RESUMEN

AIM: To evaluate the effectiveness and safety of complex orbital fracture reconstruction with titanium implants. METHODS: A retrospective review of 46 patients treated with complex orbital fractures reconstruction using titanium implants from January 2005 to December 2008 was conducted. The following data were recorded: age, gender, mechanism of injury, preoperative and postoperative orbital CT, visual acuity, diplopia, ocular motility and Hertel exophthalmometer. RESULTS: The most common cause was motor vehicle accident (47.8%), followed by industrial injury (30.4%). All patients had improved appearance after operation and CT scan at one week after operation showed the fracture defects of orbit and neighboring areas had been reconstructed. Forty-six cases had various degrees of enophthalmos before operation. Among them, 32 cases were completely corrected, 11 cases improved obviously and 3 cases had no improvement after operation. Thirty-six patients with visual acuity ≥20/60 revealed diplopia of various degrees, including 26 patients had diplopia in right ahead and/or reading positions. At the sixth month after operation, diplopia disappeared in five patients, 7 patients still had diplopia in right ahead and/or reading positions, 14 patients had diplopia in positions rather than right ahead and reading positions (<20°) and ten patients had diplopia only at peripheral gazing (>20°). All patients had various degrees of ocular motility disorders before operation. At the sixth month after operation, eyeball movement disorder disappeared in 9 patients, 31 patients showed improvement and 6 patients had no improvement. Complications of implant infection, rejection and displacement were not reported after operation. CONCLUSION: The application of titanium implants in the repair of complex orbital fractures greatly improves the appearance and functional results, which is a favorable material for plastic surgery of complex orbital fracture.

RESUMEN

OBJECTIVE: To investigate the effects of lipopolysaccharide (LPS)-induced inflammation on the differentiation of orbital pre-adipocytes in thyroid-associated ophthalmopathy (TAO) and to explore the mechanism of orbital adipose proliferation in TAO. METHODS: Orbital adipose tissues were obtained from patients with TAO undergoing orbital decompression surgery. The orbital fibroblasts cultured from orbital adipose tissues were divided into group A and group B. In group A, orbital pre-adipocytes were incubated in culture medium containing 1 mg/L LPS for 8 hours before stimulated to differentiate into mature adipocytes with Differentiation Medium I and II. No LPS or other intervention was used in group B before induced to differentiate into mature adipocyte with Differentiation Medium I and II. Intracellular fat accumulation in differentiated adipocytes was determined by oil red O staining and the expression of cyclooxygenase2 (COX2) and peroxisome proliferators activated receptor γ (PPARγ) mRNA of both groups were detected by RT-PCR. Protein expression of COX2 and PPARγ in both groups was detected by Western-blot and the secretion of PGE(2) in the supernatant was detected by ELISA. RESULTS: COX2 expression and secretion of PGE(2) in differentiated cells of both groups were significantly decreased compared with pre-differentiation (P < 0.05), while PPARγ mRNA and protein expression enhanced significantly (P < 0.05). COX2 mRNA and protein expression and secretion of PGE(2) of pre-differentiation cells in group A was significantly increased compared with group B (P < 0.05), while PPARγ mRNA and protein expression in group A was also stronger than those in the group B (P < 0.05). COX2 and PPARγ mRNA and protein expression and secretion of PGE(2) of differentiated cells in group A were greater than those in group B (P < 0.05). CONCLUSION: LPS can induce inflammatory response of orbital preadipocytes in TAO and enhance the expression of COX2, PPARγ and PGE(2). The expression of PPARγ is enhanced significantly while the expression of COX2 and PGE(2) is attenuated markedly when the orbital pre-adipocytes differentiated into adipocytes.

Asunto(s)

RESUMEN

OBJECTIVE: To investigate the clinical manifestation and pathological features of primary ocular adnexal non-Hodgkin lymphoma. METHODS: Data of 18 patients with biopsy-proven ocular adnexal non-Hodgkin lymphoma at Xiangya hospital were reviewed.The disease site, clinical manifestation,imaging and pathological features of the tumor were summarized. RESULTS: All patients had typical presentation of an adnexal mass.Twelve(66.7%) patients had orbital involvement, 3(16.7%) had conjunctival, and 3(16.7%) had lymphoma involving the eyelids.Eight patients were misdiagnosed as "inflammatory pseudotumour" before the operation according to their clinical and imaging examination,another 8 patients were diagnosed as "ocular adnexal tumour with unknown nature" before the operation. According to the pathologic diagnosis, 16 patients (88.9%)had marginal zone lymphomas of mucosa-associated lymphoid tissue(MZL-MALT) and 2 (11.1%) had NK/T-cell lymphoma. CONCLUSION: The typical presentation of ocular adnexal lymphoma is a painless mass.Orbital connective tissue is the most involved anatomical site. The diagnosis of ocular adnexal non-Hodgkin lymphoma is difficult which could easily be misdiagnosed as "inflammatory pseudotumour". MZL-MALT is the most common pathologic type.

Asunto(s)

RESUMEN

OBJECTIVE: To investigate the procedure of transcranial operation via pterional approach for cranio-orbital communicating tumors, to improve surgery skills, to summarize the incidence of main complications and to discuss tips for avoiding damage of the normal orbital tissues. METHODS: Pterional approach was adopted for the operation. After the medial orbital wall or lateral orbital wall was bitten with rongeur and the orbital roof was removed, the extraocular muscles at orbital apex were separated and protected. The head of condenser was used to freeze the tumor, and the tissue around the tumor was separated until the tumor was extirpated. In cases where the tumor penetrated the dura mater and invaded the brain, surgery was performed by neurosurgeons. RESULTS: In 37 cases, 32 cases undertook total resection of tumors and palliative resection was performed in 5 cases due to severe tumor invasion of the cavernous sinus or sphenoid sinus. Of the 37 cases, 28 cases were benign tumors and accounted for 75.67% of total cases (28/37); 9 were malignant tumors and accounted for 24.32% (9/37). Pathological examination showed that 11 cases were meningioma which was the most common type of tumor and accounted for 29.73% of total cases(11/37). The most common complication was injury to extraocular muscles, which occurred in 21 cases and accounted for 56.76% of all cases (21/37). The most serious complication was vision loss, which occurred in 4 cases and accounted for 10.81% of all cases (4/37). CONCLUSIONS: Resection of cranio-orbital communicating tumors via pterional approach provides a wide observation field and facilities exposing tumors. Protecting important tissues in posterior orbital region will result in less postoperative complications.

Asunto(s)