摘要:

We describe our 4 years' experience using axial dynamic compression plates in the management of 46 zygomatico-orbital and complex infraorbital fractures. Surgical exposure of the fracture sites was accomplished in all cases by transconjunctival orbitotomy with lateral cantholysis. Transconjunctival orbitotomy with lateral cantholysis provides excellent surgical exposure of periorbital fractures, and axial dynamic compression plates are an excellent method for repairing these fractures.

ISSN:0740-9303    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Wooden foreign bodies in the orbit can extend into the intracranial cavity without diagnostic clues from the small eyelid entrance wound, from neurologic examination, and from imaging studies such as ultrasound, plain x-rays, or computed tomography (CT) scans. In cadaver magnetic resonance imaging (MRI) studies, dry wood in the orbit can be seen as a negative or hypointense image in contrast to orbital fat. We studied fresh, green wood in dogs to determine the reliability of CT and MRI scans to image hydrated wood. Wood was placed into each orbit of two dogs. After 24 h the wood was removed from one orbit, but not the other. The dogs were then scanned with CT and MRI. Radiologists were asked to determine if any wood had been left in either or both orbits. The fresh wooden foreign bodies could not be detected despite an intensive effort. MRI does not appear to reliably demonstrate fresh wood in the orbit. MRI can show dry wooden foreign bodies that have not become hydrated, but has not yet been reliable in the clinical situation to rule out the presence of wood in the orbit.

ISSN:0740-9303    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The transconjunctival approach to the inferior orbit and orbital fat offers the potential advantage of avoidance of scar creation in the lower eyelid skin and anterior lamellae. Complications of this approach, including conjunctival fornix shortening and eyelid margin malposition, have been occasionally reported. We prospectively observed 25 patients undergoing transconjunctival blepharoplasty and orbital floor surgery. Fornix depth, eyelid margin position, and the presence or absence of eyelid retraction were measured preoperatively and at each postoperative visit. No significant permanent change in these parameters was observed. Temporary entropion was observed in two patients; this resolved with conservative treatment. One self-limited suture granuloma was observed. In a subgroup of six patients, the conjunctival incision was closed on one side and left unclosed on the other. No adverse healing was noted on the unclosed side. We conclude that the transconjunctival approach is associated with a low incidence of complications, and that it does not significantly after the fornix depth or eyelid margin position. A skin incision is avoided. The inferior orbital septum is not violated, greatly reducing the risk of development of lower eyelid retraction.

ISSN:0740-9303    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Vicryl mesh (polyglactin-910) implants were used to reconstruct the orbital floor to correct enophthalmos or hypo-ophthalmos (globe ptosis) in 16 patients. The main advantages of Vicryl mesh over other alloplastic implants is that (a) it is absorbed by host tissues, and, once absorbed, it will not cause long-term complications; (b) it is layered and is cut from folded sheets into the appropriate size, shape, and thickness for the treatment of enophthalmos or hypo-ophthalmos; and (c) it is soft and pliable and, therefore, is unlikely to erode orbital structures. We followed all 16 patients for a minimum period of 6 months after surgery and observed no significant adverse reactions to the mesh; 15 of the patients had good surgical results with a mean improvement of 1.4 mm in enophthalmos and 0.6 mm in hypo-opthalmos. After surgery, one patient with combined medial wall and floor fractures developed enophthalmos that was 2 mm more severe than the degree of preoperative enophthalmos. Vicryl mesh should be considered an alternative to both nonautogenous implants and autogenous grafts in orbital floor fracture repair especially for correction of mild and possibly moderate degrees of enophthalmos and hypoophthalmos.

ISSN:0740-9303    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Botulinum A toxin injection has great utility in the treatment of essential blepharospasm and other facial spasm disorders. Several investigators have noted the failure of botulinum toxin injections to relieve lid spasm in occasional patients and a decrease in effectiveness or duration of effect following multiple injections in other patients. We reviewed the charts of 30 consecutive patients presenting for the evaluation or treatment of facial dystonia. Of 20 patients who had received multiple injections of botulinum toxin, 10 patients were felt to be treatment failures. A new biomechanical system was developed to investigate the duration and degree of paralysis induced in the gastrocnemius muscle of the rat. Animals were treated with four sequential injections at 6-week intervals to the same muscle, resulting in muscle atrophy and an increase in the duration and degree of muscle paralysis, contrary to clinical findings in humans. The review of patient data confirms that, for many patients, repeated injection of botulinum toxin results in a decrease in duration and degree of effect despite an increased toxin dose. An opposite effect was noted in our experimental model because of progressive muscle atrophy.

ISSN:0740-9303    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Corneal discomfort often prevents the successful wearing of a cosmetic scleral shell. Such sensitive corneas are traditionally covered with a Gunderson conjunctival flap. I describe two patients in whom preexisting severe conjunctival scarring precluded the possibility of developing a Gunderson flap. An alternative procedure in which autogenous split-thickness dermal grafts were sutured over the sensitive cornea was utilized in each patient. The dermal grafts reepithelialized with mucosa within 4 weeks, and both patients were then able to retain an ocular prosthesis without discomfort. I conclude that satisfactory corneal coverage may be obtained with a dermal graft when conjunctival scarring precludes the use of a Gunderson flap.

ISSN:0740-9303    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A case of concordance for unilateral congenital ptosis in monozygotic twins is presented. The literature on genetics and congenital ptosis is reviewed. A heritability index is calculated for congenital ptosis, based on all current twin data including the present report. A value for the heritability index of 0.75 is found, suggesting a strong hereditary influence for congenital ptosis. We conclude that twin data strongly support a transmissable genetic defect as contributing to the development of congenital ptosis.

ISSN:0740-9303    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A 17-year-old boy presented with persistent swelling and ptosis of the eyelid after blunt injury. Histologic examination revealed a clinically unsuspected traumatic neuroma. Ptosis and the traumatic neuroma persisted despite two eyelid operations. Traumatic neuroma is rare after blunt trauma; it has not been previously reported in the eyelid. It is important to identify this lesion because complete excision may help to prevent recurrence.

ISSN:0740-9303    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Three cases of spontaneous hematic cyst of the orbit are described. All cases presented with acute onset of proptosis, conjunctival chemosis, choroidal folds, restricted ocular movement, and optic nerve compression syndrome with very poor vision. A computed tomography scan demonstrated a cystic lesion situated in the upper part of the orbit. Exploration revealed a cyst containing chocolate-colored fluid, Visual recovery was complete in two of three cases. There was no definite history of trauma in all three cases. Chronic hematic cysts have been described recently, but cases with acute onset such as ours have not to our knowledge been described clearly.

ISSN:0740-9303    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Chorioretinal folds have been reported as a result of many intraocular and extraocular inflammatory processes or tumors. Visual loss is usually secondary to a combination of the underlying process and chorioretinal folds involving the macula. We report a patient who developed decreased vision, metamorphopsia, chorioretinal folds, and a lamellar macular hole secondary to global compression by a bone fragment. The chorioretinal folds regressed and his vision stabilized following surgical decompression. Chorioretinal folds and lamellar macular hold formation are previously unrecognized complications of reconstructive craniofacial surgery.

ISSN:0740-9303    

出版商:OVID    

年代:1990

数据来源: OVID