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Orbital anatomy and trauma

Viet D Nguyen, Achint K Singh, Wilson B Altmeyer, Bundhit Tantiwongkosi
Imaging of the orbit plays an important role in the workup of orbital emergencies. Orbital imaging is particularly useful in the emergency department, where clinical history and physical examination may be limited or delayed until the exclusion or treatment of more life-threatening conditions. Cross-sectional orbital imaging with multidetector computed tomography (CT) and magnetic resonance (MR) imaging is commonly performed in addition to ultrasonography. In an emergent setting, CT is the preferred modality when evaluating for intraorbital foreign bodies, fractures, or calcifications within a mass lesion...
April 21, 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Alan Scott Herford, Meagan Miller, Floriana Lauritano, Gabriele Cervino, Fabrizio Signorino, Carlo Maiorana
Virtual surgical planning (VSP) has recently been introduced in craniomaxillofacial surgery with the goal of improving efficiency and precision for complex surgical operations. Among many indications, VSP can also be applied for the treatment of congenital and acquired craniofacial defects, including orbital fractures. VSP permits the surgeon to visualize the complex anatomy of craniofacial region, showing the relationship between bone and neurovascular structures. It can be used to design and print using three-dimensional (3D) printing technology and customized surgical models...
February 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
YongSeok Nam, Sujin Bahk, SuRak Eo
The infraorbital nerve (ION) can easily be damaged by orbital trauma and periorbital surgical manipulations, due to its abutment to the orbital floor. Anatomic variability of the ION and surrounding structures has infrequently been documented. The aim of this study is to give precise anatomical knowledge about the ION with surrounding structures, to avoid iatrogenic injury of the ION during periorbital procedures.Forty orbits of 40 skull subjects (20 males and 20 females) were studied to analyze structures around the ION...
January 31, 2017: Journal of Craniofacial Surgery
Bijan Beigi, Deepak Vayalambrone, Mohsen Bahmani Kashkouli, Peter Prinsley, Jan Saada
PURPOSE: To present a technique to improve the surgical treatment of frontal sinus mucocele and its recurrence. METHODS: Nine procedures performed on eight patients by a team of ENT and Ophthalmic orbital surgeons. Data collected included patient demographics, surgical details, pathological findings and complications. The surgical technique involved an external approach via the upper eyelid skin crease combined with an internal approach with a rigid 4 mm endoscope described below...
March 2016: Journal of Current Ophthalmology
Michael J Reiter, Ryan B Schwope, Jared M Theler
OBJECTIVE: The purpose of this article is to describe both the expected and unexpected imaging features of posttraumatic defects of the orbital skeleton after surgical repair. CONCLUSION: The goal of surgery is to restore the preinjury orbital anatomy to improve function and prevent enophthalmos. Radiologists need to be cognizant of the more frequently encountered operative procedures used for orbital fracture repair, the desired goals of treatment, and common complications...
June 2016: AJR. American Journal of Roentgenology
Susmitha Rajmohan, David Tauro, Bhupesh Bagulkar, Anuj Vyas
AIMS: The coronal incision with its various modifications provides the most versatile approach to various areas in the craniomaxillofacial region coupled with excellent exposure. The aesthetic advantage of a hidden scar in the hairline, accounts for its continued popularity. The aim of this study was to review the surgical anatomy, technique and problems of post-operative morbidity pertinent to coronal approach in various clinical situations such as craniofacial trauma, tumour resections and reconstructive craniofacial procedures...
August 2015: Journal of Clinical and Diagnostic Research: JCDR
Gerson Mast, Michael Ehrenfeld, Carl-Peter Cornelius, Ralph Litschel, Abel-Jan Tasman
Fractures of the midface and internal orbit occur isolated or in combination with other injuries. Frequently, the patients are first seen in emergency rooms responsible for the coordination of initial diagnostic procedures, followed by the transfer to specialties for further treatment. It is, therefore, important for all physicians treating facial trauma patients to understand the basic principles of injuries to the midface. Thus, this article aims to describe the anatomy and the current classification systems in use, the related clinical symptoms, and the essential diagnostic measures to obtain precise information about the injury pattern...
August 2015: Facial Plastic Surgery: FPS
W Reith, U Yilmaz
The aim of this 2-part review article on diseases of the orbit is to give the reader an insight into the anatomical structure and an overview of the most important diseases in the area of the eye socket. The main focus is on a description of the imaging procedures and their individual advantages and disadvantages. The most important tumors, trauma and degenerative alterations of the orbit are also described.
August 2015: Der Radiologe
Felicity Victoria Connon, S J B Austin, A L Nastri
Orbital roof fractures are relatively uncommon in craniofacial surgery but present a management challenge due to their anatomy and potential associated injuries. Currently, neither a classification system nor treatment algorithm exists for orbital roof fractures, which this article aims to provide. This article provides a literature review and clinical experience of a tertiary trauma center in Australia. All cases admitted to the Royal Melbourne Hospital with orbital roof fractures between January 2011 and July 2013 were reviewed regarding patient characteristics, mechanism, imaging (computed tomography), and management...
September 2015: Craniomaxillofacial Trauma & Reconstruction
Robert A Clark
The rectus extraocular muscles (EOMs) and inferior oblique muscle have paths through the orbit constrained by connective tissue pulleys. These pulleys shift position during contraction and relaxation of the EOMs, dynamically changing the biomechanics of force transfer from the tendon onto the globe. The paths of the EOMs are tightly conserved in normal patients and disorders in the location and/or stability of the pulleys can create patterns of incomitant strabismus that may mimic oblique muscle dysfunction and cranial nerve paresis...
July 2015: Middle East African Journal of Ophthalmology
Christopher G T Lim, Duncan I Campbell, Nicholas Cook, Jason Erasmus
In Christchurch Hospital, rapid prototyping (RP) and intraoperative imaging are the standard of care in orbital trauma and has been used since February 2013. RP allows the fabrication of an anatomical model to visualize complex anatomical structures which is dimensionally accurate and cost effective. This assists diagnosis, planning, and preoperative implant adaptation for orbital reconstruction. Intraoperative imaging involves a computed tomography scan during surgery to evaluate surgical implants and restored anatomy and allows the clinician to correct errors in implant positioning that may occur during the same procedure...
June 2015: Craniomaxillofacial Trauma & Reconstruction
Michal Kyllar, Jan Štembírek, Zdenek Danek, Radek Hodan, Jiří Stránský, Vladimír Machoň, René Foltán
Due to its similarity to humans, the pig has proven to be a suitable biomodel for both research purposes and for training medical professionals, particularly in surgical specializations. For example, new implant materials have been tested on pig jaws and pigs have also been used in the development of new surgical techniques. For optimizing the effectiveness of such research or training, detailed data on the anatomy of their particular features are needed. At present, however, only limited information related to surgical and imaging anatomy of the facial and orbital areas of the pig and its comparison to human structures from the experimental surgery point of view is available in the literature...
April 2016: Laboratory Animals
Sung Woo Park, Jong Woo Choi, Kyung S Koh, Tae Suk Oh
PURPOSE: Reconstruction of traumatic orbital wall defects has evolved to restore the original complex anatomy with the rapidly growing use of computer-aided design and prototyping. This study evaluated a mirror-imaged rapid prototype skull model and a pre-molded synthetic scaffold for traumatic orbital wall reconstruction. PATIENTS AND METHODS: A single-center retrospective review was performed of patients who underwent orbital wall reconstruction after trauma from 2012 to 2014...
August 2015: Journal of Oral and Maxillofacial Surgery
Michael J Reiter, Ryan B Schwope, Jonathan A Kini, Gerald E York, Abraham W Suhr
Ophthalmologists perform a wide array of interventions on the orbital contents. The surgical treatment of glaucoma, cataracts, retinal detachment, and ocular trauma or malignancy results in alteration of the standard anatomy, which is often readily evident at radiologic examinations. The ability to accurately recognize the various imaging manifestations after orbital surgery is critical for radiologists to avoid misdiagnosis. Of particular importance is familiarity with the numerous types of implanted devices, such as glaucoma drainage devices, orbital implants, and eyelid weights...
January 2015: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Stefan Alexander König, Sebastian Ranguis, Veronika Gramlich, Uwe Spetzger
BACKGROUND: The authors describe their experience with the reconstruction of complex anterior skull base defects after trauma or tumour resection using a "sandwich" technique with pericranial flap, titanium mesh and TachoSil. METHODS: Description of surgical anatomy, surgical technique, indications, limitations, complications, specific perioperative considerations and specific information to give to the patient about surgery and potential risks. A summary of ten key points is given...
January 2015: Acta Neurochirurgica
Johannes Wikner, Björn Riecke, Alexander Gröbe, Max Heiland, Henning Hanken
The severity of midfacial and orbital injuries depends on the one hand on cause, force vector, load point, or area and on the other hand on the bony and soft tissue resistance as well as individual anatomy. These variables result in a variety of possible injuries of the midfacial and orbital complex. The time critical choice of an adequate imaging modality of these injuries is influenced by the possible severity of concomitant injuries. Besides the confirmation of a clinical diagnosis, the need for high-resolution three-dimensional imaging for preoperative planning of facial reconstruction using intraoperative navigation has become more and more important in the past years...
October 2014: Facial Plastic Surgery: FPS
Humberto Fernández Olarte, Santiago Abello, Jaime Castro-Núñez
We present a modification of the classic lateral canthal approach by means of which the anatomy of the lateral palpebral edges will remain unscathed, with the incision beginning 2 mm lateral to the external canthus. We have used this technique in 76 patients at 3 major trauma centers in Bogota, Colombia, from January 2006 to January 2012. The approach provided excellent access to the frontozygomatic area, lateral wall of the orbit, and malar body. This method avoids important anatomic structures and offers outstanding cosmetic results, especially in adult patients...
August 2014: Journal of Oral and Maxillofacial Surgery
Jennifer A Villwock, Amar C Suryadevara
PURPOSE OF REVIEW: A myriad of surgical approaches to the craniomaxillofacial skeleton exist. Depending on the purpose of the procedure and the anatomic area to be addressed, classically used approaches include coronal approach, midfacial degloving, eyelid incisions, and other cutaneous incisions. Over the last decade, endoscopic approaches have become more popular. Whether external, transoral, or endoscopic, a detailed knowledge of the indications, anatomy, limitations, and potential complications is critical to the successful employment of these approaches...
August 2014: Current Opinion in Otolaryngology & Head and Neck Surgery
Edward K Sung, Rohini N Nadgir, Akifumi Fujita, Cory Siegel, Roya H Ghafouri, Anastasia Traband, Osamu Sakai
Traumatic ocular injuries are a significant cause of blindness and visual deficits. In the setting of acute orbital trauma, urgent ophthalmologic evaluation and intervention are critical in preserving vision. However, in the acute trauma setting, clinical evaluation of the globe may be difficult in the presence of surrounding periorbital soft-tissue swelling and other associated injuries, and patient cooperation may be limited because of unresponsiveness, altered mentation, or sedation. Often, rapid access to imaging is part of the initial diagnostic evaluation, and radiologists may be the first to identify traumatic injuries of the globe...
May 2014: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Sachin S Pawar, John S Rhee
IMPORTANCE: Frontal sinus and naso-orbital-ethmoid (NOE) fractures are among the most challenging injuries in the treatment of maxillofacial trauma. OBJECTIVE: To summarize the current knowledge regarding frontal sinus and NOE fractures and to present some of the more recent, evidence-based literature to support current treatment recommendations. EVIDENCE REVIEW: A PubMed search of articles from 1990 through 2013 was performed. Search terms included frontal sinus fracture, NOE fracture, naso-orbito-ethmoid fracture, naso-ethmoid-orbital fracture, and nasoethmoid fracture...
July 2014: JAMA Facial Plastic Surgery
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