The goals of reconstruction in orbital blow-out fractures are to restore floor continuity, provide support of orbital contents, and prevent fibrosis of soft tissues. Although ease of use has popularized alloplasts, autogenous material provides greater biocompatibility and results in low rates of infection, extrusion, and migration. Nasoseptal cartilage is an easily accessible, abundant, autogenous source that provides support to the orbital floor and minimal donor site morbidity. Thirteen patients who presented with orbital blow-out fractures underwent reconstruction with nasoseptal cartilage. Follow-up at 3 months to 4 years shows one patient with persistent manifest enophthalmos requiring further augmentation. There were no recipient or donor site complications. Nasoseptal cartilage is an underutilized and superior material for reconstruction of orbital blow-out fractures.

To evaluate the success of the temporoparietal fascial flap (TPFF) in the primary or secondary reconstruction of difficult orbital defects and to review the surgical techniques.Design: Retrospective analysis.Setting: Tertiary medical center.Patients: Nine patients with diverse orbital cavity or periorbital soft tissue and bony defects due to trauma, benign or malignant neoplasms, and radiation treatment.Interventions: Temporoparietal fascial flap anatomy and techniques of harvest and inset are reviewed in detail. Four cases are presented to illustrate possible variables in orbital reconstruction. Variables examined include the location of defects, the success of flap survival in orbital cavities after primary or secondary reconstruction, the effects of prior irradiation on flap survival, and the possibility of concurrent osteointegrated implant placement with TPFF reconstruction.Main Outcome Measures: Functional and aesthetic outcomes were determined by physical examination and preoperative and postoperative photographs.Results: All patients had successful transfer of TPFF grafts without flap compromise. Temporoparietal fascial flap was a viable option for subtle orbital and malar contour defects. In chronically inflamed wounds such as with osteoradionecrosis and orbitoantral fistula, TPFF successfully restored vascularity, obliterated the defects, and enabled the placement of osteointegrated implants. The TPFF also supported the concurrent placement of a free calvarial bone graft. Finally, split-thickness skin grafted onto a pedicled TPFF showed 100% survival. Conclusions:The TPFF is one of the most reliable and versatile regional flaps in the head and neck for orbital reconstruction. This study presents the use of TPFF in a variety of orbital defects, from lateral bony rim defects to total exenteration. Timing of repair in this study spans from immediate reconstruction to reconstruction delayed more than 50 years after the initial injury. In all cases, reconstruction with TPFF resulted in improved bony and soft tissue contours, and incurred minimal morbidity.

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The management of traumatic optic neuropathy remains controversial. In this report, we present the results of 45 patients treated with extracranial optic nerve decompression after at least 12 to 24 hours of corticosteroid therapy without improvement. Vision improved in 32 patients after surgery (71%), and the mean percentage of improvement from preoperative visual deficit was 40.7% +/- 6.9% (median improvement 41.2%). Worsening of vision occurred in none of the patients as a result of the surgery, and no intraoperative or postoperative complications were encountered. We present a treatment protocol for traumatic optic neuropathy with the use of megadose corticosteroids and optic nerve decompression.

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