Management of Injuries of the Orbital Skeleton

Abstract

These clinical studies were carried out in maxillofacial unite, 10th floor, Surgical Specialties Hospital, Medical City, Baghdad. These orbital injuries included 236 patients during 15 years of experience. Their ages ranged from 2 to 72 years (mean, 37 years); 172 were male, and 64 were female. Orbital injuries are classified into isolated orbital walls, roof, floor, lateral wall, and zygoma and medial wall and complex wall injuries, as orbital skeleton injuries, or as part of cranio-orbito-facial injuries. There were 110 cases (46.6%) with orbital floor, and 85 cases (36%) with lateral wall and zygomatic complex injuries; 6 cases (3.6%) had isolated roof injuries; there were 15 cases (6.3%) with medial wall fractures and dislocation of medial canthal ligaments; 8 cases (3.3%) were orbital skeleton injuries with superior orbital fissure syndrome in 2 cases and eyeball laceration in 1 case, and 12 cases (5.08%) were cranio-orbito-facial injuries. These cases were treated and reconstructed by chrome-cobalt mesh for orbital floor, and also, Silastic rubber silicone was used in the floor and roof. Bone graft was used for reconstruction of large defect of the floor and medial wall, and Silastic was used for secondary operation for reconstruction of the floor as additional layer in cases with slight resorption of bone graft to correct residual enophthalmos, and lyophilized dura was used for reconstruction of the roof. Follow-up of the cases was extended for 15 years. The aim of these studies was to show some interesting clinical cases and surgical challenges for the management of these cases.

Fratura de órbita por queda de cavalo e correção de estrabismo

“…Houve melhora significativa da diplopia e consequentemente da posição da cabeça, entretanto, ainda insuficiente para uma perfeita visão binocular. Esta somente foi obtida após debilitamento cirúrgico do mús-culo oblíquo inferior contralateral ao da fratura (1)(2)6,10) .…”

“…s traumatismos de face são frequentemente acompanhados de fratura de órbita (1)(2)(3)(4)(5) . Esse tipo de fratura é chamada de verdadeira quando não afeta o rebordo orbitário, como por exemplo, na fratura tipo "blow out", em que a porção posteromedial é a mais acometida por sua fragilidade.…”

“…Esse tipo de fratura é chamada de verdadeira quando não afeta o rebordo orbitário, como por exemplo, na fratura tipo "blow out", em que a porção posteromedial é a mais acometida por sua fragilidade. A lâmi-na papirácea do osso etmóide constitui outro local frágil onde frequentemente ocorre fratura (1,6) .…”

“…A estética e a diplopia são aspectos perturbadores para os pacientes vítimas de fratura de órbita (1)(2)(4)(5)(6) .…”

Trigemino-Cardiac Reflex During Orbital Floor Reconstruction: A Case Report and Review

“…In our case, pressure applied over orbital floor during floor elevation, before placing silastic [38,39] graft material must have triggered the trigemino-cardiac arc involving the neuronal transmission from the orbital structures to the ciliary ganglion, the ophthalmic division of the trigeminal nerve. When excessive pressure impulses are transmitted, the efferent pathway of the vagus nerve running alongside is stimulated, and the tonus in the parasympathetic nerve increases, resulting in Bradycardia.…”