PhD FEBO Fractura orbitae Anatomy Canalis opticus Fissura orbitalis superior Fissura orbitalis inferior Fracturae of orbit Roof frontobasal orbitofrontal ID: 931892
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Slide1
Orbit
MUDr.
Veronika Matušková,
Ph.D
.,
FEBO
Slide2Fractura
orbitae
AnatomyCanalis opticus Fissura orbitalis superiorFissura orbitalis inferior
Slide3Slide4Fracturae
of
orbit
Roof - frontobasal, orbitofrontalLateral wall – orbitozygomaticMedial wall – orbitoetmoideal
Floor
–
retromarginal
,
„
blow
out
fracture
“
Slide5Fracture
of
roof Cause – failing on a sharp object, blow to the Forehead (head in bend)Signs
:
hematoma
of
the
upper
eyelid, disturbance of craniofacial bonesSmall fractures require no treatmentFractures extending into the anterior cranial fossa - competence NCHDamage visual functions - ischemic neuropathy n. IITherapy ischemic neuropathy: decompression optical channel or megadoses of methylprednisolone
Slide6Fracture
of
lateral wall Cause - blunt trauma on cheekbonesUsually part of zygomatikomaxilárního complex (ZMK)Symptoms
:
pain
,
hematoma
of
eyelids
, conjunctiva chemosis, visual disturbances and eyeball displacement (diplopia, enophthalmos)Dg. - CT, NMRTreatment - Indications for surgery is persistent diplopia, limited mouth opening and flattening of the facial region
Slide7Slide8Orbit
fracture
Fractura
of ZMKIsolated fracture of lateral wall
Slide9Medial
wall
fractureCause - blunt traumaSymptoms - hematoma eyelid , subcutaneosu emphysema develops on blowing noseDg. - CT
Treatment
–
conservative
Slide10Blow
out orbital
floor fractureCause – sudden increase in the orbital pressure by a striking object ( larger than 5 cm) The
symptoms
-
swelling
,
hematoma
of
eyelids pseudoptóza, diplopia, inability to move the eyeball upwards (seriously elevation). Paresthesia, hypoesthesia in n.infraorbitalis.
Slide11Slide12Blow
out orbital
floor fractureDg. - X-ray orbit, CTSymptom - hammlock - wide breaking orbital floor. Significant enophthalmos, without incarceration of
m.r
.
inf
.
Symptom
-
hanging
drop - fisure fracture with soft tissue entrappmentDouble diplopia Test passive ductionTreatment - Surgery – in case of entrappemnt (in 3-5 days -resolved orbital hematoma).
Slide13Blow
out
orbital floor
fracture
Slide14Disease
of
lacrimal gland Acute dacryadenitis – rare, in isolationS: swelling of the lateral aspect of
the
eyelid
–
charakteristic
„S“
shaped
ptosis
T: usually is not requiredTumors: Lacrimal gland carcinoma - high mortality and morbidityT: surgery and radiotherapy
Slide15Disease
of
lacrimal
glandDacryadenitis
Pleomorfic
adenoma
Slide16Helter
exophtalmometr
Measurement of the position of the eye Hertel exoftalmometr measures the distance corneal apex - the external edge of the bony orbit (diameter 17 mm
,
above
20 -
pathology
)
Side
difference to 2 mm - physiological
Always
should be recorded the distance of the outer edges of the orbits
Slide17Disease
of
orbitPulsatile proptosis - the carotid cavernous fistula – abnormal communication btw vein and artery ( carotid artery and orbital cavernous
sinus
vein
)
Slide18Disease
of
orbitIntermittent proptosis - a symptom of vascular malformations in orbit (varix) - Valsalva maneuverPseudoproptosis - high axial myopiaenophthalmos
Slide19Disease
of
orbitAxial proptosis - only in the sagittal plane (Graves' disease, orbitocellulitis )Paraaxial proptosis - lesions of
peripheral
lateral
space
(
lacrimal gland tumors, frontoetmoidal mucocele, tumors of PN sinus)Bilateral proptosis - thyreotoxicosis and EO
Slide20Examination
of orbit
X ray UltrasoundCTNMR
Slide21Inflammation
of orbit
Etiopatogenesis:Microbial infectionImmune responses hyperergická-allergic-typeEndocrine ophthalmopathy (Graves disease)Microbial
infections
:
orbitocellulitis
phlegmone
orbit
abscess
of
orbitTenonitismyositis orbitalisInflammatory pseudotumor of the orbit
Slide22Inflammation
of
orbit
Orbitocelulitis
Abscess
of
orbit
Slide23Endocrine
orbitopathy (EO)
Autoimmune disease with the formation of a binding antibodies on cells of thyroid glandOrbital fatSubcutaneous tissue front of the lower legClinical picture:
Eyelid
symptoms
Eye
movement
disorder
PseudoglaukomExophtalmusNeuropathy n.II
Slide24Endocrine
orbitopathy (EO)
Slide25Endocrine
orbitopathy (EO)
Diagnosis:laboratory findingsImaging (ultrasound B scan, NMR, CT)Test passive duction (muscle fibrosis)Complications of
EO -
the
cornea
exposure
,
elevated
intraocular pressure, changes in the orbit (neuropathy)Treatment: EndokrinologistOphthalmologist - serious ocular complications - megadoses of steroids, orbital decompression, the treatment of ocular disorders
Slide26Tumours
of orbit
Benign and malignantprimarysecondarymetastaticPrimaryvascular tumorsdermoid cystnerve tumorslacrimal gland tumors
meningiomas
orbit
malignant
lymphomas
rhabdomyosarcoma
Slide27Tumours
of orbit
Slide28Tumours
of orbit
Secondarytumors of PN sinusescarcinomas of the eyelidsExtrabulbar expansion of intraocular tumorsmetastatic -
Adenocarcinomas
(
breast
,
lung
,
prostate
,
colon, pancreas, testis)TreatmentAccording to type, location and size of the tumor. Interdisciplinary cooperation Anterior, lateral, and transcranial transetmoidální orbitotomy. Orbital decompression, exenteration of the orbit.
Slide29Slide30Slide31Enucleation
and
exenteration
Enucleation of the eyeball – Removing the whole globe after ( transection of
eye
ocular
muscles
and
optic
nerve)Indications:malignant intraocular tumors without extrabulbární promotionpainful blind bulbuscosmetically unsightly blind bulbusdevastating eye injury (primary enucleation)sympathetic ophthalmia
Slide32Enucleation
and
exenteration
Enucleation of the eyeballsurgical procedurewithout orbital implantorbital implant
Slide33Exenteration
of
bulbiEvacuating of the contents of the eyeball, leaving its packaging.Indications:Endophthalmitis (panoftalmitida)The devastating trauma of the globe with the evacuation of its contents
Slide34Enucleation
and
exenteration
Without implantWith implant
Slide35Enucleation
and
exenteration
Benefits of implant:good motility of the globesatisfactory cosmetic effectDisadvantages of implant:elimination of implantthe possibility of infection
Slide36Exenteration
of the
orbitRemoving the entire contents of the orbit and the periosteumwithout retaining caps,preserving eyelidindications:tumors of the orbittumors of the eyelids and eyeball with propagation into orbitintractable infectious processestrauma (devastating injuries with extensive tissue necrosis)
Slide37Exenteration
of the
orbitWays of dealing with the defect:healing granulation tissuefree skin grafttissue flap with pedicle (muscle, fat, skin)
Slide38Exenteration
of the
orbitPermanent Cosmetic Solutions:Spectacle ectoprotesis (prostheses)Fixed implants