Upper lid transconjunctival versus transcutaneous approach for fracture repair of the lateral orbital rim.

The use of the lower eyelid transconjunctival approach in the setting of orbital trauma has becoming increasingly popular in recent years. However, experience has found that access to the lateral orbital rim can be somewhat limited with this type of incision. Many authors supplement the approach with a lateral canthotomy in order to gain adequate access laterally. Although usually well tolerated, there can be side effects associated with this incision. We examine the upper lid transconjunctival approach to the lateral orbital rim. Furthermore, we compare this technique to the more traditional transcutaneous approaches used for orbital trauma. We have found this technique to be safe, effective, and to cause no more complications than the more traditional approaches.

Incidence and risk factors of bisphosphonate-associated osteonecrosis of the jaws.

BACKGROUND: Intravenous bisphosphonate therapy has been used for treatment of benign and malignant bone diseases and has been linked to osteonecrosis of the jaws. METHODS: Records of 638 patients treated with intravenous bisphosphonates were reviewed. Drug used, number of infusions, dosing interval, dosage, duration, and occasion of osteonecrosis, diagnosed by history and physical examination, were analyzed. RESULTS: The overall incidence of osteonecrosis was 0.94% (6/638). No significant relationship was observed between the incidence of osteonecrosis and demographic parameters, primary tumor, cumulative drug dose, or dosing interval. However, patients who developed osteonecrosis had a significantly greater mean number of infusions (p = .016) and significantly greater mean hours of infusion time (p = .0036). CONCLUSIONS: The findings suggest positive correlation between the development of osteonecrosis and drug exposure as measured by number of infusions and total infusion hours. However, the relatively low incidence of osteonecrosis precluded definition of a direct dose-response relationship.

Absorbable biomaterials used within paranasal sinuses: an animal study.

BACKGROUND: The purpose of this study was to investigate the quality of mucosal regeneration in the presence of two different resorbable dressings derived from hyaluronic acid (HA): HA-carboxymethyl cellulose (HACMC) and esterified HA (HYAFF). A prospective randomized animal study was performed. METHODS: Twelve New Zealand white rabbits underwent bilateral maxillary sinusomy via a canine fossa approach. Each sinus was stripped circumferentially, except for the mucosa along the medial wall in the region of the natural ostium. Each of the 24 sinuses was then packed with either HACMC (n = 8) or HYAFF (n = 8) or left as an unpacked control (n = 8). After 14 days, each animal was killed and the sinus contents were evaluated histologically by a blinded pathologist. RESULTS: Criteria for optimal mucosal regeneration included a continuous layer of ciliated columnar epithelium with normal-appearing submucous glands and lack of both inflammatory infiltrate and fibrosis. Optimal regeneration was observed in 5/8 (62.5%) of the HACMC specimens, 1/8 (12.5%) of the HYAFF specimens, and 6/8 (75%) of the controls. The trend toward optimal regeneration using either HACMC or control was statistically significant when compared with HYAFF (p = 0.03). HYAFF specimens also were more likely to exhibit atrophic subepithelial glands in the regenerated mucosa. Polarizable foreign material was observed in 1/8 (12.5%) of the HACMC specimens and 2/8 (25%) of the HYAFF specimens. CONCLUSION: The quality of epithelial regeneration is potentially affected by the form of HA present in the healing milieu. In this series, the most optimal healing characteristics were seen in unpacked controls. Between the preparations of HA studied, HACMC exhibited more favorable healing patterns, which were nearly similar to controls.

Endoscopic management of sinus disease with frontal lobe displacement.

BACKGROUND: Advanced inflammatory disease of the paranasal sinuses may result in erosion of the skull base with frontal lobe impingement. We present a series illustrating minimally invasive management of this process. METHODS: We review 15 consecutive cases of advanced sinus inflammatory disease with frontal lobe displacement. Clinical presentation, diagnostic evaluation, and treatment modalities are described. RESULTS: Patients ranged in age from 19 to 83 years, and 13/15 were men. Presenting symptoms in all patients included progressive headache (15/15), frontal pressure (15/15), orbital involvement and visual symptoms (6/15), and new-onset seizure (1/15). Implicated diagnoses included mucocele (7/15), classic allergic fungal sinusitis (3/15), and both (5/15). Initially, 14 patients were treated endoscopically, with image-guided navigation in 12 patients. Four patients underwent trephination for combined above/below marsupialization, and three patients also underwent orbital decompression. Two patients failed initial endoscopic management. One of these was salvaged endoscopically and the other required cranialization. Another patient was managed via cranialization in the primary setting. In all cases, mucosa was observed directly against dura. No cerebrospinal fluid leaks were encountered. One patient expired 1 month postoperatively secondary to congestive heart failure. Mean follow-up in the remaining 14 patients was 13.6 months. Follow-up imaging revealed reexpansion of the frontal lobe into the decompressed space. CONCLUSION: Advanced sinus inflammatory disease associated with frontal lobe compression may have indolent presentation but significant morbidity. Minimally invasive techniques averted the need for craniotomy in 13/15 patients in this series.