Large Orbital Cavernous Hemangioma: A Case Report

Hemangioma is one of the most common congenital tumors in the region of the face and neck. Although histologically benign, these facial masses are clinically malignant for their deforming and inexorable growth, especially in so-called 'cavernous hemangioma'. Carvenous hemangioma is the most common primary tumor occurring in the adult orbit. This tumor has symptoms that characteristically develop over several years with slowly progressive proptosis, eyeball deviation, hyperopia, diplopia and optic nerve compression. Today, hemangiomas are being treated by various methods; steroids, electrocoagulation, injection of sclerosing agent, cryotherapy, radiation therapy, laser therapy, and surgical treatment, etc. In principle, surgical approaches to the orbit must provide maximum safety and optimal visualization. We have experienced a case of large cavernous hemangioma in the orbit inferolaterally. The surgical treatment of tumor was achieved by the bicoronal approach combined with inferomedial and inferolateral orbitotomy. This surgical approach allows better visualization of the tumor and greater protection of essential anatomic structures. We obtained satisfactory results in terms of aesthetic and functional consideration. We present our case with a brief review of the literature related to orbital cavernous hemangioma.

A Clinical Analysis of the Mandible Fractures

There is a tendency that facial traumas are increasing constantly due to the growing traffic accidents and criminal violences with the industrialization of the society. Among these traumas, the frequency of the mandible fracture is the second highest next to that of the nasal bone fracture. The mandible is an evitable part which makes the temporomandibular joint movement and occlusion. The reduction of these fractures is considered important in view of the aesthetic and functional aspects of human beings. This retrospective study comprised 587 patients with mandibular fracture who had been treated in the Department of Plastic and Reconstructive Surgery from March, 1, 1997 to February, 28, 2004. The studied items are age and sex distribution, prevalent time, causes of the fracture, fracture sites, accompanied soft tissue and bone injuries, treatment methods, time interval between the accident and operation, and the complications. The following results were obtained. 1. The male and female ratio of mandibular fractures was 4.1:1. The mandibular fractures of the young men in twenties were the highest(32.7%). 2. The monthly incidence was the highest on June and the greatest numbers of incidence occurred between 9 p.m and 3 a.m.(51.2%). 3. The most common cause of mandibular fracture was the traffic accident(35%). 4. The most common fracture site was symphysis (36.6%), followed by angle(28.9%), condyle(24.2%). 5. The mandibular fractures were usually accompanied with zygoma, maxilla, orbit and nasal fractures. 6. We have done 518 operative treatments out of 587 cases. We can get perfect reduction and shorten the treating period, performing operative treatment, which is open reduction with the plate and screw. In case of subcondyle level, we utilize the external fixation. 7. The most common time interval between onset and surgical intervention was less than 10 days(66.8%). 8. The long term follow up longer than 6 months was possible in 286 patients. Malocclusion(14 cases, 4.9%), sensory disturbance of lower lip(11 cases, 3.8%), malunion or nonunion(8cases, 2.8%), and infection(8cases, 2.8%) were the complications found in these patients.