Trauma intracraneal penetrante trans-orbitario: anatomía relevante, las dinámicas del trauma y los puntos clavepara el tratamiento / Trans-orbital intracranial penetrating trauma: relevant anatomy, trauma dynamics and treatment key points

Las lesiones intracraneales penetrantes trans-orbitarias representan pocos casos de todos los Traumas Craneo-encefálicos, sin embargo, representan del 25 al 50 por ciento de todos los traumas penetrantes craneales. Este tipo de traumas trans-orbitarios se han reportado por diferentes tipos de objetos, incluyendo objetos de metal y de madera. Muchos de estos traumas intracraneales pueden pasar desapercibidos en casos donde el material que ingresa no queda expuesto posterior al trauma y cuando no se presenta lesión neurológica que requiera examinación exhaustiva adicional con neuro-imágenes.

Trans-orbital penetrating intracranial injuries represent few cases of all Traumatic Brain Injuries, although they represent between 25 to 50 percent of all penetrating brain injuries. Trans-orbital intracranial penetrating injuries have been reported caused by different types of objects, including metal and wooden objects. Many of these intracranial traumas can be dismissed, especially in those cases where the material is not exposed after the injury and there is no need of further examination with neuroimaging in absence of neurological deficit.

First aid and nursing of 3 patients with cranial orbital injury / 现代临床护理

Objective To summarize first aid and nursing key points of 3 patients with cranial orbital injury. Methods Three patients with cranial orbital injury were nursed from January 2014 to March 2014, including routine nursing, nursing of eye and cerebrospinal fluid leak and prevention of infection. Results The hospital stay of the 3 patients was from 8 to 23 d, during which 1 contracted cerebrospinal fluid leakage and another rupture of left eye ball. All patients were well recovered after discharge and could be self cared in life for their own, with one patient blind on the left eye and the other 2 with facial disfigurement. Conclusions The patients with cranial orbital injury is critical. Therefore, well done first aid and nursing are key for a better prognosis.

A Case of Superior Orbital Fissure Syndrome Induced by Penetrating Orbital Injury

PURPOSE: We report a case of superior orbital fissure syndrome induced by penetrating orbital injury caused by a steel wire and analyzed the clinical outcomes. CASE SUMMARY: A 49-year-old female visited our clinic after a penetrating orbital injury through the right inferolateral conjunctiva caused by a steel wire. The best corrected visual acuity of the right eye was 0.8 and a fixed dilated pupil was detected. Partial ptosis and ophthalmoplegia were observed in the right eye. The computed tomography image revealed no sign of orbital wall fracture, retrobulbar hemorrhage or foreign body. Slightly increased signal intensity was observed on the magnetic resonance image but other abnormal findings of the extraocular muscle and optic nerve were not detected. Under the impression of superior orbital fissure syndrome, systemic steroid was administered orally. After 1 month, ptosis and ophthalmoplegia were partially improved. After 3 months, the pupil size and response were normalized. CONCLUSIONS: The oral steroid treatment was given to reduce the edema without orbital wall fracture after the penetrating orbital injury, which caused the superior orbital fissure syndrome. The symptom was relieved 3 months after the injury.

Effectiveness of Computed Tomography for Blow-out Fracture / 대한악안면성형재건외과학회지

PURPOSE: This study assessed the association between eye symptoms (enophthalmos or diplopia) and site of damage, volume, deviated inferior rectus muscle (IRM) and type of fracture with computed tomography (CT). The intent is to anticipate the prognosis of orbital trauma at initial diagnosis. METHODS: Forty-five patients were diagnosed with fractures of the inferior wall of one orbit. Fracture area, volume of displaced tissue, deviated IRM, and type of fracture were evaluated from coronal CT by one investigator. The association of those variables with the occurrence of eye symptoms (diplopia and enophthalmos) was assessed. RESULTS: Of 45 patients, 27 were symptom-free (Group A) and 18 had symptoms (Group B) of enophthalmos and/or diplopia. In Group B, 12 had diplopia, one was enophthalmos, and five had both. By CT measurement, group A mean area was 192.6 mm2 and the mean volume was 673.2 mm3. Group B area was 316.2 mm2 and volume was 1,710.6 mm3. The volume was more influential on symptom occurrence. Each patient was categorized into four grades depending on the location of IRM. Symptom occurrence and higher grade were associated. Twenty-six patients had trap-door fracture (one side, attached to the fracture), and 19 had punched-out fracture (both sides detached). The punched-out fracture was more strongly associated with symptoms and had statistically significantly higher area and volume. CONCLUSION: In orbital trauma, measurement of fracture area and volume, evaluation of the deviated IRM and classification of the fracture type by coronal CT can effectively predict prognosis and surgical indication.

A Case of Orbital Apex Syndrome Induced by Penetrating Orbital Injury with Long-Term Results

PURPOSE: To report a case of orbital apex syndrome induced by penetrating orbital injury by a wire with the recovery process and clinical outcomes. CASE SUMMARY: A 40-year-old female visited our clinic after a penetrating orbital injury through the left inferomedial conjunctiva by a wire. The best corrected visual acuity of the left eye was 0.6, and ptosis and total ophthalmoplegia were observed. The patient showed a dilated pupil, swelling of the optic disc on fundus exam, and an inferior field defect on the automated perimetry. The computed tomography image revealed mild retrobulbar hemorrhage, but there was no orbital bony fracture. Enhancement of the optic nerve sheath was observed on the magnetic resonance image. The patient was admitted and received systemic antibiotics and steroid treatment. After 1 month, visual acuity, ptosis, and limitation in adduction were partly improved. After 3 months, depression and adduction were improved and the pupil size was normalized. However, further improvement was not observed after the one-year follow-up. CONCLUSIONS: The recovery from orbital apex syndrome was achieved until 3 months after injury. The final outcomes may depend on the mechanism and pathophysiology of the injury. Emergent diagnosis and proper management are essential to achieve optimal clinical results.

Trauma anexial, orbitario y del aparato lagrimal / Anexal, orbital and lachrymal system traumas

Los traumatismos de los anejos oculares son muy frecuentes debido a su ubicación anatómica y el cumplimiento de una de sus principales funciones, protección del globo ocular. Se pueden clasificar en afecciones traumáticas de párpados, conjuntiva, órbita y traumas del aparato lagrimal. Según los datos aportados por el USEIR (United States Eye Injury Registry) las lesiones de los anejos oculares constituyen 5 % entre todos los traumas oculares, y las más frecuentes son las laceraciones canaliculares en 81 % de los casos. Se realizó una revisión del tema y se propone el protocolo diagnóstico y terapéutico para cada tipo de trauma anexial.

The ocular anexal trauma is a common entity due to the anatomical location of structures, and the fulfillment ofl one of its main functions, that is, the protection of the eyeball. They are classified in eyelid, conjunctive, orbital and lachrymal apparatus traumas. According to data provided by the USEIR (United States Eye Injury Registry), the ocular anexal injuries accounts for 5 % among all ocular traumas, and the most common is canalicular lacerations in 80% of cases. A review was made and diagnostic and therapeutic protocols for each type of anexal trauma were presented.

Two Cases of Orbital Apex Syndrome

PURPOSE: To report two cases of orbital apex syndrome: one induced by penetrating orbital injury and the other by severe optic nerve swelling associated with bacterial meningitis. METHODS: We have experienced a 40-year-old male after penetrating orbital injury who complained of loss of vision, ocular pain, ptosis, hypesthesia of forehead, and total ophthalmoplegia. The CT image of this patient showed a severe retrobulbar hemorrhage and marked enlargements of extraocular muscles. In a 62-year-old male who had a same symptom after headache and decreased mentality, a bacterial meningitis was diagnosed from CSF study and we saw a very severe swelling of the unilateral entire optic nerve and optic nerve sheath in CT. We managed these two patients with a large amount of systemic RESULTS: In 40-year-old man, there were improvements of ptosis and visual acuity from negative light perception to positive, but ophthalmoplegia was not improved. In 62-year-old man, ptosis and ophthalmo-plegia were improved after early antibiotics administration and papilledema disappeared two months after development, but visual acuity was not improved from negative light perception.