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Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
Of course, there are also many similarities between the veins and arteries: There is an inferior thyroid artery branching from the subclavian artery and an inferior thyroid vein usually branching from the brachiocephalic vein; the occipital artery is a posterior branch of the external carotid artery and the occipital vein is a posterior branch of the internal jugular vein; the facial vein gives rise to the inferior labial vein, superior labial vein, and angular vein, and the two major superior branches of the superficial venous system of the head are the maxillary veins and the superficial temporal vein, in a configuration very similar to that seen in the arterial system. Note however that the superior ophthalmic vein and the inferior ophthalmic vein run respectively superior and inferior to the eye, the superior ophthalmic vein anastomosing with the angular vein, which is a branch of the facial vein (Plate 3.22). This anastomosis is clinically important because infections of the nasal cavity, cheeks, forehead, and upper lip can be spread via the facial vein through the angular and superior ophthalmic veins to the cavernous sinus, a dural venous sinus in the base of the cranium, and result in thrombosis of this sinus. This condition affects the abducens nerve and, subsequently, the lateral rectus muscle and the movements of the eye.
Discuss the anatomical features of the extraocular muscles
Published in Nathaniel Knox Cartwright, Petros Carvounis, Short Answer Questions for the MRCOphth Part 1, 2018
Nathaniel Knox Cartwright, Petros Carvounis
Important relations of the extraocular muscles are as follows. Each oblique muscle passes below its corresponding rectus muscle. Levator palpebrae superioris runs above superior oblique and the two have fascial connections, facilitating coordinated movement. The optic nerve and ophthalmic artery enter the orbit within the tendinous ring. The ciliary ganglion lies between the optic nerve and lateral rectus. Part of the tendinous ring overlies the superior orbital fissure and (from superior to inferior) the superior division of the oculomotor nerve, the nasociliary nerve, the inferior division of the oculomotor nerve and the abducent nerve enter the orbit through this part. The lacrimal, frontal and trochlear nerves, together with the superior ophthalmic vein, pass above and the inferior ophthalmic vein passes below.
Anatomy
Published in Jonathan M. Fishman, Vivian A. Elwell, Rajat Chowdhury, OSCEs for the MRCS Part B, 2017
Jonathan M. Fishman, Vivian A. Elwell, Rajat Chowdhury
The area of facial skin bounded by the upper lip, nose, medial part of cheek and the eye is a potentially dangerous area to have an infection (the so called ‘danger area of the face’). An infection in this area may result in thrombosis of the facial vein, with spread of organisms through the inferior ophthalmic vein to the cavernous sinus. This may result in a cavernous sinus thrombosis. By the superficial middle cerebral vein, such thrombosis may spread to the cerebral hemisphere, which may be fatal unless adequately treated with antibiotics.
Acute orbital inflammation with loss of vision: a paradoxical adverse event associated with infliximab therapy for Crohn’s disease
Published in Orbit, 2022
David R. Jordan, John S. Y. Park, Danah Al-Breiki
Urgent CT venogram and subsequently MR venogram were organized and showed right-sided proptosis with extensive congestion of the orbit (e.g. fat stranding, enlarged extraocular muscles and crowding of the right orbital apex). The left orbit was minimally involved. There was no evidence of superior or inferior ophthalmic vein enlargement or cavernous sinus thrombosis seen (Figure 3). Given the lack of thrombosis on imaging and recurrent nature of the patient’s presentation, a PAE to the infliximab infusion was suspected. While awaiting further assessment in the ER, the patient noticed some spontaneous return of his vision to light perception as well as decreased periorbital edema and pain as occurred with the first episode. Intravenous methylprednisolone (1 g over 60 min) was given at this time and the vision improved to hand motion within hours after the first dose. He received two additional doses over the next 2 days for a total of 3 g in 3 days followed by an additional 8-week course of oral prednisone (tapered every few days until gone). The vision was CF after his third dose of IV solumedrol and improved to 20/320 by 4 weeks. The patient’s periorbital edema, extraocular motility, chemosis, and intraocular pressure returned to normal over this time. There was no further improvement in visual acuity at 8- or 12-weeks follow-up. No further infliximab treatments were planned.
Bilateral superior ophthalmic vein thrombosis associated with high altitude
Published in Orbit, 2021
Abtin Shahlaee, Lauren M. Hennein, Bryan J. Winn, William P. Dillon, Nailyn Rasool
On examination, visual acuity (BCVA) was 20/30 in each eye with no dyschromatopsia. Visual fields and pupillary examinations were unremarkable. External examination demonstrated superomedial orbital fullness with 1 mm of proptosis of the left eye (Figure 1). There were palpable, mildly tender superomedial orbital masses and resistance to retropulsion bilaterally. Extraocular motility demonstrated mild limitation of elevation of the left eye. The patient had a comitant left hypotropia in all directions of gaze. Anterior segment examination was unremarkable. Intraocular pressures were 28 and 25 mm Hg in the right and left eyes, respectively. Fundus examination demonstrated changes in keeping with myopia without other abnormalities of the optic nerves or retinas. CT scan of the head demonstrated extensive, symmetrically dilated bilateral superior ophthalmic veins (SOVs) without intravenous contrast filling, suggestive of bilateral SOVT (Figure 2a,b). Bilateral inferior ophthalmic veins were moderately dilated and also demonstrated findings of thrombosis. An MRI with contrast confirmed bilateral SOVT without extension into the cavernous sinus (Figure 3a,b). An extensive hypercoagulable panel was completed and was negative with the exception of beta-thalassemia minor.
Transvenous embolization of bilateral indirect carotid-cavernous fistulas via a unilateral transorbital approach
Published in Orbit, 2021
Jacquelyn F. Laplant, Lauren H. Lim, Aaron S. Dumont, John D. Nerva
Computed tomography angiography (CTA) demonstrated the dilation of bilateral SOVs with partial thrombosis on the left (Figure 1A). Magnetic resonance imaging (MRI) showed bilateral proptosis, left more than right (Figure 1B). Cerebral angiography demonstrated bilateral Barrow type B CCFs supplied by bilateral meningohypophyseal (MHT) and inferolateral (ILT) trunks of the cavernous segment of the internal carotid artery (ICA) (Figure 2A, 2D). There was anterior venous drainage via the right SOV and a left medially directed inferior ophthalmic vein (Figure 2B, 2E). Contralateral flow through the CCFs was via the intercavernous sinus (Figure 2C, 2F).