Clinical analysis of surgical approaches for orbital floor fractures.

OBJECTIVE: To identify the optimal surgical method for managing blowout fractures of the inferior orbital wall by analyzing the location and type of fracture based on computed tomographic findings and medical records. METHODS: Medical records of 102 patients with pure inferior blowout fractures who were treated between June 1996 and December 2005 were reviewed regarding fracture type and location and surgical approach. RESULTS: Ocular symptoms persisted in 14 of the 102 cases after surgery, and revision procedures were performed in 11 of those cases. Cases with persistent symptoms were analyzed in terms of fracture location and type of surgery. For anterior orbital floor fractures, symptoms persisted in 2 of the 4 cases treated using a transantral approach, while no symptoms persisted in any of the 15 cases treated using a transorbital approach or in either of the 2 cases treated using a combined approach. For posterior orbital floor fractures, symptoms persisted in 2 of the 31 cases treated using a transantral approach, in 4 of the 6 cases treated using a transorbital approach, and in 1 of the 19 cases treated using a combined approach. For anteroposterior orbital floor fractures, symptoms persisted in 2 of the 5 cases treated using a transorbital approach and in 3 of the 20 cases treated using transantral and combined approaches. CONCLUSION: Patients with large orbital floor fractures or posterior half fractures of the orbit should undergo surgery via a transantral or a combined approach, while patients with trapdoor fractures or anterior half fractures of the orbit should undergo surgery via a transorbital or a combined approach.

Juvenile Paget's disease with paranasal sinus aplasia.

Juvenile Paget's disease (JPD) is a rare skeletal disorder that's characterized by bone demineralization and elevated levels of serum alkaline phosphatase. JPD involves the paranasal sinuses in extremely rare cases. We report here on a 25-month-old Asian male who was diagnosed of JPD associated with aplasia of the paranasal sinuses, but not the ethmoid sinuses. The patient was successfully treated by surgery and we undertook no medical intervention. This appears to be the first reported case of JPD associated with bilateral paranasal sinus aplasia.

Expression of glucocorticoid receptor mRNAs in glucocorticoid-resistant nasal polyps.

Glucocorticoids (GCs) are the most effective group of medications available to treat inflammation. Although most patients with inflammation respond to GC, a small group of patients exhibit persistent GC-resistance with prolonged inflammation. Previously, it was proposed that the GC-resistance is caused by low amount of human GC receptor (hGRalpha) and/or excessive presence of a GC receptor isoform, hGRbeta that was generated from alternative splicing of the hGR message. We have tested this hypothesis by investigating correlation between the expression pattern of hGR mRNAs in patients with inflammatory nasal polyps and the effectiveness of GC treatment.? We have performed reverse transcription PCR analysis of mRNAs coding each hGRalpha and hGRbeta in nasal tissues.? hGRalpha mRNA was more expressed in patients with nasal polyps than in normal subjects. However, the elevated hGRalphamRNA expression was decreased after GC treatment. Compared with hGRalpha mRNA expression, level of hGRbeta mRNA expression was very low in all groups. In patients, hGRbetamRNA was expressed at a similar level regardless of GC efficacy, indicating that there is no correlation between the GC sensitivity and the expression level of hGRbeta mRNA. Thus, persistent GC-resistance is not associated with low expression of hGRa or over- expression of hGRbeta.

The differences of blowout fracture of the inferior orbital wall between children and adults.

OBJECTIVES: To review the clinical features and recovery period of patients with blowout fractures of the inferior orbital wall treated surgically and to examine the differences between children and adults. DESIGN: A retrospective study. SETTING: Department of Otorhinolaryngology, Maryknoll General Hospital, Busan, Korea. Patients Medical records of 70 patients were reviewed: 16 patients were children (aged <16 years) and 54 were adults (aged >or=17 years). MAIN OUTCOME MEASURES: Symptoms and fracture patterns were compared between both groups in all subjects, and the recovery period relative to the timing of surgery after the trauma was compared in subjects who complained of diplopia or extraocular limitation. RESULTS: Serious periorbital edema was noted in 43 adults (80%) and 4 children (25%), diplopia in 27 adults (50%) and 16 children (100%), and extraocular muscle limitation in 23 adults (43%) and 13 children (81%). Trapdoor fractures were frequent in the children group (n = 13; 81%), whereas 30 patients (56%) had open-door fractures in the adult group. In the children group, no differences in the recovery period relative to the timing of surgery was noted when all types of orbital fractures were considered. However, among the 13 children with trapdoor fractures, the recovery period was significantly shorter in those who underwent surgery 1 to 5 days after the trauma compared with those who underwent surgery after 6 to 14 days and 15 days or longer. In adults, the recovery period of those who underwent surgery 1 to 5 days and 6 to 14 days after the trauma were significantly shorter compared with those who underwent surgery after 15 days or longer. CONCLUSIONS: Diplopia, extraocular muscle limitation, and trapdoor fractures were more frequent in children than in adult patients. After trauma, surgical intervention might be required within 5 days in children with trapdoor fracture vs within 2 weeks in adults.