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This article reports our experience and proposes a clinical classification regarding medial orbital wall fractures. After a retrospective analysis of 2741 patients with facial fractures, we were able to evaluate 273 patients with 304 medial orbital wall fractures. The male-to-female ratio was 5:1, and most injuries involved the left orbit. Most fractures were caused by personal altercations, but more complex injuries were noted with automobile accidents and falls. Fractures were divided into types based on location and severity of injury: type I (confined to the medial orbital wall), type II (medial orbital wall continuous with floor), type III (medial orbital wall with floor-malar fractures), and type IV (medial orbital wall and complex midfacial injuries). Although visual loss (2%), diplopia (41%), and enophthalmos (12%) were seen, diplopia and enophthalmos were commonly observed with type II injuries. Imaging studies showed that about 52% of the fractures were associated with prolapse of orbital fat, but only 43% could be diagnosed with plain x rays. Type I fractures were generally explored through a frontoethmoid incision; other types were treated with subciliary or transconjunctival approaches. The usual treatment consisted of repositioning the fragments and repair of the wall with polyethylene mesh or cranial bone graft. Type I and type II fractures seemed best explained by the hydraulic mechanism of injury, whereas the type III and type IV fractures best fitted the buckling theory.
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PMID:Medial orbital wall fractures: classification and clinical profile. 770 Jun 61

In a long term animal study (min 2 weeks; max 48 weeks) on 6 minipigs, clinical related defects of the medial orbital wall extending in the orbital roof (2.5 cm x 3.5 cm) were created. The defects were bridged by slowly resorbable polydioxanon implants (so called PDS-foils, Ethicon) of different thickness (0.25/0.50 mm) and compared to control defects of identical size. The histological findings reveal: 1. After 29 weeks the resorption of both PDS-implants had been completely finished. Only the morphological intact implants had osteoconductive capabilities. 2. The osseous regeneration of the orbital defects started from the osteotomized margins of the orbital wall. The regenerates were covered by unaffected mucosa. 3. The bony regeneration was supported by the activated periosteal membrane. 4. The resorbed PDS-implants were being replaced by a tight scar tissue, which did not had any adjection to the orbital content. 5. The control defects showed a prolapse of the soft tissue with resulting enophthalmos. 6. According to the material specific characteristics, PDS-foils allow a sufficient bridging of even great and anatomically demanding orbital defects. 7. Notice: The hydrolytical broken down implant material may produce an irritation of the surrounding tissue causing a foreign body granuloma.
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PMID:[Resorbable synthetics (PDS foils) for bridging extensive orbital wall defects in an animal experiment comparison]. 808 60

Leaf and bark extracts of Byrsonima crassifolia displayed concentration-dependent, spasmogenic effects on rat fundus in vitro and biphasic effects on rat jejunum and ileum in vitro. Dose-related in vivo effects in intact rats using hippocratic screening were: decrease in motor activity, mild analgesia, back tonus, enophthalmos, reversible palpebral ptosis, ear blanching, Robichaud positive, catalepsy (awake) and strong hypothermia. Rat fundus in vitro was used as the bioassay to carry out an activity-directed separation. Bioactive material was concentrated in a 2% acetic acid leaf extract (HOAcE). Potency of HOAcE was increased by the presence of pargyline in the bathing solution. HOAcE was antagonized noncompetively by 1(1-naphthyl) piperazine (1-NP) and cyproheptadine and antagonized competitively by atropine (ATR). Cumulative concentration-response curves of HOAcE and serotonin (5-HT) did not show significant departure from parallelism (P > 0.1) and 5-HT potency was 6040 times that of HOAcE (95% confidence limits: 4620-7850). Solvent extraction of HOAcE split the spasmogenic activity of HOAcE into two types: (i) high-efficacy, low-potency, n-butanol-extracted, pargyline- and 1-NP-sensitive, ATR-insensitive activity, and (ii) low-efficacy, high-potency, ethyl acetate-extracted, pargyline-insensitive, ATR- and 1-NP-sensitive activity. HOAcE lacked muscarinic and nicotinic effects on rat jejunum and frog rectus abdominis. Results suggest the presence of more than one spasmogenic compound in the plant.
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PMID:Pharmacological and chemical screening of Byrsonima crassifolia, a medicinal tree from Mexico. Part I. 841 47

Two patients with orbital neurofibromatosis associated with enophthalmos are presented. Assessment using 3D-CT scan shows an increase in the size of the orbital cavity and an enlargement of the inferior orbital fissure, which allows orbital fat to prolapse into the infratemporal fossa, causing enophthalmos.
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PMID:Orbital neurofibromatosis with enophthalmos. 843 39

Six patients were treated for gradual onset of enophthalmos, a deep superior sulcus and globe ptosis. There was no history of orbital trauma or sinusitis. CT scan showed an opacified shrunken maxillary sinus with dehiscence and depression of the orbital floor and downward displacement of the orbital contents. Pathological review of the surgical specimens showed a respiratory mucosal lining with thick mucoid secretions, new bone formation, but no purulence. The etiology is thought to be maxillary sinus mucocele. Surgical treatment with an otolaryngologist consisted of a Caldwell-Luc procedure to evacuate the maxillary sinus with nasal antrostomy and an orbital floor exploration with insertion of a methylmethacrylate implant molded at the time of surgery to reform the orbital floor and reposition the globe. Follow-up of 2 1/2-4 years shows excellent functional and cosmetic results.
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PMID:Globe ptosis secondary to maxillary sinus mucocele. 874 16

A clinical case of Horner's syndrome is described in a Standardbred horse, and the various symptoms of cranial sympathetic denervation are studied in two ponies after experimental transection of the left cervical sympathetic trunk and vagosympathetic trunk, respectively. The most prominent symptoms of equine Horner's syndrome were ptosis, local sweating and increased cutaneous temperature in the denervated area. Enophthalmos, miosis and increased lacrimation were also observed but these symptoms were mild, variable and difficult to ascertain. Prolapse of the third eyelid was not noticed. Concomitant laryngeal hemiplegia was present in the clinical case and was provoked experimentally in one pony by transection of the left vagosympathetic trunk. The aetiology of each of these symptoms is discussed by comparing the results of pharmacological tests and histological findings in the three horses with the data from the literature.
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PMID:Horner's syndrome in the horse: a clinical, experimental and morphological study. 907 20

Sympathetic denervation in a 20-year-old, gray, Thoroughbred-Percheron gelding was manifested by cutaneous hyperthermia and sweating over the right side of the body, demarcated by a line from the withers to the elbow and extending cranially. There was cutaneous hyperthermia over the right side of the head, but other signs of Horner's syndrome (sweating, ptosis, miosis, enophthalmos) were not present. The pattern of cutaneous hyperthermia and sweating was consistent with sympathetic denervation localized to the cervicothoracic ganglion, and thoracic radiographs revealed increased density in the craniodorsal thorax. Cytologic evaluation of a sample of pleural effusion revealed mesothelial cells containing melanin and cells suggestive of melanocytes or melanoblasts. Treatment with oral cimetidine and intrapleural cisplatin was not successful. A necropsy was not performed, but the clinical findings supported a diagnosis of thoracic melanoma involving the cervicothoracic ganglion.
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PMID:Signs of sympathetic denervation associated with a thoracic melanoma in a horse. 929 73

Blepharoplasty is one of the most successful aesthetic surgical procedures. Careful preoperative planning and conservative tissue resections can help to minimize complications and optimize results. Although some young patients request blepharoplasty specifically because of age-related changes in the eyelid skin, the surgery is that of sculpture and contouring of the entire aesthetic unit. The aging process in the eyelid complex is characterized by skin texture changes with loss of elasticity and formation of wrinkles, fat redistribution, enophthalmos, and anterior displacement of fat with a lower eyelid orbital fat prolapse. Once the etiology of the deformity and the associated periorbital anatomy are recognized, a local assessment and surgical treatment plan can produce optimal results.
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PMID:Blepharoplasty and periorbital surgery. 934 63

A number of techniques have been introduced to support the orbital floor after maxillectomy without orbital exenteration. These methods include skin graft or muscular sling, but they have resulted in severe complications, such as enophthalmos, global ptosis, diplopia, and facial deformity. Currently, advanced microvascular reconstruction using bone and soft tissue is performed by many surgeons. This usually results in the filling of the postmaxillectomy defect, but the lack of support for the orbital rim and floor by the bone flap may still cause the complications mentioned above. Vascularized calvarial bone flap was chosen in this study for reconstruction of the orbital floor and infraorbital rim to function as a buttress, to reconstruct recipient sites of poor vascular bed after radiation therapy, and to withstand further postoperative radiation. By providing a solid floor and rim, these complications can be prevented with satisfactory function and aesthetically acceptable results. From September of 1995 to July of 1998, we performed vascularized bone flap for the reconstruction of the orbital floor and infraorbital rim in four cases after total maxillectomy involving the orbital floor. With a follow-up period from 19 to 35 months (mean, 27 months), we obtained significant improvement of functional and aesthetically acceptable results without global ptosis, enophthalmos, diplopia, or severe facial contour deformity.
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PMID:Orbital floor and infraorbital rim reconstruction after total maxillectomy using a vascularized calvarial bone flap. 1045 13

An adult domestic female pig (Sus scrofa) exhibited clinical signs of right-sided Horner's syndrome after experimental placement of a woven aortic stent followed by aortic catheterization. The clinical signs included a miotic pupil, ptosis of the upper eyelid, prolapse of the nictitating membrane, and enophthalmos. Necropsy revealed a large mass in the right midcervical region that encased or was in contact with the carotid artery, internal jugular vein, and vagus nerve. Closer evaluation of the mass revealed that it was a small piece of surgical suture material that was embedded within the lumen of the carotid artery. This extrinsic material served as a nidus for an inflammatory reaction involving the vagus nerve.
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PMID:Iatrogenic Horner's syndrome in an experimental pig. 1130 Jun 74


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