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At least 433 records · Page 24Linked to original sources

PubMed2001

Cadaveric study of blood supply to the lower intraorbital fat: etiologic relevance to the complication of anaerobic cellulitis in orbital floor fracture.

BACKGROUND AND PURPOSE: Although orbital fractures are common, orbital cellulitis rarely develops following orbital fracture. We hypothesized that compromise of the blood supply to the intraorbital fat during orbital floor fracture is responsible for this condition. The purpose of this study was to determine whether or not the lower intraorbital fat is supplied by a branch of the infraorbital artery along the orbital groove or canal on the orbital floor. MATERIALS AND METHODS: We dissected 14 orbits from seven fixed human cadavers and 12 orbits from six fresh cadaver heads following dye injection into the maxillary artery. The sites of dye-filled vessels branching from the infraorbital artery supplying the lower intraorbital fat were measured and plotted on a two-dimensional orbital floor graph. RESULTS: A main branch of the infraorbital artery rose through the medial orbital floor to supply the lower intraorbital fat in all of the cadaver orbits. The sites of the branching point of the vessel ranged from 0 to 5 mm (mean, 2.2 mm; n = 14) medial to the line connecting the infraorbital foramen and the infraorbital groove. The shortest distance measured from the branching point to the orbital rim ranged from 3 to 20 mm (mean, 14.1 mm; n = 14). This suggests that if orbital fracture were to occur around the infraorbital groove or canal, this vascular pedicle would be in danger of being incarcerated by bone fragments. CONCLUSION: Our cadaveric investigation revealed that the lower intraorbital fat is supplied by a branch of the infraorbital artery along the infraorbital groove or canal on the orbital floor. This finding suggests that compromised blood supply to the intraorbital fat may cause anaerobic cellulitis or enophthalmos.

Adipose Tissue↗

PubMed2005

Understanding glycine conformation through molecular orbitals.

The four most stable C(s) conformers of glycine have been investigated using a variety of quantum-mechanical methods based on Hartree-Fock theory, density-functional theory (B3LYP and statistical average of orbital potential), and electron propagation (OVGF) treatments. Information obtained from these models were analyzed in coordinate and momentum spaces using dual space analysis to provide insight based on orbitals into the bonding mechanisms of glycine conformers, which are generated by rotation of C-O(H) (II), C-C (III), and C-N (IV) bonds from the global minimum structure (I). Wave functions generated from the B3LYP/TZVP model revealed that each rotation produced a unique set of fingerprint orbitals that correspond to a specific group of outer valence orbitals, generally of a' symmetry. Orbitals 14a', 13a', 12a', and 11a' are identified as the fingerprint orbitals for the C-O(H) (II) rotation, whereas fingerprint orbitals for the C-C (III) bond rotation are located as 16a' [highest occupied molecular orbital (HOMO)], 15a' [next highest molecular occupied molecular orbital (NHOMO)], 14a', and 12a' orbitals. Fingerprint orbitals for IV generated by the combined rotations around the C-C, C-O(H), and C-N bonds are found as 16a', 15a', 14a', 13a', and 11a', as well as in orbitals 2a" and 1a". Orbital 14a' is identified as the fingerprint orbital for all three conformational processes, as it is the only orbital in the outer valence region which is significantly affected by the conformational processes regardless rotation of which bond. Binding energies, molecular geometries, and other molecular properties such as dipole moments calculated based on the specified treatments agree well with available experimental measurements and with previous theoretical calculation.

Electrons↗

PubMed2003

Clinical signs of orbital wall fractures as a function of anatomic location.

OBJECTIVE: The objective of this study was to see whether clinical signs of medial orbital wall fractures distinguished these fractures from fractures of the lateral orbital wall and the orbital floor. STUDY DESIGN: The orbital fractures of 424 patients were analyzed. The patients were divided into 2 groups: (1) patients with orbital fractures with a medial orbital wall component and (2) patients with orbital fractures without a medial orbital wall component. RESULTS: Orbital fractures with involvement of the medial orbital wall showed a significantly higher incidence (P =.001) of diplopia and exophthalmos (P =.039) than fractures without involvement of the medial wall. CONCLUSION: Posttraumatic orbital clinical signs are associated with a higher incidence of medial orbital wall component fracture. Apparent lack of involvement of the medial orbital wall should not be an exclusion criterion for a surgical intervention when clinical orbital signs exist.

Chi-Square Distribution↗

PubMed2003

Solitary fibrous tumor of the orbit: is it rare? Report of a case series and review of the literature.

PURPOSE: The real incidence of solitary fibrous tumor (SFT) of the orbit is unknown, but it seems that since it was first described in 1994, orbital SFT has been increasingly recognized. We believe that the orbital SFT is a relatively common tumor and that it should be considered in the differential diagnosis of any orbital tumor. DESIGN: Interventional case series. PARTICIPANTS: Four new cases of orbital SFT. METHODS: Four patients affected by solitary fibrous tumor of the orbit are described. One patient experienced a recurrent SFT shortly after initial surgical excision performed elsewhere. Thirty-eight cases have been reported in the literature in 7 years. RESULTS: The number of orbital SFTs reported has been increasing, reaching an average of more than five tumors reported per year. Since the first orbital SFT was described in 1994, 37 cases have been reported in the literature. We add four new cases in our series, including a recurrent tumor. A total of 42 cases have now been described, eight with recurrences. Malignant transformation occurred in one case. CONCLUSIONS: We believe that before 1994, the diagnosis orbital SFT was confused with other benign orbital tumors, such as fibrous histiocytoma and hemangiopericytoma because of a lack of use of immunohistochemical techniques. This entity should now be considered relatively common and should be included in the differential diagnosis of orbital tumors in any age group. Local recurrences of SFT are possible and usually follow an incomplete initial excision. Recurrent tumors in the orbit have shown the tendency to infiltrate the surrounding tissues and the bone, rendering complete secondary excision more difficult. Recurrent orbital SFT also has the potential for malignant transformation. The treatment of choice of orbital SFT is complete surgical excision and careful follow-up. Considering the more aggressive course followed by recurrent tumor, correct diagnosis and management is essential.

Adult↗

PubMed2006

[Orbital-bony decompression in patients with dysthyroid orbitopathy--first Croatian experiences].

INTRODUCTION: Dysthyroid orbitopathy or Graves's orbitopathy is an entity made of symptoms and signs found within ocular apparatus, orbit and adnexal tissue in patients with thyroid dysfunction. Orbital pathogenesis is based on organ-specific autoimmune reaction, resulting in extra ocular muscle dysfunction and retro bulbar tissue changes. These changes are characterized by different stages of orbital inflammation, swelling and passive congestion. No infiltrative or inactive stage of the disease is most commonly seen in younger population as mild, orbital inflammation, lid retraction, variable proptosis and retro bulbar discomfort. Infiltrative or active stage of the disease usually affects older people and is characterized by a broad spectrum of clinical symptoms such as moderate or severe orbital inflammation, retro bulbar pain, lid retraction, periocular edema, proptosis with corneal exposure, extra ocular muscle dysfunction, conjunctival and episcleral congestion and optic nerve compression with loss of visual acuity. The current treatment concept for dysthyroid orbitopathy is to achieve euthyroidism with antithyroid drugs, radioiodine and thyroidectomy. Subsequently, for the treatment of dysthyroid orbitopathy immunosuppressive drugs such as corticosteroids, cyclophosphamide, methotrexate, cyclosporine, octreotides, orbital radiotherapy and surgical decompression can be used. Indications for orbital decompression are differentiated as urgent and elective. Current opinion is that only severe proptosis with corneal exposure and damage and compressive optic neuropathy urge orbital bony decompression combined with aggressive medical treatment. Persistent, active orbitopathy, retro bulbar discomfort or pain and disfiguring proptosis are indications for elective orbital bony decompression. Orbital bony decompression is a surgical method based on principle of opening the confined orbital bony space and allowing herniation of orbital fat into paranasal sinuses, thus decreasing orbital pressure. PATIENTS, METHODS AND RESULTS: A series of patients surgically treated for dysthyroid orbitopathy from July 2004 till November 2005, were followed-up. The group included 8 patients previously treated for thyroid dysfunction. Five patients (10 eyes) were operated on by the "swinging eyelid" approach (group 1) and three patients (6 eyes) by "inferomedial approach" (group 2). In group 1 proptosis reduction occurred in all patients, varying from 4 to 6 mm within 6-10 months postoperatively; retrobulbar pain or discomfort decreased in all patients few days after the surgery; and 2 patients still felt numbness in the n. infraorbitalis innervation area at 10 months of follow up. In group 2, all patients had proptosis reduction by 3-4 mm within 6-10 months postoperatively; retro bulbar discomfort disappeared in all patients a few days after the surgery. In this group none of the patients complained of infraorbital numbness 6 months of the surgery. All patients filled out a brief questionnaire before and 4 months after the surgery, ranking their symptoms and complaints. CONCLUSION: Our patient series was rather small and selected, the data obtained are not representative of larger series. Based on these preliminary results and current literature data, we believe that orbital bony decompression is a highly effective, safe and quick procedure, easily adjustable to the surgeon as well as to the patient in achieving optimal results. We also believe that there is a need of better education of our patients considering the disease itself and treatment modalities through patient support groups or better physician-patient-nurse communication.

Adult↗

PubMed1996

Idiopathic granulomatous orbital inflammation.

PURPOSE: Granulomatous orbital inflammation may occur as an isolated condition of unknown origin. These idiopathic granulomatous lesions are believed to belong to the orbital pseudotumor group by some authors, whereas others consider them sarcoidosis limited to the orbit. The aim of this study is to define the clinicotherapeutic aspects of these lesions. METHODS: The records of all patients with diagnosis of orbital pseudotumor and orbital sarcoidosis from the Orbital Center Amsterdam in the period between 1976 and 1994 were reviewed to define those with idiopathic granulomatous orbital inflammation. The authors studied the clinicotherapeutic aspects and histopathology of idiopathic granulomatous orbital inflammation by analysis of their own series and the literature. RESULTS: Their study group encompassed seven patients with idiopathic granulomatous orbital inflammation. The mean follow-up was 9.5 years (range, 3.5-16.0 years). All had unilateral orbital presentation, with localization in the lacrimal gland in three patients. The lesions clinically presented with signs of mass effect or inflammation or both and were treated successfully with surgery, systemic corticosteroids, a combination of surgery and systemic corticosteroids, or systemic corticosteroids followed by irradiation. Histopathologic analysis showed a spectrum of granulomatous inflammation, admixed with nongranulomatous inflammation and fibrosis. There have been 30 similar cases described in the literature with comparable clinicotherapeutic characteristics. CONCLUSIONS: Based on this study and the literature, it appears that idiopathic granulomatous orbital inflammation is more related to orbital pseudotumor than to orbital sarcoidosis.

Acute Disease↗

PubMed2002

Differential effect of 180 degrees and 360 degrees acquisition orbits on the accuracy of SPECT imaging: quantitative evaluation in phantoms.

UNLABELLED: A circular 180 degrees acquisition orbit is considered standard for cardiac SPECT imaging. Theoretically, a 360 degrees acquisition orbit is preferred because of more complete Fourier spectral information on projection data. The differential effect of 180 degrees and 360 degrees acquisition orbits on image accuracy (homogeneity and defect size) was assessed quantitatively in phantom studies. METHODS: SPECT imaging with a dual-head gamma camera was performed on normal cardiac phantoms filled with a (99m)Tc solution, using 180 degrees and 360 degrees circular acquisition orbits. The phantoms were placed in the center of the orbit and at 5, 10, and 15 cm off center. Fillable defect inserts of different sizes were placed in the phantom to simulate myocardial perfusion defects. The homogeneity of count distribution in short-axis slices of the normal phantom was analyzed as the percentage of variability. Defects were quantified as a percentage of the entire phantom volume using circumferential count profiles and normal reference profiles. RESULTS: When normal phantoms were placed in the center of the orbit, percentage variability was not different whether a 180 degrees or 360 degrees acquisition orbit was used (4.2% +/- 0.1% vs. 4.4% +/- 0.2%, P = not statistically significant). However when normal phantoms were placed off center, SPECT imaging with a 180 degrees acquisition orbit showed increasing inhomogeneity, both visually and quantitatively (e.g., percentage variability for the 15-cm off-center position was 10.8% +/- 0.1% (P < 0.0001). SPECT imaging with a 360 degrees acquisition orbit showed similar homogeneity visually and quantitatively, whether the phantom was placed in or off the center (e.g., percentage variability for the 15-cm off-center position was 4.6% +/- 0.5%, P = not statistically significant). Quantification of phantom defects acquired with a 180 degrees orbit showed increasing overestimation of defect sizes with increasingly off-center positions. Quantification of phantom defects acquired with a 360 degrees orbit showed no effect from progressively off-center positions, although phantom defect sizes were mildly underestimated. CONCLUSION: SPECT images acquired with a 180 degrees orbit may have significant erroneous inhomogeneity and overestimation of defect size, in particular when the target object is off the center of the orbit, as is commonly seen in clinical cardiac imaging. In contrast, SPECT images acquired with a 360 degrees orbit may provide more accurate quantitative information.

Heart↗

PubMed1998

Orbital invasion in nasopharyngeal carcinoma: evaluation with computed tomography and magnetic resonance imaging.

BACKGROUND: Ocular symptoms and tumor cranial nerve involvement are commonly observed in patients with nasopharyngeal carcinoma (NPC). These are primarily due to tumor invasion of the cavernous sinus and/or skull base, as direct tumor invasion of the orbit is very rare. This study was designed to assess computed tomography (CT) and magnetic resonance imaging (MRI) in documenting orbital invasion caused by NPC, with a special emphasis on the route of orbital extension. METHODS: A total of 562 patients with histopathologically prove NPC were examined using CT and/or MRI for tumor staging or post-treatment follow-up. We retrospectively reviewed CT and MRI findings to identify tumor invasion to orbital cavities and to evaluate the pathway of tumor spread. RESULTS: Eighteen patients had tumor extension into the orbital cavities. Seventeen patients had ocular complaints. Fourteen of 18 showed unilateral orbital involvement and four patients showed bilateral orbital involvement. The route from the pterygopalatine fossa and inferior orbital fissure into the orbital cavities was the most common pathway of NPC invasion (n = 13), followed by ethmoid sinus and/or sphenoid sinus into the orbits (n = 4). In one patient, the route of orbital invasion was difficult to determine due to massive tumor extension. CONCLUSION: Direct orbital invasion is rare in NPC. The pterygopalatine fossa and inferior orbital fissure are the most common routes of invasion, followed by invasion via the ethmoid and/or sphenoid sinuses. Coronal sections best show these findings on CT or MRI. Our study also shows that either CT or MRI provide essential information in documenting orbital invasion and determining the pathway of tumor spread.

Adult↗

PubMed1979

Orbital syndromes--CT analysis of 100 cases.

100 cases of orbital syndromes, primary or secondary, are reviewed after CT analysis and compared with the results of plain and angiographic conventional examinations. First, the technique and normal results are described. Primary orbital syndromes (45 cases) originating in the orbit form three subgroups--tumors of the eyeball, tumors limited to the orbit and tumors of the orbit with bone lesions, with or without extra-orbital extension. Secondary orbital syndromes (55 cases) spreading to the orbit contain malignant tumors (36 cases) of which 25 are epitheliomas and benign tumors, the most frequent being meningiomas. For ocular and orbital tumors, CT allows the diagnosis of a mass and sometimes the pathological diagnosis (endocrine exophtalmos, inflammatory pseudotumors, varicose ophthalmic veins). For all other orbital tumors CT is important in determining the volume, relationships and extension, and does so better than carotid angiography or orbital phlebography. In secondary orbital syndromes, and particularly in facial malignant tumors and in meningiomas, CT is of great interest in the pretherapeutic evaluation of a tumor. It shows its volume and extension toward the face and orbital cavities, the pterygo-maxillary fossa (so important in determining the operability), the infra-temporal fossa and the endocranium, often without resorting to complementary investigational procedures which are much more aggressive. After histological diagnosis, CT allows the establishment of a therapeutic program.

Adult↗

PubMed1998

Contralateral coronoid process bone grafts for orbital floor reconstruction: an anatomic and clinical study.

PURPOSE: This study compares the contour of the coronoid process with the orbital floor using skulls and shows the use of this bone as a graft for orbital floor reconstruction. METHODS: Measurements and contour evaluations of the orbital floor and the contralateral mandibular coronoid process (12 right orbital floors with the lateral surface of the left coronoid process and 12 left orbital floors with the lateral surface of the right coronoid processes) were made in 24 dried adult human skulls (age, race, gender unknown) to assess the feasibility of using the mandibular coronoid process for orbital floor reconstruction. Applying the findings of this study, eight patients who had sustained either an isolated orbital floor blowout fracture (n = 2) or orbital floor compromise with an associated zygomatic bone fracture (n = 6) were treated by using their contralateral coronoid process for repair of the orbital floor. RESULTS: Anatomic Study: Measurements and contour comparisons of the right orbital floor with the left lateral cortex of the coronoid process in 12 skulls and the left orbital floor with the right lateral cortex of the coronoid process in the another 12 skulls showed a close match in contour and demension. CLINICAL STUDY: Although minimal trimming of the peripheral bony margins and medial coronoid cortical plate was needed, none of the grafts required recontouring of their lateral cortical surface in the eight patients. Postoperative radiographic studies showed a correct anatomic contour of the orbital floor. A 1-year follow-up of each patient showed no occurrence of diplopia, enophthalmia, muscle entrapment, or infection. All eight patients had transient (1 to 2 weeks) trismus. CONCLUSION: Based on the anatomic studies and clinical results, the coronoid process makes an excellent donor graft site for reconstruction of orbital floor deformities.

Adult↗

PubMed2003

Orbital reconstruction after exenteration: use of a transorbital temporal muscle flap.

Orbital exenteration is a disfiguring operation that involves the total removal of the orbital contents with partial or total excision of the eyelids. Common methods of orbit reconstruction include pectoralis musculocutaneous pedicled flap and free tissue transfer. The purpose of this study is to illustrate that the entire temporalis muscle may be used by creating a large window in the lateral orbit, without resection of the lateral orbital rim. Orbital exenteration was performed on four cadavers. A window was created in the lateral orbit using a 4-mm pineapple burr. Three parameters were measured: (1) the distance between the zygomatic arch to the superior aspect of the temporalis muscle; (2) the width of the temporalis muscle; and (3) the length and width of the lateral orbit window. The free edge of the transposed temporal muscle was then sutured to the skin edge around the bony orbit. This procedure was then performed on a 73-year-old man who had undergone right orbital exenteration for ocular melanoma and then postoperative radiation. The dimensions of the bony windows in the cadavers were as follows: mean 3.3 cm (SD +/- 0.19 cm) x 1.9 cm (SD +/- 0.18 cm), n = 4. The dimensions of the temporalis muscle in the cadavers were the following: mean 8.45 cm (SD +/- 0.60 cm) x 10.5 cm (SD +/- 0.33 cm), n = 4. In the patient, the size of the bony window was 3.7 cm x 2.1 cm (n = 1), and the dimensions of the temporalis muscle were 8.1 cm x 10.2 cm (n = 1). The patient recovered well without complication, with a well-healed skin graft over the top of the muscle flap. An adequate bony window can be made to allow transfer of the entire temporalis muscle for orbital reconstruction without resecting the lateral orbital rim or entering the middle cranial fossa. This option is a good alternative to the other commonly performed methods of orbital reconstruction because of its completion in one operative stage, short operative time, and minimal donor site morbidity.

Aged↗

PubMed1997

Transantral endoscopic orbital floor exploration: a cadaver and clinical study.

A cadaver and clinical study was performed to determine the value of transantral endoscopy in diagnosis and treatment of orbital floor fractures. Six fresh cadaver heads were dissected using a 30 degree, 4-mm endoscope through a 1 cm2 antrotomy. In the cadaver, the orbital floor and the course of the infraorbital nerve were easily identified. The infraorbital nerve serves as a reference point for evaluation of fracture size; three zones of the floor are described that are oriented relative to the infraorbital nerve. In the clinical study, nine patients with orbital floor fracture initially underwent endoscopy at the time of fracture repair: three patients had comminuted zygomatico-orbital fractures, five had monofragmented tetrapod fractures, and one had an isolated orbital blowout fracture. Endoscopic dissection of the orbital fractures revealed seven fractures with an area > 2 cm2 and two fractures with an area of < 2 cm2. The isolated orbital floor blowout fracture had entrapped periorbital tissue, which was completely reduced endoscopically. A separate patient with a < 2 cm2 displaced fracture also had stable endoscopic reduction. In the remaining seven patients, the endoscopic technique assisted with the floor reconstruction by identifying the precise fracture configuration as well as identifying the stable posterior ledge of the orbital floor fracture. There have been no complications in any of our patients to date. We conclude: (1) Transantral orbital floor exploration allows precise determination of orbital floor fracture size, location, and the presence of entrapped periorbita. The information obtained through endoscopic techniques may be used to select patients who would not benefit from lid approaches to the orbital floor and may possibly eliminate nontherapeutic exploration. (2) Transantral endoscopic orbital floor exploration assists the reduction of complex orbital floor fractures and allows precise identification of the posterior shelf for implant placement. (3) Transantral endoscopic techniques can completely reduce entrapped periorbital tissue caught in a trapdoor type of fracture.

Endoscopy↗

PubMed1997

Orbital development in long-term survivors of retinoblastoma.

PURPOSE: To determine the effects of enucleation, irradiation, and age at diagnosis on bony orbital growth in long-term survivors of retinoblastoma using measurements based on computed tomographic (CT) imaging. PATIENTS AND METHODS: We used CT obtained at a median age of 13 years to measure orbital volume and configuration in 54 patients who had been treated for retinoblastoma a minimum of 5 years previously. RESULTS: Enucleation and high-dose orbital irradiation (> 35 Gy) both independently adversely affected orbital development (P = .014 and P = .022, respectively). Orbital volume differences for children treated when < or = 1 year old were no greater than those for children treated when older than 1 year of age. In children treated for bilateral retinoblastoma, the impact of enucleation on orbital development was not statistically different from that of irradiation (P = .13). Small implants (12 to 14 mm in diameter) were more commonly associated with smaller orbital volumes. Migration of orbital implants was associated with the smaller orbital sphere size in children < or = 1 year of age (P < .035). CONCLUSION: Treatment for retinoblastoma compromises orbital development. Resulting orbital asymmetry seems to be at least partially related to the size of the implant. Detailed imaging-based measurements of orbital volume and configuration may aid the planning for cosmetic and reconstructive surgery in those who develop orbital asymmetry.

Age Factors↗

PubMed2002

Ophthalmological outcome after orbital entry during anterior and anterolateral skull base surgery.

OBJECT: Partial resection of the orbital bones is not uncommon during the excision of anterior and anterolateral skull base tumors. Controversy exists regarding the need for and extent of reconstruction after this procedure. The authors studied this factor in a series of patients. METHODS: The authors conducted a retrospective review of 56 patients in whom resection of 57 anterior or anterolateral skull base tumors and partial excision of the orbital bone were performed. Adverse ophthalmological outcomes were noted in 16 patients, in nine of whom adverse outcomes were believed to be directly related to resection of the orbital walls. Some degree of orbital reconstruction was performed during 23 of the 57 procedures. An adverse orbital outcome was strongly associated with resection of the orbital floor and resection of two thirds or more of two or more orbital walls, but not with the presence or absence of orbital reconstruction. The later finding, however, is likely a function of selection bias. CONCLUSIONS: In most patients elaborate orbital reconstruction is not necessary after partial excision of the orbital bones. Isolated medial and lateral orbital wall defects, or combined superior and lateral orbital wall defects, especially in cases in which the periorbita is intact, probably do not require primary reconstruction. In cases of orbital floor defects, whether isolated or part of a multiple-wall resection, primary reconstruction is recommended.

Female↗

PubMed2002

Antero-medial orbital masses associated with nasopharyngeal carcinoma.

BACKGROUND: Nasopharyngeal carcinoma (NPC) involves the orbits through direct extension to the orbital apex via the cavernous sinus. Anterior orbital masses are very rare with only a few anecdotes in the literature about an anterior spread via nasal cavity or tumour arising de novo from the lacrimal sac. Reactive lymphoid hyperplasia in the orbit has never been reported in association with NPC. MATERIALS AND METHODS: Three cases that presented with antero-medial orbital mass in association with NPC are described. Two of the three cases including one with bilateral orbital mass, had biopsy proven NPC in the orbit and presented with tearing due to lacrimal sac involvement with a palpable mass in the anteromedial orbit. The third case presented with a left antero-medial orbital mass, which on biopsy proved to be a reactive lymphoid hyperplasia. He was detected to have NPC while investigating the orbital mass. All had raised serum levels of IgA against Epstein-Barr virus (EBV). DISCUSSION: The possible mode of spread in our case with bilateral involvement is most likely to be a metastasis, though a microscopic anterior spread through the nasal cavity and nasolacrimal duct could not be ruled out despite there being no evidence of tumour in the original site or nasal cavity. In the second case, the tumour spread from the nasal cavity into the orbit is clearly via the nasolacrimal duct. The third patient presents an interesting association of lymphoproliferative disorder and NPC with Epstein-Barr virus infection. CONCLUSION: Anterior orbital masses involving nasolacrimal duct and lacrimal sac are rare in NPC, but can occur. A rare association of a reactive lymphoid hyperplasia in the orbit with NPC is described.

Adult↗

PubMed2005

[The use of CAD/CAM techniques in the repair of complex orbital fractures and the reposition of enophthalmos].

OBJECTIVE: To reconstruct the three-dimensional (3 D) imaging and computer-generated models of the complex orbital fractures, and to develop a Computer-Aided Design/Computer-Aided Manufacture (CAD/CAM) system for orbital fracture repair. METHODS: We carried out study on 12 patients with orbital fractures from August 2003 to March 2004 in the Ninth People's Hospital. Before the orbital fracture repair, helical computer tomography scanning was applied to acquire the 3 D imaging data of the patient's orbits. The 3 D imaging data were then transferred to a CAD/CAM interactive program for image processing, which then designed and produced a stereolithography model mathematically. Using the designed software, the repair of orbital fractures could be planned with the computer. At the same time, the orbital cubane was calculated. Then the operation was performed and the effect of the therapy was evaluated. RESULTS: Using the CAD/CAM system of orbital fracture repair, the 3 D image of the orbit could be reconstructed, and the orbital cubane could be calculated accurately. The preoperative surgical plan was put into reality. After the orbital fracture repair, all cases received excellent appearance and function. This system had proved to run smoothly and accurately, and could easily be controlled. CONCLUSIONS: The CAD/CAM system of the orbital fracture repair may be proved as one of the most useful clinical tools for orbital surgery.

Adult↗

PubMed2006

[Individual 3-D image prototyping models for orbital reconstruction].

OBJECTIVE: To fabricate a rapid prototyping (RP) 3-D image models for individual reconstruction of orbital bony loss. METHODS: The skull was placed on a helical CT scanner table and the Frankfort plane was perpendicular to the table. The CT data was obtained by a Aquilion (TOSHIBA, Japan) with 1 mm thickness section in spiral mode. By adjusting of CT threshold value and pixels in order to stack the segmental defects, we obtained an approximate 3-dimension visual model of the scanned skull using MedGraphics software. An orbital RP model based on the dataset of the 3-dimension visual model was fabricated by RP machine. Both 3-dimension visual model and RP model were measured against the skull with several anatomic landmarks to examine the accuracy of the models, and the errors were analysed. RESULTS: Integrity precision rapid RP models of the orbital region were reconstructed. The anterior orbital rim, middle orbital section and posterior orbital section were all fabricated. Optic foramen, superior orbital fissure, infraorbital foramen, inferior orbital fissure, lacrimal sac socket and naso-lacrimal duct were shown clearly. But some fine hole and slot, such as the anterior ethmoidal foramen, posterior ethmoidal foramen and zygomaticofrontal suture were not obviously seen. The mean difference between the 3-dimension visual model and the skull was 0.10 +/- 1.02mm. For the RP and dry skull, the mean difference was 0.22 +/- 1.04mm. There were no statistical differences between them. CONCLUSIONS: Integrity precision orbital RP models were fabricated which fulfilled the requirements of the individual reconstruction with bony orbital pathologic changes. The keys to fabricate the precision orbital RP models included a closer cooperation between the surgeon and engineer, thin CT slice in 1mm thick and an appropriated threshold value. Better results for the orbital deformities should be achieved for the contour of orbital region or eye function.

Humans↗

PubMed2002

The transcaruncular approach to the medial orbital wall.

OBJECTIVE: To demonstrate the safety and use of the transcaruncular approach as a surgical technique that provides rapid exposure of the medial orbital wall and apex through a small cosmetic conjunctival incision. METHODS: The transcaruncular anterior orbitotomy incision is made through the conjunctiva, between the plica and caruncle, with dissection to a subperiorbital plane along the medial orbital wall. This technique was used in 49 patients (58 orbits) between July 1995 and December 2000. The patients' ages ranged from 5 to 89 years (mean, 50 y). RESULTS: The transcaruncular anterior orbitotomy approach provided appropriate surgical exposure in all cases of orbital decompression for thyroid-related orbitopathy (in 33 orbits [26 patients]); for biopsy of medial orbital or orbital apex masses in 12 patients; and for drainage of an orbital abscess or marsupialization of a mucocele in 7 orbits (6 patients). Five patients (6 orbits) underwent a transcaruncular approach for release of medial rectus entrapment after fracture. The single complication was 1 patient who required a revision procedure for treatment of medial fornix scarring with resolution of diplopia. CONCLUSIONS: The transcaruncular approach provides a safe, rapid, and cosmetically pleasing surgical approach to the medial orbital wall and orbital apex. This technique can be used for a variety of indications.

Abscess↗