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P.241 Acute orbital compartment syndrome
S228
Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
Orbital pathology and surgery P.241 Acute orbital compartment syndrome K. Abdel-Galil, L. Carter, K. Mizen. Leeds Teaching Hospitals NHS Trust, Leeds, UK The orbit is a cone-shaped structure formed by rigid bony walls within which the globe and retrobulbar contents are encased. Anteriorly, the orbital septum and eyelids form another relatively inflexible boundary. The medial and lateral canthal tendons attach the eyelids to the orbital rim and also limit any anterior displacement of the globe. Although small increases in orbital volume can be compensated for by forward displacement of the globe and prolapse of fat, a rapid rise in intraorbital pressure normally ensues. This increase in pressure within the confined space of the orbit causes decreased perfusion with associated ischaemic damage not unlike that seen in other compartment syndromes. Acute orbital compartment syndrome is a rare but treatable complication of such increased pressure within the confined orbital space. The condition presents with recognizable physical findings and progressive visual deficit. Objective: To present clinical examples of this syndrome with varying aetiology, describing their management and outcomes, reinforcing the need for early intervention. Method: Retrospective review of clinical cases presenting with acute orbital compartment syndrome. Conclusion: Recognition and prompt initiation of treatment may prevent blindness due to this condition P.242 Analysis of orbital tumors for ten years in K.M.U. hospital T. Mitsui, A. Shimotsuma, K. Suzuki, O. Horio, T. Minakata, N. Kakudo, S. Miyake, K. Kusumoto. Knsai Medical University, osaka, Japan In orbit various tumors and tumor like lesions occur. In this time, twenty seven cases, which were diagnosed in Takii Hospital of Kansai Medical University for ten years, are studied in the points of the statistical incidences, the localization and the histology. The tumor outbreak was not different in sexes. The peak was on 70’s. Most common clinical symptoms were swelling of eyelid in 8 cases (29.6%) and dacryorrhea in 5 cases (18.5%). In the localization, the tumors were observed 5 cases (18.5%) only in an inconical area, 7 cases (25.9%) only in an extraconical area, 5 cases (18.5%) in both intra and extraconical areas, 6 cases (22.2%) in a lacrimal grand, 4 cases (14.8%) in a lacrimal sac. Malignant tumors were 10 cases of 27 cases. The most malignant tumors were four cases of malignant lymphoma. Inconical tumors were not different in localization, however, all extraconical tumors were observed in nasal side in orbit. Referring these data resent image equipments, orbital tumors should be diagnosed accurately and treated properly. P.243 Blowout fracture in patients with binocular vision impairment K. Sokalska, P.J. Loba, M. Kozakiewicz, O. Nowakowska, A. Broniarczyk-Loba. Norbert Barlicki Memorial Teaching Hospital No. 1, Lodz, Poland Objective: The aim of the study is to exemplify certain clinical settings in which lack of diplopia may be a misleading factor in diagnosing blow-out fractures. Methods: We present three patients with blow-out fracture. No one of them had diplopia on initial examination and the amount of vertical disparity of eyes was low to moderate. Orbital CT scans revealed orbital floor defects with tissue herniation in all three subjects. Subsequently, full orthoptic examination was carried
Abstracts, EACMFS XIX Congress out, including clinical examination, measurement of the angle of squint, assessment of ocular motility on Hess screen and forced duction test. Results: In all cases we found a substantial impairment of binocular vision, which preceded the orbital trauma. It was caused either by anisometropic amblyopia, alternating exotropia or amblyopia that resulted from delayed congenital cataract surgery. In two cases reconstructive surgery was performed due to tissue herniation that was impairing ocular motility. In the third patient superior oblique paresis was found to be a cause of ocular misalignment and was therefore treated surgically. Conclusion: Our experience shows the necessity of an orthoptic examination in every patient with blow-out fracture before any surgical intervention. Absence of diplopia in such cases may be associated with preexisting binocular vision impairment and should not be considered as a sign excluding ocular motility disturbance. P.244 Infraorbital modification of the Weber-Ferguson flap K. Andi, S.B. Holmes, I.L. Hutchison. Barts and The London NHS Trust, London, UK Objectives: The Weber-Ferguson approach has been well described as the incision of choice for exposure of the orbit or maxilla. Access to the most lateral aspect of the maxilla and infratemporal fossa may be limited by the infra-orbital neurovascular bundle which is usually transected and re-approximated at the end of the procedure. We describe a technique whereby the nerve can be kept intact without limiting access. Methods: Following elevation of the Weber-Ferguson flap the infraorbital neurovascular bundle was identified. A 5 mm osteotome was applied to the infraorbital rim with two vertical cuts made on the superior surface aiming towards the medial and lateral borders of the infraorbital foramen. The segment of roof of infraorbital canal was elevated and the neurovascular bundle released superiorly and as far laterally as possible. This facilitated access to the most lateral aspect of the maxilla/infratemporal fossa. At the end of the procedure the osteotomised roof was fixed with 1.3 mm osteosynthesis plates (Synthes Inc.) and secured with 4 mm screws. Anatomical variations of the infra orbital canal will also be discussed. Conclusions: Infraorbital orbitotomy is a simple technique which reduces patient morbidity following midface access. P.245 Orbital abscess after orbital blowout fracture. A rare case G. Tzortzis1 , S. Tzintzos1 . 1 OMFS, 2 ENT, General Hospital Tripoli, Greece Orbital infection is a recognized though uncommon phenomenon. Possible causes include sinusitis, periorbital trauma, orbital reconstruction, haematogenous spread or odontogenic infection. If left untreated it can lead to blindness, cavernous sinus thrombosis, meningitis or cerebral abscess. The purpose of the study is to report the incidence of orbital abscess after orbital blowout fracture. Orbital abscesses are more common when paranasal sinus infections preexist or occur within 6 weeks of the injury. Surgery is required to drain the orbital abscess. A case is reported of a 23-year old male referred with a diagnosis of an odontogenic abscess. The patient had extensive bruising, swelling and pain behind the left eye with tenderness in the left infra-orbital region. The medical history revealed orbital trauma of the left eye due to assault 6 weeks prior. Computer tomography confirmed blowout fracture of the left orbit and ethmoid bone together with opaque left ethmoidal
Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
Orbital pathology and surgery P.241 Acute orbital compartment syndrome K. Abdel-Galil, L. Carter, K. Mizen. Leeds Teaching Hospitals NHS Trust, Leeds, UK The orbit is a cone-shaped structure formed by rigid bony walls within which the globe and retrobulbar contents are encased. Anteriorly, the orbital septum and eyelids form another relatively inflexible boundary. The medial and lateral canthal tendons attach the eyelids to the orbital rim and also limit any anterior displacement of the globe. Although small increases in orbital volume can be compensated for by forward displacement of the globe and prolapse of fat, a rapid rise in intraorbital pressure normally ensues. This increase in pressure within the confined space of the orbit causes decreased perfusion with associated ischaemic damage not unlike that seen in other compartment syndromes. Acute orbital compartment syndrome is a rare but treatable complication of such increased pressure within the confined orbital space. The condition presents with recognizable physical findings and progressive visual deficit. Objective: To present clinical examples of this syndrome with varying aetiology, describing their management and outcomes, reinforcing the need for early intervention. Method: Retrospective review of clinical cases presenting with acute orbital compartment syndrome. Conclusion: Recognition and prompt initiation of treatment may prevent blindness due to this condition P.242 Analysis of orbital tumors for ten years in K.M.U. hospital T. Mitsui, A. Shimotsuma, K. Suzuki, O. Horio, T. Minakata, N. Kakudo, S. Miyake, K. Kusumoto. Knsai Medical University, osaka, Japan In orbit various tumors and tumor like lesions occur. In this time, twenty seven cases, which were diagnosed in Takii Hospital of Kansai Medical University for ten years, are studied in the points of the statistical incidences, the localization and the histology. The tumor outbreak was not different in sexes. The peak was on 70’s. Most common clinical symptoms were swelling of eyelid in 8 cases (29.6%) and dacryorrhea in 5 cases (18.5%). In the localization, the tumors were observed 5 cases (18.5%) only in an inconical area, 7 cases (25.9%) only in an extraconical area, 5 cases (18.5%) in both intra and extraconical areas, 6 cases (22.2%) in a lacrimal grand, 4 cases (14.8%) in a lacrimal sac. Malignant tumors were 10 cases of 27 cases. The most malignant tumors were four cases of malignant lymphoma. Inconical tumors were not different in localization, however, all extraconical tumors were observed in nasal side in orbit. Referring these data resent image equipments, orbital tumors should be diagnosed accurately and treated properly. P.243 Blowout fracture in patients with binocular vision impairment K. Sokalska, P.J. Loba, M. Kozakiewicz, O. Nowakowska, A. Broniarczyk-Loba. Norbert Barlicki Memorial Teaching Hospital No. 1, Lodz, Poland Objective: The aim of the study is to exemplify certain clinical settings in which lack of diplopia may be a misleading factor in diagnosing blow-out fractures. Methods: We present three patients with blow-out fracture. No one of them had diplopia on initial examination and the amount of vertical disparity of eyes was low to moderate. Orbital CT scans revealed orbital floor defects with tissue herniation in all three subjects. Subsequently, full orthoptic examination was carried
Abstracts, EACMFS XIX Congress out, including clinical examination, measurement of the angle of squint, assessment of ocular motility on Hess screen and forced duction test. Results: In all cases we found a substantial impairment of binocular vision, which preceded the orbital trauma. It was caused either by anisometropic amblyopia, alternating exotropia or amblyopia that resulted from delayed congenital cataract surgery. In two cases reconstructive surgery was performed due to tissue herniation that was impairing ocular motility. In the third patient superior oblique paresis was found to be a cause of ocular misalignment and was therefore treated surgically. Conclusion: Our experience shows the necessity of an orthoptic examination in every patient with blow-out fracture before any surgical intervention. Absence of diplopia in such cases may be associated with preexisting binocular vision impairment and should not be considered as a sign excluding ocular motility disturbance. P.244 Infraorbital modification of the Weber-Ferguson flap K. Andi, S.B. Holmes, I.L. Hutchison. Barts and The London NHS Trust, London, UK Objectives: The Weber-Ferguson approach has been well described as the incision of choice for exposure of the orbit or maxilla. Access to the most lateral aspect of the maxilla and infratemporal fossa may be limited by the infra-orbital neurovascular bundle which is usually transected and re-approximated at the end of the procedure. We describe a technique whereby the nerve can be kept intact without limiting access. Methods: Following elevation of the Weber-Ferguson flap the infraorbital neurovascular bundle was identified. A 5 mm osteotome was applied to the infraorbital rim with two vertical cuts made on the superior surface aiming towards the medial and lateral borders of the infraorbital foramen. The segment of roof of infraorbital canal was elevated and the neurovascular bundle released superiorly and as far laterally as possible. This facilitated access to the most lateral aspect of the maxilla/infratemporal fossa. At the end of the procedure the osteotomised roof was fixed with 1.3 mm osteosynthesis plates (Synthes Inc.) and secured with 4 mm screws. Anatomical variations of the infra orbital canal will also be discussed. Conclusions: Infraorbital orbitotomy is a simple technique which reduces patient morbidity following midface access. P.245 Orbital abscess after orbital blowout fracture. A rare case G. Tzortzis1 , S. Tzintzos1 . 1 OMFS, 2 ENT, General Hospital Tripoli, Greece Orbital infection is a recognized though uncommon phenomenon. Possible causes include sinusitis, periorbital trauma, orbital reconstruction, haematogenous spread or odontogenic infection. If left untreated it can lead to blindness, cavernous sinus thrombosis, meningitis or cerebral abscess. The purpose of the study is to report the incidence of orbital abscess after orbital blowout fracture. Orbital abscesses are more common when paranasal sinus infections preexist or occur within 6 weeks of the injury. Surgery is required to drain the orbital abscess. A case is reported of a 23-year old male referred with a diagnosis of an odontogenic abscess. The patient had extensive bruising, swelling and pain behind the left eye with tenderness in the left infra-orbital region. The medical history revealed orbital trauma of the left eye due to assault 6 weeks prior. Computer tomography confirmed blowout fracture of the left orbit and ethmoid bone together with opaque left ethmoidal