ABSTRACT
The naso-orbito-ethmoidal region is composed of delicate bones and when fractured may result in significant aesthetic-functional impairment. Diagnosis through clinical and imaging findings is extremely important for surgical planning. This study aims to report a case of type III fracture of the naso-orbito-ethmoidal region. Patient D.R.S., female, 13 years old, attended the emergency department of Hospital dos Fornecedores de Cana de Piracicaba (HFCP) - SP with complaint of pain in the fronto-nasal region and respiratory distress after trauma in face of baseball bat. Physical examination showed edema and short blunt injury in the region of the nasal dorsum and frontal region, bilateral periorbital hematoma, hyposphagma in right eye and traumatic telecanthus. When analyzing the computed tomography, it was observed fracture of the nasal bones, also affecting the medial wall of the orbit. The procedure was osteosynthesis of the fractures and reconstruction of the nasal dorsum. The fracture traces were exposed from coronal access, reduction of fractures and use of calvarial bone graft for nasal dorsum reconstruction. The fracture and the graft were fixed with plates of 1,6mm. Postoperative computed tomography analysis showed good graft positioning, but there was still a slight sinking of the left lateral wall of the nose. In a second moment another surgical intervention was done to reduce this wall and an internal containment device was installed. Currently the patient is in a state of observation and a follow-up period of 665 days. In cases of complex nasoorbito-ethmoidal fractures early diagnosis and treatment is essential to minimize sequelae and provide a better aesthetic and functional result.
La región etmoidal nasoorbital está compuesta de huesos delicados y, cuando se fractura, puede provocar una lesión estética-funcional significativa. El diagnóstico mediante hallazgos clínicos y de imagen es de suma importancia para la planificación quirúrgica. El paciente D.R.S., mujer, 13 años, leucoderma, asistió al servicio de emergencia del Hospital de Proveedores de Caña de Azúcar de Piracicaba quejándose de dolor en la región frontal-nasal y dificultad para respirar después de un traumatismo en la cara con un palo. El examen físico reveló edema y lesión contundente en el dorso nasal y la región frontal, hematoma periorbitario bilateral, hiposfagma del ojo derecho y telecanto traumático. Al analizar la tomografía computarizada se observó fractura de los huesosnasales en libro abierto, afectando también la pared medial de la órbita. El enfoque aplicado fue la osteosíntesis de fracturas y la reconstrucción del dorso nasal. Los rastros de fractura se expusieron del abordaje coronal, se redujeron las fracturas y se usaron injertos de casquete para reconstruir el dorso nasal. La fractura y el injerto se fijaron con placas de sistema de 1,6 mm y se realizó la cantopexia de los ligamentos cantales mediales. Se requirió cirugía reparadora secundaria para la corrección de la pared lateral de la nariz, que persistió en el postoperatorio. Actualmente el paciente se encuentra en un estado de conservación y período de seguimiento de 665 días. En casos de fracturas nasoorbitales-etmoidales complejas, el diagnóstico y el tratamiento tempranos son esenciales para minimizar las secuelas y proporcionar un mejor resultado estético y funcional.
Subject(s)
Humans , Female , Adolescent , Skull Fractures/surgery , Ethmoid Bone/surgery , Open Fracture Reduction/methods , Nasal Bone/surgery , Orbital Fractures/surgery , Skull Fractures/diagnostic imaging , Tomography, X-Ray Computed , Ethmoid Bone/injuries , Fracture Fixation , Nasal Bone/injuriesABSTRACT
Abstract Introduction: Radiologic evaluation is mandatory to assess the type of endoscopic approach concerning sinonasal pathology and reconstruction of fractured defects before any treatment modalities are instituted related to medial wall of the orbit. Objective: The goal was to provide improved understanding of the lamina papyracea variations and the relationship with the orbital morphometry. Methods: This retrospective study was performed using computed tomography scans of 200 orbits and results were compared with respect to age, sex, laterality and LP variations. Results: Lamina papyracea variations were categorized as type A, 80.5% (161/200); type B, 16% (32/200); type C, 3.5% (7/200). For medial wall the anterior and posterior lamina papyracea heights and angles were found as 17.14 mm, 147.88º and 9.6 mm, 152.72º, respectively. Also, the length of the lamina papyracea, the mean area of the orbital floor, medial wall, lamina papyracea and orbital entrance were 33.3 mm, 7.2 cm2, 6.89 cm2, 4.51 cm2 and 12.46 cm2 respectively. The orbital height and width were measured as 35.9 mm and 39.2 mm respectively. The mean orbital cavity depth was 46.3 mm from optic foramen to the orbital entrance and the orbital volume was 19.29 cm3. We analyzed the morphometric measurements tending to increase with aging and greater in men and the relationship of them with lamina papyracea types. Conclusion: Precise knowledge of the lamina papyracea anatomy using computed tomography is essential for safer and more effective surgery and preforming the dimensions of an implant. In this way, the postoperative complications can be decreased and the best outcome can be provided.
Resumo Introdução: A avaliação radiológica é mandatória para avaliar o tipo de abordagem endoscópica no tratamento cirúrgico de doença nasossinusal e na reconstrução de fraturas antes de quaisquer modalidades de tratamento relacionadas à parede medial orbital. Objetivo: O objetivo foi proporcionar uma melhor compreensão das variações da lâmina papirácea e a relação com a morfometria orbital. Método: Este estudo retrospectivo foi realizado por meio de tomografia computadorizada de 200 órbitas, e os resultados foram comparados em relação à idade, sexo, lateralidade e variações da lâmina pairácea. Resultados: As variações da lâmina papirácea foram categorizadas como tipo A, 80,5% (161/200); tipo B, 16% (32/200); tipo C, 3,5% (7/200). Para a parede medial, as medidas das alturas anteriores e posteriores da lâmina papirácea e ângulos foram de 17,14 mm, 147,88º e 9,6 mm, 152,72º, respectivamente. Além disso, as medidas do seu comprimento da, da área média do assoalho orbital, e da parede medial, lâmina papyracea e entrada orbital foram: 33,3 mm, 7,2 cm2, 6,89 cm2, 4,51 cm2 e 12,46 cm2, respectivamente. As medidas da altura e da largura orbitais foram 35,9 mm e 39,2 mm, respectivamente. A profundidade média da cavidade orbital foi de 46,3 mm, do forame óptico até a entrada orbital, e o volume orbital foi de 19,29 cm3. Analisamos as medidas morfométricas com tendência a aumentar com o envelhecimento e nos indivíduos do sexo masculino, e a relação das mesmas com os tipos de lâmina. Conclusões: O conhecimento preciso da anatomia da lâmina papirácea por meio de tomografia computadorizada é essencial para uma cirurgia mais segura e eficaz, além de permitir pré-moldar as dimensões do implante. Assim, as complicações pós-operatórias podem ser minimizadas, obtendo-se melhores resultados.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Orbit/anatomy & histology , Orbit/diagnostic imaging , Tomography, X-Ray Computed/methods , Endoscopy/methods , Orbit/injuries , Paranasal Sinuses/surgery , Paranasal Sinuses/injuries , Paranasal Sinuses/diagnostic imaging , Postoperative Complications/prevention & control , Retrospective Studies , Ethmoid Bone/injuries , Ethmoid Bone/diagnostic imagingABSTRACT
Abstract Background: Orbital floor fractures are a common finding in facial trauma and may be accompanied by medial orbital wall fracture in 7 to 53% of the cases. Isolated medial wall fractures are rare and usually asymptomatic, being detected as incidental findings. case report: We report a 75 years old female consultingin the emergency room due to a left orbital trauma. An orbital CAT scan identified a fracture of the medial orbit wall that did not require treatment.
Resumen Introducción: Las fracturas del suelo de la órbita son habituales en los traumatismos faciales y entre un 7 y un 53% de los casos se asocian con fracturas de la pared medial. Pero las fracturas aisladas de la pared medial son infrecuentes y la mayoría asintomáticas, siendo un hallazgo habitualmente incidental. Sin embargo, ciertos signos de alarma (limitación de la movilidad del recto medial, siendo habitual que aparezca de forma retardada por isquemia del músculo debido al atrapamiento) pueden plantear una cirugía urgente. Descripción del caso: Presentamos un caso de una paciente de 75 años que acude al Servicio de Urgencias de nuestro hospital remitida por médico de atención continuada por traumatismo sobre órbita izquierda. A la exploración presenta importante hematoma periorbitario y malar, sin alteraciones visuales. En TC orbitaria se identifica fractura de la pared medial de la órbita que, en ausencia de clínica acompañante, no requiere tratamiento alguno.
Subject(s)
Humans , Female , Aged , Orbital Fractures/diagnostic imaging , Multidetector Computed Tomography , Ethmoid Bone/injuries , Facial Injuries/complicationsABSTRACT
Fractures of the naso-orbitoethmoid complex (NOE) remain one of the most challenging tasks in facial reconstruction and account for 2.1% of facial trauma cases. Clinical analyses of NOE fractures showed that they usually affect the telecanthus and cause deformities that would then require retropositioning of the nasal pyramid. Therefore, computed tomographyis an essential technique for further assessment and to identify bone dislocations and fistulas. Treatment involves reconstruction of the intercanthal distance, nasal projection, and internal orbital structures.
A fratura do complexo nasoetmoideorbital (NEO) permanece como uma das tarefas mais desafiadoras no trauma facial. Corresponde a 2,1% dos casos de trauma de face. Achados clínicos clássicos das fraturas NEOs são telecanto e deformidade com retroposicionamento da pirâmide nasal. O estudo com tomografia computadorizada é imprescindível para determinar detalhes e procurar localizar deslocamentos ósseos e fístulas. O tratamento é direcionado à reconstrução da relação intercantal, da projeção nasal e das estruturas internas da órbita.
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Middle Aged , Nose Deformities, Acquired/surgery , Orbital Fractures/surgery , Ethmoid Bone/surgery , Ethmoid Bone/injuries , Nasal Bone/surgery , Nasal Bone/injuries , Plastic Surgery Procedures/methods , Tomography, X-Ray Computed , Methods , Patients , Therapeutics , Wounds and InjuriesABSTRACT
Se comunica un caso de enfisema subcutáneo palpebral por fractura del etmoides postraumatismo mínimo, como diagnóstico diferencial de celulitis orbitaria no comunicado previamenteen pediatría. Niña de 8 años de edad, derivada con diagnóstico de celulitis orbitaria para internación, tratamiento antibiótico endovenoso y evaluación urgente por oftalmología. Sin embargo, en la evaluación ulterior se diagnostica fractura de lámina papirácea del etmoides, con resolución clínica completa a los 4 días de tratamiento ambulatorio. Nuevamente, se comprueba que la anamnesis meticulosa y el prolijo examen físicoson irreemplazables para la adecuada toma de decisiones.
We report a case of orbital emphysema secondary to ethmoidal fracture after minimal trauma as differential diagnosis of orbital cellulitis not reported before in children. An 8 year-old girl with diagnosis of orbital cellulitis was remitted for admittance, IV antibiotics and evaluation by an ophthalmologist. However, further evaluation led to a diagnosis of ethmoidal lamina papyracea fracture. Patient showed complete resolution in 4days with outpatient treatment. Once again, this case corroborates that meticulous history taking and physical examination are irreplaceable for decision making.
Subject(s)
Humans , Female , Child , Diagnosis, Differential , Orbital Fractures/diagnosis , Ethmoid Bone/injuries , Orbital Cellulitis , Eyelids/pathology , Subcutaneous EmphysemaABSTRACT
La reconstrucción funcional y estética del párpado traumático requiere el conocimiento anatómico y funcional de sus partes. El análisis semiológico previo permite reconocer la causa de la ptosis y poder planificar el acto quirúrgico...La reconstrucción palpebral traumática con alteración de todas las unidades requiere la individualización de cada unidad anatómica. La exploración minuciosa, permite detectar la causa y poder restablecer con diferentes procedimientos la función natural palpebral. El caso clínico-quirúrgico presentado demuestra que restableciendo los parámetros anátomos-funcionales de la región se puede ofrecer un tratamiento tanto reparador como estético.
The functional and aesthetic reconstruction of the traumatic eyelid requires the precise knowledge of the periorbital anatomy. A previous complete semiologic exam helps to clarify the ethiology of ptosis and planning the surgical procedure...The patient recovers the eyelid function and presents a very good post op evolution with a good functional and aesthetic result. The surgical aproach detects the etiology and with different techniques provides a natural eyelid function. This clincal case shows that we can offer a direct repair and aesthetic solution by restablishing the anatomic-functional periorbital units.
Subject(s)
Humans , Male , Adolescent , Blepharoplasty , Blepharoptosis/pathology , Conditioning, Eyelid , Ethmoid Bone/injuries , Ophthalmologic Surgical Procedures , Eyelids/injuriesABSTRACT
An unusual case of a nasogastric (Ryle's) tube inserted in the brain in a patient having severe head injury with skull base fractures is reported here along with a brief review of literature. A 35 years male was referred from a peripheral institute following head trauma with endotracheal tube and nasogastric tube in situ. A CT scan of the brain showed multiple skull base fractures and a high parietal extradural hematoma. It also revealed that the nasogastric tube had inadvertently found its way into the brain through the lamina cribrosa of the ethmoid bone. The tube was removed under aseptic conditions in the operation theatre but the patient expired on day 2 of admission due to the head injuries sustained.
Subject(s)
Adult , Brain Injuries/etiology , Craniocerebral Trauma/therapy , Ethmoid Bone/injuries , Ethmoid Sinus/injuries , Fatal Outcome , Foreign Bodies , Hematoma, Epidural, Cranial/etiology , Humans , Intubation, Gastrointestinal/adverse effects , Male , Medical Errors , Subarachnoid Hemorrhage/etiology , Tomography, X-Ray ComputedABSTRACT
La rinorrea del líquido cefelorraquídeo (LCR) tiene un riesgo potencial de infección intracraneal por lo que es importante el diagnóstico cñínico y demostración radiológica de la fístula. Se analizaron 19 enfermos con fístula de lìquido cefalorraquídeo (FLC) de variable etiología traumática, postquirúrgica y espontánea. Todas las fístulas fueron evaluadas con tomografía computada (TC). En 18 casos la fístula fue demostrada sin utilizar material de contraste y solamente una fístula fue necesario contraste intratercal en un paciente para demostrar la fístula. Nosotros sugerimos que las fístulas de líquido cefalorraquídeo pueden ser evaluadas sin la ayuda de material de contraste.