摘要:

PurposeTo present an avulsion injury of the rectus muscle after orbital trauma, usually the inferior rectus, and detail its diagnosis and operative repair.MethodsForty-three patients underwent repair of flap tears of 62 rectus muscles. During surgery, we found the muscle abnormality was often subtle, with narrowing or thinning of the remaining attached global layer of muscle. The detached flap of external (orbital) muscle was found embedded in surrounding orbital fat and connective tissue. Retrieval and repair were performed in each case.ResultsThe causes of orbital trauma were as follows: orbital fractures (15 patients), blunt trauma with no fracture (11 patients), suspected trauma but did not undergo computerized tomographic scan (12 patients), and status after retinal detachment repair (5 patients). Of note, 15 of the 43 patients (35%) underwent repair of the flap tear alone, without any additional orbital or strabismus surgery. Diagnostically, the predominant motility defect in 45 muscles was limitation toward the field of action of the muscle, presumably as a result of a tether created by the torn flap; these tethers simulated muscle palsy. Seventeen muscles were restricted away from their field of action, simulating entrapment. The direction taken by the flap during healing determined the resultant strabismus pattern. All patients with gaze limitation toward an orbital fracture had flap tears. The worst results after flap tear repair were seen in patients (1) who had undergone orbital fracture repair before presentation, (2) who had undergone previous attempts at strabismus repair, and (3) who had the longest intervals between the precipitating event and the repair. The best results were obtained in patients who underwent simultaneous fracture and strabismus repair or early strabismus repair alone.ConclusionsAvulsion-type flap tears of the extraocular muscles are a common cause of posttraumatic strabismus. Early repair produces the best results, but improvement is possible despite long delay.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo report 5 patients with a black material accumulating in the conjunctiva around the titanium peg and sleeve systems.MethodsRetrospective small case series. The clinical features of 5 patients were reviewed. Histopathologic analysis was performed on specimens from 3 patients. Neutron activation analysis was performed on 1 sample.ResultsFive asymptomatic patients with black material accumulating in the conjunctiva at the conjunctival-titanium peg interface were evaluated. All patients had a hydroxyapatite-coated titanium sleeve with a titanium peg in position. Histopathologic analysis performed on specimens from 3 patients revealed a mixed inflammatory cell infiltrate with focal areas of a black, foreign-appearing material showing birefringence under polarized light that was predominantly intracytoplasmic. This black material did not respond to bleaching, and in 2 patients, it showed positive staining for iron (Perls method). The material from one patient was evaluated by neutron activation analysis and was found to contain titanium, aluminum, and vanadium. In 18 to 48 months of follow-up, the presence of the material did not appear to be associated with any problems.ConclusionsThe presence of a black substance accumulating in the conjunctiva around some titanium coupling posts is uncommon and appears to be without any consequence in 18 to 48 months of follow-up. Our analysis revealed this substance to be consistent with titanium alloy (Ti-6Al-4V).

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo describe the incidence and patterns of orbital and adnexal injuries in patients with open-globe injuries.MethodsCharts of 300 consecutive patients with open-globe injuries presenting to the Massachusetts Eye and Ear Infirmary were retrospectively reviewed. The data were analyzed with respect to the type of open globe (penetrating, perforating, or rupture) and location (zone) of globe injury. Each of these subgroups was then evaluated for the absence (group 1) or presence (group 2) of coexisting orbital and/or adnexal injury. Visual acuity at presentation was compared between the two groups.ResultsOrbital and adnexal injuries were present in 25.7% of patients with open globes. The most common concurrent injuries were lacerations of the eyelid, orbital fracture, and retrobulbar hemorrhage. The mechanisms of globe injury differed significantly between groups 1 and 2. Penetrating injuries accounted for 82.1% of group 1 but only 49.3% of group 2 patients, whereas rupture occurred more frequently in group 2 (48.1%) than in group 1 (17.0%) patients. Orbital and adnexal injuries were associated with poorer visual acuity at presentation, probably because of the high incidence of posterior globe injuries in these patients.ConclusionsOrbital and adnexal injuries were observed in 25.7% of patients who sustained trauma that resulted in open globes. Concurrent injury to these extraocular structures is associated with worse visual acuity at presentation and an increased likelihood of posterior globe injuries.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo present the clinical applications of color Doppler imaging (CDI) as an adjunctive study in the diagnosis and treatment of orbital lesions.MethodsRetrospective noncomparative case series. Medical records of 17 patients with orbital lesions who underwent orbital CDI were reviewed, and their orbital CDI results, diagnosis, and treatment were studied. The main outcome measures were detection of abnormal orbital vascular flow and presence or absence of blood flow within orbital lesions by CDI.ResultsAbsence of intralesional flow was associated with an orbital lesion considered benign. Tumors in which flow was present were more frequently malignant or had malignant potential. Reversal of flow in the superior ophthalmic vein was observed in patients with carotid-cavernous fistula and orbital varix.ConclusionsCDI is a useful adjunctive imaging study for evaluating the vascularity of orbital tumors. The absence or presence of intratumoral blood flow as demonstrated by CDI can help determine the nature of the orbital mass and can assist with surgical planning.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

When skin grafts are used in the reconstruction of eyelid defects, they are usually covered by a Telfa bolster sutured to surrounding tissue. The bolster creates a contact between the underlying skin graft and the remaining eyelid, which promotes vascularization of the skin graft, increasing its chance of viability. However, when a skin graft is applied over a tarsoconjunctival flap, a bolster is not typically used. This article describes the use of a bolster over a skin graft that is applied to the tarsoconjunctival flap to increase the chance of skin graft survival. The author reports having used this technique in hundreds of cases without the loss of any skin graft.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A unique case of alternating, poorly controlled, intermittent strabismus that improved after repair of bilateral, alternating congenital ptosis is described. A 7-year-old boy with bilateral, alternating congenital ptosis and poorly controlled, intermittent exotropia underwent bilateral frontalis suspensions. After surgery, the patient demonstrated improved control of his exotropia.We conclude that an alternating ptosis may lead to sensory deprivation of the occluded eye and decreased fusion, causing an intermittent strabismus to be poorly controlled. Repair of the ptosis to a sufficient eyelid height bilaterally may improve control of the strabismus, obviating strabismus surgery.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Radiological evidence of pneumatization of the intraorbital optic nerve sheath following severe head trauma in an adult is reported. A young man was admitted to the emergency department following a high-speed motorcycle accident with unconsciousness, forehead laceration, and multiple fractures of the skull and extremities. On admission, the pupils were dilated and fixed. Computed tomography revealed right subdural hematoma with midline shift, brain stem hemorrhage, contusion of the left temporal lobe, multiple facial bone fractures, cerebral edema with intracerebral air, and meningeal pneumatization of the optic nerve sheaths bilaterally. This case demonstrates that after severe head trauma, air may extend in the optic nerve sheath, which could be a marker of severe optic nerve injury.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We report the clinicopathologic features of a 22-year-old patient with aneurysmal bone cyst and fibrous dysplasia of the orbit. The patient was evaluated clinically with computed tomography of the orbit before surgery. An orbital biopsy specimen was examined histologically with conventional light microscopy. The lesion was treated with combined neurosurgical and orbital intervention. Clinical evaluation revealed axial and inferior displacement of the globe. Computed tomography revealed a cystic mass in the superotemporal left orbit with adjacent bone erosion. “Ground-glass” thickening of the adjacent frontal bone and sphenoid bone was observed. Microscopic examination showed fibrous stroma with giant cells and hemosiderin-laden macrophages with adjacent trabeculae of woven bone and osteoblast cells. A fronto-orbital craniotomy was performed, the cystic cavity was excised, and the hyperostotic bone was debulked. After treatment, the globe position and patient appearance have improved. There has been no sign of recurrence of the aneurysmal bone cyst. Aneurysmal bone cyst should be considered in patients with fibrous dysplasia that has a cystic component, or in patients with fibrous dysplasia who present with sudden expansion of their lesion.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We describe a case of bilateral infraorbital nerve involvement in idiopathic orbital myositis. Computed tomographic scanning of the orbits showed enlargement of extraocular muscles consistent with orbital myositis and enlargement of the ipsilateral infraorbital nerve. With disease progression, infiltration of the contralateral infraorbital nerve also developed. Biopsies of the inferior oblique muscle and infraorbital nerve showed the same inflammatory infiltrate: a mixed population of lymphocytes (B and T) with B cells expressing kappa and lambda light chains. Although orbital myositis may be associated with several conditions, to the best of our knowledge, this is the first time a case of idiopathic orbital myositis with bilateral infraorbital nerve involvement has been described.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID