Search Results (59)

Background and Objectives: The surgical management of three-wall orbital fractures remains a significant challenge due to complex anatomy, limited exposure, and the absence of clear landmarks. These extensive reconstructions are rare and traditionally burdened by high complication rates and inconsistent outcomes. This study presents a standardized surgical protocol for complex three-wall orbital reconstruction, highlighting the role of digital planning and a novel two-piece interlocking patient-specific implant (PSI). Materials and Methods: Between 2018 and 2024, 17 patients with unilateral three-wall orbital fractures underwent reconstruction using digitally planned, patient-specific two-piece titanium implants designed to restore the orbital floor, medial, and lateral walls. Implant positioning was assessed through qualitative evaluation of postoperative CT scans and quantitative comparison between planned and actual implant positions, as well as orbital volume analysis between reconstructed and unaffected orbits. Clinical outcomes were evaluated pre- and postoperatively. Results: Reconstruction was classified as ideal in 16 cases (94.1%) and satisfactory in one case (5.9%). Quantitative analysis demonstrated a high level of concordance between the planned and postoperative implant positions, with a mean deviation of 0.982 ± 0.107 mm (95% CI: 0.927–1.037 mm). All implants were positioned within 1.5 mm of the planned location. Postoperative orbital volumes closely approximated those of the contralateral side, with a mean volume difference of 1.371 ± 0.176 cm³ (95% CI: 1.280–1.461 cm³). Diplopia resolved in all patients, and enophthalmos was fully corrected in 15 cases (88.2%). No major complications or revision surgeries were observed. Conclusions: The proposed two-piece interlocking PSI enabled precise and reproducible reconstruction of complex three-wall orbital fractures. This approach demonstrates that even technically demanding orbital reconstructions can be performed with greater reliability, leading to favorable functional and aesthetic outcomes. Full article

Orbital fractures account for up to 16% of all facial fractures. Surgical intervention for these fractures depends on several factors, including globe displacement. This case-control study aimed to quantify the effects of orbital reconstruction on the three-dimensional globe position after orbital trauma. Pre- and post-operative radiological data of 29 cases (27 patients, with two patients requiring reintervention) with an orbital fracture were analyzed. The contralateral, unaffected orbits of the same patients served as the control group. This study used a recently validated method employing semi-automatic registration algorithms to measure globe displacement after trauma and its post-operative change. The statistical analysis, performed using the Mann–Whitney U test, showed significant globe position restoration in the anterior–posterior (2.15 mm, p ≤ 0.001) and medial–lateral (1.34 mm, p ≤ 0.001) directions, as well as in overall three-dimensional Euclidean distance (3.04 mm, p = 0.014) after surgery. The repositioning was clinically relevant in 62% of the cases, indicating that the three-dimensional globe repositioning was 2 mm or more with a positive clinical impact. Additionally, it was important to note that both the number of fractured walls and fractures of the inferomedial strut significantly affected globe repositioning after trauma. This finding highlights the importance of accurately considering the fracture pattern in surgical planning, as a better understanding of globe displacement following orbital trauma could enhance patient selection, surgical planning, and clinical outcomes. Full article

Paediatric orbital fractures require careful reconstruction to prevent long-term functional and aesthetic sequelae. Material selection is critical due to the anatomical and developmental considerations unique to children. Comparative data to guide decision making remain sparse and inconclusive. A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase (through February 2025), following Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Studies reporting outcomes and/or complications associated with implant materials used in the reconstruction of paediatric orbital fractures were included. Outcomes included postoperative diplopia, enophthalmos, restriction of eye movements, removal of material, and return to theatre (RTT). In total, 54 studies encompassing a total of 562 patients and 563 implants were included. Polymers (n = 169), alloplasts (n = 167) and autologous (n = 166) implants were the most commonly used reconstructive material. Late postoperative diplopia occurred in 7% of polymers (12/169), 6% of alloplasts (10/167), 29% of allografts (6/21), 24% of xenografts (6/25) and 33% of metals (2/6). Reported enophthalmos was highest in the autologous group (8%) but was only reported in 34 of the 54 studies. Infection, removal of implant material and RTT were low across all groups (1–4%). No donor site morbidity was reported. Robust studies with standardised outcomes and adequate follow-up are needed to inform evidence-based material selection in paediatric orbital reconstruction. Full article

Introduction: Primary Cytomegalovirus (CMV) infection occurs in 0.7–4.1% of all pregnancies. Our study aims to analyze the incidence rate of ultrasound anomalies, as well as CMV PCR analysis of the amniotic fluid sample obtained from amniocentesis in CMV-infected pregnancies, as well as the outcome of the pregnancies and neonatal follow-up. Methods: We analyzed cases of recent maternal CMV infections confirmed by serological testing at the Department of Obstetrics and Gynecology, Semmelweis University, between 2001 and 2023. In cases of primary CMV infection confirmed by serological testing during pregnancy, we offered amniocentesis at the genetic counseling, which was performed at the 20–21 weeks stage of the pregnancy. Results: In 130 cases of recent maternal CMV infection confirmed by serological testing, amniocentesis was performed, and a total of 11 cases (8.46%) were found to have CMV DNA in the amniotic fluid. Based on the neonatological follow-up examinations in 116 deliveries, 18 newborns had complications (15.52%); however, some cases were associated with multiple complications, resulting in a total of 33 types of complications being identified (28.45%). Among the 11 neurological complications (9.48%), we found 1 case each (0.86%) of severe inoperable intracranial space occupation, hydrocephalus, balance disorder, sleep disorder–sleep apnea, and speech development disorder. Two cases (1.72%) were found to have rigid muscles, epilepsy, and hypotonic muscles. Ophthalmological complications occurred in five cases (4.31%), such as enophthalmos, cataract, and retinopathy of prematurity (ROP), one case each, and two cases of strabism. Other complications were detected in 17 cases (14.66%). Conclusions: Because of the high incidence rate of recent CMV infection, serological testing is recommended following fetal abnormality detected by ultrasound. If a serologically confirmed new infection is diagnosed, the affected couple should be offered amniocentesis. Full article

Background/Objectives: Isolated orbital floor fractures are a common consequence of midfacial trauma and are frequently associated with functional and aesthetic complications such as diplopia, enophthalmos, infraorbital hypoesthesia, restricted ocular motility, and, in rare cases, blindness. Current therapeutic approaches vary significantly between different surgeons. This systematic review aimed to evaluate different treatment strategies for isolated orbital floor fractures to determine the most effective approaches. Methods: Electronic systematic searches were conducted using keywords to identify studies reporting isolated orbital floor fractures. Publications were screened for eligibility, and relevant data were extracted and evaluated. Results: This systematic review included 444 patients from 27 selected studies. 42 patients were treated conservatively, while 381 underwent various surgical interventions. Overall, the mentioned treatment modalities were successful in correcting enophthalmos (85.2%), diplopia (74.8%), ocular motility restriction (61.6%), and sensory disturbances (61.1%) in their respective patient cohorts. The complication and reoperation rates for the surgical interventions were low during the follow-up periods ranging from 6 weeks to 10 years. The timing, surgical approach, and reconstructive technique varied widely across the studies. Conclusions: Both conservative and surgical management of isolated orbital floor fractures can achieve satisfactory clinical outcomes. Clinical symptoms, defect size, and the surgeon’s preference define the ideal treatment modality. Full article

Orbital floor fractures are primarily caused by blunt trauma to the area around the eyes. These injuries most commonly affect the orbital floor and medial wall due to the fragility of these structures. The mechanism typically involves transmission of force through the orbital rim or an acute increase in intraorbital pressure caused by globe displacement. Blowout fractures often occur alongside additional maxillofacial fractures and periorbital soft tissue injuries. The reported causes mirror those of general maxillofacial trauma and include motor vehicle collisions, interpersonal violence, falls, sports-related injuries, incidents involving firearms, and occupational accidents. Here, we present the case of a 56-year-old male patient who sustained an exceptionally rare injury pattern characterized by a complete orbital floor fracture with globe dislocation into the maxillary sinus. Such extensive fractures are associated with significant functional impairments, including diplopia, enophthalmos, and restricted extraocular muscle movement, as well as marked aesthetic deformity. Comprehensive diagnostic imaging, comprising coronal, sagittal, and three-dimensional CT reconstructions, was crucial for accurately assessing the extent of bony disruption and soft tissue involvement. Particular emphasis should be placed on imaging that clearly delineates the extraocular muscles and the optic nerve, as precise evaluation of these structures is essential for surgical planning and prognosis. Surgical management involved repositioning of the globe and the orbital contents, followed by reconstruction of the orbital floor using a titanium mesh anchored to the infraorbital rim. This case highlights the technical challenges of total orbital floor reconstruction, emphasizing the importance of meticulous anatomical restoration for achieving optimal functional and aesthetic outcomes. Full article

Intraosseous hemangiomas (IH) are rare intrabony lesions that represent less than 1% of intraosseous tumors. IH are mostly seen in the axial skeleton and skull. Most commonly, the frontal bone, zygomatic, sphenoid, maxilla, ethmoid, and lacrimal bone can manifest IH. Currently, IH is classified as a developmental condition of endothelial origin. According to WHO, the five histological types of IH are cavernous, capillary, epithelioid, histiocytoid, and sclerosing. IH of the zygoma is an extremely rare condition with female predominance. A systematic review recently estimated that there were 78 cases published in the literature until 2023. The lesion is usually asymptomatic and presents with a gradually deteriorating deformity of the malar area, and the patient might be able to recall a history of trauma. Numbness due to involvement of the infraorbital nerve might also be present; however, atypical skin and bone sensations might also occur. Other symptoms include painful swelling, bone asymmetry, skin irritation, sinus pressure, paresthesia, diplopia, enophthalmos, or atypical neuralgia. A bony lesion with a trabecular pattern in a radiating formation (sunburst pattern) or a multilocal lytic lesion pattern created by the multiple cavernous spaces (honeycomb pattern) is commonly observed during radiologic evaluation. We present a rare case of IH of the zygoma in a 65-year-old generally healthy woman. A cyst-like bone tumor was revealed from the CT scan, which made preoperative biopsy of the lesion problematic. A careful radiological diagnostic differentiation of the lesion should always be conducted in such cases to outline a safe surgical plan and possible alternatives if needed. The patient underwent total tumor resection in the operating room, and the defect was reconstructed with the use of a titanium mesh and a synthetic hydroxyapatite bone graft based on a 3D surgical guide printed model. Full article

Background/Objectives: Orbital fractures are common facial injuries that require precise reconstruction to restore both function and esthetics. Heterologous cortical lamina and titanium preformed meshes are widely used for orbital wall reconstruction; however, comparative data on their outcomes remain limited. Methods: This retrospective observational study analyzed 67 patients treated for orbital fractures at Santa Maria Hospital, Terni, between January 2021 and November 2024. Patients underwent orbital reconstruction using either a heterologous cortical lamina or titanium mesh. Clinical data, including demographics, trauma etiology, fracture characteristics, surgical approach, and postoperative complications were collected. Outcomes such as diplopia, enophthalmos, ocular motility, and sensory impairment were assessed preoperatively and postoperatively and compared between groups. Statistical analyses included Chi-square and Mann–Whitney U tests, with logistic regression to identify risk factors for complications. Results: Accidental falls were the leading cause of injury (46.3%), with the orbital floor being the most commonly affected site (83.6%). Postoperative complications occurred in 15% of patients, with diplopia significantly reduced from 47.8% preoperatively to 10.4% postoperatively (p < 0.05). Sensory impairment and motility restrictions also improved significantly. Patients reconstructed using heterologous cortical lamina experienced significantly fewer postoperative complications compared to those treated with titanium mesh (OR = 0.171, 95% CI: 0.023–0.799, p = 0.040). Conclusions: Both heterologous cortical lamina and titanium mesh provide effective orbital reconstruction; however, the heterologous cortical lamina was associated with fewer postoperative complications, particularly diplopia and sensory impairment. Material selection should consider the fracture complexity, patient characteristics, and potential long-term outcomes. Full article

Background: Orbital floor blowout fractures (OFBF) can have serious consequences for the patient. Selecting the right treatment method and materials is essential. Krenkel’s maxillary sinus implant has been used successfully for more than 40 years in clinical practice. The aim of this study was to evaluate the long-term outcome of this implant compared to polydioxanone (PDS) sheets. Material and methods: This retrospective study examined a cohort of 82 OFBF patients over a seven-year period. Clinical and geometric data were collected. Defect size, location, and the volume of the herniated tissue were measured from conventional computer tomography (CT) or cone beam computer tomography (CBCT) scans. The relationship between ophthalmologic rehabilitation and treatment modality was analyzed using logistic regression. Results: The study included 82 patients, 28% female and 72% male, with a median age of 45.2 years. Defect size and hernia volume correlated with preoperative ophthalmological symptoms. At follow-up, 14.8% in the implant group and 28.6% in the PDS group showed mild visual impairment, with no severe diplopia. Conclusions: Our results suggest this method is a reliable and effective solution for repairing OFBFs and ophthalmologic rehabilitation. However, further research in a clinical controlled trial is needed. Full article

Objective: Trauma is a leading cause of enophthalmos, typically resulting from an increase in the volume of the bony orbit. The general consensus is that post-traumatic primary deformity repair should aim to restore the premorbid volume, shape, and cosmesis of the orbitozygomatic complex (OZC). This study aims to utilise novel three-dimensional (3D) printed patient-specific moulds to intraoperatively fabricate enophthalmos wedges and onlays using polymethylmethacrylate (PMMA) bone cement to reconstruct the OZC. Methods: A total of seven patients underwent digital surgical planning using Freeform software to virtually correct orbitozygomatic complex deformities guided by a design algorithm. Three-dimensionally printed nylon patient-specific moulds were used intraoperatively to fabricate enophthalmos wedges and/or onlays using an industry-standard PMMA bone cement. Clinical examination and application of the proposed design algorithm determined that enophthalmos wedges were indicated for four patients, with one also requiring an onlay; and periorbital onlays were required for the three remaining patients. Results: Hertel exophthalmometry at a mean follow-up of 19.1 months demonstrated good outcomes in the correction of post-traumatic enophthalmos and hypoglobus and with patients reporting good subjective cosmetic results. Patients 5 and 7 had follow-up three-dimensional computed tomography (3D-CT) to confirm correct placement. Conclusion: The use of patient-specific PMMA wedges and onlays, fabricated intraoperatively with the aid of 3D-printed moulds, offers a reliable and effective approach for correcting post-traumatic enophthalmos and hypoglobus. This method allows for the restoration of orbital volume and anatomical contours, addressing both functional and aesthetic concerns. Our results demonstrate that this technique yields favourable outcomes. Full article

Objectives: Although considered a safe procedure, functional endoscopic sinus surgery (FESS) can cause various significant ophthalmic complications, i.e., serious extraocular muscle (EOM) damage. The aim of this study is to review the surgical management outcomes of patients with mechanical strabismus and diplopia as a complication of FESS, who referred to ophthalmological department in Norbert Barlicki University Teaching Hospital No. 1 over the 5-year period from 2018 to 2023. Methods: The records of seven consecutive patients with diplopia following endoscopic sinus surgery were retrospectively reviewed. Demographics, ophthalmological and orthoptic examination, the results of orbital imaging, type of FESS, type of strabismic surgery, and the timing of the first intervention were analysed. Results: The time from FESS to referral for strabismic intervention varied from one day to two months. Two patients, who were operated upon immediately after the FESS procedure, underwent direct reunion of the proximal and distal parts of the ruptured medial rectus muscle. One patient required maxillofacial intervention in order to improve prominent enophthalmos. The remaining five demonstrated severe adhesion formation around at least one of the EOMs and orbital walls. Only patients who were operated upon within a short period after complicated FESS achieved orthotropia and lack of diplopia in the primary position with a single surgery. Conclusions: Early recognition of the orbital complications subsequent to FESS and prompt referral are essential for achieving a satisfactory surgical result. Appropriate treatment should be based on the mechanism, location, type, and severity of muscle damage. Full article

Background: Changes in the bony structures of the nose and sinuses such as the medialization of the lamina papyracea and enophthalmos have been reported after sinus surgery. Evidence for the persistence of inferior turbinate (IT) position after IT outfracture is lacking. Objectives: To evaluate for anatomical changes of the IT, lamina and the globes, after sinus surgery and the durability of inferior turbinate outfracture. Methods: A total of forty-four patients who underwent revision endoscopic sinus surgery that included complete ethmoidectomy and IT outfracture were matched. Pre- and post-operative computed tomography scans (CT) were used for evaluating and measuring the anatomical changes in different planes. The posterior globe position in the axial plane, the distance between the lamina papyracea (IOD_Axial, IOD_Coronal) in coronal and axial planes and the distance from the IT to the septum (IT_M) and the lateral nasal wall (IT_L) were measured. Results: There were 16 women and 28 men. Mean follow-up time (time from procedure to post-operative CT scan) was 38.9 ± 20.1 months. Statistically significant lateralization of the IT was observed with IT_L (95%CI 1.1 mm to 1.5 mm p < 0.0001) and IT_M (95%CI −1.5 mm to −1.1 mm; p < 0.0001). No statistically significant differences were seen in IOD_Axial and IOD_Coronal in pre-op and post-op CT scans. (p = 0.23 and p = 0.7, respectively) and no significant displacement of the globe in antero-posterior direction was seen (p = 0.915). Conclusions: IT outfracture appears to have a durable effect on IT position that lasts for several years. Ethmoidectomy did not cause the medialization of the laminae nor altered the position of the globes. Full article

Background/Objectives: In Japan, artificial orbital implants are not approved as medical materials, limiting the number of facilities that perform orbital implant surgery. However, this procedure is crucial for improving the quality of life of ocular prosthesis users by enhancing cosmetic outcomes. This study aimed to evaluate the short-term outcomes of orbital implant surgery using costal cartilage grafts and assess the cosmetic impact by comparing upper eyelid positions between patients who underwent the procedure and those who did not. Methods: Patients were divided into two groups: those who underwent evisceration and orbital implant grafting with costal cartilage (Group 1) and those who used a prosthetic eye without an orbital implant (Group 2). In Group 1 cases, following evisceration, a spherical implant was created using the sixth autologous costal cartilage and covered with four pedicled scleral flaps. The incidence of complications and the necessity for additional surgery were investigated through medical records, and both complications and upper eyelid symmetry were assessed at least 12 months after the final surgical procedure. Results: A total of 23 patients were included: 13 in Group 1 and 10 in Group 2. Group 1 had a significantly lower median age (52 vs. 68 years, p = 0.002) and a higher proportion of females (76.9% vs. 30%, p = 0.024). Upper eyelid asymmetry was significantly greater in Group 2 than in Group 1 (p < 0.05). Orbital fracture was associated with a higher risk of requiring additional surgery (100% vs. 37.5%, p = 0.075), though not statistically significant. Conclusions: Orbital implant surgery with costal cartilage grafts improves eyelid symmetry and cosmetic appearance. Early and accurate orbital volume repair is essential for preventing enophthalmos. Full article

Silent sinus syndrome is a rare condition characterized by an almost always unilateral collapse of the maxillary sinus. The most characteristic symptom of this syndrome is enophthalmos. Naso-sinusal disorders are rarely associated with this condition. We are going to discuss a case that was associated with recurrent sinusitis. In this case report, we describe how we managed this rare syndrome so we can share our experience with those colleagues that may face this condition. Full article

Background/Objectives: This study aims to evaluate the computed tomography (CT) scans of glaucoma patients using prostaglandin analogs (PGA) in one eye, investigate findings associated with prostaglandin-associated periorbitopathy (PAP), and compare these findings with those of the contralateral eyes. Methods: Patients with open-angle glaucoma who had CT images of the orbital region taken for another reason at least one month after starting PGA treatment in one eye were included in the study. Enophthalmos measurements from thin-slice CT images, along with 3D volume measurements of orbital fat tissue, periorbital muscles, and the optic nerve, were performed. Ophthalmological examination findings and treatment information were collected. The values were compared with those of the contralateral eyes of the same patients not using PGA. Intraclass correlation coefficients (ICCs) were computed to evaluate measurement repeatability. Results: Forty patients were included in the study. Among them, 29 (72.5%) used latanoprost, 9 (22.5%) used bimatoprost, and 2 (5%) used travoprost. The mean enophthalmos values on the treated side (15.5 ± 2.0 mm) were lower than on the untreated side (16.1 ± 1.4 mm), but this difference was not statistically significant (p = 0.07). In 29 patients (72.5%), enophthalmos measurements were smaller on the treated side, with 7 patients (17.5%) showing a difference of 2 mm or more. No significant correlation was found between the duration of PGA use and enophthalmos measurements (p = 0.768 r = −0.048). Additionally, no significant differences were found in orbital fat volume, total extraocular muscle volume, and optic nerve volume (p > 0.05). ICC values demonstrated excellent reliability (ICC > 0.75) for all measurements. Conclusions: We did not find significant differences in enophthalmos measurements, orbital fat volume, total muscle volume, and optic nerve volume between the PGA-treated and untreated eyes. Full article