The use of virtual surgical planning and navigation in the treatment of orbital trauma

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. Additionally, intraoperative navigation may be useful as an aid in performing the surgery. Navigation is useful for both the surgical dissection as well as to confirm the placement of the implant. Navigation has been found to be especially useful for orbit and sinus surgery. The present paper reports a case describing the use of VSP and computerized navigation for the reconstruction of a large orbital floor defect with a custom implant.

Clinical features,radiological imaging,and treatment strategies of nonmetallic intraorbital foreign bodies:a retrospective analysis

AIM:To provide comprehensive data on nonmetallic intraorbital foreign bodies(IOFBs)by summarizing and analyzing material types,clinical manifestations,imaging features,and treatment strategies.METHODS:Totally 28 nonmetallic IOFB cases treated at Shengjing Hospital of China Medical University from 2012 to 2020 were retrospectively reviewed.The types of foreign bodies,clinical features,imaging manifestations,and treatment outcomes were analyzed.RESULTS:Among all cases,67.8%(19/28)of the foreign bodies were organic.The top three entrances were the upper eyelid skin(7/28),lower fornix conjunctiva(6/28),and lower eyelid skin(4/28).In most cases(11/28,39.3%),foreign bodies remained in the medial orbits.The major clinical manifestations included eyelid redness and swelling(20/28,71.4%),conjunctival congestion and edema(17/28,60.7%),and ophthalmoptosis(15/28,53.6%).Infection was the main complication,which occurred in 57.1%(16/28)of all cases.Computerized tomography(CT)values differed for different foreign bodies and varied in the different periods after injury.The plant-and grease-derived foreign bodies and the surrounding pus cysts showed different signals on magnetic resonance imaging(MRI).The prognosis varied with different foreign body types,surgery timing,and intraoperative management.CONCLUSION:The majority of nonmetallic IOFBs are organic and often remain in the superior,medial,and inferior areas of the orbit.Clinical manifestations vary owing to their different textures.CT and MRI facilitate the identification of foreign body materials.Plant-derived foreign bodies should be completely removed,and surgical treatment is a complicated process.

Globe luxation may prevent myopia in a child:A case report

BACKGROUND Globe luxation is rare and is mostly due to direct orbital trauma with fractures of the medial and floor walls,which displace the globe into the maxillary sinus.Only a few cases have been reported;moreover,patients who suffer global luxation rarely achieve eyesight recovery.CASE SUMMARY This report describes the treatment and prognosis of global luxation occurring in a child.A 6-year-old boy presented with left globe luxation that occurred after a sudden stop on a tricycle,without any injury to the orbital or maxillofacial bony structures.After admission to the hospital,an external canthus incision,globe repositioning,orbital exploration and temporary blepharoplasty were performed.Finally,the child completely recovered and maintained good eyesight in his left eye even though the right eye developed myopia after four years of follow-up.CONCLUSION The aim of this study was to report the special occurrence of globe luxation in the child and share some experience of the treatment.Immediate surgical management plays an important role in the recovery of visual function,and globe luxation may prevent nearsightedness by reducing the distortion of the eyeball,shortening the axis and improving ciliary function.