A case of traumatic delayed meningo-encephalocele suffered orbital fracture, but bony defects in frontal sinus had not been found on CT scanning. We treated the patient with surgery of intranasal endoscopy and repaired the skull base defect successfully during the first attempt. There was no recurrence in 10 months followed up. The leak site may not correlate with imaging in traumatic delayed meningo-encephalocele by comparing operative findings with the imaging estimate and endoscopy. Therefore, endoscopical approaching is effective in seeking and treatment.
Encephalocele ; complications ; Endoscopy ; Exophthalmos ; etiology ; Frontal Sinus ; pathology ; Humans ; Orbital Fractures ; pathology ; Recurrence ; Tomography, X-Ray Computed

PURPOSES: To measure orbital volumes in normal adults using computed tomography to help make proper diagnoses and treatments of orbital diseases. METHODS: Among the patients who had CT scan taken between July 1995 and March 2001, we evaluated the scan results of 142 orbits in 112 adults over the age of 20 years with no pathology in the orbit. The anterior and posterior borders were defined as the zygomatico-frontal suture and the optic canal, respectively. We summed up the area according to the serial coronal views covering the whole orbit, calculated the volume of the whole orbit mathematically and compared the volume between the left and right eyes according to the sex. RESULTS: The normal mean orbital volume of male adults was 24.51+/-2.89 mm(3) (range, 19.3~31.9 mm(3)), and that of women, 21.59+/-2.19 mm(3) (range 18.0~26.5 mm(3)), showing the difference of 2.92 mm(3) (p=0.049) between the sexes. When both orbital volume measurements were summed up, the volume of the left and right orbits was 24.41 cm(3) and 24.10 cm(3) in adult men, respectively. On the other hand, it was 21.54 cm(3) and 21.45 cm(3) in adult women, respectively. The differences in each group (0.31 cm(3), male; 0.09 cm(3), female) showed no statistical significance (p=0.064, male; 0.698, female). CONCLUSIONS: We could measure orbital volumes of normal adults with accurate data on orbital structures by orbital CT. We believe our data will be very helpful in diagnosis of orbital bone fractures, anophthalmic socket, tumors and abnormalities of the orbit. Furthermore, they will play an important role in treatment as well.
Adult* ; Diagnosis ; Female ; Fractures, Bone ; Hand ; Humans ; Male ; Orbit* ; Orbital Diseases ; Pathology ; Sutures ; Tomography, X-Ray Computed*

This study was performed to evaluate the clinical symptom, fracture finding, and surgical outcome in children with orbital trapdoor fracture. Forty-four patients with pure orbital trapdoor fracture, under 18 yr of age, were included. Time interval between injury and surgery, length of time for improvement, resolution of ocular motility restriction, and other factors were analyzed in 36 patients who underwent surgery. The median improvement time was 3.5 days for patients (n=8) receiving surgery within 5 days, 18.0 for those (n=19) receiving surgery between 6 and 14 days, and 50.0 for those (n=9) receiving surgery after 15 days (p=0.03). One month after operation, the mean change in supraduction limitation was 3.50+/-0.53 for patients receiving surgery within 5 days, 2.11+/-1.24 for those receiving surgery between 6 and 14 days, and 1.67+/-0.82 for those receiving surgery after 15 days (p=0.04). Three months after operation, the mean change in supraduction limitation was 3.88+/-0.35, 2.94+/-1.55, and 2.50+/-1.38, respectively (p=0.14). In conclusion, trapdoor fracture of the orbit in children must be diagnosed by careful CT evaluation and clinical evidence of entrapment. For patients with severe limitation of ocular motility, early surgery within 5 days of injury leads to more rapid and better postoperative improvement.
Adolescent ; Adult ; Child ; Eye Movements ; Female ; Human ; Male ; *Orbital Fractures/pathology/surgery ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVE: To analyze the features of orbital fracture and to discuss its forensic expertise points. METHODS: One hundred and thirty cases of simple orbital fracture from 2010 to 2012 collected from one public security bureau were retrospectively analyzed such as age, gender, tools, position and morphology of the fracture, periorbital and orbital compound injury and the follow-up results after 6 months. RESULTS: In the 130 cases, the wounded were mainly young men and hit by fist. The fracture of simple medial orbital wall accounted for up to 81.5% in all cases. In the periorbital and orbital compound injury, laceration and contusion of eyelid and ethmoidal cellules and maxillary sinus always occurred. After 6 months follow-up, there were 30 cases of comminuted fracture remained enophthalmos compared with the uninjured side. CONCLUSION It is inappropriate to judge the fracture of simple medial orbital wall as minor injury. We should judge the degree of simple orbital fracture after the injury is stable. Detailed ophthalmology inspection is necessary for forensic expertise of simple orbital fracture.
Craniocerebral Trauma ; Enophthalmos ; Female ; Fractures, Comminuted/pathology* ; Humans ; Male ; Ophthalmologic Surgical Procedures ; Orbit ; Orbital Fractures/surgery* ; Retrospective Studies ; Severity of Illness Index ; Trauma Severity Indices

OBJECTIVE: To show imaging findings of inferior orbital fissure (IOF) and groove (IOG) on axial CT scans and to discover their anatomic variations, so as to avoid misdiagnosing them as orbital fracture. METHODS: 25 normal skull were used to investigate the configurations of IOF and IOG. Five skulls were performed axial CT scans. 20 normal orbital axial scans were studied as well. MPR and RT-3D reconstructions were used in this study. RESULTS: Skulls scans and normal orbital images on axial CT showed three sorts of findings: (1) single bony dehiscence between lateral and inferior walls; (2) first type of double bony dehiscence between lateral and inferior walls, among the dehiscence interposing a small bone. The long axis of the small bone was parallel to orbital wall; (3) second type of double bony dehiscence between lateral and inferior walls, but the long axis of the small bone was in anteroposterior direction. Anatomy and variation of three sorts of CT findings were corresponded respectively to: (1) a baseball club-shaped IOF; (2) a "V"-shaped IOF, that is composed of both of lateral and internal ramus, lateral ramus situates between the zygoma and the lateral portion of greater wing of sphenoid, and internal ramus between the maxilla and the internal portion of greater wing of sphenoid, both rami intercross caudally and open upwards in a "V"-shaped configuration; (3) a deep IOG with a protuberant lateral wall. CONCLUSION Familiarity of imaging features on the axial CT scans and understanding of their anatomy of IOF and IOG would be helpful for avoiding misdiagnosis of orbital fracture.
Cadaver ; Forensic Medicine ; Humans ; Imaging, Three-Dimensional ; Orbit/diagnostic imaging* ; Orbital Fractures/pathology* ; Skull/diagnostic imaging* ; Sphenoid Bone/diagnostic imaging* ; Tomography, X-Ray Computed/methods*

Child ; Edema ; diagnostic imaging ; etiology ; Emphysema ; diagnostic imaging ; etiology ; Ethmoid Bone ; diagnostic imaging ; injuries ; Eyelid Diseases ; diagnostic imaging ; etiology ; Humans ; Male ; Orbit ; diagnostic imaging ; Orbital Diseases ; diagnosis ; diagnostic imaging ; pathology ; Radiography ; Skull ; diagnostic imaging ; pathology ; Skull Fractures ; complications ; diagnostic imaging