Humans ; Neck/surgery* ; Orbit/injuries* ; Thorax ; Wounds, Penetrating

PURPOSE: To report a case of chemical injury of the cornea caused by high-dose ethanol during orbital wall fracture repair. CASE SUMMARY: A 56-year-old male presented with pain after blowout fracture repair surgery. During the surgery, 2% hexethanol solution (2% chlorhexidine and 72% ethanol mixture), which was used for disinfection of the face, flowed into the left eye. Conjunctival injection in the left limbus, a large corneal epithelial defect, and severe stromal edema were subsequently observed. The patient was treated with topical antibiotics, steroids, and autologous serum eye drops. After 1 week, the corneal epithelial defect was improved, but at the second month of therapy, recurrent corneal erosion with deterioration of the endothelial cell function occurred. Anterior stromal puncture and laser keratectomy were performed. The corneal epithelial defect and erosion improved, but the endothelial cell density was severely decreased. CONCLUSIONS: The 2% hexethanol solution is usually used for preoperative skin disinfection, but it contains a high concentration of ethanol. The surgeon should be aware that high concentrations of ethanol may result in severe corneal damage, including corneal endothelial dysfunction and limbal cell deficiency.
Anti-Bacterial Agents ; Chlorhexidine ; Cornea ; Corneal Injuries ; Corneal Surgery, Laser ; Disinfection ; Edema ; Endothelial Cells ; Ethanol ; Humans ; Male ; Middle Aged ; Ophthalmic Solutions ; Orbit ; Punctures ; Skin ; Steroids

Choristoma ; pathology ; surgery ; Dermoid Cyst ; diagnosis ; Diagnosis, Differential ; Dissection ; methods ; Eyelids ; pathology ; Hemangioma ; diagnosis ; Humans ; Infant, Newborn ; Male ; Neuroglia ; pathology ; Orbit ; diagnostic imaging ; Orbital Neoplasms ; diagnosis ; Treatment Outcome ; Ultrasonography ; methods

Patients who have a lower facial asymmetry with compensatory head posture (developmental facial asymmetry) may have minor temporomandibular (T-M) joint problems and tend to mask their asymmetry by tilting the head for camouflage of their chin deviation. However, this compensatory head posture can give the impression of orbital dystopia and c spine deviation. When these patients undergo bimaxillary orthognathic surgery, orbital canting and head tilting improves gradually without the need for camouflage, and bleary eyes become clearer. We evaluated 13 patients who underwent LeFort I osteotomy combined with bilateral sagittal split osteotomy of the mandible for developmental facial asymmetry to quantitatively observe whole facial postural changes after surgery. Pre-operative and post-operative 1:1 full-face photographs of the patients were analyzed to compare the degrees of head tilting and orbital canting and the sizes of the eye opening. After bimaxillary orthognathic surgery, eye canting decreased from 2.6° to 1.5°, eye and lip lines came closer to parallel, and the degree of head tilting decreased from 3.4° to 1.3°. The eyes also appeared to open wider. Correction of lower facial skeletal asymmetry through bimaxillary orthognathic surgery improved head tilting and orbital canting gradually by eliminating the need of compensatory head posture. Facial expressions also changed as the size of the eyes increased due to the reduction of facial muscle tension caused by T-M joint dysfunction.
Chin ; Facial Asymmetry ; Facial Expression ; Facial Muscles ; Head ; Humans ; Joints ; Lip* ; Mandible ; Masks ; Orbit ; Orthognathic Surgery* ; Osteotomy ; Posture ; Spine ; Treatment Outcome

Intraorbital wooden foreign bodies may present difficulties in diagnosis due to their radiolucent nature. Delayed recognition and management can cause significant complications. We present a case report that demonstrates these problems and the sequela that can follow. A 56-year-old man presented with a 3-cm laceration in the right upper eyelid, sustained by a slipping accident. After computed tomography (CT) scanning and ophthalmology consultation, which revealed no fractures and suggested only pneumophthalmos, the wound was repaired by a plastic surgery resident. Ten days later, the patient’s eyelid displayed signs of infection including pus discharge. Antibiotics and revisional repair failed to solve the infection. Nearly 2 months after the initial repair, a CT scan revealed a large wooden fragment in the superomedial orbit. Surgical exploration successfully removed the foreign body and inflamed pocket, and the patient healed uneventfully. However, the prolonged intraorbital infection had caused irreversible damage to the superior rectus muscle, with upgaze diplopia persisting 1 year after surgery and only minimal muscle function remaining. We report this case to warn clinicians of the difficulties in early diagnosis of intraorbital wooden foreign bodies and the grave prognosis of delayed management.
Anti-Bacterial Agents ; Delayed Diagnosis ; Diagnosis ; Diplopia ; Early Diagnosis ; Eye Foreign Bodies ; Eye Injuries, Penetrating ; Eyelids ; Foreign Bodies* ; Humans ; Lacerations ; Middle Aged ; Ophthalmology ; Orbit ; Prognosis ; Suppuration ; Surgery, Plastic ; Tomography, X-Ray Computed ; Wounds and Injuries

BACKGROUND: Nasal fracture and orbital blowout fracture often occur concurrently in cases of midface blunt trauma. Generally, these multiple fractures treatment is surgery, and typically, the nasal bone and orbit are operated on separately. However, we have found that utilizing a transconjunctival approach in patients with concurrent nasal bone fracture and orbital blowout fracture is a useful method. METHODS: The participants in the present study included 33 patients who visited the Plastic Surgery outpatient department between March 2014 and March 2017 and underwent surgery for nasal fracture and orbital blowout fracture. We assessed patients’ and doctors’ satisfaction with surgical outcomes after indirect open reduction via a transconjunctival approach for the treatment of nasal bone fracture with associated orbital blowout fracture. RESULTS: According to the satisfaction scores, both patients and doctors were satisfied with transconjunctival approach. CONCLUSION: We presented here that our method enables simultaneous operation of nasal fracture accompanied by orbital blowout fracture, rather than treating the two fractures separately, and it allows precise reduction of the nasal fracture by direct visualization of the fracture site without any additional incisions or difficult surgical techniques. Also, by preventing the use of excessive force during reduction, this method can minimize damage to the nasal mucosa, thereby reducing the incidence of nasal bleeding.
Epistaxis ; Facial Bones ; Fractures, Multiple ; Humans ; Incidence ; Methods ; Nasal Bone* ; Nasal Mucosa ; Orbit* ; Orbital Fractures ; Outpatients ; Surgery, Plastic

To review retrospectively six cases of rhino-orbital related endoscopic surgeries aided by Fusion electromagnetic system,to explore the indications and clinical value of image guided technique in endonasal endoscopic surgery.Retrospective research methods were used.In this study,six cases of nasal endoscopic sinus surgery using Fusion electromagnetic system were analyzed,including 1 nasal penetrating foreign body,2 optic nerve decompressions,1 orbital apex hemangioma,1 sieve frontal sinus cyst,1 intraorbital mass biopsy.The preparation time of navigation system,the accuracy of intraoperative positioning and surgical coherence,intraoperative and postoperative complications of surgery were recorded.The average preparation time was(8.13 ± 1.858)min.In the navigation,the sinus ostium,orbital cardboard,skull base,optic nerve,internal carotid artery and other important structures can be accurately located in all patients,while registrations had been accurate within 1 mm.Six patients were successfully operated by image guided technique.There was no intracranial or intraorbital complications due to intraoperation error.Image guided technique allows for a truely microinvasive and accurate rhino-orbital related endoscopic surgeries.It requires less preoperative preparation time,has high surgical navigation accuracy,improves the surgical coherence and safety,and reduces the surgical complicationgs.However,as an auxiliary tool,it can not replace the surgeon's anatomical knowledge,surgical training and clinical experience.
Endoscopy ; methods ; Humans ; Nasal Cavity ; surgery ; Orbit ; surgery ; Retrospective Studies ; Skull Base ; surgery ; Surgery, Computer-Assisted

BACKGROUND: Along with the advances in technology of three-dimensional (3D) printer, it became a possible to make more precise patient-specific 3D model in the various fields including oral and maxillofacial surgery. When creating 3D models of the mandible and maxilla, it is easier to make a single unit with a fused temporomandibular joint, though this results in poor operability of the model. However, while models created with a separate mandible and maxilla have operability, it can be difficult to fully restore the position of the condylar after simulation. The purpose of this study is to introduce and asses the novel condylar repositioning method in 3D model preoperational simulation. METHODS: Our novel condylar repositioning method is simple to apply two irregularities in 3D models. Three oral surgeons measured and evaluated one linear distance and two angles in 3D models. RESULTS: This study included two patients who underwent sagittal split ramus osteotomy (SSRO) and two benign tumor patients who underwent segmental mandibulectomy and immediate reconstruction. For each SSRO case, the mandibular condyles were designed to be convex and the glenoid cavities were designed to be concave. For the benign tumor cases, the margins on the resection side, including the joint portions, were designed to be convex, and the resection margin was designed to be concave. The distance from the mandibular ramus to the tip of the maxillary canine, the angle created by joining the inferior edge of the orbit to the tip of the maxillary canine and the ramus, the angle created by the lines from the base of the mentum to the endpoint of the condyle, and the angle between the most lateral point of the condyle and the most medial point of the condyle were measured before and after simulations. Near-complete matches were observed for all items measured before and after model simulations of surgery in all jaw deformity and reconstruction cases. CONCLUSIONS: We demonstrated that 3D models manufactured using our method can be applied to simulations and fully restore the position of the condyle without the need for special devices.
Chin ; Congenital Abnormalities ; Equidae ; Glenoid Cavity ; Humans ; Jaw ; Joints ; Mandible ; Mandibular Condyle ; Mandibular Osteotomy ; Maxilla ; Methods ; Oral and Maxillofacial Surgeons ; Orbit ; Orthognathic Surgery ; Osteotomy, Sagittal Split Ramus ; Surgery, Oral ; Temporomandibular Joint

Virtual surgical planning (VSP) has recently been introduced in craniomaxillofacial surgery with the goal of improving efficiency and precision for complex surgical operations. Among many indications, VSP can also be applied for the treatment of congenital and acquired craniofacial defects, including orbital fractures. VSP permits the surgeon to visualize the complex anatomy of craniofacial region, showing the relationship between bone and neurovascular structures. It can be used to design and print using three-dimensional (3D) printing technology and customized surgical models. Additionally, intraoperative navigation may be useful as an aid in performing the surgery. Navigation is useful for both the surgical dissection as well as to confirm the placement of the implant. Navigation has been found to be especially useful for orbit and sinus surgery. The present paper reports a case describing the use of VSP and computerized navigation for the reconstruction of a large orbital floor defect with a custom implant.
Adult ; Female ; Humans ; Ketones ; Orbit ; diagnostic imaging ; injuries ; surgery ; Polyethylene Glycols ; Printing, Three-Dimensional ; Reconstructive Surgical Procedures ; methods ; Surgery, Computer-Assisted ; methods ; Tomography, X-Ray Computed

Ophthalmic plastic and reconstructive surgery combines the precision of ophthalmic microsurgery with plastic and reconstructive surgical principles, allowing for subspecialized care of the eyelid, orbital, and lacrimal system. A foundation in ophthalmology allows the oculoplastic surgeon's knowledge and skills to safely and successfully protect the globe while achieving good functional and aesthetic results. Oculoplasty emerged following World War II, in which a high rate of ophthalmic and oculoplastic trauma occurred. Following this, more structured and specialized studies dedicated to clinical and surgical management led to the development of a highly specific and rapidly growing sub-specialty dedicated to eyelid, lacrimal, and orbital care. Stem cell treatments in oculoplasty has been spanned a wide array of subfields, ranging from reconstruction of the eyelid to the generation of artificial lacrimal glands and oncological therapeutics. Tissue engineering represents the future of regenerative and reconstructive medicine, with significant potential applications in ophthalmic plastic surgery. Difficulty remains in disease modeling for various disorders, owing to genetic and functional variation across patients as well as the complexity of several diseases. Progressive advances in the understanding of the immunopathogenesis of diseases such as thyroid eye disease and lacrimal gland carcinoma continue to spur clinical trials utilizing targeted therapies to enhance treatment outcomes. Continued investigation of the molecular mechanisms of disease will expand potential treatments. In the future, public awareness and interest in the field of oculoplasty will further grow, and personalized and optimized treatment will become a cornerstone of modern medicine.
Eye Diseases ; Eyelids ; Graves Ophthalmopathy ; History, Modern 1601- ; Humans ; Lacrimal Apparatus ; Microsurgery ; Ophthalmology ; Orbit ; Plastics ; Stem Cells ; Surgery, Plastic ; Thyroid Gland ; Tissue Engineering ; World War II