Nasoorbital Ethmoid Complex
Jeffrey R. Marcus, Detlev Erdmann, Eduardo D. Rodriguez in Essentials of CRANIOMAXILLOFACIAL TRAUMA, 2014
Fractures that do not move during physical examination or show displacement on the CT scan can be safely observed. However, any crepitus or instability of the medial orbital wall segments on manual manipulation or displacement on the CT scan warrants surgical intervention. The only exception is a type I fracture with a greenstick pattern at the angular process of the frontal bone, with displacement at the inferior orbital rim segment (see Fig. 19-5). Patients typically present without telecanthus; however, they exhibit a strung bow appearance of the lower eyelid. A subtle inferior and medial displacement of the canthal ligament on the involved side is present, as well as a lengthened palpebral fissure. Rarely, these fractures can be adequately reduced by closed manipulation.2
Management of the Medial Canthal Tendon in Nasoethmoid Orbital Fractures: The Importance of the Central Fragment in Classification and Treatment
Niall MH McLeod, Peter A Brennan in 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
The authors gave a detailed description of the fracture classification of the central fragment. This classification is helpful in scientific reports and in clinical treatment, as it is well described and reproducible by others. The treatments described by the authors can be defined as an expert opinion. They are clear about the plate fixation of the Type I injuries and the indication for transnasal wiring in Type II and III injuries. It is not clearly described what the indications for additional bone grafting of the nasal dorsum and septum were. The authors stated that successful outcome of NOE fractures is dependent on reduction and stabilisation of the central fragment of the fracture with its medial canthal tendon. Although this statement has been supported by many others in the decades after this report, the authors do not clearly describe their parameters for failure or success in their original article. Unfavourable outcome, including telecanthus, was mentioned in general in the discussion section, but the outcome of their own research population was not clear.
Surgical management of orbital hypertelorism
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
Orbital hypertelorism is defined as an increased distance between both the medial and lateral sides of the orbits and should not be confused with telecanthus.1−3 It is a physical finding associated with a number of congenital midline anomalies: craniofrontonasal dysplasia, f rontonasal dysplasia, encephalocele, midline dermoid cyst, syndromes characteristic of midface retrusion and craniosynostosis (e.g. Apert and Crouzon syndromes), and atypical midline cleft anomalies. Though all patients with hypertelorism exhibit some telecanthus, not all patients with telecanthus are hyperteloric (Figures 77.1 and 77.2, Table 77.1).2,4−6 These anomalies characteristically cause widening of the upper craniofacial segment and orbital hypertelorism.7,8 Generally, these are nonprogressive entities and best addressed once the cranioorbital units are near skeletal maturity (5–8 years of age).7,9 The extent and location of facial widening dictates which procedure is performed: box osteotomies versus facial bipartition.
Novel de novo interstitial deletion in 2q36.1q36.3 causes syndromic hearing loss and further delineation of the 2q36 deletion syndrome
Published in Acta Oto-Laryngologica, 2019
Jing Guan, Linwei Yin, Hongyang Wang, Guohui Chen, Cui Zhao, Dayong Wang, Qiu-Ju Wang
However, we describe the patient who shares some but not all features of WS or CDHS. He was no white forelocks, no heterochromia of the irides and no evidence of any skin depigmentation. His hands and feet were relatively small and had a slight ulnar deviation of the hands but no abnormalities. His temporal bone CT scans and internal auditory canal MRI were normal. Patients with chromosome 2q36 deletion were previously reported to show highly variable clinical manifestations likely resulting from the size and the different genes of the deletion (Table 1), but not detailed genotype-phenotype correlations and not clearly showed degree of hearing loss. Their predominant clinical features include hearing loss (4/16), telecanthus (7/16), dental abnormalities (4/16), hand or toe malformations (5/16), vertebral dysplasia (spina bifida or scoliosis, 5/16) and developmental or intellectual disability (11/16), which are major suggestive phenotypes of 2q36.1q36.3 deletion syndromes.
Ophthalmologic findings in the Cornelia de Lange syndrome
Published in Ophthalmic Genetics, 2019
Angell Shi, Alex V. Levin
The largest study in which the intercanthal distance was measured in patients indicated that telecanthus (60%) is more commonly found than hypertelorism (30%) (11). A study of 34 patients with HDAC8 mutations and CdLS-like features described hypertelorism in 47% and telecanthus in 64% (6). Nicholson et al. reviewed 48 cases and also noted telecanthus, but not hypertelorism (23). In a report of 12 cases of CdLS that were based on clinical diagnosis, 16.6% demonstrated hypertelorism (24) although no description of methodology was reported. The methodology of measurement does greatly influence the interpretation of the oculofacial findings (13).
Multiple lacrimal drainage anomalies in proboscis lateralis
Published in Orbit, 2021
Nandini Bothra, Milind Naik, Mohammad Javed Ali
A 9-year-old girl presented with complaints of watering and discharge from the left eye of 3-year duration. On examination, the patient had three distinct eyelids on the left side – upper, lower and a well-formed and distinct medial eyelid, positioned in between the upper and lower eyelids (Figure 1a and 1b). Punctum was seen on the lower eyelid (Figure 1c) with regurgitation of mucoid discharge on pressure. There was an upper punctal agenesis (Figure 1d). Regurgitation was also noted from a fistula present on the middle eyelid (Figure 1e). There was an acquired telecanthus with surgical reconstruction of the proboscis to the right nostril (Figure 1a). Limitation of motility on dextroversion, elevation, and depression was noted. There were signs of earlier attempts for a cleft lip and cleft palate repair (Figure 1a and 1f). Remaining anterior segment and posterior segment evaluation were within normal limits. Right eye showed exotropia with end gaze nystagmus. Both eyes had a refractive error with ametropic amblyopia. Lacrimal irrigation was freely patent on the right side, whereas total regurgitation was seen on the left side from the fistula. Probing was attempted on the left side to understand the passage of the lacrimal drainage pathway and it revealed a hard stop at a far distance from the punctum around 8–9 mm away. When the probe was turned vertically, it gets into a free space, however, not opening into the mouth but towards the malformed sinuses (Figure 1g). Nasal endoscopy showed an erroneous bony projection with granulation tissue in the inferior meatus and floor of the right nostril, secondary to cleft palate repair (Figure 1h). Left nostril was the tubular structure which was reconstructed and did not show any nasal structures or mucosal lining. 3D computed tomography dacryocystography (3D CT-DCG) revealed a left-sided dilated and malpositioned lacrimal sac with internal septae obstructing the passage of the dye to reveal the whole sac (Figure 2a). The sac was present almost on the orbital floor and reaching up to the middle of the inferior orbital rim (Figure 2a). Computed tomography scans also showed under-developed sinuses (Figure 2b) on the left side with persistent cleft palate (Figure 2a). Dacryocystorhinostomy in this case was not an option owing to the large distance between the contralateral nasal cavity and the anomalous position of the lacrimal sac and also due to the reconstructed left nasal cavity in the interim through which a long passage cannot be reconstructed. Thus, to take care of the discharge and also to improve the cosmesis, a left dacryocystectomy with excision of the middle medial eyelid along with the lacrimal fistula and medial canthal reconstruction was performed (Figure 2c and 2d). Histopathologically, the section showed a cavity lined with columnar epithelial cells with sub-epithelial chronic inflammatory cells, fibrocollagenous tissue, and blood vessels, suggestive of chronic dacryocystitis. Post-operatively, the patient was relieved of discharge with good cosmetic outcomes.
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