Neumomediastino secundario a fractura aislada de piso de órbita / Pneumomediastinum secondary to isolated fracture of orbit floorx

Resumen Introducción: El neumomediastino se define como la presencia de aire o gas dentro de los planos fasciales del mediastino. Por lo general, es un fenómeno secundario a perforaciones traumáticas del tracto aerodigestivo. El neumomediastino secundario a una fractura orbitaria es un evento raro. Se asocia a complicaciones potencialmente mortales como el neumotórax, el neumopericardio y la mediastinitis. Objetivo: Describir un caso de neumomediastino secundario a una fractura aislada de piso orbitario y su manejo médico-quirúrgico. Caso clínico: Paciente de sexo femenino de 42 años que sufre traumatismo en regiones facial, cervical y torácica desarrollando secundariamente un enfisema subcutáneo panfacial y un neumomediastino, el cual se resuelve exitosamente. Discusión: El neumomediastino secundario a una fractura aislada de piso orbitario es un evento muy raro. El aire puede descender a lo largo de los espacios fasciales hasta el mediastino. En este sentido, sonarse la nariz es un factor de riesgo para desarrollar esta pa-tología. Conclusión: Ocurrido un trauma maxilofacial puede presentarse enfisemas de espacios profundos de la cabeza, cuello e incluso el mediastino.

Introduction: Pneumomediastinum is defined as the presence of air or gas within the fascial planes of the mediastinum. It is usually a phenomenon secondary to traumatic perforations of the aerodigestive tract. Pneumomediastinum secondary to an orbital fracture is a rare event. And it is related to life-threatening complications such as pneumothorax, pneumopericardium and mediastinitis. Aim: To describe a case of pneumomediastinum secondary to an isolated orbital floor fracture and its medical-surgical management. Clinical case: A 42-year-old female patient who suffers trauma to the facial, cervical and thoracic regions, secondary development of a subcutaneous panfacial emphysema and pneumomediastinum, which resolves successfully. Discussion: Pneumomediastinum following an isolated orbital floor fracture is a very rare event. The air can descend along the fascial spaces to the mediastinum. In this sense, blowing your nose is a risk factor to develop this pathology. Conclusion: After a maxillofacial trauma, emphysema of the deep spaces of the head, neck and even the mediastinum can occur

Inferior orbital fissure and groove: axial CT findings and their anatomic variation / 法医学杂志

OBJECTIVE@#To show imaging findings of inferior orbital fissure (IOF) and groove (IOG) on axial CT scans and to discover their anatomic variations, so as to avoid misdiagnosing them as orbital fracture.@*METHODS@#25 normal skull were used to investigate the configurations of IOF and IOG. Five skulls were performed axial CT scans. 20 normal orbital axial scans were studied as well. MPR and RT-3D reconstructions were used in this study.@*RESULTS@#Skulls scans and normal orbital images on axial CT showed three sorts of findings: (1) single bony dehiscence between lateral and inferior walls; (2) first type of double bony dehiscence between lateral and inferior walls, among the dehiscence interposing a small bone. The long axis of the small bone was parallel to orbital wall; (3) second type of double bony dehiscence between lateral and inferior walls, but the long axis of the small bone was in anteroposterior direction. Anatomy and variation of three sorts of CT findings were corresponded respectively to: (1) a baseball club-shaped IOF; (2) a "V"-shaped IOF, that is composed of both of lateral and internal ramus, lateral ramus situates between the zygoma and the lateral portion of greater wing of sphenoid, and internal ramus between the maxilla and the internal portion of greater wing of sphenoid, both rami intercross caudally and open upwards in a "V"-shaped configuration; (3) a deep IOG with a protuberant lateral wall.@*CONCLUSION@#Familiarity of imaging features on the axial CT scans and understanding of their anatomy of IOF and IOG would be helpful for avoiding misdiagnosis of orbital fracture.

Fratura de órbita: classificação e tratamento / Orbital and Zygoma fractures: classification assessment and treatment

Foram avaliados clinicamente, 111 paciente de acordo com os métodos de fixação de fraturas orbitárias. Técnicas de fixação rígida, semi-rígidas e com fio de Kirschnner foram avaliadas. Um tratamento baseado na classificação dessas fraturas foi apresentado. Parâmetros clínicos, como anormalidades na posição do globo ocular (distopia e enoftalmia), projeção do malar e teste de sensibilidade foram avaliados. O presente estudo confirma que podemos usar material de baixo custo com bons resultados.

We evaluated 111 pacientes to assess clinically the results of fixation methods on orbital and zygoma fractures. Rigid plate fixation, wire techniques and fixation with Kirschnner were used. A treatment guidline based on classification of orbital fractures is presented. The major clinical parameters assessed were globe position abnormalities (enophthalmus and dystopia), malar projection and cheek sensation. The present study confirms that we can use low-cost material with good results.

Orbital Trapdoor Fracture in Children

This study was performed to evaluate the clinical symptom, fracture finding, and surgical outcome in children with orbital trapdoor fracture. Forty-four patients with pure orbital trapdoor fracture, under 18 yr of age, were included. Time interval between injury and surgery, length of time for improvement, resolution of ocular motility restriction, and other factors were analyzed in 36 patients who underwent surgery. The median improvement time was 3.5 days for patients (n=8) receiving surgery within 5 days, 18.0 for those (n=19) receiving surgery between 6 and 14 days, and 50.0 for those (n=9) receiving surgery after 15 days (p=0.03). One month after operation, the mean change in supraduction limitation was 3.50+/-0.53 for patients receiving surgery within 5 days, 2.11+/-1.24 for those receiving surgery between 6 and 14 days, and 1.67+/-0.82 for those receiving surgery after 15 days (p=0.04). Three months after operation, the mean change in supraduction limitation was 3.88+/-0.35, 2.94+/-1.55, and 2.50+/-1.38, respectively (p=0.14). In conclusion, trapdoor fracture of the orbit in children must be diagnosed by careful CT evaluation and clinical evidence of entrapment. For patients with severe limitation of ocular motility, early surgery within 5 days of injury leads to more rapid and better postoperative improvement.