Association of titanium mesh and bovine pericardium membrane in the treatment of severe enophthalmos

The blowout fractures may be classified as pure or impure depending on the associated structures. There are 2 main theories attempting to describe the mechanism of injury, the hydraulic, and blocking mechanism. The complications of this type of fracture may involve diplopia, enophthalmos, and ocular movement restriction. Several materials are available for the reconstruction of orbital floor, including the titanium mesh, which present great properties, such as easy modeling and stabilization, small thickness, and shape maintenance. There, however, are disadvantages such as the possibility of adherence formation. The aim of this report is to describe the case of a patient with an 8-month blowout fracture sequel, presenting extensive enophthalmos and treated by affixing a titanium mesh associated with bovine pericardium membrane in the orbital floor. Therefore, based on a 2-year follow-up, it was possible to observe how effective the association between these 2 materials in solving the case was.

Bone and cartilage wedge technique in posttraumatic enophthalmos treatment

To evaluate a new surgical method, using calvarial bone graft combined with a wedge of irradiated homologous costal cartilage, for the revision repair of posttraumatic enophthalmos.

Diagnosis and management of enophthalmos

Enophthalmos is a relatively frequent and misdiagnosed clinical sign in orbital diseases. The knowledge of the different etiologies of enophthalmos and its adequate management are important, because in some cases, it could be the first sign revealing a life-threatening disease. This article provides a comprehensive review of the pathophysiology, evaluation, and management of enophthalmos. The main etiologies, such as trauma, chronic maxillary atelectasis (silent sinus syndrome), breast cancer metastasis, and orbital varix, will be discussed. Its objective is to enable the reader to recognize, assess, and treat the spectrum of disorders causing enophthalmos.

Revisión sistemática de la literatura: efecto de los rellenos inyectables en la región periorbitaria

Introducción: El conocimiento actual de la fisiopatología del envejecimiento periorbitario justifica la aplicación de materiales de relleno inyectables, dado que se enfocan en la restauración del volumen perdido en esta zona, convirtiéndose en una excelente alternativa a procedimientos quirúrgicos que remueven el tejido excedente. Sin embargo los efectos y la seguridad de esta naciente tendencia terapéutica aún no se sustentan en una sólida base científica. El objetivo de esta revisión es identificar el material de relleno inyectable más adecuado para el manejo de los defectos volumétricos estéticos de la región periorbitaria. Metodología: Se realizó una búsqueda exhaustiva de los artículos indexados publicados del 1º de enero de 2.000 al 30 de septiembre de 2.013, en diversas bases de datos electrónicas, se seleccionaron catorce publicaciones, se extrajo la información referente a datos demográficos, la intervención, el seguimiento y los desenlaces y se realizó un análisis de 14 estudios que cumplieron los criterios. Resultados: Todos los artículos incluidos poseían un bajo nivel de evidencia y del grado de recomendación. Todos los materiales de relleno se asociaron a altos niveles de satisfacción para el paciente, adecuada mejoría de la apariencia estética y similares efectos colaterales, el ácido hialurónico fue el material de relleno inyectable más utilizado en la región periorbitaria. Discusión: Los materiales de relleno inyectable mejoran los defectos volumétricos estéticos de la región periorbitaria pero es necesaria mayor evidencia para determinar el tipo relleno más apropiado para esta condición.

The frontotemporal-orbitozygomatic approach : reconstructive technique and outcome

Background The frontotemporal-orbitozygomatic (FTOZ) approach, also known as "the workhorse of skull base surgery," has captured the interest of many researchers throughout the years. Most of the studies published have focused on the surgical technique and the gained exposure. However, few studies have described reconstructive techniques or functional and cosmetic outcomes. The goal of this study was to describe the surgical reconstruction after the FTOZ approach and analyze the functional and cosmetic outcomes. Methods Seventy-five consecutive patients who had undergone FTOZ craniotomy for different reasons were selected. The same surgical (one-piece FTOZ) and reconstructive techniques were applied in all patients. The functional outcome was measured by complications related to the surgical approach: retro-orbital pain, exophthalmos, enophthalmos, ocular movement restriction, cranial nerve injuries, pseudomeningocele (PMC) and secondary surgeries required to attain a reconstructive closure. The cosmetic outcome was evaluated by analyzing the satisfaction of the patients and their families. Questionnaires were conducted later in the postoperative period. A statistical analysis of the data obtained from the charts and questions was performed. Results Of the 75 patients studied, 59 had no complications whatsoever. Ocular movement restriction was found in two patients (2.4 %). Cranial nerve injury was documented in seven patients (8.5 %). One patient (1.2 %) underwent surgical repair of a cerebrospinal fluid (CSF) leak from the initial surgery. Two patients (2.4 %) developed delayed postoperative pseudomenigocele. One patient (1.2 %) developed intraparenchymal hemorrhage (IPH). Full responses to the questionnaires were collected from 28 patients giving an overall response rate of 34 %. Overall, 22 patients (78.5 %) were satisfied with the cosmetic outcome of surgery. Conclusion The reconstruction after FTOZ approach is as important as the performance of the surgical technique. Attention to anatomical details and the stepwise reconstruction are a prerequisite to the successful preservation of function and cosmesis. In our series, the orbitozygomatic osteotomy did not increase surgical complications or alter cosmetic outcomes.

Uso de Polietigel® intra-orbitário em paciente com atrofia hemifacial progressiva: relato de caso

O objetivo é relatar o caso de portadora de atrofia hemifacial progressiva, atendida na Faculdade de Medicina de Botucatu-UNESP: A paciente do sexo feminino, 43 anos, branca, queixava-se de afundamento progressivo do olho esquerdo e região orbitária há aproximadamente 10 anos, com dor na região periorbitária ipsilateral e diminuição da acuidade visual. O exame tomográfico confirmou a hipótese e o tratamento foi feito com injeção de Polietigel® na órbita, com bom resultado estético e melhora da função palpebral. O Polietigel pode ser uma alternativa para o tratamento do enoftalmo na síndrome de Parry-Romberg.

Experimental study of progressive facial hemiatrophy: effects of cervical sympathectomy in animals

Progressive facial hemiatrophy (Romberg's syndrome) is of unknown cause and uncertain pathogenesis. The main pathogenetic hypotheses are: sympathetic system alterations, localized scleroderma, trigeminal changes, possibly of genetic origin. To test the hypothesis of sympathetic system alterations, we designed an experimental model with ablation of the superior cervical sympathetic ganglion in rabbits, cats and dogs. All the animals were operated upon when 30 days old and were examined monthly for 1 year. During this period localized alopecia, corneal ulceration, keratitis, strabismus, enophthalmos, ocular atrophy, hemifacial atrophy and slight bone atrophy on the side of the sympathectomy were observed. Thus, cervical sympathectomy reproduces in animals the principal clinical alterations of Romberg's syndrome. Our data suggest that the sympathetic system is involved in the pathogenesis of this syndrome.

Management of pure medial orbital wall fracture with autogenous bone graft

The orbit is an irregular conical cavity formed from 7 bones including the frontal, sphenoid, zygomatic, maxillary, ethmoid, lacrimal, and palatine bones. Fractures of the internal orbit can cause a number of problems, including diplopia, ocular muscle entrapment, and enophthalmos. Although muscle entrapment is relatively rare, diplopia and enophthalmos are relatively common sequelae of internal orbital fractures. Medial orbital wall fracture is relatively uncommon and represents a challenge for its anatomical reconstruction. In this context, autogenous bone graft has been the criterion standard to provide framework for facial skeleton and orbital walls. Therefore, it is possible to harvest grafts of varying size and contour, and the operation is performed through the bicoronal incision, which is the usual approach to major orbital reconstruction. Thus, this article aimed to describe a patient with a pure medial orbital wall fracture, and it was causing diplopia and enophthalmos. The orbital fracture was treated using autogenous bone graft from calvarial bone. The authors show a follow-up of 12 months, with facial symmetry and without diplopia and enophthalmos. In addition, a computed tomography scan shows excellent bone healing at the anterior and posterior parts of the medial orbital wall reconstruction. Copyright © 2013 by Mutaz B. Habal, MD.

Orbital wall reconstruction with titanium mesh:Retrospective study of 24 patients

The aim of this study was to evaluate the efficacy and safety of traumatic orbital defect reconstruction with titanium mesh. A retrospective study was made. Evaluations were made after a minimum postoperative follow-up of 12 months, looking for the main complications. Twenty-four patients were included in this evaluation; 19 were male (79.1%) and 5 (20.8%) were female. The main injury etiology was vehicle accidents (50%) followed by other causes. Fourteen patients (58.3%) presented orbital floor fractures, and 10 had more than one wall fractured (41.6%). Permanent infraorbital nerve hypoesthesia was observed in two patients (8.3%), enophthalmos occurred in five patients (20.8%), and exophthalmos was found in two patients (8.3%). Four patients (16.6%) still presented evidence of residual prolapsed intraorbital content, and one of those needed further surgical correction; sinusitis occurred in one patient (4.1%). Titanium mesh is a reliable option for orbital reconstruction, despite some complications found in this sample.

Orbitale Fettgewebsatrophie bei lokaler Bimatoprost-Therapie - Kann Bimatoprost einen Enophthalmus verursachen?

PURPOSE: The aim of this communication is to report enophthalmos as a possible new adverse effect of topical bimatoprost treatment. PATIENTS AND METHODS: A retrospective case series of five glaucoma patients under long-term topical bimatoprost treatment was evaluated. Documentation with photo and Hertel exophthalmometry was reviewed. RESULTS: In all five patients a deep lid sulcus, reduced infraocular fat pads and enophthalmos-suspicious Hertel values were found (mean 11.9 mm; SD 2.4). Other aetiologies for enophthalmos were excluded anamnestically and by clinical examination. CONCLUSION: Bimatoprost may lead to an alteration of the eyelid with deepening of the lid sulcus and may also be responsible for an iatrogenic orbital fat atrophy. A possible mechanism of action might be the induction of apoptosis of orbital fibroblasts with a remodelling of the extracellular matrix. Prospective studies are necessary to confirm this cross-sectional observation.