotics and surgical procedure, the patient was treated from beginning with thrombolytics specimen, fraxiparine. The methods of treatment of cavernous sinus thrombosis with thrombolytic specimens evoke in the literature controversial opinions. In the author's opinion the early application of fraxiparine in presented case could be regarded as responsible for stopping the process orbital veins and sinus cavernous thrombosis and even causing it to recess. The complete cure without complications (e.g. blindness) is attributed by the authors to the anticoagulation treatment. The authors also stress that fraxiparine may by used for treatment of cavernous sinus thrombophlebitis even when the surgical procedure is planned.
CT is valuable to complete ultrasound findings in the evaluation of tumors of the eyeball. Tumoral and nontumoral space-occupying lesions and malformations of the orbit and the exact demarcation of these conditions within the periorbital structures are well demonstrated. In several different pathological conditions the CT appearances are often similar and only sometimes characteristic. Additional clinical data are helpful in giving hints for the diagnostic differentiation of the CT findings.
We carried out Hartree-Fock (HF) and density functional theory calculations for 61 compounds, the conjugated bases of carboxylic acids, phenols, and alcohols, and analyzed their acid-base behavior using molecular orbital (MO) energies and their dependence on solvent effects. Despite the well-known correlation between highest-occupied MO (HOMO) energies and pKa, we observed that HOMO energies are inadequate to describe the acid-base behavior of these compounds. Therefore, we established a criterion to identify the best frontier MO for describing pKa values and also to understand why the HOMO approach fails. The MO that fits our criterion provided very good correlations with pKa values, much better than those obtained by HOMO energies. Since they are the frontier molecular orbitals that drive the acid-base reactions in each compound, they were called frontier effective-for-reaction MOs, or FERMOs. By use of the FERMO concept, the reactions that are HOMO driven, and those that are not, can be better explained, independently from the calculation method used, as both HF and Kohn-Sham methodologies lead to the same FERMO.
The nuclear orbital plus molecular orbital (NOMO) theory was developed in order to determine the nonadiabatic nuclear and electronic wave functions. This study presents a formulation to remove the contamination of rotational motion as well as translational motion in the NOMO theory. We have formulated the translation- and rotation-free (TRF)-NOMO theory by introducing the TRF Hamiltonian. The principal moment of inertia, which is the denominator in the rotational Hamiltonian, is expanded in a Taylor series. The zeroth-order of the Taylor expansion corresponds to a rigid-body rotator. The first-order terms contribute the coupling between the vibration and the rotation. Hartree-Fock equations have been derived in the framework of the TRF-NOMO theory. Numerical assessments, which were preformed for H2, D2, T2, mu2 (muon dimmer), and H2O, confirmed the importance of the TRF treatment.
The translation- and rotation-free nuclear orbital plus molecular orbital (TRF-NOMO) theory was developed to determine the nonadiabatic nuclear and electronic wave functions. This study presents a formulation of TRF-NOMO second-order Moller-Plesset (MP2) perturbation and Epstein-Nesbet (EN) theory with the use of the TRF Hamiltonian. Numerical assessment of the TRF-NOMO/MP2 and EN is performed for several molecules. We confirm the importance of the elimination of translational and rotational motions in the many-body calculations.
A 62-year-old woman presented with a 10-week history of blurred vision in the left eye. Examination revealed mild limitation of upgaze of the left eye and evidence of a left optic neuropathy. Magnetic resonance imaging revealed an enhancing mass in the posteromedial left orbit as well as an enhancing lesion in the inferior occipital lobe. The patient underwent a left orbital biopsy and partial decompression via a left nasal endoscopic approach, following which the optic neuropathy improved significantly. Histopathologic examination yielded a diagnosis of carcinoid tumor. Biopsy of the occipital lesion was also consistent with this diagnosis. The primary tumor was found in the lungs.
Radical tumour removal in the region of the anterior skull base with involvement of the orbit requires not only good exposure but also acceptable reconstruction with good cosmesis, no visible scars and no injury to the eye. The possible approaches, which should be flexible and adapted to the location and extent of the pathology and the appropriate methods of reconstruction, are illustrated by four patients. The relevant literature is reviewed. Emphasis on the need for a 3-dimensional concept in the reconstruction and the importance of a multi disciplinary team is stressed.
Three cases are presented of subperiosteal hematomas, which can be thought of as epidural hematomas of the orbit. One occurred in a child associated with an episode of violent vomiting, the second in an adult with a history of remote head trauma who presented with a slowly progressive course suggestive of thyroid eye disease, and the third in a young patient after acute trauma probably associated with the injections of a local anesthetic agent or possibly the passage of a deep suture. Skull x-rays, computed tomography, and ultrasonographic examinations detected and localized the lesion in each case. Both patients who were operated on enjoyed prompt and total resolution of their symptoms after surgical extirpation of the lesion. In the third patient, the lesion regressed on its own.
We examined a 53-year-old man who had diplopia and proptosis of the right eye. Computed axial tomography showed a mass extending from the retrobulbar space to the apex and the lower portion of the right orbit. The tumor removed by the first operation from the retrobulbar space was diagnosed as leiomyoma. The mass palpated through the tissues of the lower right eyelid in the initial examination enlarged 7 months after the first operation. The tumor specimen subsequently obtained from this portion histologically revealed inflammatory pseudotumor. Therefore it was concluded that this patient had a leiomyoma accompanied by an inflammatory pseudotumor ipsilaterally.