Advances in ophthalmic plastic and reconstructive surgery最新文献

Medial wall blowout fractures may accompany orbital floor fractures or may occur as isolated fractures after blunt facial trauma. A "Z-plasty"-type incision over the medial orbital region allows the best exposure and cosmetic result following the repair of an isolated medial wall fracture.

Injury to the optic nerve may occur after seemingly minor trauma. Evulsion of the nerve from the globe may be partial or complete as a result of several concussive or rotational forces. A depressed or visibly absent lamina cribrosa indicates a disinsertion of the nerve fibers from the globe. Visual loss ranges from severe to complete. Transections of the optic nerve within the orbit generally occur after penetrating orbital injuries or surgical resection, resulting in complete blindness. Medical or surgical intervention has not been shown to improve the visual prognosis once such injuries occur. The etiology, clinical features, and histopathology are also discussed.

The repair of orbital floor fractures is complicated not only by the technical aspects of the procedure, but by the decision-making process one must initiate to determine when and if the fracture should be repaired. This article examines the indications for repairing orbital floor fractures through the maxillary approach and describes the technical aspects and results that can be achieved with this technique.

Although penetrating orbital wounds are an uncommon entity they are often associated with vision and life-threatening complications. By careful attention to the history and physical signs of the injured patient and the use of modern computed tomography (CT) scan imaging, the physician will be better able to make an accurate analysis and prognosis of the problem at hand as well as a well-planned therapeutic approach.

Orbital-cranial injuries have the greatest potential for death and disability of any condition treated by the ophthalmologist. An object that penetrates through the orbit into the brain may leave only a small entrance wound. Patients can have normal vision, neurologic exam, and plain x-rays despite trauma that may lead to meningitis, brain abscess, or pneumocephalus. The CT scan greatly aids in both the early and late management of blunt and penetrating orbital-cranial trauma. The detection of pneumocephalus may be the only clue that intracranial penetration has occurred. Blunt trauma can cause vision loss, ophthalmoplegia, ptosis, and intracranial injury. Management of orbital-cranial trauma frequently requires a team approach by the ophthalmologist and neurosurgeon due to the complexity of these injuries.

The management of traumatic ptosis is dependent on its etiology, interval between occurrence and examination, degree of ptosis, and levator function. The surgical approach and timing of intervention varies with each case and provides a challenge to the oculoplastic surgeon. We discuss our approach to the management of traumatic ptosis. Secondary surgery may be necessary to repair over- or undercorrection.

Many injuries and complications of orbital fractures are instantaneous and unpreventable, some develop over time, and some are a result of surgery. Most complications can either be managed or prevented and are anticipated based on the fracture location and size. A thorough search for probable complications is mandatory, especially ocular injuries and intracranial complications. Most patients are carefully followed for 7-14 days, and the significant residual sequelae are managed. Some complications, however, require urgent care.