OBJECTIVETo investigate the treatment of minor exophthalmos by enlargement of orbital volume through conjunctive approach.

METHODSThrough the conjunctive approach medial to the eye ball, the dissection was performed subperiosteally to expose the ethmoid bone at the medial orbital wall. The exposure bone was 2.5-3.0 cm in length and 2.0-2.5 cm in width. Then the ethmoid bone was fractured to enlarge the orbital volume. From June 2006 to April 2008, 3 cases were treated.

RESULTSThe patients recovered in a short time with no visible skin scar. The technique was mini-invasive, and didn't affect the function of eyeball.

CONCLUSIONIt is easy and effective way to correct the minor exophthalmos by enlargement of orbital volume through conjunctive approach.

Adult ; Conjunctiva ; surgery ; Exophthalmos ; surgery ; Female ; Humans ; Orbit ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo determine the efficacy of endoscopic transnasal orbital balanced decompression technique for the treatment of severe Graves' orbitopathy.

METHODSSix cases (12 eyes) of severe Graves'orbitopathy were included in this study. All patients were undergone endoscopic transnasal orbital balanced decompression technique (orbital inner and lower wall decompression+ lateral orbital decompression) for severe Graves'orbitopathy and serious affecting visual function or appearance.

RESULTSThe follow-up ranged from 12 months to 2 years and 4 months. Postoperatively, the visual acuity markly improved from 0.23 ± 0.08 to 0.48 ± 0.13 (t=-5.749, P<0.001). Proptosis measured by exophthalmoter distictly reduced from (22.08 ± 1.08) mm to (15.67 ± 1.44) mm (t=17.924, P< 0.001). The palpebral fissures obviously reduced from (12.03 ± 0.91) mm to (8.62 ± 0.75) mm (t=9.600, P< 0.001), and orbital volume evidently increased from (26.84 ± 0.62) cm³ to (31.56 ± 1.10) cm³ (t=-16.567, P<0.001). Compared with the preoperative result, the orbital pressure was significantly decreased after operation (t=-6.759 (Y=100 g), t=-11.850 (Y=200 g), t=-6.189 (Y=300 g), P<0.001). Diplopia was appeared in 3 cases, and disappeared 3 to 5 months after surgery.

CONCLUSIONEndoscopic transnasal orbital balanced decompression technique is effective for the treatment of severe Graves'orbitopathy.

Decompression, Surgical ; methods ; Endoscopy ; Exophthalmos ; pathology ; Graves Ophthalmopathy ; surgery ; Humans ; Orbit ; surgery ; Postoperative Period ; Visual Acuity

OBJECTIVETo study the feasibility of the modified osteotomy of transcranial orbitotomy in the treatment of intraorbital tumor.

METHODSWe treated 8 patients with intraorbital tumor during six years. By the bicoronary incision, all cases underwent double bone flap osteotomy on the frontal bone: the superior orbital rim bone flap and roof flap instead of single fronto-orbital bone flap in the conventional transcranial orbitotomy. After removal of bone flaps, intracranial and intraorbital operation was performed. Then, two bone flaps were reduced respectively and fixated with titanic micro-plates and nails. At last, the scalp flap was sutured.

RESULTSThe operative field was very well exposed. It was found that the retrobulbar tumor was located at the superolateral, median and superonasal area respectively, which was coincided with the preoperative CT and MRI. The tumor included adenocarcinoma of the lacrimal gland, neurinoma, meningioma, and cavernous hemangioma. Four patients had blood transfusion during the operation. No other postoperative complications happened except 3 cases of diplopia and one case of blindness. After 3 to 6 months follow up, diplopia of the 3 cases gradually disappeared. Of the 8 cases, 6 reached the same visual acuity as the preoperative state. One decreased visual acuity and one lost light perception. There was well-balanced fronto-orbital appearance and eyeball position compared with the healthy side in all cases.

CONCLUSIONSThis surgical method for the treatment of intraorbital tumor is safe with well-exposed operative field. It has advantages not only in simpleness and less trauma, but also in keeping orbital roof and anterior fossa intact and decreasing complications.

Adult ; Craniotomy ; methods ; Exophthalmos ; surgery ; Feasibility Studies ; Female ; Humans ; Male ; Orbit ; surgery ; Orbital Neoplasms ; surgery ; Surgical Flaps ; Young Adult

Fibrous dysplasia is a bone disease of unknown etiology in which cellular fibrous tissue gradually replaces normal bone and involves the cranium infrequently. Recently, we have experienced 3 cases of fibrous dysplasia which involved the frontal, sphenoid and parietal bones with vault deformity. The 2 cases, in which the frontal and sphenoid bones were involved, presented with proptosis and exophthalmos. All of the cases manifested vault deformity which caused cosmetic problems. We performed decompressive and plastic surgery for the purpose of relieving the compression of cranial nerves and for the sake of the cosmetic effect. The clinical courses were uneventful.
Bone Diseases ; Congenital Abnormalities ; Cranial Nerves ; Exophthalmos ; Parietal Bone ; Skull ; Sphenoid Bone ; Surgery, Plastic

Crouzon syndrome is one of the craniofacial syndromes characterized by craniosynostosis, midfacial hypolpasia and ocular proptosis. Distraction osteogenesis is becoming important technique to treat craniofacial dysplaisa. It has many advantages compared with standard orthognathic surgery. Maxillary distraction osteogenesis after Le Fort III osteotomy with the RED system presents successful maxillary protraction to Crouzon syndrome patient with severe maxillary deficiency. It also allows remarkable improvement of facial esthetics and respiratory functions.
Craniofacial Dysostosis* ; Craniosynostoses ; Esthetics ; Exophthalmos ; Humans ; Orthognathic Surgery ; Osteogenesis, Distraction* ; Osteotomy

Retrobulbar hemorrhage is a rare complication following cardiopulmonary bypass surgery, which has never been reported in Korea. Our cardiac surgery tearn diagnosed a case of 30 year-old female patient as atrial septal defect and performed direct closure for it. Proptosis of the right eye was developed during surgery and she was consulted to Department of Ophthalmology, St. Mary's Hospital, Catholic University Medical College. We confirmed the evidence of the proptosis of the right eye with Hertel's exophthalmo meter and diagnosed this case as retrobulbar hemorrhage that orbital CT showed a large ovoid shaped non-enhancing hyperdense mass shadow at superior portion of the right orbit. So we report our case with a brief review of the literature related to retrobulbar hemorrhage during cardiopulmonary bypass surgery.
Adult ; Cardiopulmonary Bypass* ; Exophthalmos ; Female ; Heart Septal Defects, Atrial ; Humans ; Korea ; Ophthalmology ; Orbit ; Retrobulbar Hemorrhage* ; Thoracic Surgery

exophthalmos become manifest. Radiologically, unilateral cases are much more frequent than bilateral, and Waters' view shows complete opacity of the expanded maxillary sinus and some masses. CT scan shows a large heterogeneous enhancing mass causing considerable expansion of the maxillary sinus with bony erosion. On MR imaging, the mass usually has a variable signal intensity on T1- and T2- weighted images, ranging from low to high. After contrast administration, discrete areas of enhancement are present within the mass. Although the disease is essentially benign and nonneoplastic, differential diagnosis from neoplastic disease including malignancy both clinically and radiologically has been always problematic. Accurate preoperative diagnosis of organized hematoma of the maxillary sinus is important to avoid unnecessary extensive surgery, because this condition is curative with a simple, conservative surgical approach and rarely recur. Organized hematoma of the maxillary sinus should be included in the differential diagnosis when patients have recurrent epistaxis, slow-growing mass of the cheek, nasal obstruction, and expansile mass in the maxillary sinus. A 33-year-old man was referred to the department of oral and maxillofacial surgery with a three-month history of slowly growing painful swelling of the left cheek. The mass of the maxillary sinus was resected by a Caldwell-Luc approach. Histopahtoly showed only a fibous encapsulated organized hematoma. To our knowledge, organized hematoma of the maxillary sinus has not been previously described in the Korean literature of the oral and maxillofacial surgery. We report a case of organized hematoma of the maxillary sinus presenting with an enlarging maxillary sinus mass.]]>
Adult ; Cheek ; Diagnosis, Differential ; Displacement (Psychology) ; Epistaxis ; Exophthalmos ; Headache ; Hematoma ; Humans ; Hydrazines ; Maxillary Sinus ; Nasal Obstruction ; Surgery, Oral

PURPOSE: To evaluate the efficacy and safety of customized orbital decompression surgery combined with eyelid surgery or strabismus surgery for mild to moderate thyroid-associated ophthalmopathy (TAO). METHODS: Twenty-seven consecutive subjects who were treated surgically for proptosis with disfigurement or diplopia after medical therapy from September 2009 to July 2012 were included in the analysis. Customized orbital decompression surgery with correction of eyelid retraction and extraocular movement disorders was simultaneously performed. The patients had a minimum preoperative period of 3 months of stable range of ocular motility and eyelid position. All patients had inactive TAO and were euthyroid at the time of operation. Preoperative and postoperative examinations, including vision, margin reflex distance, Hertel exophthalmometry, ocular motility, visual fields, Goldmann perimetry, and subject assessment of the procedure, were performed in all patients. Data were analyzed using paired t-test (PASW Statistics ver. 18.0). RESULTS: Forty-nine decompressions were performed on 27 subjects (16 females, 11 males; mean age, 36.6 +/- 11.6 years). Twenty-two patients underwent bilateral operations; five required only unilateral orbital decompression. An average proptosis of 15.6 +/- 2.2 mm (p = 0.00) was achieved, with a mean preoperative Hertel measurement of 17.6 +/- 2.2 mm. Ocular motility was corrected through recession of the extraocular muscle in three cases, and no new-onset diplopia or aggravated diplopia was noted. The binocular single vision field increased in all patients. Eyelid retraction correction surgery was simultaneously performed in the same surgical session in 10 of 49 cases, and strabismus and eyelid retraction surgery were performed in the same surgical session in two cases. Margin reflex distance decreased from a preoperative average of 4.3 +/- 0.8 to 3.8 +/- 0.5 mm postoperatively. CONCLUSIONS: The customized orbital decompression procedure decreased proptosis and improved diplopia, in a range comparable to those achieved through more stepwise techniques, and had favorable cosmetic results when combined with eyelid surgery or strabismus surgery for mild to moderate TAO.
Adolescent ; Adult ; Decompression, Surgical/*methods ; Exophthalmos/*surgery ; Eye Movements/physiology ; Eyelids/*surgery ; Female ; Graves Ophthalmopathy/*surgery ; Humans ; Male ; Middle Aged ; Oculomotor Muscles/surgery ; *Ophthalmologic Surgical Procedures ; Orbit/*surgery ; Retrospective Studies ; Strabismus/*surgery ; Visual Field Tests ; Visual Fields/physiology

Osteoid osteoma was first reported in 1935 by Jaffe. It is a kind of benign bone disease with the limitation of well-defined lesions. It is rarely seen in the periorbital region. The only symptom of the patient was unilateral proptosis of right. The result of MRI examination was cystic masses in the edge of the right orbit. The tumor was complete removed by the nasal endoscopic approach during the surgery. Pathology result was reported as osteoid osteoma. There was no significant complications of diplopia, visual acuity decreased, enophthalmos, cerebrospinal fluid leakage and others.
Endoscopy ; Exophthalmos ; Face ; Humans ; Magnetic Resonance Imaging ; Nasal Surgical Procedures ; Nose ; Osteoma, Osteoid ; surgery ; Skull Base ; pathology ; Skull Base Neoplasms ; surgery

surgery. Orbital infections can be divided into preseptal infection, orbital subperiosteal abscess, orbital abscess, and postorbital abscess. Symptoms which can be observed are swelling of the eyelids and erythema, orbital edema, displacement of the eyeball, exophthalmos, ophthalmoplegia, and even impairment of the optic nerve. Here we present the case of a patient who had an orbital abscess secondary to an abscess of the right maxillary third molar. Rapid recovery occurred following surgical treatment and antibiotic therapy. In addition a brief review of the literature is included.]]>
Abscess ; Displacement (Psychology) ; Edema ; Erythema ; Exophthalmos ; Eyelids ; Humans ; Inflammation ; Molar, Third ; Ophthalmoplegia ; Optic Nerve ; Orbit ; Paranasal Sinuses ; Periodontitis ; Skin ; Surgery, Oral ; Tooth Extraction