Adjuvant therapy for orbital non-rhabdomyosarcoma soft tissue sarcoma:comparison of long-term outcome between radiotherapy and chemotherapy

AIM:To illustrate clinicopathological features of orbital non-rhabdomyosarcoma soft tissue sarcoma(NRSTS),and to compare the treatment outcome between postoperative radiotherapy(RT) and chemotherapy in a retrospective analysis nearly 20y.METHODS:A retrospective cohort study of 56 patients with orbital NRSTS were reviewed,34 of whom received postoperative RT,and 22 received postoperative chemotherapy.The clinicopathological features,local recurrence,metastases,and survival data were recorded.Survival analysis was performed using the Kaplan-Meier method.RESULTS:During follow-up(111.8mo,ranged 8-233mo) for 56 patients,19 patients of them developed local recurrence,and 7 patients developed distant metastases.Fifteen patients died during follow-up period.Overall survival rates considering the whole study group was 78.57% at 5y,and 72.16% at 10y after the initial diagnosis.Compared with chemotherapy,RT was associated with lower risk of local recurrence [hazard ratio for RT vs chemotherapy,0.263,95% confidence interval(CI),0.095-0.728,P=0.0015];with lower risk of distant metastasis(hazard ratio for RT vs chemotherapy,0.073,95%CI,0.015-0.364,P=0.0014);and with lower risk of death from disease(hazard ratio for RT vs chemotherapy,0.066,95%CI,0.022-0.200,P<0.0001).The 5-year survival rate in RT group was 97.06% compared to 50% in chemotherapy group.CONCLUSION:In patients with orbital NRSTS,postoperative RT provides better control of local recurrence,distant metastasis,and death from disease than chemotherapy.RT is the more preferrable adjuvant therapy compared to chemotherapy possibly.

Role of orthoptics and scoring system for orbital floor blowout fracture:surgical or conservative treatment

AIM:To assess the role of orthoptics in referring patients with orbital floor blowout fracture(OFBF)for conservative or surgical treatment and based on the results,to propose a scoring system for such decision making.METHODS:A retrospective analysis of 69 patients with OFBF was performed(35 treated conservatively,34 surgically).The role of orthoptics in referring to surgery or conservative treatment was retrospectively evaluated,the factors with the highest significance for decision making were identified,and a scoring system proposed using Logistic regression.RESULTS:According to defined criteria,the treatment was unsuccessful in 2(6%)surgically treated and only in one(3%)conservatively treated patient.The proposed scoring system includes the defect size and several values resulting from the orthoptic examination,the elevation of the eyebulb measured on Lancaster screen being the most significant.CONCLUSION:The study demonstrates the benefits of orthoptic examination when making decisions on conservative or surgical treatment and for diagnosing ocular motility disorder(with or without binocular diplopia)in OFBF patients.The proposed scoring system could,following verification in a prospective study,become a valuable adjunctive tool.

Repeated Hemorrhage after Repair of Orbital Floor Fracture with a Silicone Implant

A 16-year-old girl was accidentally kicked in her right eye by her cheerleading teammate in an exercise. Upward gaze ability of her right eye was severely impaired and computed tomography (CT) showed a trapdoor fracture of the right orbital floor. After surgical exploration, a silicone implant was inserted. No bleeding was confirmed at this time. The next day, CT detected a hematoma on the right orbital floor. The hematoma was drained and meticulous cautery was used to control any potential bleeding. The same silicone implant was re-inserted. Irrespective of attempts to avoid hemorrhage, this occurred twice after the respective evacuations. During a fourth operation, we removed the silicone implant simultaneously with hematoma evacuation. No hematoma has occurred since, and the patient’s ocular movement has dramatically improved to a normal binocular single vision field. When repeated hemorrhages occur after an orbital floor fracture repair with insertion of a silicone implant, removal of the implant is an effective strategy to resolve the hemorrhage.

Orbital Floor Fractures: Epidemiological, Clinical and Therapeutical Study at Sylvanus Olympio University Teaching Hospital in Loméabout 51 Cases

Introduction: Orbital floor fractures are a significant pathology among maxillofacial injuries. They can cause oculomotor, sensory, and sometimes esthetic disorders. The goal of this study was to determine the epidemiological profile of orbital floor fractures and show their clinical and therapeutic approach in Lomé. Patients and method: This was a descriptive retrospective study of orbital floor fractures collected in the ENT and maxillofacial surgery department of Sylvanus Olympio University Hospital in Lomé over 8 years (January 1, 2011 to December 31, 2018). Results: We reviewed 63 cases of orbital floor fractures out of 552 cases of facial trauma. According to the inclusion and non-inclusion criteria, we retained 51 cases. The hospital frequency of orbital floor fractures was 9.24% of facial fractures. The average age of the patients was 35 ± 10.34 years. Males were predominant (ratio = 7.5). The main etiology was road accidents (92.16%). Ophthalmological signs were dominated by vertical diplopia (31.37%), limited eye movement (25.49%), and enophthalmia (29.41%). The sensory sign was dominated by suborbital hypoesthesia (13.73%). Surgical treatment was performed in 86.27% of patients. The average intervention time was 17.84 ± 12.69 days after the trauma. The main approach was the subciliary route (65.91%). The surgical procedures consisted of muscle and fat removal (20.45%) and orbital floor repair by mesh plate (50%). The average length of hospitalization was 9.63 ± 5.23 days. Surgical site infection was the main postoperative complication observed in 3.92% of patients. The main sequelae were diplopia (4.55%), suborbital hypoesthesia (4.55%), and enophthalmos (4.55%). Conclusion: Orbital floor fractures are mainly due to road accidents. Management must be multidisciplinary and adequate in order to avoid irreversible functional and/or morphological sequelae. Their prevention consists of effective combat of road accidents.

Materials to facilitate orbital reconstruction and soft tissue filling in posttraumatic orbital deformaties

Posttraumatic orbital reconstruction has been a challenging mission for decades in craniomaxillofacial surgery.Complications like enophthalmos,diplopia and gaze obstacles emerge when orbital trauma occurs,affecting people’s daily life as well as their appearance.Advances in technology and research gained through years of experience has provided us with a greater understanding of the changes following trauma,as well as providing us with a variety of filling materials that we can choose from to handle the deformities.However,the best type of material for repair of orbital deformities remains controversial.This paper reviewed approximately 60 articles discussing materials used in orbital reconstruction or soft tissue defect filling in the past years,with the aim of giving a comprehensive overview of the advantages and disadvantages of materials used in this field so as to help surgeons to make a better choice.

Clinical outcome after orbital floor fracture reduction with special regard to patient's satisfaction

Purpose: Primary reconstruction via transconjunctival approach is a standardized treatment option for orbital floor fractures. The aim of this study was to compare the findings of specific ophthalmologic assessment with the patient's complaints after fracture reduction. Methods: A retrospective medical chart analysis was performed on patients who had undergone transconjunctival orbital floor fracture reduction for fracture therapy with resorbable foil (ethisorb sheet or polydioxanone foil). A follow-up assessment including ophthalmological evaluation regarding visual acuity (eye chart projector), binocular visual field screening (Bagolini striated glasses test) and diplopia (cover test, Hess screen test) was conducted. Additionally, a questionnaire was performed to assess patients' satisfaction. Results: A total of 53 patients with a mean follow-up of 23 months (ranging from 11 to 72) after surgical therapy were included. Diplopia was present preoperatively in 23 (43.4%) and reduced in follow-up examination (n = 12, 22.6%). Limitations in ocular motility reduced from 37.7% to 7.5%. The questionnaire about the patient's satisfaction revealed excellent outcomes in relation to the functional and esthetical parameters. Conclusion: Transconjunctival approach is a safe approach for orbital fracture therapy. Postoperative diplopia is nearly never perceptible for the individual and differs to pathologic findings in the ophthalmic assessment.

面中部骨折伴发眶底骨折的临床分析

目的探讨面中部骨折伴发眶底骨折的诊治方法。方法对136例面中部骨折伴发眶底骨折患者的治疗进行回顾性研究。136例患者均采用切开复位内固定术进行治疗,其中49例行眶底手术治疗,21例有眶底骨缺损的患者采用自体骨、钛网或多孔高分子聚乙烯进行眶底重建。结果136例骨折患者的面部外形和功能显著恢复,术后未发生永久性严重并发症,仅2例出现切口局部感染,1例暂时失明,经及时治疗后痊愈。结论面中部骨折伴发眶底骨折的首选诊断方法是CT;治疗原则是恢复眶底的解剖形态和眶腔容积,还纳疝入上颌窦的眶内容物,植入修复材料重建眶底。

眶底和眶内侧壁骨折后眶内软硬组织移位的相关性

目的:对眶底和眶内侧壁骨折范围面积的大小和眶内移位软组织体积之间关系进行相关性研究。方法:15例颧眶骨折伴有眶底、眶内侧壁骨折、眶内软组织移位的患者分别做MSCT扫描,利用Simplant软件测量眶底和眶内侧壁骨折范围面积的大小和眶内移位软组织体积,做统计学分析,并将骨折形态以STL格式文件存储。结果:平均眶底骨折范围面积的大小为(4.64±0.77)cm2,平均眶底移位软组织体积是(2.58±1.33)cm3,两者相关关系是y=1.18602x-2.929,R=0.683。平均眶内侧壁骨折范围面积的大小为(5.53±1.14)cm2,平均移位软组织体积是(2.59±1.05)cm3,两者相关关系是y=0.6894x-1.1342,R=0.7829。结论:眶底和眶内侧壁骨折范围面积大小与其相应移位软组织容积存在线性相关关系。

眶底骨折与眶底软组织移位相关性研究

目的:对眶底骨折范围面积的大小和眶底移位软组织体积之间关系进行相关性研究。方法:15例颧眶骨折伴有眶底骨折及眶底软组织移位的患者分别做MSCT扫描,利用Simplant软件测量眶底和眶底侧壁骨折范围面积的大小和眶底移位软组织体积,做统计学分析,并将骨折形态以STL格式文件存储。结果:平均眶底骨折范围面积大小为(4.64±0.77)cm2,平均眶底移位软组织体积为(2.58±1.33)cm3,两者相关关系是y=1.18602x-2.929,R=0.683。结论:眶底骨折范围面积大小与其相应移位软组织容积存在线性相关关系。

眶颧复合体骨折合并眶底骨折的手术治疗

目的评价颧眶复合体骨折合并眶底骨折的手术治疗效果。方法对81例眶颧复合体骨折合并眶底骨折患者根据骨折时间及部位选择性地采用冠状切口、下睑缘切口、口内切口,复位、固定骨折并行同期眶底重建,所有患者术前、术后均摄双眶水平及冠状位CT、头面部三维CT像,并进行比较。结果术后随访6～37个月,平均12.5个月,所有患者面形基本对称,开口度正常,58例复视基本消失,5例有不同程度改善;66例眼球内陷者中,60例基本矫正,4例内陷﹤2mm,2例内陷2～3mm。3例出现轻度下睑外翻,2例巩膜暴露,无人造骨片排异和移位出现。结论颧眶复合体骨折合并眶底骨折应根据患者症状确定是否行眶底探查,颧弓及颧蝶缝是骨折复位的重要参考点。

透明质酸钠预防兔眼眶软组织粘连形成的研究

目的探讨透明质酸钠对眼眶软组织粘连的预防作用和机制。方法成年家兔10只,左右眼分别为实验眼和对照眼。在上直肌与对应眼眶骨膜间人为制造创伤,实验组在创面间涂抹透明质酸钠凝胶,对照组不予处理。于术后1周肉眼观察两组粘连情况,行病理学评分和转化生长因子(TGF-β)免疫组织化学染色。结果粘连程度评分为对照组4分者5眼,3分者3眼,2分者2眼;实验组4分者0眼,3分者2眼,2分者2眼,1分者5眼,两组差异有统计学意义(u=61.5,P<0.01)。炎症反应程度评分为对照组4分者4眼,3分者4眼,2分者2眼;实验组4分者0眼,3分者1眼,2分者5眼,1分者4眼,两组差异有统计学意义(u=64,P<0.01)。成纤维母细胞数量实验组明显低于对照组,差异有统计学意义(u=55,P<0.01)。TGF-β免疫组织化学染色结果显示对照组染色呈强阳性,实验组呈弱阳性。结论透明质酸钠可以促进内皮细胞生长,抑制成纤维细胞生长,减少胶原纤维的合成,有效抑制兔眶损伤后粘连的发生。

高密度聚乙烯多孔材料在创伤性眶底缺损整复的临床观察

目的:观察高密度聚乙烯多孔材料Medpor在眶底缺损修复中的临床应用效果,分析相关并发症的术后改善情况。方法: 2001年1月起选取20例创伤性眶底缺损患者采用高密度聚乙烯多孔材料作为眶底填充材料实施眼眶重建术,同期选取16例常规钛金属修复作为对照。术后6m嘱患者进行复查评价两者的治疗效果;评价内容包括患者外貌、眼球功能和创伤性眶底缺损常见并发症的改善情况等;术前及术后6m头颅三维螺旋CT检查观察眶底缺损修复后眼眶结构的连续性。结果:36例患者术后面中部对称性都逐渐恢复,眼球的运动功能明显好转。创伤性眶底缺损常见并发症如眼球内陷、复视及眶下神经感觉迟钝术后明显改善,采用Medpor材料修复和常规钛金属修复的患者无明显差异。同期螺旋三维CT显示与钛金属修复相比,采用生物材料保持了眶结构的连续性,维持了正常眶容积。有利于缺损修复,骨缺损面积明显缩小。结论:研究表明高密度聚乙烯多孔材料操作容易,可塑性高,材料在体内可促进自体骨组织长入,具有较好的修复效果,对临床眼眶修复重建的手术治疗具有一定的指导意义。

眼眶软组织肿瘤455例临床病理观察

目的:探讨眼眶软组织肿瘤临床病理特征。方法:回顾性分析我院2003-11/2018-11眼眶软组织肿瘤患者455例的病例资料,观察其临床特点、病理分类和少见肿瘤的病理学特征。结果:眼眶软组织肿瘤患者455例中,良性肿瘤421例(92.5%),居于前5位的依次为海绵状血管瘤258例、毛细血管瘤58例、神经纤维瘤16例、纤维瘤15例和神经鞘瘤14例;中间型27例(5.9%),其中孤立性纤维性肿瘤(SFT)23例、低度恶性纤维组织细胞瘤2例、低度恶性黏液性神经纤维瘤2例;恶性7例(1.5%),其中眼眶恶性SFT者2例,眼眶髓系肉瘤(MS)2例,黏液样脂肪肉瘤(MLS)、梭形细胞未分化肉瘤和外周原始神经外胚叶肿瘤(PNET)各1例。对部分病例进行免疫组化和分子检测,结果发现新抗体如STAT6和分子检测技术的应用能提高诊断准确性。结论:眼眶软组织肿瘤中,良性肿瘤占大部分,脉管肿瘤中的海绵状血管瘤居于首位,不乏眼眶部位少见软组织肿瘤病理学类型如Erdheim-Chester病(ECD)、砂粒体性骨化性纤维瘤(POF)、平滑肌瘤和黏液瘤等;中间型和恶性肿瘤少见,眼眶部位SFT、MLS、梭形细胞未分化肉瘤和MS等少见的病理学类型常诊断困难,容易漏诊误诊,新型免疫组化抗体和分子检测技术能提高诊断的准确率。

网状眶底修复钛板治疗眶底骨折

目的:观察网状眶底修复钛板用于治疗眶底骨折的效果。方法:本文通过对27例眶周骨折患者采用坚强内固定技术固定骨折,并用网状眶底修复钛板治疗不易固定的眶底骨折,对术后效果进行跟踪观察。结果:所有患者眼球内陷和神经症状都得到了纠正,疗效满意。结论:使用眶底修复钛板或眶内侧壁修复钛板能有效恢复眶腔骨质延续性,并可以节省手术时间,降低手术创伤,术后并发症少,是处理眶底复杂骨折的有效方法之一。

下睑缘入路手术修复眶底骨折的临床评价

目的 探讨下睑缘入路手术修复眶底骨折的治疗效果。方法 3 6例眶底骨折均伴有颧骨复合体骨折、双侧上颌骨骨折和鼻眶筛复合体骨折。以下睑缘入路羟基磷灰石人造骨眶底重建。结果 术后并发症包括睑外翻 2例 ,下睑撕裂 3例 ,巩膜暴露 2例。结论 下睑缘入路提供了足够的手术视野 ,既能修复眶下缘骨折 ,又能修复眶底缺损 ,术后并发症较少。

HRCT诊断眼眶底壁骨折

目的 :探讨高分辨力CT(HRCT)诊断眼眶底壁骨折的临床价值。材料和方法 :对 10 5例眼钝力伤患者进行横断+冠状高分辨力CT扫描 ,进行图像对比分析。结论 :10 5例患者中 41例有眼眶底壁骨折 ,其中眶内下壁骨折 15例 ,眶下沟骨折 16例 ,眶底前缘骨折 10例。合并眶内容物疝出 2 5例 ,窦口—鼻道复合体狭窄 4例 ,眶下神经管或眶下孔骨折 5例 ,鼻泪管骨折 2例。结论 :HRCT冠状扫描显示眼眶底壁骨折优于横断扫描。眼眶底壁骨折HRCT诊断除应仔细观察骨折类型以外 ,还应充分估计眶下神经、窦口—鼻道复合体及鼻泪管的损伤情况 ,为临床制定治疗方案及预后提供有利依据。

不同基质眼膏进入豚鼠眶组织的不良反应

目的:观察不同基质眼膏进入眼眶软组织后的不良反应。方法:63只豚鼠采用随机数字表法分为3组,每组21只。将凡士林和液状石蜡为基质的红霉素眼膏(A组)、玻璃酸钠和卡波姆为基质的氧氟沙星眼膏(B组)或可以降解吸收的羟丙基甲基纤维素(C组,对照)各0.3mL注入3组豚鼠眼眶软组织中,分别在2h、1d、3d、7d、14d、21d和28d时观察眼眶局部炎症反应,大体标本观察眼膏扩散和降解情况,HE染色观察病理组织学变化。结果:A组早期结膜肿胀、眼球突出,球后阻力增加最为严重,持续时间最长,病理学早期以中性粒细胞为主的炎症细胞浸润,晚期可见成纤维细胞增生包裹,炎症浸润和细胞增殖反应最重;B组3d内炎症反应重,以中性粒细胞和嗜酸性粒细胞为主的炎症细胞浸润,但未见成纤维细胞增生;C组注射后眶组织充血水肿消失快,炎症细胞最少,未见纤维组织增生。注射后3d3组间结膜肿胀、眼球突出及球后阻力情况比较,差异均有统计学意义(H=9.089、16.830和17.084,P均<0.05)。结论:不同基质眼膏进入豚鼠眼眶软组织后的不良反应存在差异:凡士林液状石蜡为基质的红霉素眼膏炎症反应最重、降解所需时间最长、病理变化最明;玻璃酸钠和卡波姆为基质的氧氟沙星眼膏较轻;羟丙基甲基纤维素反应最轻。

鼻眼联合手术入路治疗爆裂性眶底骨折31例

目的探讨鼻眼联合手术入路治疗爆裂性眶底骨折的临床效果。方法 31例(31眼)爆裂性眶底骨折,采用下睑睫毛下切口入路和经上颌窦柯-陆氏入路,分别在直视下和鼻内窥镜下联合修复眶底骨折,解除粘连和嵌顿,还纳眶内容物。观察手术前后患者眼球突出度、复视程度、眼球牵拉试验及眼外肌功能的改善情况,分析手术疗效。结果 31例(31眼)爆裂性眶底骨折手术前均存在眼球凹陷,患眼与健眼眼球突出度相差4.0～8.0(5.0±1.3)mm,差异具有统计学意义(t=6.798,P=0.000);正前方及前下方视野内均有垂直复视;31眼眼球牵拉试验结果均为阳性(眼球向上被动牵引时存在阻力),眼球向上和向下运动均明显受限。手术后3个月,31眼眼球凹陷均得到满意恢复,患眼与健眼眼球突出度相差0～1.0(0.3±0.5)mm,差异无统计学意义(t=1.309,P=0.200)。手术前后自身患眼眼球突出度比较,相差2.0～5.0(3.0±0.1)mm,差异具有统计学意义(t=4.956,P=0.000);31眼中28眼正前方复视消失,16眼前下方复视消失;31眼眼球牵拉试验结果均为阴性(眼球向上被动牵引时不存在阻力),眼球上转均恢复正常,15眼仍有下转受限。结论鼻眼联合手术入路修复爆裂性眶底骨折,术野暴露充分,手术损伤相对较轻,临床效果可靠,尤其适用于严重的大范围眶底骨折患者。

眶周软组织扩张术对眶距增宽矫正后骨愈合的影响

目的 建立兔眶距增宽矫正手术的动物模型 ,探讨使用眶周软组织扩张技术对眶内移后骨愈合的影响。方法 4～ 6个月龄新西兰兔 1 6只 ,随机分为两组 ,一组为实验组 ,眶周软组织扩张后 ,行颅内外联合径路眶周截骨眶内移 ;另一组为对照组 ,眶周软组织不扩张 ,直接眶周截骨眶内移。 1 6只兔均在眶内移术后 1 2周处死 ,取下眶间骨胳进行内眶距测量 ,X线摄片和组织学检查。结果 术后 1 2周 ,实验组平均内眶距为 (5 .7± 0 .4 )mm ,对照组平均内眶距为 (6 .8± 0 .7)mm ,两组有显著性差异 (P <0 .0 1 )。X线结果可见 ,术后 1 2周实验组较对照组骨密度增高 ,截骨间隙缩小。组织学检查证实 ,对照组眶间新生骨组织较多。结论 使用眶周软组织扩张技术 ,可有效地防止眶内移后眶距增宽的复发 ,证明眶周软组织不足 。

基于MRI三维重建的正常眼部与眼眶肿瘤的软组织测量分析

目的探讨基于MRI三维重建的正常眼部与眼眶肿瘤的软组织测量方法与效果。方法采用回顾性研究方法。2014年9月到2018年1月选择在我院进行诊治的眼眶肿瘤72例(72只眼)作为观察组,同期选择在我院进行检查的正常眼部人群72例(72只眼)作为对照组,两组都进行常规MRI扫描、MRI DWI扫描与三维重建,测量眼眶软组织相关指标。结果相对于对照组,观察组眼眶MRI特征多表现为形态不规则、边界不清楚、累及眶外结构、T_1WI与T_2WI等信号强度、T_1WI与T_2WI信号均匀。观察组中TICⅠ型2例,Ⅱ型30例,Ⅲ型40例;对照组分别为43例、20例与9例,对比有显著差异(P <0. 05)。在b值=500、1000 s/mm^2条件下,观察组眼眶软组织的ADC值都显著低于对照组(P <0. 05)。观察组眼眶软组织的Ktrans值显著高于对照组(P <0. 05)。结论基于MRI三维重建的正常眼部与眼眶肿瘤的软组织测量可反映眼眶肿瘤的特征,有很好的临床诊断与鉴别价值。