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At least 55 records · Page 3Linked to original sources
PubMed1992

Miniplate reconstruction of the lateral orbital rim after orbital decompression for Graves disease.

BACKGROUND: Removal of lateral orbital bone with or without simultaneous removal of the lateral orbital rim is an accepted method of orbital decompression for Graves disease. Once removed, the bone is no longer available for reconstruction and secondary complications such as rounding of the canthal angle, canthal dystopia, and globe dystopia may result. METHODS: The authors replaced the excised bone with a titanium miniplate to protect the globe and fixate the lateral canthal tendon in 18 patients (33 orbits). The orbital rim and lateral orbital wall were completely removed, and the inner aspect of the orbit was enlarged with a cutting burr. A standard titanium miniplate was then anchored to remaining bone, and soft tissue was secured to the miniplate to reconstruct the lateral canthus. RESULTS: The results, as manifest by appearance of the lateral canthus and position of the eyelid in apposition to the globe, were graded as excellent in all patients and orbits. There were no early or late complications. CONCLUSION: Miniplate reconstruction of the lateral orbital rim after decompression for Graves disease allows the beneficial affect of lateral decompression and preserves the functional aspect of the lateral orbital wall.

Adult↗
PubMed2005

Thyroid transcription factor-1 in orbital adipose tissues: potential role in orbital thyrotropin receptor expression.

Thyroid transcription factor-1 (TTF-1) is required for maximal expression of thyrotropin receptor (TSHR) in the thyroid. Extrathyroidal TSHR expression is detectable in normal orbital adipose tissues, with increased levels found in orbital tissues from patients with Graves' ophthalmopathy (GO), and in orbital preadipocyte cultures following differentiation. In order to determine whether TTF-1 might be involved in orbital TSHR expression, we used quantitative real-time polymerase chain reaction (PCR) to assess relative expression of this and other thyroid-associated transcription factors (TTF-2 and Pax-8) in GO orbital tissue specimens (n = 28) and cultures (n = 3), and in normal orbital tissues (n = 19) and cultures (n = 3). We detected TTF-1 and TTF-2 mRNA in GO and normal orbital tissue samples, with no difference in levels noted between the tissues. In the GO orbital cultures, TTF-1 mRNA was higher in differentiated than in control (undifferentiated) cultures (p < 0.05), while TTF-2 was unchanged. In the normal cultures, neither TTF-1 nor TTF-2 mRNA levels increased in differentiated cultures. Pax8 was undetectable in all orbital tissues and cell cultures. The presence of mRNA encoding TTF-1 in orbital tissues and cultures suggest that this transcription factor may play an important role in extrathyroidal, as it does in thyroidal, TSHR expression.

Adenosine Triphosphatases↗
PubMed2002

Reduction of diplopia following endoscopic orbital decompression: the orbital sling technique.

OBJECTIVE: Although endoscopic orbital decompression has become the surgical treatment of choice for patients with proptosis from Graves disease, postoperative diplopia requiring corrective eye muscle surgery can occur in up to 63% of patients. The purpose of the study was to evaluate a new technique intended to reduce the incidence of diplopia following endoscopic orbital decompression. STUDY DESIGN: Case-control. METHODS: Endoscopic orbital decompression was performed on 58 orbits in 37 patients with proptosis from Graves disease. The orbital sling technique, which makes use of a horizontal strip of periorbital fascia to prevent prolapse of the medial rectus muscle, was used on 20 orbits in 13 patients. Conventional endoscopic decompression was performed in 24 control subjects. The mean duration of follow-up was 3.3 +/- 1.3 years (range, 1.7-5.1 y). RESULTS: The incidence of new-onset or worsened diplopia following endoscopic decompression was significantly lower for the orbital sling group compared with control subjects (0% vs. 29.2%, respectively [ =.038]). No patients in the orbital sling group developed new-onset diplopia following surgery. Of the eight patients with pre-existing diplopia from the orbitopathy, double vision improved in four patients (50%) and was unchanged in the remaining four patients (50%). The mean reduction in proptosis was comparable for the orbital sling and control groups (5.1 +/- 1.1 mm vs. 5.0 +/- 1.9 mm, respectively [ P=.98]). CONCLUSIONS The preservation of a fascial sling overlying the medial rectus muscle during endoscopic orbital decompression appears to reduce the incidence of postoperative diplopia, while still allowing for a satisfactory reduction in proptosis. This modification of the standard decompression technique should be considered for the treatment of patients with proptosis.

Adult↗
PubMed2005

Reconstruction of the anophthalmic orbit by orbital osteotomy and free flap transfer.

It is a challenging problem for the plastic surgeon to perform adequate reconstruction of the postenucleation and radiated orbit of patient with retinoblastoma. Rebuilding of the orbital structure, reconstruction of the eye socket, and restoration of periorbital volume are required in this kind of orbital reconstruction. In this study, we reviewed 12 patients with hypoplastic orbital deformities who underwent orbital osteotomy and free flap transfer. Reconstruction of the orbital cavity was achieved using "C" osteotomy of the lateral portion of the orbit in mild and moderate cases or transverse "U" osteotomy of the lateral wall, roof, and floor by an intracranial approach in a portion of severe cases. Socket reconstruction and periorbital volume restoration was achieved using dorsalis pedis free flap transfer by microsurgery. What we concluded from our experience was that the combination of orbital osteotomy and free flap transfer could meet the multirequirements for anophthalmic orbital reconstruction, including both orbital bony enlargement and soft tissue restoration.

Adolescent↗
PubMed2000

[Measurement of orbital volume by computed tomography--especially on the growth of orbit].

PURPOSE: Using reconstructed X-ray computed tomography (CT) images of serial coronal sections, we measured the orbital volume and studied its changes with age. METHODS: The subjects consisted of 109 patients (74 males, 35 females) who had undergone X-ray CT. After the reproducibility of orbital volume measurements and laterality in individuals were confirmed, the relation between the orbital volume and the age, sex, weight, and interlateral orbital rim distance were examined. RESULTS AND CONCLUSION: The difference between two measurements in the same patients was 0.4% for measured volume, which showed the reproducibility of this measurement to be good. The laterality in individuals was 0.06 cm3; this difference was very small and not significant. The orbital volume showed no unbalance between the right and left at any stage of growth. Both the height and the interlateral orbital rim distance had a strong correlation with the orbital volume. Referring to the relation between age and orbital volume, a strong correlation with an almost identical approximate equation was obtained for both sexes under 12 years of age. Presumably, the rapid growth of the orbit comes to an end by 15 years of age in males and 11 years in females. This means that more than 95% growth of adults has already been completed in the first half of the teens. The mean orbital volume in adult Japanese is 23.6 +/- 2.0(mean +/- standard deviation)cm3 in males and 20.9 +/- 1.3 cm3 in females.

Adolescent↗
PubMed2000

Transconjunctival orbital fat repositioning: transposition of orbital fat pedicles into a subperiosteal pocket.

Rejuvenation of the lower eyelid complex is based on the principle that the contour changes characterizing aging involve not only prolapse of orbital fat but also descent of the cheek tissues, resulting in accentuation of the orbital rim and tear trough groove. When a deep groove is present along the orbital rim in the area of the tear trough deformity, it is advantageous, rather than removing orbital fat, to reposition the fat over the orbital rim through the opened arcus marginalis onto the superior face of the maxilla. Orbital fat repositioning can be accomplished through a transconjunctival approach. The arcus marginalis is exposed and incised, and a subperiosteal pocket is created over the superior face of the maxilla. The subperiosteal pocket shape and location are customized based on the desired location of the orbital fat pedicle; often the origins of the levator superioris labialis and the levator alae nasi muscles are partially dissected. Medial and central fat pedicles are created and rotated over the orbital rim into the subperiosteal pocket. A 6-0 polypropylene externalized sutured is used to fixate the fat pedicle in position. The suture can be removed after 3 to 5 days. Twenty-four patients were followed clinically after orbital fat repositioning, with follow-up ranging from 6 to 30 months. Although the fat pedicle undergoes some variable resorption, the viability of the graft, the texture and contour of the repositioned fat after a healing period of 1 to 2 months, and the excellent patient acceptance are indicative of the viability of orbital fat repositioning.

Adipose Tissue↗
PubMed2006

Orbital decompression as an alternative management strategy for patients with benign tumors located at the orbital apex.

PURPOSE: Tumors located in the intraconal portion of the orbital apex, especially those inferior to the optic nerve, can be difficult to access surgically, carrying a significant risk of ocular morbidity. The purpose of this study was to investigate outcomes in 5 patients with benign-appearing but symptomatic tumors located in the intraconal portion of the orbital apex in which orbital decompression was performed as an alternative management strategy to resection. DESIGN: Retrospective interventional case series. PARTICIPANTS: Five patients were diagnosed with a compressive optic neuropathy secondary to a benign-appearing tumor at the orbital apex. INTERVENTION: Each patient underwent surgical decompression of the affected orbit. None of the patients had the tumor biopsied or resected. MAIN OUTCOME MEASURES: Best-corrected visual acuity (VA), pupillary responses, visual fields (VFs), color vision, and orbital imaging. RESULTS: Each of the patients demonstrated improvement in visual function, as measured by VA, VFs, and, in some cases, color vision. One patient required a second orbital decompression for recurrent optic neuropathy 4 years after the initial decompression. Complications included ptosis and enophthalmos in 2 patients and diplopia in the extreme right gaze in 1 patient. CONCLUSIONS: Orbital decompression is a therapeutic option for patients with compressive optic neuropathies from benign orbital apex tumors, offering potential improvement in optic nerve function while sparing morbidity from attempts at surgical resection.

Adult↗
PubMed2000

Delayed orbital infection after endoscopic orbital decompression for dysthyroid orbitopathy.

OBJECTIVE: To present a delayed complication of endoscopic orbital decompression that has not been reported previously in the literature. DESIGN: Retrospective non-comparative small case series. PARTICIPANTS: Three patients with dysthyroid orbitopathy. INTERVENTION: The medical records of patients with dysthyroid orbitopathy who underwent endoscopic orbital decompression and subsequently developed orbital infection were reviewed. RESULTS: Three patients with dysthyroid orbitopathy developed orbital infection (cellulitis or abscess) originating from the frontal sinus more than 2 years after their endoscopic orbital decompression surgery. Management required drainage of the abscess, administration of antibiotics, and creation of adequate frontal sinus drainage. CONCLUSIONS: Delayed orbital infection can occur after endoscopic orbital decompression for dysthyroid orbitopathy when the frontal sinus ostium is obstructed by orbital fat or scar tissue. Infection within the frontal sinus can cause secondary orbital cellulitis or abscess. Early signs and symptoms of a frontal sinus infection can be easily misdiagnosed as progression of the patient's thyroid eye disease. Awareness of this possible complication followed by appropriate early intervention will prevent a potentially blinding condition. Furthermore, ever since this complication was observed, the authors' surgical technique of endoscopic decompression has been modified to leave the most anterosuperior portion of the lamina papyracea to prevent fat prolapse and scar formation into the region of the frontal recess.

Abscess↗
PubMed2002

Classification and surgical management of orbital fractures: experience with 111 orbital reconstructions.

Orbital skeletal injuries are frequently associated with other significant injuries and require a substantial surgical effort to correct. The use of a unified classification of orbital injury may better predict the surgical effort required to correct such injuries and help with future comparisons of results. In an attempt to summarize the principles of reconstruction of the orbital skeleton following trauma and introduce a unified classification system for orbital injuries, a retrospective review of all consecutive orbital reconstructions in a tertiary care teaching hospital was conducted. The nasoethmoidal region was involved in 32%, the zygomatic complex in 50%, and the frontal region in 28% of orbital fractures. Of the orbital walls, four walls were involved in 5%, three walls in 17%, two walls in 30%, and one wall in 53%. Associated ocular and neurologic injury was encountered in 33% and 57% of patients, respectively. Regions of fixation ranged from one to eight. Bone grafts were used in 20% and titanium mesh in 34% of the orbits. In general, the authors recommend an aggressive approach to orbital injuries, addressing all associated injuries simultaneously.

Adolescent↗
PubMed1983

The longitudinal orbital CT projection: a versatile image for orbital assessment.

The newer generation of CT scanners allows reconstruction of images in coronal, sagittal, and oblique planes from a single set of axial scans. These computer-generated images are described as reformatted. We have found an oblique image reformatted along the plane connecting the apex of the orbit and the center of the globe to be especially useful in assessing orbital disorders. We have named this image the longitudinal orbital projection. This projection allows direct visualization of the inferior rectus muscle and orbital floor in acute and old orbital trauma. With the image produced life size, direct measurements of enophthalmos and proptosis can be made preoperatively and postoperatively, thereby facilitating planning and follow-up. The projection is also useful in combination with other planes of reformation for the localization of tumors. The longitudinal orbital projection is now a routine part of the CT examination of the orbit in our institution. Whereas it already has become an invaluable aid in the diagnosis and follow-up of congenital and acquired orbital lesions, the longitudinal orbital projection promises to clarify the effects of trauma on the inferior rectus muscle and globe position.

Accidents, Traffic↗
PubMedDate not supplied

Congenital unilateral orbital fibrosis with suspected prenatal orbital penetration.

Congenital fibrosis of the extraocular muscles includes various abnormalities ranging from isolated fibrosis of a single muscle to bilateral involvement of all extraocular muscles. Congenital unilateral orbital fibrosis is a specific fibrosis syndrome with only five cases previously reported. Although these reports postulated that a prenatal orbital inflammatory process caused the fibrosis, no etiology was proposed, nor was a mechanism suggested for entrance of the inflammation into the orbit. We discuss three additional cases in which evidence suggested prenatal orbital penetration. In one, a dense scar was found at birth from the skin of the upper lid to beyond the trochlea. The second had a dense fibrous tract extending from the upper lid skin to the trochlea and beyond into the orbit without a skin scar. These lesions could have been inflicted by the fetuses' own fingers or toes or, in the second case, by the twin fetus. The third had a benign mesenchymoma of the nasopharynx and skull that had eroded the medial orbital wall, which was seen on computed tomography scan but not on routine x-rays. The nature of the inflammatory substance is unknown. There was no other evidence of inflammation or infection in the eight reported cases. Possibly amniotic fluid itself, entering the orbit "late" in gestation, might cause this inflammation. We recommend that all children with congenital unilateral orbital fibrosis be examined specifically for defects in the orbit, and that computed tomography be employed rather than plain x-rays.

Cicatrix↗
PubMed2006

[Two cases of orbital myositis with 67Ga accumulation in the orbits].

We reported two patients of orbital myositis with abnormal accumulation of 6 Ga in the bilateral orbits. The first patient, a 34-year-old man, developed bilateral lid swelling and external ophthalmoplegia. T1-weighted MRI of the bilateral orbits showed enlargement of the bilateral extraocular muscles. 67Ga scintigraphy also showed abnormal accumulation in the orbits. The second patient, a 64-year-old woman, developed diplopia caused by restricted abduction of the bilateral eyes. 67Ga scintigraphy showed abnormal accumulation in the bilateral orbits, in spite of no finding in the MRI of the extraocular muscles. Both cases were treated with 1 g of methylprednisolone per day for 3 days and subsequently 1 mg/kg per day of oral prednisolone, which resulted in improvement of opthalmoplegia and disappearance of the abnormal accumulation of 67Ga in the orbits. There is no report about orbital myositis with abnormal accumulation of 67Ga in the orbit. Our cases suggest that 67Ga shows the activity of orbital myositis and can be useful for diagnosis, especially in case of no abnormality in MRI study.

Adult↗
PubMed2003

Extended pterional orbital decompression in severe orbital cellulitis.

BACKGROUND: Bacterial orbital cellulitis is a relatively uncommon infective process, which can threaten the function of orbital structures. Apart from antibiotic therapy, sinus surgery with or without abscess drainage via an orbito-otorhinolaryngological approach might be necessary. CASE DESCRIPTION: We present three cases of severe orbital cellulitis, leading to increasing loss of vision, proptosis, afferent pupillary disturbances and restriction of extra-ocular movements, despite antibiotic therapy. After extended pterional orbital decompression and reducing the orbital pressure by removal of the lateral and superolateral orbital walls, all patients showed distinct improvement of initial symptoms, without any complications related to the operation. INTERPRETATION: Extended pterional orbital decompression represents an effective treatment alternative and supplement in cases of a severe, threat to ocular function due to orbital cellulitis, where acute reduction of pressure on orbital, neural and vascular structures is intended.

Adult↗
PubMed2001

Recurrent orbital inflammation from metastatic orbital carcinoid tumor.

PURPOSE: To report an unusual clinical presentation for carcinoid tumor metastatic to the orbit. METHODS: Two adult patients with metastatic carcinoid tumor and unilateral orbital masses are described. RESULTS: Both patients sought treatment for acute unilateral orbital inflammation. Neuroimaging revealed orbital metastases adjacent to the inflamed adnexal tissue. Based on each patient's description of similar, prior, untreated episodes, minimal medical management was initiated. Resolution of the inflammatory signs was spontaneous in one case and assisted by pulsed, systemic corticosteroids in the second case. Compressive neuropathic vision loss occurred 11 months later in the second case. CONCLUSIONS: Carcinoid tumor metastatic to the orbit may manifest as recurrent orbital and ocular adnexal inflammation. These signs differ from systemic carcinoid syndrome in that they are unilateral, limited to only the orbital and ocular adnexal soft tissues, and resolve over days. Clinicians must carefully differentiate this manifestation from that of tumor necrosis, adnexal infection, or orbital outlet obstruction. This presentation may result from the spontaneous release of local inflammatory mediators intrinsic to the orbital tumor.

Adult↗
PubMed2005

Gene expression profiling of orbital adipose tissue from patients with Graves' ophthalmopathy: a potential role for secreted frizzled-related protein-1 in orbital adipogenesis.

CONTEXT: The signs and symptoms of Graves' ophthalmopathy (GO) result from inflammation and increased volume of the orbital adipose tissues and extraocular muscles. OBJECTIVE: Our objective was to identify differentially regulated genes that may be involved in stimulating the orbital adipose tissue expansion seen in GO. DESIGN: Gene expression profiling was used to compare genes expressed in orbital adipose tissues from GO patients and normal individuals. SETTING: The study took place at a private practice tertiary referral center. PATIENTS: Orbital adipose tissues were collected at transantral orbital decompression surgery from 20 euthyroid patients undergoing this procedure for severe GO and at early autopsy from eight normal individuals having no evidence of thyroid or ocular disease. RESULTS: Of the 12,686 genes analyzed, 25 known genes were increased in expression (>4-fold) in GO orbital tissues, whereas 11 genes were decreased (>4-fold). Up-regulated genes, confirmed by quantitative RT-PCR, included secreted frizzled-related protein-1 (sFRP-1; 18.5-fold) and several adipocyte-related genes, including peroxisome proliferator activated receptor-gamma (44.1-fold) and adiponectin (25-fold). Treatment in vitro of GO orbital preadipocytes with recombinant sFRP-1 (100 nm) significantly increased adiponectin (2.0-fold; P < 0.05), leptin (7-fold; P < 0.002), and TSH receptor mRNA (13-fold; P < 0.003) levels and enhanced Oil red-O staining in the cultures. CONCLUSIONS: These results support the concept that orbital adipogenesis is enhanced in GO and suggest that elevated levels of sFRP-1 in the GO orbit may be involved in stimulating this pathogenic process.

Adipocytes↗
PubMed1995

Maxillary sinus orbital fistula secondary to repair of an orbital floor fracture.

Orbital emphysema can occur after a blow-out fracture of the orbit, usually involving the medial wall. Repair of orbital floor fractures often involves the reduction of the herniated orbital contents and implantation of a sturdy, inelastic material to prevent the orbital contents from prolapsing into the maxillary sinus. We report a case of a maxillary sinus orbital fistula that occurred after the repair of a blow-out fracture of the right orbit, resulting in orbital emphysema. This was corrected with an autogenous fascia lata graft.

Adult↗