Acute retrobulbar hemorrhage complicating a malar fracture

A Rare Case of Mydriasis as an Immediate Complication After Orthognathic Surgery in a Patient with Cleft Lip and Palate

“…Mydriasis after orthognathic surgery may be related to the separation of the pterygoid plate from the sphenoid bone, causing direct or indirect injury to the OCN. 9 Direct trauma to these structures can be observed in cases of severely displaced fractures, which may extend to the region of the base of the skull and orbit, resulting in the direct injury of OCN, 4 retrobulbar hemorrhage, 15 blindness 5 or CCF. 7 Therefore, knowledge of the anatomy of the posterior region of the maxilla becomes extremely important so that it is possible to minimize complications during and after surgery.…”

“…4,8,15 Given that, the structural anomalies, as the greater length of medial pterygoid plate, present in the maxilla of patients with CLP, associated with scarring of the palate (due to palatoplasty) difficulties the pterygomaxillary disjunction and mobilization and may implicate in a higher risk for cranial neuropathy after orthognathic surgery. 15…”

“…The second hypothesis concerns the direct deposition of LA in the pterygomaxillary fossa, which may diffuse directly to the CS, 4,15,18,19 anesthetizing the CN III 18,19 ; or pass from the pterygopalatine fossa to the inferior orbital fissure and block the ciliary ganglion 16 (Figure 4). This theory is found in several studies that show the occurrence of ophthalmologic alterations after PSAN block.…”

“…This situation would be suspected in cases of difficulty in mobilizing the maxilla and for patients with CLP. 4,8,15 Given that, the structural anomalies, as the greater length of medial pterygoid plate, present in the maxilla of patients with CLP, associated with scarring of the palate (due to palatoplasty) difficulties the pterygomaxillary disjunction and mobilization and may implicate in a higher risk for cranial neuropathy after orthognathic surgery. 15 In the present clinical case, after the pterygomaxillary disjunction, the down-fracture of the maxilla was performed by the surgeon using the hands, without great bone resistance.…”

A Rare Case of Mydriasis as an Immediate Complication After Orthognathic Surgery in a Patient with Cleft Lip and Palate

“…Mydriasis after orthognathic surgery may be related to the separation of the pterygoid plate from the sphenoid bone, causing direct or indirect injury to the OCN. 9 Direct trauma to these structures can be observed in cases of severely displaced fractures, which may extend to the region of the base of the skull and orbit, resulting in the direct injury of OCN, 4 retrobulbar hemorrhage, 15 blindness 5 or CCF. 7 Therefore, knowledge of the anatomy of the posterior region of the maxilla becomes extremely important so that it is possible to minimize complications during and after surgery.…”

“…4,8,15 Given that, the structural anomalies, as the greater length of medial pterygoid plate, present in the maxilla of patients with CLP, associated with scarring of the palate (due to palatoplasty) difficulties the pterygomaxillary disjunction and mobilization and may implicate in a higher risk for cranial neuropathy after orthognathic surgery. 15…”

“…The second hypothesis concerns the direct deposition of LA in the pterygomaxillary fossa, which may diffuse directly to the CS, 4,15,18,19 anesthetizing the CN III 18,19 ; or pass from the pterygopalatine fossa to the inferior orbital fissure and block the ciliary ganglion 16 (Figure 4). This theory is found in several studies that show the occurrence of ophthalmologic alterations after PSAN block.…”

“…This situation would be suspected in cases of difficulty in mobilizing the maxilla and for patients with CLP. 4,8,15 Given that, the structural anomalies, as the greater length of medial pterygoid plate, present in the maxilla of patients with CLP, associated with scarring of the palate (due to palatoplasty) difficulties the pterygomaxillary disjunction and mobilization and may implicate in a higher risk for cranial neuropathy after orthognathic surgery. 15 In the present clinical case, after the pterygomaxillary disjunction, the down-fracture of the maxilla was performed by the surgeon using the hands, without great bone resistance.…”

Craniofacial Fracture Symptoms

“…Massive retrobulbar hemorrhage in the posterior region of the muscle cone, triggered by vessel disruption, leads to progressive exophthalmus with concurrent pupil dilatation, reduced vision and increased intraocular pressure (Ord 1981;Ord and El Altar 1982). This is a consequence of complex lateral and centrolateral midface fractures and rarely of dislocated fractures in the region of the orbital apex (Hardt and Sgier 1991).…”

A Rare Case of Mydriasis as an Immediate Complication After Orthognathic Surgery in a Patient with Cleft Lip and Palate

“…Mydriasis after orthognathic surgery may be related to the separation of the pterygoid plate from the sphenoid bone, causing direct or indirect injury to the OCN. 9 Direct trauma to these structures can be observed in cases of severely displaced fractures, which may extend to the region of the base of the skull and orbit, resulting in the direct injury of OCN, 4 retrobulbar hemorrhage, 15 blindness 5 or CCF. 7 Therefore, knowledge of the anatomy of the posterior region of the maxilla becomes extremely important so that it is possible to minimize complications during and after surgery.…”

“…4,8,15 Given that, the structural anomalies, as the greater length of medial pterygoid plate, present in the maxilla of patients with CLP, associated with scarring of the palate (due to palatoplasty) difficulties the pterygomaxillary disjunction and mobilization and may implicate in a higher risk for cranial neuropathy after orthognathic surgery. 15…”

“…The second hypothesis concerns the direct deposition of LA in the pterygomaxillary fossa, which may diffuse directly to the CS, 4,15,18,19 anesthetizing the CN III 18,19 ; or pass from the pterygopalatine fossa to the inferior orbital fissure and block the ciliary ganglion 16 (Figure 4). This theory is found in several studies that show the occurrence of ophthalmologic alterations after PSAN block.…”

“…This situation would be suspected in cases of difficulty in mobilizing the maxilla and for patients with CLP. 4,8,15 Given that, the structural anomalies, as the greater length of medial pterygoid plate, present in the maxilla of patients with CLP, associated with scarring of the palate (due to palatoplasty) difficulties the pterygomaxillary disjunction and mobilization and may implicate in a higher risk for cranial neuropathy after orthognathic surgery. 15 In the present clinical case, after the pterygomaxillary disjunction, the down-fracture of the maxilla was performed by the surgeon using the hands, without great bone resistance.…”

Craniofacial Fracture Symptoms

“…Massive retrobulbar hemorrhage in the posterior region of the muscle cone, triggered by vessel disruption, leads to progressive exophthalmus with concurrent pupil dilatation, reduced vision and increased intraocular pressure (Ord 1981;Ord and El Altar 1982). This is a consequence of complex lateral and centrolateral midface fractures and rarely of dislocated fractures in the region of the orbital apex (Hardt and Sgier 1991).…”

A Rare Case of Mydriasis as an Immediate Complication After Orthognathic Surgery in a Patient with Cleft Lip and Palate

“…Mydriasis after orthognathic surgery may be related to the separation of the pterygoid plate from the sphenoid bone, causing direct or indirect injury to the OCN. 9 Direct trauma to these structures can be observed in cases of severely displaced fractures, which may extend to the region of the base of the skull and orbit, resulting in the direct injury of OCN, 4 retrobulbar hemorrhage, 15 blindness 5 or CCF. 7 Therefore, knowledge of the anatomy of the posterior region of the maxilla becomes extremely important so that it is possible to minimize complications during and after surgery.…”

“…4,8,15 Given that, the structural anomalies, as the greater length of medial pterygoid plate, present in the maxilla of patients with CLP, associated with scarring of the palate (due to palatoplasty) difficulties the pterygomaxillary disjunction and mobilization and may implicate in a higher risk for cranial neuropathy after orthognathic surgery. 15…”

“…The second hypothesis concerns the direct deposition of LA in the pterygomaxillary fossa, which may diffuse directly to the CS, 4,15,18,19 anesthetizing the CN III 18,19 ; or pass from the pterygopalatine fossa to the inferior orbital fissure and block the ciliary ganglion 16 (Figure 4). This theory is found in several studies that show the occurrence of ophthalmologic alterations after PSAN block.…”

“…This situation would be suspected in cases of difficulty in mobilizing the maxilla and for patients with CLP. 4,8,15 Given that, the structural anomalies, as the greater length of medial pterygoid plate, present in the maxilla of patients with CLP, associated with scarring of the palate (due to palatoplasty) difficulties the pterygomaxillary disjunction and mobilization and may implicate in a higher risk for cranial neuropathy after orthognathic surgery. 15 In the present clinical case, after the pterygomaxillary disjunction, the down-fracture of the maxilla was performed by the surgeon using the hands, without great bone resistance.…”

Craniofacial Fracture Symptoms

“…Massive retrobulbar hemorrhage in the posterior region of the muscle cone, triggered by vessel disruption, leads to progressive exophthalmus with concurrent pupil dilatation, reduced vision and increased intraocular pressure (Ord 1981;Ord and El Altar 1982). This is a consequence of complex lateral and centrolateral midface fractures and rarely of dislocated fractures in the region of the orbital apex (Hardt and Sgier 1991).…”