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Growth of the Orbit
Published in D. Dixon Andrew, A.N. Hoyte David, Ronning Olli, Fundamentals of Craniofacial Growth, 2017
The forward growth (and forward displacement) of the orbit brought about by the combinations of sutural growth and surface remodeling; by the anterior growth of the supraorbital ridge caused both by anterior fossa expansion and by development of the frontal sinus; and especially by the forward displacement of the maxilla from its pterygoid abutment — these all serve to advance the midface from the relative retrusion of the neonate and infant. Again, Figures 10.5-10.7 of tomograms and Figure 10.14A of the orbit floor, show the position of the middle cranial fossa — and therefore of the temporal lobe of the brain — behind the orbit. There is resorption on the greater wing of sphenoid both on its endocranial aspect (Enlow, 1982) and on its orbital aspect. The positioning of the sphenozygomatic suture in the lateral wall, the lateral growth of the orbital plate of the maxilla both at the zygomaticomaxillary suture, and by the inferior orbital fissure, all make for that lengthening of the lateral wall and its lateralward movement described before. Thus orbital capacity and middle fossa capacity are simultaneously increased — lateralwards movement of the middle fossa here brought about also by ectocranial accretion, and the accompanying shift of the zygomaticotemporal process by medial resorption and lateral deposition.
Excision of skin lesions and orbital and nasal reconstruction
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
A coronal approach is performed, exposing the supraorbital and lateral orbital rims. If CT or MRI has indicated the posterior extent of the mass to be more than one- half of the orbit, fronto-orbital craniotomy is indicated. Anterior masses can be approached via an orbital rim osteotomy which is planned to allow sufficient margins of bony and peri-orbital tissue for malignant tumours of the lacrimal gland. The inferior limb of the osteotomy can be taken to the orbital floor and posterior to the sphenozygomatic suture. Before the lateral canthus is detached, it is identified with a suture or it can be osteotomized with a small (6–8 mm) portion of lateral rim bone to allow precise reattachment with wire or micro-screw fixation. The orbital rim and wall are put aside (with miniplates attached) for later placement.
The spectrum of orbital dermoid cysts and their surgical management
Published in Orbit, 2020
Jasmina Bajric, Gerald J. Harris
Intraorbital lesions may expand from a number of suture lines. In the lateral orbit, cysts can originate from the frontozygomatic, frontosphenoidal and sphenozygomatic sutures. Clinical presentation may be delayed until frank proptosis is apparent. In general, access to the orbit is provided by an eyelid crease incision and skin/orbicularis muscle dissection to the superior and lateral orbital rims. This is followed by Colorado needle incision through periosteum and elevation of periorbita into the superior and lateral subperiosteal space until the cyst wall is encountered. With broad-based cysts, bone cuts in the lateral rim (Krönlein bone flap) are not performed to avoid rupture before most of the capsule has been dissected. Growth under pressure within the orbital confines will often cause a broad and intimate association of the cyst’s outer layer and the bony wall. Therefore, a substantial capsule that peels easily from the bone may be lacking (Figure. 4A-C). If rupture occurs and piecemeal resection is needed, all epidermal elements should be removed from the osseous aspect with a bone curette or high-speed burr. An angled endoscope or small dental mirror allows inspection of all aspects of the bony fossa.
Lateral orbital wall anomaly in a patient with thyroid eye disease
Published in Orbit, 2023
Sukriti Mohan, Lily Koo Lin, Tiffany C. Ho, Sandy Zhang-Nunes, Vishal Patel, Jessica R. Chang
Sphenoid wing hypoplasia is an uncommon finding, often but not always associated with neurofibromatosis type 1.15 Sphenoid wing hypoplasia may lead to more dramatic lateral orbital wall abnormality as the intracranial contents may encroach on the orbital contents, causing pulsatile proptosis, or it may be more subtle, causing enlarged inferior orbital fissure and enophthalmos.16–19 Our patient may have had incomplete fusion of the sphenozygomatic suture on the left side from birth, or the bone may have been thin with the defect developing or enlarging after onset of TED with increased orbital pressure and/or the alterations in bone metabolism associated with hyperthyroidism and corticosteroids.