经鼻内镜治疗陈旧性眶内壁骨折致眼球内陷体会

头面部经常遭受外伤,眶壁骨折可单独发生也可以是复合性颜面部外伤的一部分,往往一些眶壁骨折的患者易因其他部位的伤情或眼球的病情而延误治疗。1.1临床资料。收集我科2012年6月~2014年6月就诊的55例陈旧性眶内壁骨折导致眼球内陷≥2 mm患者,均经CT确诊由眼科医师检查转诊耳鼻喉科入院。男46例,女9例,年龄18~57岁,平均(32.75±9.97)岁。右眼17例,左眼38例;

Severe absence of intra-orbital fat in a patient with orbital venous malformation:A case report

BACKGROUND The orbital venous malformation is quite common in orbital diseases.Clinically,it is usually characterized by proptosis.However,among patients with distensible venous malformations,if the lesions continuously progress,they may induce enlargement of the orbital bone or orbital lipoatrophy,which in turn leads to enophthalmos.CASE SUMMARY Here,we report a patient who presented with enophthalmos and had a severe absence of intra-orbital fat secondary to orbital venous malformation.The patient was a 66-year-old female with a 20-year history of enophthalmos.Hertel exophthalmometry readings in a relaxed upright position were 4 mm OD and 13 mm OS with a 97 mm base.It was determined that she had positional“proptosis”.Physical examination also revealed a bulging mass on her hard palate.Computed tomographic scan and magnetic resonance imaging showed an expansion of the right orbit with local bony defects and multiple soft-tissue masses.CONCLUSION Long-term lack of awareness about the presence of orbital venous malformations,persistent venous congestion could lead to compression of the orbital fat,which in turn induces atrophy or the absence of intra-orbital fat.

Silent Sinus Syndrome: Clinical Findings and Differential Diagnosis

The Silent Sinus Syndrome (SSS) is a rare condition that causes facial asymmetry, unilateral enophthalmos and diplopia. It is thought to be secondary to chronic maxillary sinus atelectasis (CMA) with reabsorbed bone and subsequent displacement of the orbital floor. Such anatomic modifications occur over time, and therefore it is possible to encounter different stages of the same disease with or without orbital displacement. Clinical findings can be unclear so it makes sense to recognize potentially evolving SSS while other disturbances have to be ruled out. Our purpose is to underline clinical findings for different diagnosis and proper management. We consider Functional Endoscopic Sinus Surgery (FESS) indicated in CMA and SSS to halt the progression of the disease. Nevertheless restitution treatment of enophtalmos due to orbital floor displacement involves plastic reconstruction of the floor of the orbit via transconjunctival approach. We report a case of SSS and discuss distinctive features of non-neoplastic lesions involving the maxillary sinus that should be considered for differential diagnosis.

隐匿性鼻窦综合征

隐匿性鼻窦综合征(silent sinus syndrome,SSS)是以自发性、渐进性且不伴其它症状的单侧眼球陷落为主要临床特征的一组综合征。CT检查发现患侧上颌窦萎缩有助于诊断,手术建立窦腔通畅引流具有较好的治疗效果及预后。本文就其病因、临床表现、辅助检查、诊断、鉴别诊断及治疗进行综述。

Does reconstruction affect outcomes following exclusively endoscopic endonasal resection of benign orbital tumors: A systematic review with meta-analysis

Objective:As exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread,high-quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection.The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices.Methods:Data Sources:PubMed,EMBASE,Web of Science.A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted.Articles not reporting orbital reconstruction details were excluded.Patient and tumor characteristics,operative details,and outcomes were recorded.Variables were compared usingχ^(2),Fisher’s exact,and independentt tests.Results:Of 60 patients included from 24 studies,34(56.7%)underwent orbital reconstruction following resection.The most common types of reconstruction were pedicled flaps(n=15,44.1%)and free mucosal grafts(n=11,32.4%).Rigid reconstruction was uncommon(n=3,8.8%).Performance of orbital reconstruction was associated with preoperative vision compromise(P<0.01).The tendency to forego orbital reconstruction was associated with preoperative proptosis(P<0.001),larger tumor size(P=0.001),and operative exposure of orbital fat(P<0.001)and extraocular muscle(P=0.035).There were no statistically significant differences between the reconstruction and nonreconstruction groups in terms of short-or long-term outcomes when considering all patients.In patients with intraconal tumors,however,there was a higher rate of short-term postoperative diplopia when reconstruction was foregone(P=0.041).This potential benefit of reconstruction did not persist:At an average of two years postoperatively,all patients for whom reconstruction was foregone either had improved or unchanged diplopia.Conclusion:Most outcomes assessed did not appear affected by orbital reconstruction status.This general equivalence may suggest that orbital reconstruction is not a necessity in these cases or that the decision to reconstruct was well-selected by surgeons in the reported cases included in this systematic review.

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.