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OBJECTIVE: To present marginal reflex distance (MRD-1) outcomes based on intra-operative quantification of levator aponeurosis advancement. METHODS: Forty-eight patients with unilateral aponeurotic ptosis underwent anterior levator aponeurosis advancement. Distance of advancement intra-operatively was compared with MRD-1 outcomes at the immediate postoperative sitting, approximately 1 week, and 1 month period. Surgical success was defined as a symmetric MRD-1 or an MRD-1 within 1 millimeter of the contralateral eyelid. RESULTS: Most MRD-1 exhibited the following trends: 1) initial decrease at about 1 week and increase at 1 month (n = 11), 2) initial increase at about 1 week with levelling at 1 month (n = 8), and 3) increasing through time (n = 7). Success rate significantly decreased through time (p = .0464). The change in proportion of successful and failed surgeries was insignificant. Surgical revision rate was 10.4%. CONCLUSION: Levator aponeurosis advancement distances do not correlate with MRD-1 outcomes linearly. MRD-1 exhibited stability over time with a satisfactory success rate at 1 month.
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Background/Objectives: This study aims to compare the clinical findings, particularly symptomatic diplopia, associated with an inferomedial orbital strut fracture versus intact strut and to determine the clinical significance of the inferomedial orbital strut in patients with orbital floor and medial orbital wall fractures. Methods: A 10-year retrospective observational study involving orbital blowout fracture cases was conducted in our institution. Patients with fractures of the orbital floor medial to the infraorbital groove and medial orbital wall, as seen on computed tomography (CT) scans, were included in this study. Patients with concomitant orbital rim fracture and those with old orbital fractures were excluded. Fracture of the inferomedial orbital strut was diagnosed via coronal CT images and patients were classified into those with an inferomedial orbital strut fracture and those without. Results: A total of 231 orbits from 230 patients was included in the study (fractured strut on 78 sides and intact strut on 153 sides). Approximately 2/3 of patients in both groups had the field of binocular single vision in primary position upon first examination (p = 0.717). Patients with strut fractures demonstrated only comminuted or open fractures, while those without strut fractures showed diverse fracture patterns (p < 0.001). Conclusions: Inferomedial orbital strut fracture does not automatically result in diplopia in patients with orbital blowout fractures. The integrity of the orbital periosteum plays a more essential role in hampering extraocular muscle displacement, thereby preventing symptomatic diplopia in these patients.
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Músculos Oculomotores , Fraturas Orbitárias , Humanos , Músculos Oculomotores/lesões , Músculos Oculomotores/cirurgia , Fraturas Orbitárias/cirurgia , Fraturas Orbitárias/diagnóstico , Fraturas Orbitárias/complicações , Masculino , Adulto , Feminino , Tomografia Computadorizada por Raios X , Pessoa de Meia-IdadeRESUMO
Pyomyositis is a bacterial infection of skeletal muscle leading to abscess formation. Younger males are predominantly involved, but pyomyositis may occur in all ages and sexes. Underlying systemic disease or accompanying immunocompromised states may increase the risk of pyomyositis. This is a report of a 72-year-old, male, with uncontrolled diabetes mellitus, presenting initially as a case of orbital cellulitis. Magnetic resonance imaging confirmed the presence of an abscess in the left lateral rectus. Antibiotic therapy was promptly initiated, and drainage of the abscess was performed via a transconjunctival approach. Pyomyositis resolved post-surgery and medical therapy. Residual exotropia was noted at the eighth month of follow-up necessitating subsequent strabismus surgery. Nine months post-treatment, left lateral rectus pyomyositis did not recur.
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Although several studies have suggested a possible association between sarcopenia and knee osteoarthritis (OA) in the elderly, there remains no definitive evidence. Recently, however, the serum creatinine/cystatin C ratio (sarcopenia index: SI) was reported to correlate with skeletal muscle mass. The present retrospective study therefore investigated the impact of reduced skeletal muscle mass on advanced knee OA using SI. In 55 individuals scheduled for knee osteotomy or knee arthroplasty, correlations between SI and patient-reported outcomes such as the Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Oxford Knee Score (OKS) were explored. Significant associations were found between SI and the KSS functional activity score (ß=0.37; p=0.022), KOOS subscale for activities of daily living (ß=0.42; p=0.0096), and OKS (ß=0.42; p=0.0095). This study underscores the role of reduced muscle mass in functional outcomes and introduces SI as a valuable marker for assessing muscle loss in knee OA patients.
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Músculo Esquelético , Osteoartrite do Joelho , Sarcopenia , Humanos , Osteoartrite do Joelho/patologia , Osteoartrite do Joelho/cirurgia , Masculino , Feminino , Idoso , Estudos Retrospectivos , Músculo Esquelético/patologia , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Atividades Cotidianas , Artroplastia do JoelhoRESUMO
PURPOSE: To present the demographics and clinical characteristics of pure (rim-sparing) orbital roof fractures. METHODS: This retrospective observational study used 10 years of data from a single institution. Patient age, sex, laterality, field of binocular single vision, associated injuries, and radiologic features were analyzed. Orbital roof fractures were categorized into four groups: comminuted/open, hinged, trapdoor, and linear. These were further subdivided into blow-in (-down) and blow-out (-up) fractures. Injury etiology was classified into fall, traffic accidents, sports injuries, assault, work-related, and others. RESULTS: Data documented a low incidence rate of 2.5% (27 patients) in 1074 patients. Most patients were male (81%). The most common cause of injury was fall (48%), followed by traffic accidents (22%). Comminuted/open fractures constituted the bulk of fracture types (54%), followed by hinged, and linear fractures. Blow-in and blow-out fractures had an incidence rate of 50% each. Concomitant fractures of the medial and inferior orbital walls were predominant. Low surgical intervention was noted owing to acceptable field of binocular single vision outcomes, and the field of binocular single vision included the primary position of gaze in 88% of patients. CONCLUSION: Pure orbital roof fractures occurred in 2.5% of patients with pure orbital fractures. Patients were predominantly male with trauma caused by high energy forces, which regularly caused comminution of the roof and fractures of the medial and inferior orbital walls. Most patients were managed conservatively.
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Fraturas Orbitárias , Humanos , Fraturas Orbitárias/epidemiologia , Fraturas Orbitárias/cirurgia , Fraturas Orbitárias/complicações , Masculino , Estudos Retrospectivos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adolescente , Adulto Jovem , Incidência , Acidentes de Trânsito/estatística & dados numéricos , Acidentes por Quedas/estatística & dados numéricos , CriançaRESUMO
The aim of this study was to present the demographic and clinical characteristics of sports-related pure (rim-sparing) orbital blowout fractures and to analyze these differences by type of sport. Ten years of sports-related orbital fracture data were accumulated. Patients were classified into similar sports (i.e., soccer and futsal) wherein orbital blowout fractures were obtained, producing 14 groups. This study included 377 sides from 374 patients. The majority of patients were male (83.4%), and the mean population age was 20.9 ± 10.8 years. The most common sports causing injuries were baseball/softball, rugby/football, and martial arts. Single-wall fractures were found in 78.8% of patients, but baseball/softball had a higher frequency of multiple-wall fractures (p = 0.035). Concomitant ocular and periocular injuries occurred in 18.6% of patients, which were frequently caused by baseball/softball (p < 0.001). The field of binocular single vision (BSV) included primary gaze in 84.2% of patients. Surgical management was conducted in 52.1% of patients. This study showed that baseball and softball had the highest rate of multi-wall fractures and concomitant ocular and periocular injuries. The field of BSV measured during the first examination was acceptable in most cases.
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A 47-year-old Japanese woman presented with a 1-year history of right-sided epiphora. On initial consultation, the patient had a high right tear meniscus height. CT images revealed bilateral soft tissue opacification in the nasal cavity and maxillary, frontal, and ethmoid sinuses. The lesion in the right nasal cavity and maxillary sinus involved the right lacrimal sac and nasolacrimal duct. Blood test results showed elevated eosinophil count. Endoscopic sinus surgery and excisional biopsy of the nasolacrimal duct were performed. Histopathological examinations of the excised right nasolacrimal duct and nasal polyps from the nasal cavity and maxillary sinus showed high levels of eosinophilic inflammatory infiltrates. The definite diagnosis of eosinophilic chronic rhinosinusitis was made, based on clinical, radiological, and histopathological findings. At 1.5-year follow-up, tear meniscus height was normal, the lacrimal drainage system remained patent, and the rhinosinusitis did not recur.
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Eosinofilia , Obstrução dos Ductos Lacrimais , Ducto Nasolacrimal , Rinite , Sinusite , Tomografia Computadorizada por Raios X , Humanos , Feminino , Pessoa de Meia-Idade , Sinusite/diagnóstico , Sinusite/complicações , Doença Crônica , Rinite/diagnóstico , Rinite/complicações , Ducto Nasolacrimal/patologia , Ducto Nasolacrimal/diagnóstico por imagem , Obstrução dos Ductos Lacrimais/diagnóstico , Obstrução dos Ductos Lacrimais/etiologia , Eosinofilia/diagnóstico , Eosinofilia/complicações , Endoscopia , RinossinusiteRESUMO
We retrospectively reviewed the medical records of all patients diagnosed with lacrimal canalicular wall dehiscence/thinning from January 2020 to January 2024 and found three patients. Two patients were male, and the other patient was female. Patient ages ranged from 53 to 82 years. None of the patients had a history of ocular trauma, congenital anomaly, or other ocular diseases except for cataract. All patients complained of epiphora, and the duration of symptom ranged from 15 months to 10 years. Unilateral involvement of the lower canaliculus and isolated single wall involvement affecting only the canalicular roof were observed in all patients. The roof was dehiscent in one case and thinned out in the other two cases. The dehiscent canaliculus was closed by sutures, and the thinned-out canalicular wall of one patient was covered using a conjunctival flap. However, recurrences were noted at two and five months after surgery.
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ABSTRACT: We have recently shown that including the blood flow from the lateral thoracic artery (LTA) in addition to the thoracoacromial artery in the pectoralis major muscle musculocutaneous (PMMC) flap (bipedicle PMMC flap) can increase the perfusion of the flap. We also developed the concept of the supercharged PMMC flap, in which the LTA included in the flap was once cut and anastomosed to a cervical artery under a microscope. It is an effective solution to maintain the additional blood flow from the LTA, when the length of the LTA is compromised for reconstruction. The mandibular reconstruction of an oral cancer patient was performed with a supercharged PMMC flap. Intraoperative indocyanine green angiography was performed in a single pedicle, bipedicle, and supercharged conditions, and the videos were analyzed with a quantitative assessment system of perfusion using some parameters. As a result, blood supply from the LTA was essential for flap survival in this patient, and supercharging from the cervical artery improved flap perfusion compared with the perfusion in the bipedicle condition. The supercharged PMMC flap can resolve the compromise of pedicle length and be also hemodynamically advantageous, thus making the reconstruction more reliable than the conventional technique.
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Verde de Indocianina , Retalho Miocutâneo , Músculos Peitorais , Procedimentos de Cirurgia Plástica , Humanos , Angiografia/métodos , Corantes , Hemodinâmica/fisiologia , Neoplasias Bucais/cirurgia , Retalho Miocutâneo/irrigação sanguínea , Retalho Miocutâneo/transplante , Músculos Peitorais/irrigação sanguínea , Procedimentos de Cirurgia Plástica/métodosRESUMO
PURPOSE: This study aims to determine the incidence of pure orbital fractures with concomitant lacrimal drainage system injuries. METHODS: A retrospective observational study involving 956 sides from 940 pure orbital blowout fracture patients was conducted in our institution. Patients with concomitant orbital rim fracture and those with old orbital fractures were excluded. RESULTS: A total of 13 sides (1.4%) from 13 patients were included in the study. Canalicular laceration, bony nasolacrimal canal fracture, and lacrimal sac wall laceration were found in 9, 4, and 1 patients, respectively (one overlapping). Majority of the injuries resulted from either sports or falls. Inferomedial orbital strut fracture (23.1% vs. 7.6%; p = .075) and orbital floor fracture occurring lateral to the infraorbital groove (30.8% vs. 9.9%; p = .035) tended to be higher in patients with lacrimal drainage system injuries. CONCLUSION: There is a 1.4% incidence rate of pure orbital fractures with concomitant lacrimal drainage system injuries among the Japanese population included in this study. Inferomedial orbital strut fractures and orbital floor fracture lateral to the infraorbital groove were found to have higher association with lacrimal drainage system injuries.
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INTRODUCTION: The aim of this study is to compare data on the incidence of pediatric orbital fractures before the onset of the coronavirus disease 2019 (COVID-19) pandemic and during the period of the pandemic in the Japanese population. METHODS: This retrospective, single-center, observational study including 225 patients (226 sides) aged ≤ 18 years old diagnosed with orbital fracture was conducted in our institution from March 2017 to April 2023. The study compared the incidence of pediatric orbital fractures in the pre-pandemic period from March 2017 to March 2020 and during the pandemic from April 2020 to April 2023. RESULTS: The most common cause of injury was sports in both groups (137 sides, 60.6%), and the ratio of causes of injury (P = 0.610) or between outdoor and indoor sports (P = 1.000) was not statistically different between the groups. Although the daily rate of patient consults was lowest during the country's state of emergency with priority preventative measures, the difference between pre-pandemic and pandemic was not statistically significant (P = 0.911). CONCLUSION: Despite the restrictions mandated by the Japanese government during the COVID-19 pandemic, the physical activities of children did not significantly decline. Hence, the risk of pediatric orbital fractures remained the same.
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A 71-year-old Japanese man presented with a 2-month history of diplopia. He had been followed up at another hospital for ocular sarcoidosis for 3 years. On initial consultation, the best-corrected decimal visual acuity was 0.3 on OU. Slit-lamp and funduscopic examinations were unremarkable. The left lacrimal gland was easily palpable. The patient had restricted infraduction in the OD. MRI showed thickened superior ophthalmic veins on both sides and an enlarged left lacrimal gland. Blood tests showed elevated soluble interleukin-2 receptors. Biopsy of the enlarged lacrimal gland showed numerous epithelioid granuloma and lymphocytic infiltrates consistent with sarcoidosis. No other systemic sarcoidal lesions were detected. The patient started to take prednisolone of 30 mg/day, and the dose was tapered by 5 mg every 2 weeks. At 1 month after taking prednisolone, imaging showed no thickening of the superior ophthalmic veins. At 5 months follow-up, the left lacrimal gland was not palpable, limitation of infraduction improved, and diplopia resolved.
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Imageamento por Ressonância Magnética , Doenças Orbitárias , Sarcoidose , Humanos , Masculino , Idoso , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico , Doenças Orbitárias/diagnóstico , Prednisolona/uso terapêutico , Veias/patologia , Glucocorticoides/uso terapêutico , Aparelho Lacrimal/patologia , Aparelho Lacrimal/diagnóstico por imagemRESUMO
PURPOSE: To disclose that the lacrimal sac is classified within the orbital tissue. MATERIALS AND METHODS: Ten orbits of 9 Japanese cadavers aged 64 to 85 years at death were included. The attachment site of the orbital septum in the medial canthal area was grossly dissected. The relationship between the orbital septum attachment site and the location of the lacrimal sac was examined. RESULTS: In the upper region, the orbital septum was attached to the most superior area of the lacrimal fossa and the medial canthal tendon. In the lower region, the septum was attached to the anterior lacrimal crest and the medial canthal tendon. In both the upper and lower regions, none of the septa attached to the posterior lacrimal crest. The lacrimal sac was situated behind the orbital septum. CONCLUSION: The lacrimal sac, which is situated behind the orbital septum, is classified within the orbital tissue.
The lacrimal sac, which is situated behind the orbital septum attaching to the anterior lacrimal crest and the medial canthal tendon, is classified within the orbital tissue.
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PURPOSE: To investigate the medial pretarsal adipose tissue thickness of the upper eyelid in the Japanese population. METHODS: Sixty-two whole upper eyelids were harvested from 35 Japanese cadavers and fixed in paraffin. The samples were cut into 5 µm sagittal microsections and stained with hematoxylin and eosin, as well as Masson's trichrome. Data obtained from images and measurements were taken with Aperio ScanScope and ImageScope software and underwent statistical analysis. RESULTS: The samples were divided into 3 shapes sagittal cross-sections of the eyelid (triangular, rectangular, and flat) corresponding to the shape of the medial pretarsal adipose tissue. Type I (triangular shape, 48.4%) had a ratio of fat thickness at 1/2 tarsal height to peak fat thickness of <0.9, and type IIa (rectangular shape, 30.6%) and IIb (flat shape, 21.0%) had pretarsal adipose tissue thickness to tarsal height ratio of ≥0.2 and <0.2, respectively. The mean values of tarsal thickness at 1/2 tarsal height were 1021 µm for the type I group, 1100 µm for the type IIa group, and 764.4 µm for the type IIb group ( p = 0.01). The mean values of fat thickness at 1/2 tarsal height were 410.6 µm for the type I group, 303.3 µm for the type IIa group, and 242.6 µm for the type IIb group ( p = 0.26). CONCLUSIONS: The thickness of the medial pretarsal adipose tissue was different according to the shape of the sagittal cross-section of the eyelid. Awareness of the medial pretarsal adipose tissue thickness contributes to effective suture placement and safe suture depth during blepharoptosis surgery.
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Tecido Adiposo , Povo Asiático , Pálpebras , Humanos , Pálpebras/anatomia & histologia , Tecido Adiposo/anatomia & histologia , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Povo Asiático/etnologia , Japão , Adulto , População do Leste AsiáticoRESUMO
PURPOSE: To report adult patients with an orbital trapdoor fracture with extraocular muscle entrapment. METHODS: We retrospectively reviewed 566 adult patients (>18 years) with a pure orbital fracture who were referred to us from January 2016 to May 2023. The following data were collected: age, sex, affected side, causes of injury, concomitant ocular injury and nasal bone fracture, presence or absence of oculocardiac reflex and infraorbital nerve hypesthesia, period from injury to surgery, follow-up period, and pre- and postoperative limitation of extraocular muscle motility and fields of a binocular single vision. RESULTS: We found 5 patients (0.9%) with an orbital trapdoor fracture with extraocular muscle entrapment (age range, 19-47 years; all males; 2 right and 3 left). Causes of injury included performing a bench press, fall, assault, boxing, and bicycle accident. Entrapment of the inferior and medial recti muscles was seen in 2 and 3 patients, respectively. None of the patients had any sign of oculocardiac reflex. After surgical reduction, the field of binocular single vision became normal in 3 patients and was incompletely recovered in 2 patients, in whom consultation with us was delayed. CONCLUSION: Adults with extraocular muscle entrapment may not present with an oculocardiac reflex. Urgent release of an entrapped muscle is, however, still recommended to avoid permanent limitation of extraocular muscle motility.
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Traumatismos Oculares , Fraturas Orbitárias , Masculino , Adulto , Humanos , Adulto Jovem , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Fraturas Orbitárias/complicações , Fraturas Orbitárias/diagnóstico , Fraturas Orbitárias/cirurgia , Estudos Retrospectivos , Traumatismos Oculares/complicações , Acidentes por QuedasRESUMO
When Bacillus subtilis cells face environmental deterioration, such as exhaustion of nutrients and an increase in cell density, they form spores. It is known that phosphorylation of Spo0A and activation of σH are key events at the initiation of sporulation. However, the initiation of sporulation is an extremely complicated process, and the relationship between these two events remains to be elucidated. To determine the minimum requirements for triggering sporulation initiation, we attempted to induce cell sporulation at the log phase, regardless of nutrients and cell density. In rich media such as Luria-Bertani (LB) medium, the cells of B. subtilis do not sporulate efficiently, possibly because of excess nutrition. When the amount of xylose in the LB medium was limited, σH -dependent transcription of the strain, in which sigA was under the control of the xylose-inducible promoter, was induced, and the frequency of sporulation was elevated according to the decreased level of σA. We also employed a fusion of sad67, which codes for an active form of Spo0A, and the IPTG-inducible promoter. The combination of lowered σA expression and activated Spo0A allowed the cells in the log phase to stop growing and rush into spore development. This observation of enforced initiation of sporulation in the mutant strain was detected even in the presence of the wild-type strain, suggesting that only intracellular events initiate and fulfill spore development regardless of extracellular conditions. Under natural sporulation conditions, the amount of σA did not change drastically throughout growth. Mechanisms that sequester σA from the core RNA polymerase and help σH to become active exist, but this has not yet been elucidated.
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Bacillus subtilis , Fatores de Transcrição , Bacillus subtilis/genética , Fatores de Transcrição/genética , Fator sigma/genética , Fator sigma/metabolismo , Xilose , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Esporos Bacterianos/genética , Regulação Bacteriana da Expressão Gênica , Transcrição GênicaRESUMO
Introduction: The aim of the study was to report a rare case of lacrimal gland abscess. Case Presentation: A 47-year-old woman noticed upper eyelid swelling on the right side 1.5 months before referral to our service. Oral antibiotics were administered, based on the diagnosis of acute dacryoadenitis at another clinic. The symptom had once subsided 20 days later but recurred. On the first examination, the right upper eyelid was swollen with tenderness. The right lacrimal gland was palpable. Blood tests revealed positive proteinase 3-anti-neutrophil cytoplasmic antibody. T2-weighted magnetic resonance and diffusion-weighted images showed a high signal intensity lesion in an enlarged right lacrimal gland, while apparent diffusion coefficient map demonstrated the lesion with a low signal intensity. We started administration of intravenous antibiotics. Abscess drainage and lacrimal gland biopsy were performed 4 days after the first examination. Culture test of the abscess showed only 1 colony growth of Cutibacterium acnes. The specimen harvested from the lacrimal gland showed proliferation of fibrous connective tissue and infiltration of inflammatory cells without vasculitis. After the drainage, the swelling gradually subsided. Administration of antibiotics discontinued at 22 days of follow-up. At 4-month follow-up, the patient did not have any symptom related to the lacrimal gland abscess. Conclusion: The diffusion-weighted images and apparent diffusion coefficient map are helpful for the diagnosis of lacrimal gland abscess when the culture tests provide poor results.
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This retrospective, observational study examined the surgical outcomes of bilateral inferior rectus (IR) recession in thyroid eye disease. Twelve patients who underwent bilateral IR muscle recession were included in the study. Surgical success was defined as patient achievement of the following conditions: (1) a postoperative angle of vertical ocular deviation of ≤3°; (2) a postoperative cyclotropic angle of ≤2°; (3) postoperative binocular single vision, including the primary position; and (4) postoperative enlargement of the field of binocular single vision. Linear regression analyses were performed to analyze the relationship between postoperative changes in the vertical and torsional ocular deviation angles and the amount of IR muscle recession and nasal transposition. Consequently, 9 out of 12 patients were deemed to have had successful surgical outcomes. There was a positive correlation between a change in the vertical deviation angle and a side-related difference in the amount of IR muscle recession in successful cases (crude coefficient, 2.524). A positive correlation was also found between a change in the torsional deviation angle and the amount of IR recession (crude coefficient, 1.059) and nasal transposition (crude coefficient, 5.907). The results will be helpful to more precisely determine the amount of recession and nasal transposition of the IR muscle in patients with thyroid-related bilateral IR myopathy.
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PURPOSE: To report the surgical outcomes of 4-handed endoscopic and transcaruncular approaches for orbital apex tumours located in the medial orbit. METHODS: This retrospective, observational study included 6 patients (2 males and 4 females; 3 right and 3 left; mean age, 49.5 years; age range, 38-60 years) who underwent excision of an orbital apex tumour in the medial orbit via 4-handed endonasal and transcaruncular approaches. Data on age, sex, affected side, surgical record and complications, and results of pathological examinations, imaging studies, and ophthalmologic examinations were collected. RESULTS: Tumours pathologically corresponded to a cavernous haemangioma in 5 cases and a schwannoma in 1 case. The cavernous haemangioma was completely removed in all cases, while the schwannoma was only debulked because the tumour attached to the surrounding tissues. The medial orbital wall was reconstructed simultaneously in 1 case and 8 days after tumour resection in 1 case. Postoperatively, the visual acuity improved or was maintained in all patients. One patient without medial orbital wall reconstruction showed significant enophthalmos on the affected side after surgery. Another patient without medial orbital wall reconstruction did not obtain binocular single vision field in any direction of gaze after surgery due to severe esotropia. CONCLUSIONS: This report indicates that 4-handed endoscopic and transcaruncular approaches are useful for removal of an orbital apex tumour located in the medial orbit. Medial orbital wall reconstruction after tumour resection may be a better option for reducing the risk of postoperative enophthalmos and esotropia.