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Modabber A, Winnand P, Hölzle F, Ilgner J, Hackenberg S. [Current developments in primary and secondary surgical treatment of midface and periorbital trauma]. HNO 2022; 70:756-764. [PMID: 36044058 DOI: 10.1007/s00106-022-01226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 11/04/2022]
Abstract
Fractures of the periorbita and the midface are among the most common bony facial injuries. Aesthetic and functional reconstruction is a challenge in clinical routine. This article illustrates recent developments in the primary and secondary surgical treatment of midface and periorbital trauma. Resorbable patches and films increase the anatomic reconstructive capacity and enable treatment of extensive orbital fractures. Orbital fractures with involvement of supporting key structures are advantageously reconstructed using patient-specific implants (PSI), which are fabricated by computer-assisted manufacturing techniques and positioned by intraoperative navigation. If late complications such as bulbar malposition and enophthalmos have occurred after the initial procedure, they can be addressed by overcorrective restoration of orbital volume. The use of PSI for initial fracture restoration of the midface is not yet established but may be useful in re-osteotomies of misconsolidated fragments. Extensive midface defects with significant soft tissue involvement can be reconstructed using microvascular grafts. Consecutive reconstructive procedures may include orthognathic surgery and local flap reconstruction. In summary, the integration and advancement of computer-assisted techniques now offers individualized reconstruction procedures, which may be a viable alternative to conventional implants and compression miniplates. Future developments may focus on the search for innovative biomaterials, which can be integrated into computer-aided design and manufacturing processes.
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Affiliation(s)
- A Modabber
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - P Winnand
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - F Hölzle
- Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - J Ilgner
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinik RWTH Aachen, Aachen, Deutschland
| | - S Hackenberg
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinik RWTH Aachen, Aachen, Deutschland
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Noda R, Inoue T, Tsunoda S, Akabane A. Surgical management for IgG4-related ophthalmic disease by a transcranial biopsy combined with extraorbital decompression: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE20170. [PMID: 35855308 PMCID: PMC9241348 DOI: 10.3171/case20170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Immunoglobulin G4–related ophthalmic disease (IgG4-ROD) accounts for 22% of Japanese lymphoproliferative orbital disease and occurs in 4%–34% of patients with IgG4-related disease, according to the largest case series published to date. Because the optic nerve mass often appears as a tumor-like lesion, it is important, although difficult, to differentiate IgG4-ROD from other orbital tumors and diseases, and biopsy is essential for diagnosis. Here, the authors describe the surgical management of an IgG4-ROD case. OBSERVATIONS A 63-year-old man presented to the authors’ hospital with proptosis and visual impairment. Ophthalmic examination revealed intraocular hypertension. IgG4-related disease with an ophthalmic lesion was suspected on the basis of a blood test and imaging studies. Transcranial biopsy with extraorbital decompression was performed. The patient’s symptoms, including visual impairment, improved 3 days after operation, and his IgG4-related disease resolved after corticosteroid treatment. LESSONS The standard treatment for IgG4-related disease is systemic corticosteroid therapy. However, this treatment should not be administered to patients with IgG4-ROD who a high risk of blindness. In this case, the authors completed a diagnostic and symptom-relieving transcranial biopsy without affecting the patient’s aesthetic characteristics. This is the first study, to our knowledge, to report extraorbital decompression via a transcranial approach as a surgical option for IgG4-ROD.
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Affiliation(s)
- Ryuichi Noda
- Department of Neurosurgery, Nippon Telegraph and Telephone Corporation Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan
| | - Tomohiro Inoue
- Department of Neurosurgery, Nippon Telegraph and Telephone Corporation Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan
| | - Sho Tsunoda
- Department of Neurosurgery, Nippon Telegraph and Telephone Corporation Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan
| | - Atsuya Akabane
- Department of Neurosurgery, Nippon Telegraph and Telephone Corporation Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan
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Marin L, Nahon-Esteve S, Baillif S, Toumi E, Martel A. [Anatomical description of the retro-caruncular approach and its application in oculoplastics: A cadaveric study]. ANN CHIR PLAST ESTH 2019; 65:244-251. [PMID: 31543280 DOI: 10.1016/j.anplas.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 08/30/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the anatomical landmarks of the retro-caruncular approach and its clinical applications based on a cadaveric study. PATIENTS AND METHOD A dissection of 8 orbits providing from 4 fresh cadavers was carried out at the anatomical laboratory of the University Hospital of Nice, France between October 2018 and January 2019. RESULTS Main anatomical relationships encountered are anteriorly the Duverney-Horner muscle and the lacrimal sac, posteriorly the anterior and posterior ethmoidal arteries, superiorly the pulley of the superior oblique muscle, inferiorly the lacrimonasal duct and the tendon of the inferior oblique muscle. The retro-caruncular approach allows a safe surgical access behind the lacrimal sac and Duverney-Horner muscle. Many oculoplastic surgical procedures can be performed through this approach: dacryocystorhinostomy, medial orbital fractures repair, "médial" orbital "décompression", biopsy of medial and extraconal tumours, medial periosteal fixation in third-nerve palsy. CONCLUSION The retro-caruncular approach is a safe procedure avoiding skin incision. It allows a wide surgical space even if it is reduced compared to a more conventional skin route. It requires a great anatomical knowledge and a longer surgical learning curve.
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Affiliation(s)
- L Marin
- Service d'ophtalmologie, centre hospitalier universitaire de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - S Nahon-Esteve
- Service d'ophtalmologie, centre hospitalier universitaire de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - S Baillif
- Service d'ophtalmologie, centre hospitalier universitaire de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France; Université Côte d'Azur, 06000 Nice, France
| | - E Toumi
- Service d'ophtalmologie, centre hospitalier universitaire de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - A Martel
- Service d'ophtalmologie, centre hospitalier universitaire de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France; Université Côte d'Azur, 06000 Nice, France; Équipe 1, Inserm U1065, centre méditerranéen de médecine moléculaire (C3M), 06200 Nice, France.
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He H, Cai M, Li M, Wei L, Luo L, Chen Z, Yang H, Guo Y, Li W. Surgical Techniques and the Choice of Operative Approach for Cranioorbital Lesions. J Neurol Surg B Skull Base 2019; 81:686-693. [PMID: 33381374 DOI: 10.1055/s-0039-1696684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022] Open
Abstract
Objectives Cranioorbital lesions present a great challenge for neurosurgeons and ophthalmologists. There is no consensus on the choice of surgical approach. The aims of this study were to investigate 49 cases of cranioorbital lesions and evaluate surgical approaches and outcomes. Patients and Methods A retrospective study was done on 49 patients (51 operations) from 2009 to 2018. Information about the lesion was used to decide whether the supraorbital eyebrow approach (SEA) or pterional approach (PA) was performed. Results Twenty-eight patients had surgical resection using SEA, 21 patients received PA, each group included one case of recurrence, who underwent reoperation via the same approach. SEA provided better cosmetic satisfaction, and a shorter incision than PA ( p < 0.05). There was no significant difference in total resection rates, visual outcomes, recovery of ptosis, and other new surgical-related complications between SEA group and PA group ( p > 0.05). Forty-nine cases of proptosis (94.1%, 49/51) were improved. Thirty-three patients (33/37, 89.2%) who underwent follow-up for longer than 12 weeks had a modified Rankin Scale (mRS) score ≤ 3. Conclusion Surgery is the preferred treatment for cranioorbital lesions, but total resection is difficult. SEA may be a more minimally invasive option for some more limited lesions superior to optic nerve. PA may be more reasonable for the lesion with obvious hyperostosis and more extensive lesions.
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Affiliation(s)
- Haiyong He
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Meiqin Cai
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Manting Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Lei Wei
- Department of Neurology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510060, People's Republic of China
| | - Lun Luo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zhuopeng Chen
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Huasheng Yang
- Department of Eye Tumor and Orbital Disease, Zhongshan Ophthalmic Center (ZOC) of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ying Guo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Wensheng Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
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Rokohl AC, Koch KR, Kabbasch C, Kreppel M, Lüers JC, Grau S, Heindl LM. [Importance of interdisciplinary collaboration for optimal treatment of orbital tumors]. HNO 2019; 67:528-533. [PMID: 30941456 DOI: 10.1007/s00106-019-0659-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Optimal treatment of tumors with orbital invasion may exceed the competences of an individual medical specialty and require interdisciplinary cooperation. The aim of this article is to present an interdisciplinary treatment concept based on the examples of intraorbital hemangioma and squamous cell carcinoma of the paranasal sinuses infiltrating the orbit. In addition to a detailed medical history and a complete ophthalmological examination, a detailed imaging technique with standardized echography and tomography methods such as orbital thin-slice CT and/or in many cases MRI is essential for the primary classification of an intraorbital pathology. Depending on the type of pathology, a purely surgical procedure involving various disciplines such as ophthalmology, otorhinolaryngology, maxillofacial surgery, neurosurgery, and pathology, or an interdisciplinary treatment regimen including (neo)adjuvant radiotherapy or chemotherapy is necessary. Orbital tumors have a wide range of potential pathologies, requiring complex surgical procedures and multimodal therapies. In case of infiltration of the paranasal sinuses or intracranial structures, an interdisciplinary team including neuroradiologists, oral-maxillofacial surgeons, otorhinolaryngologists, neurosurgeons, radiation therapists, ophthalmologists, pathologists, oncologists, and psycho-oncologists is essential for successful treatment.
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Affiliation(s)
- A C Rokohl
- Universitätsklinik Köln, Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - K R Koch
- Universitätsklinik Köln, Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - C Kabbasch
- Universitätsklinik Köln, Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universität zu Köln, Köln, Deutschland
| | - M Kreppel
- Universitätsklinik Köln, Klinik für Mund-Kiefer-Gesichtschirurgie, Universität zu Köln, Köln, Deutschland
| | - J-C Lüers
- Universitätsklinik Köln, Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universität zu Köln, Köln, Deutschland
| | - S Grau
- Universitätsklinik Köln, Zentrum für Neurochirurgie, Universität zu Köln, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland
| | - L M Heindl
- Universitätsklinik Köln, Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland
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