Search Results (53)

Intraosseous hemangiomas (IH) are rare intrabony lesions that represent less than 1% of intraosseous tumors. IH are mostly seen in the axial skeleton and skull. Most commonly, the frontal bone, zygomatic, sphenoid, maxilla, ethmoid, and lacrimal bone can manifest IH. Currently, IH is classified as a developmental condition of endothelial origin. According to WHO, the five histological types of IH are cavernous, capillary, epithelioid, histiocytoid, and sclerosing. IH of the zygoma is an extremely rare condition with female predominance. A systematic review recently estimated that there were 78 cases published in the literature until 2023. The lesion is usually asymptomatic and presents with a gradually deteriorating deformity of the malar area, and the patient might be able to recall a history of trauma. Numbness due to involvement of the infraorbital nerve might also be present; however, atypical skin and bone sensations might also occur. Other symptoms include painful swelling, bone asymmetry, skin irritation, sinus pressure, paresthesia, diplopia, enophthalmos, or atypical neuralgia. A bony lesion with a trabecular pattern in a radiating formation (sunburst pattern) or a multilocal lytic lesion pattern created by the multiple cavernous spaces (honeycomb pattern) is commonly observed during radiologic evaluation. We present a rare case of IH of the zygoma in a 65-year-old generally healthy woman. A cyst-like bone tumor was revealed from the CT scan, which made preoperative biopsy of the lesion problematic. A careful radiological diagnostic differentiation of the lesion should always be conducted in such cases to outline a safe surgical plan and possible alternatives if needed. The patient underwent total tumor resection in the operating room, and the defect was reconstructed with the use of a titanium mesh and a synthetic hydroxyapatite bone graft based on a 3D surgical guide printed model. Full article

Background/Objectives: Orbital fractures are common facial injuries that require precise reconstruction to restore both function and esthetics. Heterologous cortical lamina and titanium preformed meshes are widely used for orbital wall reconstruction; however, comparative data on their outcomes remain limited. Methods: This retrospective observational study analyzed 67 patients treated for orbital fractures at Santa Maria Hospital, Terni, between January 2021 and November 2024. Patients underwent orbital reconstruction using either a heterologous cortical lamina or titanium mesh. Clinical data, including demographics, trauma etiology, fracture characteristics, surgical approach, and postoperative complications were collected. Outcomes such as diplopia, enophthalmos, ocular motility, and sensory impairment were assessed preoperatively and postoperatively and compared between groups. Statistical analyses included Chi-square and Mann–Whitney U tests, with logistic regression to identify risk factors for complications. Results: Accidental falls were the leading cause of injury (46.3%), with the orbital floor being the most commonly affected site (83.6%). Postoperative complications occurred in 15% of patients, with diplopia significantly reduced from 47.8% preoperatively to 10.4% postoperatively (p < 0.05). Sensory impairment and motility restrictions also improved significantly. Patients reconstructed using heterologous cortical lamina experienced significantly fewer postoperative complications compared to those treated with titanium mesh (OR = 0.171, 95% CI: 0.023–0.799, p = 0.040). Conclusions: Both heterologous cortical lamina and titanium mesh provide effective orbital reconstruction; however, the heterologous cortical lamina was associated with fewer postoperative complications, particularly diplopia and sensory impairment. Material selection should consider the fracture complexity, patient characteristics, and potential long-term outcomes. Full article

Background: Orbital floor blowout fractures (OFBF) can have serious consequences for the patient. Selecting the right treatment method and materials is essential. Krenkel’s maxillary sinus implant has been used successfully for more than 40 years in clinical practice. The aim of this study was to evaluate the long-term outcome of this implant compared to polydioxanone (PDS) sheets. Material and methods: This retrospective study examined a cohort of 82 OFBF patients over a seven-year period. Clinical and geometric data were collected. Defect size, location, and the volume of the herniated tissue were measured from conventional computer tomography (CT) or cone beam computer tomography (CBCT) scans. The relationship between ophthalmologic rehabilitation and treatment modality was analyzed using logistic regression. Results: The study included 82 patients, 28% female and 72% male, with a median age of 45.2 years. Defect size and hernia volume correlated with preoperative ophthalmological symptoms. At follow-up, 14.8% in the implant group and 28.6% in the PDS group showed mild visual impairment, with no severe diplopia. Conclusions: Our results suggest this method is a reliable and effective solution for repairing OFBFs and ophthalmologic rehabilitation. However, further research in a clinical controlled trial is needed. Full article

Objective: Trauma is a leading cause of enophthalmos, typically resulting from an increase in the volume of the bony orbit. The general consensus is that post-traumatic primary deformity repair should aim to restore the premorbid volume, shape, and cosmesis of the orbitozygomatic complex (OZC). This study aims to utilise novel three-dimensional (3D) printed patient-specific moulds to intraoperatively fabricate enophthalmos wedges and onlays using polymethylmethacrylate (PMMA) bone cement to reconstruct the OZC. Methods: A total of seven patients underwent digital surgical planning using Freeform software to virtually correct orbitozygomatic complex deformities guided by a design algorithm. Three-dimensionally printed nylon patient-specific moulds were used intraoperatively to fabricate enophthalmos wedges and/or onlays using an industry-standard PMMA bone cement. Clinical examination and application of the proposed design algorithm determined that enophthalmos wedges were indicated for four patients, with one also requiring an onlay; and periorbital onlays were required for the three remaining patients. Results: Hertel exophthalmometry at a mean follow-up of 19.1 months demonstrated good outcomes in the correction of post-traumatic enophthalmos and hypoglobus and with patients reporting good subjective cosmetic results. Patients 5 and 7 had follow-up three-dimensional computed tomography (3D-CT) to confirm correct placement. Conclusion: The use of patient-specific PMMA wedges and onlays, fabricated intraoperatively with the aid of 3D-printed moulds, offers a reliable and effective approach for correcting post-traumatic enophthalmos and hypoglobus. This method allows for the restoration of orbital volume and anatomical contours, addressing both functional and aesthetic concerns. Our results demonstrate that this technique yields favourable outcomes. Full article

Objectives: Although considered a safe procedure, functional endoscopic sinus surgery (FESS) can cause various significant ophthalmic complications, i.e., serious extraocular muscle (EOM) damage. The aim of this study is to review the surgical management outcomes of patients with mechanical strabismus and diplopia as a complication of FESS, who referred to ophthalmological department in Norbert Barlicki University Teaching Hospital No. 1 over the 5-year period from 2018 to 2023. Methods: The records of seven consecutive patients with diplopia following endoscopic sinus surgery were retrospectively reviewed. Demographics, ophthalmological and orthoptic examination, the results of orbital imaging, type of FESS, type of strabismic surgery, and the timing of the first intervention were analysed. Results: The time from FESS to referral for strabismic intervention varied from one day to two months. Two patients, who were operated upon immediately after the FESS procedure, underwent direct reunion of the proximal and distal parts of the ruptured medial rectus muscle. One patient required maxillofacial intervention in order to improve prominent enophthalmos. The remaining five demonstrated severe adhesion formation around at least one of the EOMs and orbital walls. Only patients who were operated upon within a short period after complicated FESS achieved orthotropia and lack of diplopia in the primary position with a single surgery. Conclusions: Early recognition of the orbital complications subsequent to FESS and prompt referral are essential for achieving a satisfactory surgical result. Appropriate treatment should be based on the mechanism, location, type, and severity of muscle damage. Full article

Background: Changes in the bony structures of the nose and sinuses such as the medialization of the lamina papyracea and enophthalmos have been reported after sinus surgery. Evidence for the persistence of inferior turbinate (IT) position after IT outfracture is lacking. Objectives: To evaluate for anatomical changes of the IT, lamina and the globes, after sinus surgery and the durability of inferior turbinate outfracture. Methods: A total of forty-four patients who underwent revision endoscopic sinus surgery that included complete ethmoidectomy and IT outfracture were matched. Pre- and post-operative computed tomography scans (CT) were used for evaluating and measuring the anatomical changes in different planes. The posterior globe position in the axial plane, the distance between the lamina papyracea (IOD_Axial, IOD_Coronal) in coronal and axial planes and the distance from the IT to the septum (IT_M) and the lateral nasal wall (IT_L) were measured. Results: There were 16 women and 28 men. Mean follow-up time (time from procedure to post-operative CT scan) was 38.9 ± 20.1 months. Statistically significant lateralization of the IT was observed with IT_L (95%CI 1.1 mm to 1.5 mm p < 0.0001) and IT_M (95%CI −1.5 mm to −1.1 mm; p < 0.0001). No statistically significant differences were seen in IOD_Axial and IOD_Coronal in pre-op and post-op CT scans. (p = 0.23 and p = 0.7, respectively) and no significant displacement of the globe in antero-posterior direction was seen (p = 0.915). Conclusions: IT outfracture appears to have a durable effect on IT position that lasts for several years. Ethmoidectomy did not cause the medialization of the laminae nor altered the position of the globes. Full article

Background/Objectives: In Japan, artificial orbital implants are not approved as medical materials, limiting the number of facilities that perform orbital implant surgery. However, this procedure is crucial for improving the quality of life of ocular prosthesis users by enhancing cosmetic outcomes. This study aimed to evaluate the short-term outcomes of orbital implant surgery using costal cartilage grafts and assess the cosmetic impact by comparing upper eyelid positions between patients who underwent the procedure and those who did not. Methods: Patients were divided into two groups: those who underwent evisceration and orbital implant grafting with costal cartilage (Group 1) and those who used a prosthetic eye without an orbital implant (Group 2). In Group 1 cases, following evisceration, a spherical implant was created using the sixth autologous costal cartilage and covered with four pedicled scleral flaps. The incidence of complications and the necessity for additional surgery were investigated through medical records, and both complications and upper eyelid symmetry were assessed at least 12 months after the final surgical procedure. Results: A total of 23 patients were included: 13 in Group 1 and 10 in Group 2. Group 1 had a significantly lower median age (52 vs. 68 years, p = 0.002) and a higher proportion of females (76.9% vs. 30%, p = 0.024). Upper eyelid asymmetry was significantly greater in Group 2 than in Group 1 (p < 0.05). Orbital fracture was associated with a higher risk of requiring additional surgery (100% vs. 37.5%, p = 0.075), though not statistically significant. Conclusions: Orbital implant surgery with costal cartilage grafts improves eyelid symmetry and cosmetic appearance. Early and accurate orbital volume repair is essential for preventing enophthalmos. Full article

Silent sinus syndrome is a rare condition characterized by an almost always unilateral collapse of the maxillary sinus. The most characteristic symptom of this syndrome is enophthalmos. Naso-sinusal disorders are rarely associated with this condition. We are going to discuss a case that was associated with recurrent sinusitis. In this case report, we describe how we managed this rare syndrome so we can share our experience with those colleagues that may face this condition. Full article

Background/Objectives: This study aims to evaluate the computed tomography (CT) scans of glaucoma patients using prostaglandin analogs (PGA) in one eye, investigate findings associated with prostaglandin-associated periorbitopathy (PAP), and compare these findings with those of the contralateral eyes. Methods: Patients with open-angle glaucoma who had CT images of the orbital region taken for another reason at least one month after starting PGA treatment in one eye were included in the study. Enophthalmos measurements from thin-slice CT images, along with 3D volume measurements of orbital fat tissue, periorbital muscles, and the optic nerve, were performed. Ophthalmological examination findings and treatment information were collected. The values were compared with those of the contralateral eyes of the same patients not using PGA. Intraclass correlation coefficients (ICCs) were computed to evaluate measurement repeatability. Results: Forty patients were included in the study. Among them, 29 (72.5%) used latanoprost, 9 (22.5%) used bimatoprost, and 2 (5%) used travoprost. The mean enophthalmos values on the treated side (15.5 ± 2.0 mm) were lower than on the untreated side (16.1 ± 1.4 mm), but this difference was not statistically significant (p = 0.07). In 29 patients (72.5%), enophthalmos measurements were smaller on the treated side, with 7 patients (17.5%) showing a difference of 2 mm or more. No significant correlation was found between the duration of PGA use and enophthalmos measurements (p = 0.768 r = −0.048). Additionally, no significant differences were found in orbital fat volume, total extraocular muscle volume, and optic nerve volume (p > 0.05). ICC values demonstrated excellent reliability (ICC > 0.75) for all measurements. Conclusions: We did not find significant differences in enophthalmos measurements, orbital fat volume, total muscle volume, and optic nerve volume between the PGA-treated and untreated eyes. Full article

Study Design: Prospective pre-post study. Objective: Maxillofacial trauma presenting to the emergency department (ED) are often accompanied with complex concomitant injuries, thereby making thorough diagnosis and treatment plan quite an exacting task owing to the demanding conditions of the ED. The use of a structured maxillofacial trauma template helps in documenting the injuries comprehensively, aids in treatment planning, avoids medical negligence thereby improving the quality of care given to the patient. The study introduced a structured maxillofacial trauma template to improve the quality of the ED documentation. Methods: A total of 220 patients were evaluated for the quality of their ED documentation from September 2023 till February 2024. The group A included 110 patients where complete medical documentation was done routinely on a blank A4 sized paper, group B included 110 patients where the documentation was done using the structured oral and maxillofacial trauma template. The ED notes were thoroughly evaluated by the 2 independent authors for record completeness and documentation rate of history and examination findings. Results: The introduction of trauma template demonstrated a significant improvement of 18.95% in record completeness. Significant improvement was seen in documentation rate among the covariates like place of injury, time of evaluation, primary care given, wound classification, dento-alveolar injury, ophthalmic evaluation, nerve injury evaluation, comorbidities with p = 0.001, and referral with p = 0.03. The ophthalmic evaluation showed significant improvement among covariates (loss of visual acuity, reflexes, diplopia, enophthalmos, subconjunctival haemorrhage, chemosis, periorbital oedema, periorbital ecchymosis, ocular dystopia) with p = 0.001, and extraocular muscle restriction with p = 0.004. Conclusions: The study demonstrated that the use of a structured oral and maxillofacial trauma template can significantly improve the quality of the ED documentation and contributes to better patient care in the ED. Full article

Background: The treatment of spheno-orbital meningiomas (SOMs) requires extensive bone resections, creating significant defects in a complex geometrical space. Bone reconstruction represents a fundamental step that optimizes long-term aesthetic and functional outcomes. In recent years, 3D printing technology has also been exploited for complex skull base reconstructions, but reports remain scarce. Methods: We retrospectively analyzed four consecutive patients who underwent SOM resection and one-step 3D PEEK customized reconstruction from 2019 to 2023. A systematic review of 3D printing customized implants for SOM was then performed. Results: All patients underwent a frontotemporal craniotomy, removal of SOM, and reconstruction of the superolateral orbital wall and pterional region. The aesthetic outcome was extremely satisfactory in all cases. No orbital implant malposition or infectious complications were documented. Eleven papers were included in the literature review, describing 27 patients. Most (23) patients underwent a single-stage reconstruction; in three cases, the implant was positioned to correct postoperative delayed enophthalmos. Porous titanium was the most used material (16 patients), while PEEK was used in three cases. Prosthesis malposition was described in two (7.4%) patients. Conclusions: Single-step reconstruction with a personalized 3D PEEK prosthesis represents a valid reconstruction technique for the treatment of SOMs with good aesthetic outcomes. Full article

Blowout fractures are common midfacial fractures in which one or several of the bones of orbital vault break. This is usually caused by a direct trauma to the eye with a blunt object such as a fist. Fracturing of the fragile orbital bones can lead to changes in the orbital volume, which may cause enophthalmos, diplopia, and impaired facial aesthetics. Objectives: The aim of this study is to investigate whether there is an association between volume change of the bony orbit and age, gender, or trauma mechanism. Methods: A retrospective study of patients with unilateral blowout or blow-in fractures treated and examined in Päijät-Häme Central Hospital, Lahti, Finland was conducted. Altogether, 127 patients met the inclusion criteria. Their computed tomographs (CT) were measured with an orbit-specific automated segmentation-based volume measurement tool, and the relative orbital volume change between fractured and intact orbital vault was calculated. Thereafter, a statistical analysis was performed. A p-value less than 0.05 was considered significant. Results: We found that relative increase in orbital volume and age have a statistically significant association (p = 0.022). Trauma mechanism and gender showed no significant role. Conclusions: Patient’s age is associated with increased volume change in fractures of the bony orbit. Full article

The mouse Harderian gland (HG) is a secretory gland that covers the posterior portion of the eyeball, opening at the base of the nictitating membrane. The HG serves to protect the eye surface from infection with its secretions. Mice open their eyelids at about 2 weeks of age, and the development of the HG primordium mechanically opens the eye by pushing the eyeball from its rear. Therefore, when HG formation is disturbed, the eye exhibits enophthalmos (the slit-eye phenotype), and a line of Fgf10^+/− heterozygous loss-of-function mice exhibits slit-eye due to the HG atrophy. However, it has not been clarified how and when HGs degenerate and atrophy in Fgf10^+/− mice. In this study, we observed the HGs in embryonic (E13.5 to E19), postnatal (P0.5 to P18) and 74-week-old Fgf10^+/− mice. We found that more than half of the Fgf10^+/− mice had markedly degenerated HGs, often unilaterally. The degenerated HG tissue had a melanized appearance and was replaced by connective tissue, which was observed by P10. The development of HGs was delayed or disrupted in the similar proportion of Fgf10^+/− embryos, as revealed via histology and the loss of HG-marker expression. In situ hybridization showed Fgf10 expression was observed in the Harderian mesenchyme in wild-type as well as in the HG-lacking heterozygote at E19. These results show that the Fgf10 haploinsufficiency causes delayed or defective HG development, often unilaterally from the unexpectedly early neonatal period. Full article

Enophthalmos is a severe complication of primary reconstruction following orbital floor fractures, oncological resections, or maxillo-facial syndromes. The goal of secondary orbital reconstruction is to regain a symmetrical globe position to restore function and aesthetics. In this article, we present a method of computer-assisted orbital floor reconstruction using a mirroring technique and a custom-made titanium or high-density polyethylene mesh printed using computer-aided manufacturing techniques. This reconstructive protocol involves four steps: mirroring of the healthy orbit computer tomography files at the contralateral affected site, virtual design of a customized implant, computer-assisted manufacturing (CAM) of the implant using Direct Metal Laser Sintering (DMLS) or Computer Numerical Control (CNC) methods, and surgical insertion of the device. Clinical outcomes were assessed using 3dMD photogrammetry and computed tomography measures in 13 treated patients and compared to a control group treated with stock implants. An improvement of 3.04 mm (range 0.3–6 mm) in globe protrusion was obtained for the patients treated with patient-specific implants (PSI), and no major complications have been registered. The technique described here appears to be a viable method for correcting complex orbital floor defects needing delayed reconstruction. Full article

Purpose: This pilot study aims to evaluate the feasibility and effectiveness of computer-assisted surgery protocol with 3D-preformed orbital titanium mesh (3D-POTM), using presurgical virtual planning and intraoperative navigation in primary inferomedial orbital fracture reconstruction. Methods: Between March 2021 and March 2023, perioperative data of patients undergoing surgery for unilateral inferomedial orbital fracture treated with 3D-POTM were analyzed. Presurgical virtual planning with a Standard Triangle Language file of preformed mesh was conducted using the mirrored unaffected contralateral side as a reference, and intraoperative navigation was used. The reconstruction accuracy was determined by: correspondence between postoperative reconstruction mesh position with presurgical virtual planning and difference among the reconstructed and the unaffected orbital volume. Pre- and postoperative diplopia and enophthalmos were assessed. Results: Twenty-six patients were included. Isolated orbital floor fracture was reported in 14 (53.8%) patients, meanwhile medial wall and floor one in 12 (46.1%) cases. The mean difference between final plate position and ideal digital plan was 0.692 mm (95% CI: 0.601–0.783). The mean volume difference between reconstructed and unaffected orbit was 1.02 mL (95% CI: 0.451–1.589). Preoperative diplopia was settled out in all cases and enophthalmos in 19 (76.2%) of 21 patients. Conclusion: The proposed protocol is an adaptable and reliable workflow for the early treatment of inferomedial orbital fractures. It enables precise preoperative planning and intraoperative procedures, mitigating pitfalls and complications, and delivering excellent reconstruction, all while maintaining reasonable costs and commitment times. Full article