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Khan RI, Golahmadi AK, Killeen RP, O' Brien DF, Murphy C. Image-guided navigation in posterior orbital tumour surgery: a comparative cohort study. Orbit 2024:1-10. [PMID: 38687963 DOI: 10.1080/01676830.2024.2343299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE The posterior orbit is a confined space, harbouring neurovascular structures, frequently distorted by tumours. Image-guided navigation (IGN) has the potential to allow accurate localisation of these lesions and structures, reducing collateral damage whilst achieving surgical objectives. METHODS We assessed the feasibility, effectiveness and safety of using an electromagnetic IGN for posterior orbital tumour surgery via a comparative cohort study. Outcomes from cases performed with IGN were compared with a retrospective cohort of similar cases performed without IGN, presenting a descriptive and statistical comparative analysis. RESULTS Both groups were similar in mean age, gender and tumour characteristics. IGN set-up and registration were consistently achieved without significant workflow disruption. In the IGN group, fewer lateral orbitotomies (6.7% IGN, 46% non-IGN), and more transcutaneous lid and transconjunctival incisions (93% IGN, 53% non-IGN) were performed (p = .009). The surgical objective was achieved in 100% of IGN cases, with no need for revision surgery (vs 23% revision surgery in non-IGN, p = .005). There was no statistically significant difference in surgical complications. CONCLUSION The use of IGN was feasible and integrated into the orbital surgery workflow to achieve surgical objectives more consistently and allowed the use of minimal access approaches. Future multicentre comparative studies are needed to explore the potential of this technology further.
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Affiliation(s)
- Rizwana I Khan
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- School of Medicine, Royal College of Surgeons Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Ronan P Killeen
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Donncha F O' Brien
- School of Medicine, Royal College of Surgeons Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Department of Neurosurgery, National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
| | - Conor Murphy
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- School of Medicine, Royal College of Surgeons Ireland University of Medicine and Health Sciences, Dublin, Ireland
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Zoia C, Maiorano E, Borromeo S, Mantovani G, Spena G, Pagella F. Endoscopic approaches to the orbit: Transnasal and transorbital, a retrospective case series. Brain Spine 2024; 4:102770. [PMID: 38510598 PMCID: PMC10951755 DOI: 10.1016/j.bas.2024.102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
Introduction Orbital pathologies requiring surgery are traditionally treated by open approach with different techniques depending on the lesion location. Recently, minimally invasive endoscopic approaches, such as the Endoscopic Endonasal Approach (EEA) and the Endoscopic Transorbital Approach (ETA) have been introduced in orbital surgery. Research question The purpose of this study is to report the combined experience of the Neurosurgical and Ear-Nose-Throat (ENT) Units in the endoscopic approach of orbital pathologies. Material and methods We retrospectively retrieved data on patients treated at our Institution between 2016 and 2021 with endoscopic approach for orbital pathologies. The Clavien-Dindo classification and the Scar Cosmesis Assessment and Rating (SCAR) Scale have been used to assess complications and cosmetic outcomes. Results 39 patients met the inclusion criteria. EEA (15 patients) or ETA (20 patients) were chosen to approach the lesions. In three cases we used a combination of endoscopic and anterior orbitotomy and in one patient a combination of EEA + ETA. The type of procedure performed was orbital biopsy (9 cases), orbital decompression (6 cases), subtotal resection of the lesion (STR) (8 cases) and total resection of the lesion (GTR) (16 cases). The more frequent postoperative complications were diplopia (5.1%, with 1 case of permanent diplopia), trigeminal paraesthesia and dysesthesia (5.1%), palpebral edema (17.9%), periorbital ecchymosis (7.7%). Mean follow up time was 21 months (range 2-63 months). Discussion and conclusion Endoscopic approaches to orbital compartments provide minimally invasive access to every orbital compartment with low complications rate and good cosmetic outcome.
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Moriggia Pelascini Hospital, Gravedona e Uniti, Italy
| | - Eugenia Maiorano
- Department of Surgical Science, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Sara Borromeo
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Giorgio Mantovani
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giannantonio Spena
- Neurosurgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Fabio Pagella
- Department of Surgical Science, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
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Zoia C, Mantovani G, Müther M, Suero Molina E, Scerrati A, De Bonis P, Cornelius J, Roche P, Tatagiba M, Jouanneau E, Manet R, Schroeder H, Cavallo L, Kasper E, Meling T, Mazzatenta D, Daniel R, Messerer M, Visocchi M, Froelich S, Bruneau M, Spena G. Through the orbit and beyond: Current state and future perspectives in endoscopic orbital surgery on behalf of the EANS frontiers committee in orbital tumors and the EANS skull base section. Brain Spine 2023; 3:102669. [PMID: 37720459 PMCID: PMC10500473 DOI: 10.1016/j.bas.2023.102669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023]
Abstract
Introduction Orbital surgery has always been disputed among specialists, mainly neurosurgeons, otorhinolaryngologists, maxillofacial surgeons and ophthalmologists. The orbit is a borderland between intra- and extracranial compartments; Krönlein's lateral orbitotomy and the orbitozygomatic infratemporal approach are the historical milestones of modern orbital-cranial surgery. Research question Since its first implementation, endoscopy has significantly impacted neurosurgery, changing perspectives and approaches to the skull base. Since its first application in 2009, transorbital endoscopic surgery opened the way for new surgical scenario, previously feasible only with extensive tissue dissection. Material and methods A PRISMA based literature search was performed to select the most relevant papers on the topic. Results Here, we provide a narrative review on the current state and future trends in endoscopic orbital surgery. Discussion and conclusion This manuscript is a joint effort of the EANS frontiers committee in orbital tumors and the EANS skull base section.
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Affiliation(s)
- C. Zoia
- UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
| | - G. Mantovani
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - M. Müther
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - E. Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - A. Scerrati
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - P. De Bonis
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - J.F. Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - P.H. Roche
- Department of Neurosurgery, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - M. Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - E. Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - R. Manet
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - H.W.S. Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Germany
| | - L.M. Cavallo
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Policlinico Federico II University Hospital, Italy
| | - E.M. Kasper
- Department of Neurosurgery, Steward Medical Group, Brighton, USA
| | - T.R. Meling
- Department of Neurosurgery, The National Hospital, Rigshospitalet, Copenhagen, Denmark
| | - D. Mazzatenta
- Department of Neurosurgery, Neurological Sciences Institut IRCCS, Bologna, Italy
| | - R.T. Daniel
- Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital, Lausanne, Switzerland
| | - M. Messerer
- Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital, Lausanne, Switzerland
| | - M. Visocchi
- Department of Neurosurgery, Institute of Neurosurgery Catholic University of Rome, Italy
| | - S. Froelich
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - M. Bruneau
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - G. Spena
- Neurosurgery Unit, IRCSS San Matteo Hospital, Pavia, Italy
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Mombaerts I, Allen RC. The transconjunctival orbitotomy: A versatile approach to the orbit and beyond. Surv Ophthalmol 2023; 68:265-279. [PMID: 36372115 DOI: 10.1016/j.survophthal.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
In the management of orbital disorders and defects, minimally invasive surgical approaches have become increasingly efficient for their reduction of operative trauma and access without compromise of therapeutic benefit or diagnostic yield. Various approaches have focused on bone- and canthal-sparing techniques and concealed and small skin incisions. We review the current state of knowledge of procedures to enter the orbit via the conjunctiva. Any quadrant of the orbit can be accessed via the conjunctiva. Surgical incisions involve the orbital palpebral, forniceal, and bulbar conjunctiva. According to the location, nature, and size of the lesion, the transconjunctival orbitotomy can be used as a single procedure, in combination with a caruncular approach or as an adjunct in a multidisciplinary procedure for lesions extending deep into or outside the orbit. The working space and field of operating view can be expanded by releasing the horizontal tension of the eyelid with a lateral cantholysis, lateral paracanthal blepharotomy, or medial lid split procedure. Complications related to the conjunctival incision are reduced to dry eye disease.
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Affiliation(s)
- Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium; Department of Neurosciences, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium.
| | - Richard C Allen
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.; Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Dallan I, Cristofani-Mencacci L, Fiacchini G, Benettini G, Picariello M, Lanzolla G, Lazzerini F, Rocchi R, Turri-Zanoni M, Menconi F, Sellari-Franceschini S, Marinò M. Functional outcomes and complications in refractory dysthyroid optic neuropathy management: Experience with 3 different surgical protocols. Am J Otolaryngol 2022; 43:103451. [PMID: 35439657 DOI: 10.1016/j.amjoto.2022.103451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/04/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Dysthyroid optic neuropathy (DON) is the most severe complication of Graves' orbitopathy (GO) and its management may require decompression surgery. Clear recommendations do not exist about which surgery should be performed and how extended the decompression should be. In this paper we present our experience regarding the management of DON via 3 different surgical protocols: a modified extended orbital apex decompression, a 2 walls decompression (inferior and lateral) and a 3 walls decompression (inferior, lateral and medial) and evaluate the functional outcomes. METHODS Retrospective evaluation of subjects affected by DON not responding to medical therapy has been performed. All patients were submitted to pre- and post-operative ophthalmologic evaluations and orbital and sinuses CT scan in order to evaluate functional and surgical outcomes. RESULTS 27 patients were enrolled in the study. Surgical procedures were performed on 42 orbits. A statistically significant post-operative improvement was recorded in visual acuity, proptosis, color vision and fundus oculi evaluation for all groups. No patient developed major or minor complications after surgery. CONCLUSIONS Extended endonasal approach and 3 walls decompression have been proved effective in the management of DON. The choice between them is done according to degree of proptosis, general status and eye-surface damages.
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Albanese G, Harieaswar S, Sampath R. Orbital metastasis from neuroendocrine tumour: Case report and literature review. Eur J Ophthalmol 2021; 32:2498-2504. [PMID: 34787007 DOI: 10.1177/11206721211060633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Orbital metastases from neuroendocrine tumour are rare entities. An incidental finding of orbital metastasis originating from neuroendocrine tumour is presented in the context of a comprehensive review of all case reports and series published to date. Demographics, clinical features, diagnostic work-up, treatment and prognostic data from the published literature are discussed. Ninety-five patients with orbital metastases from neuroendocrine tumours have been reported so far. Average age at presentation is 63.8 years (range 25-86), with no significant gender predominance. Gastrointestinal tract is the most common site of primary neuroendocrine tumours (62-85%). Typical presentation includes proptosis (80-85%) and diplopia (27-62%) in patients with known primary neuroendocrine tumour elsewhere. Histological subtype and presence of metastases seem to be important prognostic factors. Incidental finding of neuroendocrine tumour mestastases in asymptomatic patients with unknown primary disease is uncommon. In such cases, orbital biopsy and structural and functional imaging are essential to establish a diagnosis and stage the disease.
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Affiliation(s)
- Giorgio Albanese
- 156756Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, UK
| | - Sreemathi Harieaswar
- 156756Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, UK
| | - Raghavan Sampath
- 156756Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, UK
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Archer SM. A 2020 Update on 20/20 X 2: Diplopia after Ocular Surgery: Diplopia after Orbital Surgery. J Binocul Vis Ocul Motil 2021; 71:127-131. [PMID: 34752185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In a review of 261 strabismus surgeries performed after previous orbital surgery, it was found that diplopia associated with orbital surgery most commonly occurs after orbital decompression for thyroid eye disease or after repair of orbital fractures. Other types of orbital surgery account for only a small number of cases. While the orbital surgery itself may contribute to the development or worsening of diplopia, in most cases, the post-operative strabismus is largely attributable to the underlying disease or trauma. However, in a small number of cases, a specific surgical misadventure can result in diplopia.
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Affiliation(s)
- Steven M Archer
- W. K. Kellogg Eye Center, the University of Michigan, Ann Arbor, Michigan
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Chung SY, Kazim M, Gudis DA. Minimally invasive surgery for massive orbital osteomas. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 4:125-127. [PMID: 34140264 DOI: 10.1016/j.anorl.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/04/2021] [Accepted: 04/27/2021] [Indexed: 11/20/2022]
Affiliation(s)
- S Y Chung
- Department of Otolaryngology - Head and Neck Surgery, New York-Presbyterian Hospital Columbia University Medical Center, New York, NY, USA
| | - M Kazim
- Department of Ophthalmology, New York-Presbyterian Hospital Columbia University Medical Center, New York, NY, USA
| | - D A Gudis
- Department of Otolaryngology - Head and Neck Surgery, New York-Presbyterian Hospital Columbia University Medical Center, New York, NY, USA.
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Bermudez-Castellanos I, Marques-Fernandez V, Gonzalez-Gonzalez D, Alvarez-Garcia M, Galindo-Ferreiro A. Orbital neuromuscular choristoma of the ophthalmic nerve. Eur J Ophthalmol 2021; 32:NP85-NP90. [PMID: 34109844 DOI: 10.1177/11206721211024821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Neuromuscular choristoma (NC) is a rare tumor composed of striated muscle fibers admixed with nerve fibers that often affects large peripheral nerve trunks in children. To the best of our knowledge, this is the first reported case in the literature of a NC of the ophthalmic nerve in an adult. CASE DESCRIPTION A 27-year-old woman presented with a 20-day history of left periorbital headache radiating to the frontotemporal region, with associated tearing, nausea, and vomiting. The examination was normal, except for hypoesthesia in the distribution of the first trigeminal nerve branch (V1). Cranial computerized tomography showed a lesion in the left orbit and cavernous sinus with widening of the superior orbital fissure. On magnetic resonance imaging, the lesion was well-defined with fusiform morphology and showed a central cystic component and peripheral enhancement. An extradural approach was performed with subtotal tumor resection. Biopsy showed proliferation of striated muscle cells admixed with nerve fascicles and Schwann cells. A pathological diagnosis of NC of V1 was determined. Six months after surgery, left hypotropia with limitation of supraduction was observed, as well as hypoesthesia and paralysis of the left forehead with ipsilateral eyebrow ptosis. The rest of the examination remained within normal limits. CONCLUSION NC should be considered in the differential diagnosis of a young patient with periorbital headache and hypoesthesia in the V1 region.
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Bhatt H, Okafor L, Bhatt R. Allogenic dehydrated human pericardium patch graft (Tutoplast): A novel use for reconstruction in orbital implant exposure. Eur J Ophthalmol 2021; 32:725-728. [PMID: 33736492 DOI: 10.1177/11206721211004398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Exposure of orbital implant post enucleation or evisceration remains one of the common complications irrespective of the type of implant used. Dermis fat graft and temporalis fascia have been used to repair the implant exposure in anophthalmic sockets. Tutoplast® pericardium, gamma sterilised dehydrated human pericardium, has been used as a scleral patch graft for glaucoma drainage device exposure and scleral thinning post squint surgery. We report the novel use of Tutoplast® patch graft to repair orbital implant exposure in this case series. METHODS The case notes of three patients who received Tutoplast® pericardium patch graft to repair implant exposure were reviewed. Data regarding presenting symptoms, implant type, time to exposure from primary surgery, post-operative complications and length of follow up post Tutoplast® pericardium patch graft were collected. RESULTS Three patients presented with implant exposure following evisceration. The presenting symptoms were recurrent infection, discharging socket and discomfort in all three patients. One patient had a Medpore implant, two had silicone implants. Total follow-up ranged from 9 to 22 months. In all three cases, there was relief from symptoms and the graft had incorporated fully into the surrounding orbital tissue with no recurrent exposure noted during the follow-up period. CONCLUSION Tutoplast® pericardium has demonstrated a good safety profile and is a suitable material to use as a patch graft for orbital implant exposure.
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Affiliation(s)
- Hetvi Bhatt
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Linda Okafor
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Rina Bhatt
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
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Cruz AAV, Equiterio BSN, Cunha BSA, Caetano FB, Souza RL. Deep lateral orbital decompression for Graves orbitopathy: a systematic review. Int Ophthalmol 2021; 41:1929-1947. [PMID: 33517506 DOI: 10.1007/s10792-021-01722-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To systematically review the literature on the deep lateral orbital decompression (DLD). METHODS The authors searched the MEDLINE, Lilac, Scopus, and EMBASE databases for all articles in English, Spanish, and French that used as keywords the terms orbital decompression and lateral wall. Two articles in German were also included. Data retrieved included the number of patients and orbits operated, types of the approach employed, exophthalmometric and horizontal eye position changes, and complications. The 95% confidence intervals (CI) of the mean Hertel changes induced by the surgery were calculated from series with 15 or more data. RESULTS Of the 204 publications initially retrieved, 131 were included. Detailed surgical techniques were analyzed from 59 articles representing 4559 procedures of 2705 patients. In 45.8% of the reports, the orbits were decompressed ab-interno. Ab-externo and rim-off techniques were used in 25.4% and 28.8% of the orbits, respectively. Mean and 95% CI intervals of Hertel changes, pooled from 15 articles, indicate that the effect of the surgery is not related to the technique and ranges from 2.5 to 4.5 mm. The rate of new onset of diplopia varied from zero to 8.6%. Several complications have been reported including dry eye, oscillopsia, temporal howling, lateral rectus damage, and bleeding. Unilateral amaurosis and subdural hematoma have been described in only one patients each. CONCLUSIONS The low rate of new-onset diplopia is the main benefit of DLD. Prospective studies are needed to compare the rate of complications induced by the 3 main surgical techniques used.
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Affiliation(s)
- Antonio Augusto V Cruz
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil.
| | - Bruna S N Equiterio
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
| | - Barbara S A Cunha
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
| | - Fabiana Batista Caetano
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
| | - Roque Lima Souza
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil
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Abstract
PURPOSE To present clinical ocular manifestations, radiological features and surgical results of giant paranasal osteomas involving the orbit. DESIGN Retrospective, interventional, case series. METHODS The study included patients treated for giant paranasal osteoma involving the orbit. Total or subtotal excision of the tumor was performed via external approach. Clinical characteristics including presenting symptoms, radiologic investigation, histopathology and details of the surgery were recorded. RESULTS Of the six patients included; four were male and two were female. Mean age was 46.8 years (range 12-70 years). Five patients had unilateral, one patient had bileteral disease. The presenting complaints included complete (n = 2/6) or partial (n = 4/6) limitation of eye movements depending on the location and size of the tumor, diplopia (n = 5/6), vision loss (n = 2/6) exophthalmos (n = 6/6) and reduced pupillary light reflex (n = 2/6). The presumed origin of the tumor was frontoethmoidal region (n = 2/6), frontal sinus (n = 3/6) and ethmoid sinus (n = 1/6). Total resection was achieved in three of the patients whereas partial resection was achieved in remaining three patients due to risk of incremental neurological damage. Mild ptosis was observed in all patients during the postoperative period (temporary, n = 4; permanent, n = 2). CONCLUSION Despite the benign nature of osteomas, severe functional impairment including vision loss due to compression of the optic nerve and diplopia might occur in case of orbital involvement. Osteomas with an orbital extension > %50 of the bony orbit volume are more prone to cause irreversible visual loss. Surgical resection is still the mainstay of therapy.
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Affiliation(s)
- Selam Yekta Sendul
- Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Eye Clinic, İstanbul, Turkey
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13
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Sentucq C, Schlund M, Bouet B, Garms M, Ferri J, Jacques T, Nicot R. Overview of tools for the measurement of the orbital volume and their applications to orbital surgery. J Plast Reconstr Aesthet Surg 2020; 74:581-591. [PMID: 33041237 DOI: 10.1016/j.bjps.2020.08.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/09/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
There are numerous applications in craniofacial surgery with orbital volume (OV) modification. The careful management of the OV is fundamental to obtain good esthetic and functional results in orbital surgery. With the growth of computer-aided design - computer-aided manufacturing (CAD-CAM) technologies, patient-specific implants and custom-made reconstruction are being used increasingly. The precise measurement of the OV before surgery is becoming a necessity for craniofacial surgeons. There is no consensus on orbital volume measurements (OVMs). Manual segmentation of computed tomography (CT) images is the most used method to determine the OV, but it is time-consuming and very sensitive to operator errors. Here, we describe the various methods of orbital volumetry validated in the literature that can be used by surgeons in preoperative planning of orbital surgery. We also describe the leading software employed for these methods and discuss clinical use (posttraumatic enophthalmos prediction and orbital reconstruction) in which OVMs are important.
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Affiliation(s)
- Camille Sentucq
- Department of Oral and Maxillofacial Surgery, University of Lille, CHU Lille, F-59000, France
| | - Matthias Schlund
- Department of Oral and Maxillofacial Surgery, University of Lille, CHU Lille, INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, Bd du Prof Emile Laine, F-59000 Lille Cedex, France
| | - Benjamin Bouet
- Department of Oral and Maxillofacial Surgery, University of Lille, CHU Lille, F-59000, France
| | - Martin Garms
- Department of Radiology, University of Lille, Huriez Hospital, CHU Lille, F-59000, France
| | - Joel Ferri
- Department of Oral and Maxillofacial Surgery, University of Lille, CHU Lille, INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, Bd du Prof Emile Laine, F-59000 Lille Cedex, France
| | - Thibaut Jacques
- Department of Musculoskeletal Radiology, University of Lille, CCIAL, CHU Lille, F-59000, France
| | - Romain Nicot
- Department of Oral and Maxillofacial Surgery, University of Lille, CHU Lille, INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, Bd du Prof Emile Laine, F-59000 Lille Cedex, France.
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Donofrio CA, Capitanio JF, Riccio L, Herur-Raman A, Caputy AJ, Mortini P. Mini Fronto-Orbital Approach: "Window Opening" Towards the Superomedial Orbit - A Virtual Reality-Planned Anatomic Study. Oper Neurosurg (Hagerstown) 2020; 19:330-340. [PMID: 31960061 DOI: 10.1093/ons/opz420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Surgical approaches to the orbit are challenging and require combined multispecialist skills. Considering its increasing relevance in neurosurgical practice, keyhole surgery could be also applied to this field. However, mastering a minimally invasive approach necessitates an extended learning curve. For this reason, virtual reality (VR) can be effectively used for planning and training in this demanding surgical technique. OBJECTIVE To validate the mini fronto-orbital (mFO) approach to the superomedial orbit, using VR planning and specimen dissections, conjugating the principles of skull base and keyhole neurosurgery. METHODS Three-dimensional measurements were performed thanks to Surgical Theater (Surgical Theater© LLC), and then, simulated craniotomies were implemented on cadaver specimens. RESULTS The mFO approach affords optimal exposure and operability in the target area and reduced risks of surrounding normal tissue injuries. The eyebrow skin incision, the minimal soft-tissue retraction, the limited temporalis muscle dissection and the single-piece craniotomy, as planned with VR, are the key elements of this minimally invasive approach. Furthermore, the "window-opening" cotton-tip intraorbital dissection technique, based on widening surgical corridors between neuromuscular bundles, provides a safe orientation and a deep access inside the orbit, thereby significantly limiting the risk of jeopardizing neurovascular structures. CONCLUSION The mFO approach associated to the window-opening dissection technique can be considered safe, effective, suitable, and convenient for treating lesions located in the superomedial orbital aspect, up to the orbital apex.
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Affiliation(s)
- Carmine Antonio Donofrio
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jody Filippo Capitanio
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Lucia Riccio
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Anthony J Caputy
- Department of Neurosurgery, George Washington Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Abstract
PURPOSE To compare the four-petal evisceration technique and the standard evisceration technique. METHODS In this retrospective, comparative case series study, sixteen charts of patients fulfilled the inclusion criteria and were were reviewed. Orbital implant exposition and complication rates between the two surgical techniques were evaluated. RESULTS A total of 16 eye of 16 patients fulfilled the inclusion criteria and were included in the analysis (eight in the four petal group and eight in the standard evisceration group).During postoperative follow-up there were no cases of implant exposure or migration in the four-petal group and two cases (25%) of implant exposure in the standard evisceration group.Exposed orbital implants dimension were both 16 mm and patients eviscerated for phtisis bulbiAll surgeries were uneventful, and there were no serious complications during the study. CONCLUSION Four petal evisceration technique seems particularly useful in patients with phtisis bulbi because it allowed the placement of an implant significantly larger than the standard technique with low rate of esposition.
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Affiliation(s)
| | | | - Paolo Nucci
- Universita degli Studi di Milano, Milano, Lombardia, Italy
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16
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Karlin JN, Krauss HR. Ophthalmic and orbital considerations in the evaluation of skull base malignancies. J Neurooncol 2020; 150:483-91. [PMID: 32361865 DOI: 10.1007/s11060-020-03516-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The orbital contents, afferent and efferent visual pathways, and the cranial nerves involved in eye movement, corneal sensation and eyelid closure traverse the skull base, a region bounded by the intracranial cavity, the paranasal sinuses, and the deep spaces of the face and head. As such, tumors from above or below have potential to affect some aspect of the visual system. METHODS We discuss here the clinical ophthalmologic and orbital considerations in the evaluation of patients with these tumors, as well as the ophthalmic sequelae of treatment with radiation or surgery (or both). And for the surgeon, we discuss the ophthalmic and orbital considerations in surgical planning, the role of the orbital surgeon in skull base surgery, and briefly discuss transorbital approaches to the skull base. RESULTS AND CONCLUSION Ophthalmic and orbital dysfunction may be the main source of disability in patients with skull base malignancy; it is thus incumbent on those who manage patients with tumors of this region to be aware of the ophthalmic, neuro-ophthalmic and orbital manifestations, so as to best tailor therapy and monitor treatment outcomes.
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17
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Swendseid BP, Roden DF, Vimawala S, Richa T, Sweeny L, Goldman RA, Luginbuhl A, Heffelfinger RN, Khanna S, Curry JM. Virtual Surgical Planning in Subscapular System Free Flap Reconstruction of Midface Defects. Oral Oncol 2019; 101:104508. [PMID: 31864958 DOI: 10.1016/j.oraloncology.2019.104508] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/25/2019] [Accepted: 12/01/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Reconstruction of the midface has many inherent challenges, including orbital support, skull base reconstruction, optimizing midface projection, separation of the nasal cavity and dental rehabilitation. Subscapular system free flaps (SF) have sufficient bone stock to support complex reconstruction and the option of separate soft tissue components. This study analyzes the effect of virtual surgical planning (VSP) in SF for midface on subsite reconstruction, bone segment contact and anatomic position. MATERIALS AND METHODS Retrospective cohort of patients with midface defects that underwent SF reconstruction at a single tertiary care institution. RESULTS Nine cases with VSP were compared to fourteen cases without VSP. VSP was associated with a higher number of successfully reconstructed subunits (5.9 vs 4.2, 95% CI of mean difference 0.31-3.04, p = 0.018), a higher number of successful bony contact between segments (2.2 vs 1.4, 95% CI of mean difference 0.0-1.6, p = 0.050), and a higher percent of segments in anatomic position (100% vs 71%, 95% CI of mean difference 2-55%, p = 0.035). When postoperative bone position after VSP reconstruction was compared to preoperative scans, the difference in anteroposterior, vertical and lateral projection compared to the preoperative 'ideal' bone position was <1 cm in 82% of measurements. There were no flap losses. CONCLUSION VSP may augment SF reconstruction of the midface by allowing for improved subunit reconstruction, bony segment contact and anatomically correct bone segment positioning. VSP can be a useful adjunct for complex midface reconstruction and the benefits should be weighed against cost.
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Affiliation(s)
- Brian P Swendseid
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA.
| | - Dylan F Roden
- Rutgers University, Department of Otolaryngology, Newark, NJ, USA
| | - Swar Vimawala
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA
| | - Tony Richa
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA
| | - Larissa Sweeny
- Louisiana State University Health Science Center, Department of Otolaryngology - Head & Neck Surgery, New Orleans, LA, USA
| | - Richard A Goldman
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA
| | - Adam Luginbuhl
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA
| | - Ryan N Heffelfinger
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA
| | - Shachika Khanna
- Thomas Jefferson University, Department of Oral and Maxillofacial Surgery, Philadelphia, PA, USA
| | - Joseph M Curry
- Thomas Jefferson University, Department of Otolaryngology - Head & Neck Surgery, Philadelphia, PA, USA
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18
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Gellrich NC, Dittmann J, Spalthoff S, Jehn P, Tavassol F, Zimmerer R. Current Strategies in Post-traumatic Orbital Reconstruction. J Maxillofac Oral Surg 2019; 18:483-489. [PMID: 31624425 DOI: 10.1007/s12663-019-01235-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Posttraumatic orbital reconstruction is one of the most fascinating fields in reconstructive craniomaxillofacial surgery. Hardly any other field in craniomaxillofacial surgery has changed so much in terms of diagnostics, biomaterial selection for reconstruction, surgical techniques including approaches and quality control. In particular, in the field of reconstructive orbital surgery all advances in modern medical treatment are summarized and represented. Reconstructive orbital surgery thus became the medical field spearheading all reconstructive surgical specialties in terms of use of DICOM-data, computer assistance, change towards patient-specific solutions and establishing digital workflows for adequate quality control during all phases of treatment, i.e. pre-, intra- and postoperative. With this paper, this evolutionary process shall be demonstrated as well as display the spirit of change that was necessary to optimize reconstructive orbital surgery and to improve medical care in all areas of reconstruction. Finally, reconstructive orbital surgery could prove to be a highly foreseeable field nowadays, thus giving the next generation of CMF-surgeons a huge opportunity to drive this topic further into the future.
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Affiliation(s)
| | - Jan Dittmann
- Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Simon Spalthoff
- Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Philipp Jehn
- Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Frank Tavassol
- Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Rüdiger Zimmerer
- Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
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Alzhrani GA, Gozal YM, Sherrod BA, Couldwell WT. A Modified Lateral Orbitotomy Approach to the Superior Orbital Fissure: A Video Case Report and Review of Anatomy. Oper Neurosurg (Hagerstown) 2019; 16:685-691. [PMID: 30101355 DOI: 10.1093/ons/opy199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The lateral orbitotomy approach (LOA) is often used for accessing the orbital contents and middle skull base; however, most prior descriptions of the LOA involve complete drilling of the lateral orbital wall. This practice requires retraction of the orbital contents and produces postoperative diplopia that the patient experiences for a limited time. OBJECTIVE To describe a modified LOA with partial sparing of the lateral orbital wall for accessing lesions of the superior orbital fissure (SOF). METHODS One patient with a progressively enlarging SOF lesion and visual loss underwent a modified LOA for resection. The orbital rim lateral to the SOF was removed as a bone flap, and the greater wing of the sphenoid inferior to the SOF was drilled to expose the lesion. The lateral orbital wall was thinned but was not completely removed. The orbital rim was resecured with miniplates and screws. RESULTS Gross total resection of the SOF mass was achieved without unnecessary exposure or retraction of the orbital contents. Histopathologic analysis of the resected mass was consistent with a cavernous hemangioma. The patient had a good cosmetic outcome without complication. CONCLUSION Modified LOA with partial sparing of the lateral orbital wall is a feasible approach for lesions of the SOF.
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Affiliation(s)
- Gmaan A Alzhrani
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah.,Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Yair M Gozal
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Brandon A Sherrod
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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20
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Ta NH, Addison A, Beigi B, Philpott C. Unilateral visual loss resulting from orbital encroachment of an ethmoidal juvenile trabecular ossifying fibroma. Ann R Coll Surg Engl 2019; 101:e111-e114. [PMID: 30854866 DOI: 10.1308/rcsann.2019.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ossifying fibromas are mainly found in the mandible and maxilla. Reports of them arising in the ethmoid sinuses and orbits are rare. We present a case of an otherwise healthy 20-year-old man with gradual onset of right visual disturbance signified by right relative afferent pupillary defect due to a large unilateral ossifying fibroma arising from the ethmoid sinus compressing the medial half of the right orbit. We emphasise the multidisciplinary combined endoscopic endonasal and external approach to ensure a successful debulking of the fibroma.
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Affiliation(s)
- N H Ta
- Norwich Medical School, University of East Anglia , Norwich , UK
| | - A Addison
- Ear, Nose and Throat Department, James Paget University Hospital , Great Yamouth , UK
| | - B Beigi
- Ophthalmology Department, Norfolk and Norwich University Hospitals NHS Foundation , Norwich , UK
| | - C Philpott
- Norwich Medical School, University of East Anglia , Norwich , UK
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21
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Castelnuovo P, Arosio AD, Volpi L, De Maria F, Ravasio A, Donati S, Azzolini C, Dallan I, Bignami M, Locatelli D. Endoscopic Transnasal Cryo-Assisted Removal of Orbital Cavernous Hemangiomas: Case Report and Technical Hints. World Neurosurg 2019; 126:66-71. [PMID: 30771539 DOI: 10.1016/j.wneu.2019.01.235] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cryoprobe devices are used by ophthalmic and orbital surgeons for extraction of fluid-filled intraorbital lesions. No series has described cryodissection via an exclusively transnasal approach. We describe 2 cases of purely endoscopic transnasal removal of intraconal orbital hemangiomas with the aid of a dedicated cryoprobe. METHODS All transnasal endoscopic intraorbital procedures were collected and analyzed. In cases in which intraorbital dissection was performed with the use of an Optikon Cryo-line probe, clinical features, histology, size and location of the lesion, early and late complications, surgical procedure time, and hospital length of stay were analyzed. Patient follow-up included endoscopic endonasal evaluations performed at 2, 4, and 8 weeks after surgery and ophthalmologic and orthoptic evaluations performed 2 days and 2 months after surgery. RESULTS Two transnasal intraorbital endoscopic procedures with the aid of the dedicated Cryo-line probe were collected. Lesions were located in the intraconal space, medial to the optic nerve. In both patients, the histologic evaluation was compatible with cavernous hemangioma, and complete resection was obtained. Mean hospital stay was 5.5 days. Postoperative ophthalmologic and orthoptic evaluations performed 2 months postoperatively revealed complete resolution of preoperative symptoms. CONCLUSIONS Cryoprobes represent an adjunctive tool in the orbital surgeon's armamentarium useful in the extraction of fluid-filled intraorbital lesions. This preliminary experience suggests that their use can ease the removal of intraconal hemangiomas with an exclusively transnasal approach. The analysis of further cases is necessary to confirm safety and efficacy.
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Affiliation(s)
- Paolo Castelnuovo
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Centre (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Alberto D Arosio
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Centre (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Luca Volpi
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Centre (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Federico De Maria
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Centre (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Arianna Ravasio
- Unit of Opthamology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Simone Donati
- Unit of Opthamology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Claudio Azzolini
- Unit of Opthamology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Iacopo Dallan
- First ENT Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Maurizio Bignami
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Centre (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Davide Locatelli
- Head and Neck Surgery & Forensic Dissection Research Centre (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Division of Neurological Surgery, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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22
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Natsis K, Piagkou M, Chryssanthou I, Skandalakis GP, Tsakotos G, Piagkos G, Politis C. A simple method to estimate the linear length of the orbital floor in complex orbital surgery. J Craniomaxillofac Surg 2018; 47:185-189. [PMID: 30497949 DOI: 10.1016/j.jcms.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 06/29/2018] [Accepted: 11/02/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The orbital floor (OrF) and infraorbital rim (IOR) repair in cases of complete destruction is challenging mainly due to the fact that the defect length cannot be measured. The aim of the current study is to develop a method of calculating the Orf length by using the gender and the lengths of the medial, superior and lateral orbital walls (OrW) of the same orbit. MATERIAL AND METHODS Ninety-seven (59 male and 38 female) European adult dry skulls were classified according to age: 20-39, 40-59 and 60 years and above. The length of each OrW was measured by using the direct distance between the optic foramen and a landmark in each orbital rim. RESULTS A side asymmetry was detected for the lengths of the inferior, superior and medial OrW. Although a gender dimorphism was detected, no correlation with the age was found. Using the Stepwise multiple regression analysis two formulas were developed, one for the right and one for the left OrF with coefficient of determination R2 0.43 and 0.57, respectively. CONCLUSIONS The proposed formulas represent a simple, applicable and individualized method to calculate the OrF linear length in cases of complete destruction of the IOR and OrF, with accuracy and without the use of expertise material. Such data may improve the surgery planning of orbital floor fractures and complex orbital reconstructions.
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Affiliation(s)
- Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, (Chairperson: Professor Dr. K. NATSIS), Medical School, Aristotle University of Thessaloniki, Greece
| | - Maria Piagkou
- Department of Anatomy, (Chairperson: Professor Dr. P. SKANDALAKIS), Medical School, National and Kapodistrian University of Athens, Greece.
| | - Ioannis Chryssanthou
- Department of Anatomy, (Chairperson: Professor Dr. P. SKANDALAKIS), Medical School, National and Kapodistrian University of Athens, Greece
| | - Georgios P Skandalakis
- Department of Anatomy, (Chairperson: Professor Dr. P. SKANDALAKIS), Medical School, National and Kapodistrian University of Athens, Greece
| | - Georgios Tsakotos
- Department of Anatomy, (Chairperson: Professor Dr. P. SKANDALAKIS), Medical School, National and Kapodistrian University of Athens, Greece
| | - Giannoulis Piagkos
- Department of Anatomy, (Chairperson: Professor Dr. P. SKANDALAKIS), Medical School, National and Kapodistrian University of Athens, Greece
| | - Constantinus Politis
- OMFS-IMPATH Research Group Department of Imaging and Pathology, (Chairperson: Professor Dr. C. Politis), Belgium; Department of Oral and Maxillofacial Surgery, Hasselt University, Diepenbeek, Belgium
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23
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Grandoch A, Kreppel M, Safi AF, Zirk M, Zöller JE. Laterocaudal approach to the inferior rim of the orbit. J Craniomaxillofac Surg 2018; 46:1218-1222. [PMID: 29907433 DOI: 10.1016/j.jcms.2018.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/21/2018] [Accepted: 04/10/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Fractures of the orbital floor and orbital rim are frequently treated in maxillofacial departments. Various approaches to the orbital floor are described in the literature. We present an investigation of a modified subciliary approach (laterocaudal approach) with respect to its feasibility and clinical outcome. MATERIALS AND METHODS Our retrospective study investigated 130 well-documented cases of patients with orbital floor fractures who received surgical reconstruction using a laterocaudal approach, and compared the results with the current literature, with a focus on subciliary and transconjunctival approaches. RESULTS 111 patients (85.4%) presented a Vancouver scar scale (VSS) of 0.14 patients (10.8%) had a VSS score of 1. No patients had a VSS of 2. Just five patients (3.8%) had a slight ectropium and therefore a VSS score of 3. CONCLUSION The laterocaudal approach can be safely performed and presents advantages over comparable techniques such as the subciliary and transconjunctival approaches if performed correctly.
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Affiliation(s)
- Andrea Grandoch
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany.
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - Ali-Farid Safi
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany
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24
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Graillon N, Foletti JM, Le Roux MK, Alessandrini M, Benzaquen M, Guyot L. Impact of antithrombotic treatment in orbital haematoma. J Stomatol Oral Maxillofac Surg 2018; 119:489-492. [PMID: 29792939 DOI: 10.1016/j.jormas.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/27/2018] [Accepted: 05/11/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Orbital haematomas threaten the visual prognosis, but no treatment guidelines have been proposed. Antithrombotics could affect their prognosis and treatment. This study aimed to evaluate the effect of antithrombotics in the management of orbital haematomas and to suggest a standardised protocol. MATERIAL AND METHODS We conducted a retrospective study by sending a standardised questionnaire to 20 French maxillofacial surgery university departments to collect all the cases of orbital haematoma. RESULTS Twenty-five cases from 10 centres were collected, including five patients treated with anticoagulant and one patient treated with dual antiplatelet. Antithrombotics increased the risk of amaurosis and ocular disorders significantly. Surgery was performed for 66.7% of patients treated with antithrombotic and for 89.5% of other patients. Surgical delay was longer in patients treated with antithrombotic. Surgical drainage was used in most of the cases, whereas canthotomy with inferior cantholysis was the least-used technique. CONCLUSION Antithrombotics appear to worsen the functional prognosis of orbital haematomas. A surgical management of orbital haematoma in patients treated with antithrombotics is not contraindicated. Surgical delay must be shortened as much as possible. A lateral canthotomy with inferior cantholysis seems to be an appropriate solution.
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Affiliation(s)
- N Graillon
- Oral and Maxillofacial surgery department, North hospital, assistance publique hôpitaux de Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France.
| | - J M Foletti
- Oral and Maxillofacial surgery department, North hospital, assistance publique hôpitaux de Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - M K Le Roux
- Oral and Maxillofacial surgery department, North hospital, assistance publique hôpitaux de Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - M Alessandrini
- Aix Marseille Université, SPMC EA 3279, 27, boulevard Jean-Moulin, 13385 Marseille, France
| | - M Benzaquen
- Oral and Maxillofacial surgery department, North hospital, assistance publique hôpitaux de Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - L Guyot
- Oral and Maxillofacial surgery department, North hospital, assistance publique hôpitaux de Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France
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Iwai T, Mikami T, Yasumura K, Tohnai I, Maegawa J. Use of Occlusal Splint for Noninvasive Fixation of a Reference Frame in Orbital Navigation Surgery. J Maxillofac Oral Surg 2015; 15:410-412. [PMID: 27752217 DOI: 10.1007/s12663-015-0860-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION When prepping for navigation surgery, a reference frame must be fixed to the patient's head with a Mayfield clamp, bone anchor, headset, or headband. Fixation of the clamp or bone anchor with a screw or head pins is invasive, whereas use of a headband or headset is noninvasive. However, during orbital surgery for blowout fractures or orbital tumors, surgeons or instruments can interfere between the reference frame and the optical tracking navigation system, even if using noninvasive fixation. MATERIALS AND METHODS We used an occlusal splint for noninvasive fixation of a reference frame in orbital navigation surgery to overcome the problems. RESULTS A surgeon could operate without interferences between the reference frame and the optical tracking navigation system during orbital navigation surgery. CONCLUSION We recommend the use of an occlusal splint for noninvasive fixation of a reference frame in orbital navigation surgery.
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Affiliation(s)
- Toshinori Iwai
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
| | - Taro Mikami
- Department of Plastic and Reconstructive Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
| | - Kazunori Yasumura
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024 Japan
| | - Iwai Tohnai
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
| | - Jiro Maegawa
- Department of Plastic and Reconstructive Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
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Macchi V, Regoli M, Bracco S, Nicoletti C, Morra A, Porzionato A, De Caro R, Bertelli E. Clinical anatomy of the orbitomeningeal foramina: variational anatomy of the canals connecting the orbit with the cranial cavity. Surg Radiol Anat 2015; 38:165-77. [PMID: 26233593 DOI: 10.1007/s00276-015-1530-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/28/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE In addition to the optic canal and the superior orbital fissure, orbits are connected with the cranial cavity via inconstant canals including the orbitomeningeal foramen. This study has been carried out in order to define many anatomical and radiological details of the orbitomeningeal foramen that are relevant in the clinical practice. METHODS Almost 1000 skulls and 50 computerized tomographies were examined to determine incidence, number, length, and caliber of the orbitomeningeal foramen as well as the topography of their orbital and cranial openings. A retrospective study of angiographies carried out on more than 100 children was performed to look for arteries candidate to run through the orbitomeningeal foramen. RESULTS Orbitomeningeal foramina were detected in 59.46% of skulls and in 54% of individuals by computerized tomography. Orbits with two to five foramina were found. Canals were classified as M-subtype or A-subtype depending on their cranial opening. Large foramina, with the caliber ranging between 1 and 3 mm, were found in 12.17% of orbitomeningeal foramen-bearing orbits. By computed tomography the average caliber measured 1.2 ± 0.3 and 1.5 ± 0.5 mm (p < 0.005) at the orbital and cranial openings, respectively (p < 0.005). Angiographies showed meningo-lacrimal and meningo-ophthalmic arteries, meningeal branches of the lacrimal and supraorbital arteries, and some unidentified arteries that could pass through the orbitomeningeal foramina. CONCLUSIONS Orbitomeningeal foramina are a common occurrence. When large they may house important arteries that can be the source of severe bleedings during deep dissection of the lateral wall of the orbit. Orbital surgeons should be aware of their existence.
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Affiliation(s)
- Veronica Macchi
- Department of Molecular Medicine, Institute of Human Anatomy, University of Padova, Via A. Gabelli 65, 35127, Padua, Italy
| | - Marì Regoli
- Department of Life Sciences, University of Siena, Via Aldo Moro 2, 53100, Siena, Italy
| | - Sandra Bracco
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - Claudio Nicoletti
- Gut Health and Food Safety Institute Strategic Program, Institute of Food Research, Norwich, UK
| | - Aldo Morra
- Section of Radiology, Euganea Medica Center, Via Colombo 3, Sant'Agostino Di Albignasego, 35127, Padua, Italy
| | - Andrea Porzionato
- Department of Molecular Medicine, Institute of Human Anatomy, University of Padova, Via A. Gabelli 65, 35127, Padua, Italy
| | - Raffaele De Caro
- Department of Molecular Medicine, Institute of Human Anatomy, University of Padova, Via A. Gabelli 65, 35127, Padua, Italy
| | - Eugenio Bertelli
- Department of Life Sciences, University of Siena, Via Aldo Moro 2, 53100, Siena, Italy.
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Ponto KA, Zwiener I, Al-Nawas B, Kahaly GJ, Otto AF, Karbach J, Pfeiffer N, Pitz S. Piezosurgery for orbital decompression surgery in thyroid associated orbitopathy. J Craniomaxillofac Surg 2014; 42:1813-20. [PMID: 25059686 DOI: 10.1016/j.jcms.2014.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022] Open
Abstract
The purpose of this study was to assess a piezosurgical device as a novel tool for bony orbital decompression surgery. At a multidisciplinary orbital center, 62 surgeries were performed in 40 patients with thyroid associated orbitopathy (TAO). Within this retrospective case-series, we analyzed the medical records of these consecutive unselected patients. The reduction of proptosis was the main outcome measure. Indications for a two (n = 27, 44%) or three wall (35, 56%) decompression surgery were proptosis (n = 50 orbits, 81%) and optic neuropathy (n = 12, 19%). Piezosurgery enabled precise bone cuts without intraoperative complications. Proptosis decreased from 23.6 ± 2.8 mm (SD) by 3 mm (95% CI: -3.6 to -2.5 mm) after surgery and stayed stable at 3 months (-3 mm, 95% CI: -3.61 to -2.5 mm, p < 0.001, respectively). The effect was higher in those with preoperatively higher values (>24 mm versus ≤ 24 mm: -3.4 mm versus -2.81 mm before discharge from hospital and -4.1 mm versus -2.1 mm at 3 months: p < 0.001, respectively). After a mean long-term follow-up period of 14.6 ± 10.4 months proptosis decreased by further -0.7 ± 2.0 mm (p < 0.001). Signs of optic nerve compression improved after surgery. Infraorbital hypesthesia was present in 11 of 21 (52%) orbits 3 months after surgery. The piezosurgical device is a useful tool for orbital decompression surgery in TAO. By cutting bone selectively, it is precise and reduces the invasiveness of surgery. Nevertheless, no improvement in outcome or reduction in morbidity over conventional techniques has been shown so far.
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Affiliation(s)
- Katharina A Ponto
- Dept. of Ophthalmology (Head: Prof. Dr. N. Pfeiffer), University Medical Center Mainz, Germany; Center of Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Germany.
| | - Isabella Zwiener
- Dept. of Biostatistics, University Medical Center Mainz, Germany; Center of Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Germany
| | - Bilal Al-Nawas
- Dept. of Maxillofacial Surgery, University Medical Center Mainz, Germany
| | | | - Anna F Otto
- Dept. of Ophthalmology (Head: Prof. Dr. N. Pfeiffer), University Medical Center Mainz, Germany
| | - Julia Karbach
- Dept. of Maxillofacial Surgery, University Medical Center Mainz, Germany
| | - Norbert Pfeiffer
- Dept. of Ophthalmology (Head: Prof. Dr. N. Pfeiffer), University Medical Center Mainz, Germany
| | - Susanne Pitz
- Dept. of Ophthalmology (Head: Prof. Dr. N. Pfeiffer), University Medical Center Mainz, Germany
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