Study on the treatment of traumatic orbital apex syndrome by nasal endoscopic surgery

Abstract

Orbital apex syndrome (OAS) is a complex disease caused by a variety of pathological factors, and trauma is one of the main factors/causes. Clinical data of 17 cases of traumatic OAS treated by nasal endoscopic surgery in our department from January 2002 to April 2009 were gathered and reviewed. Among them, the six patients presented with OAS after injury to the lateral wall of orbital apex. Seven other patients exhibited OAS after injury to the medial wall of orbital apex, two displayed OAS after zygomatic trauma, while OAS manifested in the other two patients with craniocerebral trauma 3 days after they had decompressive craniotomy--of them, one was blind in both eyes. In the 17 cases, 6 patients were without light sensation, 1 was blind in both eyes; the sight-chart index of eight patients was 0.1, that of three other patients was 0.1-0.2. Fifteen patients displayed eyeball movement disturbance (disorder) and cornea sensory disturbance (disorder), two were with the eyeball abducent disturbance. After the nasal endoscopic surgeries for OAS performed on the 17, the sight of the most patients was restored in varying degrees. The sight of nine patients was between 0.2 and 0.3, that of two patients was between 0.1 and 0.2, that of the other two patients was 0.1, and that of four patients remained unchanged. The eyeball movement and the cornea esthesia in 15 patients recovered from the surgeries, one patient recovered with good eyeball adducent movement and the cornea esthesia but with eyeball abducent disturbance, the other patient did not make a recovery from the eyeball immobility, cornea anesthesia and ptosis. A follow-up lasting 2 months to 2 years suggested that the 16 patients had stable recovery from the surgeries. Satisfactory results could be achieved in the treatment of traumatic OAS by nasal endoscopic surgery. From objective assessment of the therapeutic effects of traumatic OAS, it can be concluded that if a patient is diagnosed with fractures of the optic canal and the superior and medial walls of orbital apex, nasal endoscopic decompression of superior and medial walls of orbital apex and optic canal via the approach to the sphenoid and ethmoid sinuses is the most ideal operative therapy.

Thyroid-Associated Orbitopathy

“…The aetiologies are quite varied and include infections, neoplasm, TAO, granulomatous, iatrogenic mucocele and vascular lesions. [4][5][6][7][8] In our case no mass lesions or localised collections were noticed on imaging. MRI showed inflammation and swelling of ocular muscles and optic nerve.…”

Orbital apex syndrome after trauma in a 6-year-old – a rare occurrence

“…[5] Although trauma is one of the main causes, [6] reports of OAS associated with facial bone fractures are relatively rare. [7][8][9][10] There are only 17 reported cases in the literature, with the locations of the fractures as follows: 7 medial wall, 7 lateral wall, 1 floor, 1 roof, 1 floor and roof. [6][7][8][9][10] These fractures were probably due to a globe-to-wall contact mechanism.…”

“…[7][8][9][10] There are only 17 reported cases in the literature, with the locations of the fractures as follows: 7 medial wall, 7 lateral wall, 1 floor, 1 roof, 1 floor and roof. [6][7][8][9][10] These fractures were probably due to a globe-to-wall contact mechanism. [12] In the treatment of OAS associated with orbital fractures, the therapeutic targets are saving the globe, saving the third to sixth cranial nerves, and saving the optic nerve.…”

Penetrating cranial injury with giant intraorbital foreign body

“…Наличие двух апертур -зрительного отвер-стия и верхней глазничной щели -определяет офтальмологическую картину в варианте синдро-мов верхней глазничной щели и вершины орбиты [13,24,40].…”