Reconstrucción de Fracturas Orbitarias Utilizando Tecnología Digital Tridimensional: Una forma de Optimizar Resultados / Orbital Fracture Reconstruction Using Digital Three-Dimensional Technology: A Way to Optimize Results

La reconstrucción de las paredes orbitarias fracturadas es compleja debido a la gran cantidad de parámetros volumétricos que posee. Una restitución inadecuada de ellas habitualmente está asociada a secuelas postquirúrgicas en el paciente. El contar con herramientas que optimicen la restitución de la forma anatómica de la órbita en su reconstrucción es de vital importancia, y la utilización de nuevas tecnologías ha permitido mejorar los resultados quirúrgicos, tanto anatómicos como funcionales. El objetivo de este artículo es mostrar dos herramientas quirúrgicas que permiten optimizar los resultados terapéuticos en pacientes con fractura de órbita, que son el modelo estereolitográfico con imagen en espejo y la tomografía computada intraoperatoria. Se presentan las características de estas herramientas, su utilización en tres casos de pacientes con fractura orbitaria y los resultados obtenidos en el post operatorio.

The reconstruction of fractured orbital walls is complex due to the many volumetric parameters involved. An inadequate restitution of these walls may be associated with postsurgical sequelae in the patient. Is vitally important to count with tools that optimize the restitution of the orbit's anatomic shape during its reconstruction, and the use of new technologies has allowed the improvement of the surgical results, both anatomical and functional. The aim of this article is to show two surgical tools that allow to optimize the therapeutic results in patients with orbital fracture, which are stereolithographic models with mirror image technique, and intraoperative computed tomography. Their characteristics, their use in three cases of patients with orbital fractures, and the postoperative results are shown.

Dilatação e torção de ceco associada à obstrução por fitobezoar em bezerra / Cecal dilatation and torsion associated with phytobezoar obstruction in a heifer

Background: Dilatation of the cecum associated with intestinal torsion is a fermentative digestive disease that has a lowoccurrence in veterinary medicine, particularly in large animal practice. This condition is most prevalent in dairy cattle.The etiology of this digestive system disorder is related to changes in nutritional management. As it is an uncommoncondition that is frequently observed in the practice of veterinary medicine, the objective of this report was to describe acase of dilatation and torsion of the cecum associated with phytobezoar obstruction in a heifer that was examined at theVeterinary Hospital of the Federal Rural University of Pernambuco (HOVET-UFRPE), Recife, Brazil.Case: A 55-day-old heifer, with a history of abdominal distension associated with difficulty feeding and neurological signsof hind limb paresis, intentional head tremors, and prostration, was examined at the HOVET-UFRPE large animal clinic.A clinical examination demonstrated the presence of enophthalmos, abdominal distension, pale coloration of the ocularmucous membranes, and a moderate level of dehydration (3%). The dehydration was treated through the administrationof 1.150 L of saline solution along with 6 mL of Bionew (Vetnil®), 15 mL of calcium solution, and 5 mL of 50% glucose.Subsequently, the animal underwent intestinal washing through the insertion of an oral probe, which resulted in the expulsion of putrid content. Afterward, the animals blood was collected and sent to the Clinical Pathology Laboratory of theDepartment of Veterinary Medicine at HOVET-UFRPE for a complete blood count...(AU)

Dilatação e torção de ceco associada à obstrução por fitobezoar em bezerra / Cecal dilatation and torsion associated with phytobezoar obstruction in a heifer

Background: Dilatation of the cecum associated with intestinal torsion is a fermentative digestive disease that has a lowoccurrence in veterinary medicine, particularly in large animal practice. This condition is most prevalent in dairy cattle.The etiology of this digestive system disorder is related to changes in nutritional management. As it is an uncommoncondition that is frequently observed in the practice of veterinary medicine, the objective of this report was to describe acase of dilatation and torsion of the cecum associated with phytobezoar obstruction in a heifer that was examined at theVeterinary Hospital of the Federal Rural University of Pernambuco (HOVET-UFRPE), Recife, Brazil.Case: A 55-day-old heifer, with a history of abdominal distension associated with difficulty feeding and neurological signsof hind limb paresis, intentional head tremors, and prostration, was examined at the HOVET-UFRPE large animal clinic.A clinical examination demonstrated the presence of enophthalmos, abdominal distension, pale coloration of the ocularmucous membranes, and a moderate level of dehydration (3%). The dehydration was treated through the administrationof 1.150 L of saline solution along with 6 mL of Bionew (Vetnil®), 15 mL of calcium solution, and 5 mL of 50% glucose.Subsequently, the animal underwent intestinal washing through the insertion of an oral probe, which resulted in the expulsion of putrid content. Afterward, the animal’s blood was collected and sent to the Clinical Pathology Laboratory of theDepartment of Veterinary Medicine at HOVET-UFRPE for a complete blood count...

Does Early Repair of Orbital Fractures Result in Superior Patient Outcomes? A Systematic Review and Meta-Analysis.

PURPOSE: To date, no clear evidence-based guidelines exist pertaining to the ideal timing to perform surgical treatment of orbital fractures. The purpose of this study was to determine if early treatment of orbital fractures resulted in better patient outcomes. MATERIALS AND METHODS: We designed and implemented a systematic review and meta-analysis to test the null hypothesis of no difference in outcomes between different time intervals between orbital injury and surgical intervention. PubMed, Embase, the Cochrane Library, the Elsevier text mining tool database, and clinicaltrials.gov trial registry were queried. The quality of evidence was based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The predictor variable was the timing of operative repair (early vs late). The outcome variable was complete recovery. Other variables of interest were diplopia, enophthalmos, and preoperative motility restriction. Meta-analyses were performed when definitions of active and control interventions and patient outcomes were deemed similar. In addition, χ2 tests were performed to determine differences in clinical outcomes between early and late operative repair. RESULTS: Of the 1,160 articles reviewed, 20 met the inclusion criteria. Surgery performed less than 2 weeks after injury was significantly associated with greater odds of complete recovery of symptoms (odds ratio [OR], 6.9 [95% confidence interval (CI), 1.35-35.06]), as well as a lower incidence of postoperative diplopia (OR, 0.3 [95% CI, 0.1-0.9]) and enophthalmos (OR, 0.2 [95% CI, 0.1-0.9]). Repair performed less than 30 days after injury was associated complete resolution of preoperative motility restriction (OR, 24.6 [95% CI, 1.30-462.34]) as well as diplopia. CONCLUSIONS: Differences in the timing of surgery and definition of patient outcomes, as well as variations in methods of evaluating postoperative outcomes, potentiate the risk of bias and warrant downgrading of the quality of evidence in a study. The timing of repair varied among 2, 4, and 8 weeks after injury. However, a short time to surgical intervention was significantly associated with resolution of vertical dystopia, postoperative enophthalmos, and motility restriction.

[Imploding antrum syndrome: three cases with different management approaches]. / Síndrome de implosión maxilar: tres casos y sus diferentes abordajes de tratamiento.

BACKGROUND: Silent sinus or imploding antrum syndrome is a very rare condition, consisting of a usually asymptomatic spontaneous collapse of the sinus walls and floor of the orbit. It is associated with negative pressures, and when this occurs, it presents with manifestations such as enophthalmos, hypoglobus, and tilt flow orbital floor. As its incidence is very low, it is frequently missed as a diagnosis, and in fact there are currently fewer than 150 cases reported in the literature. CLINICAL CASES: Three patients have been identified in our practice over a period of two years, with different symptoms that influenced the decision of the treatment modality, which were: watch and wait, endoscopic sinus surgery, or endoscopic sinus surgery plus orbitoplasty. CONCLUSIONS: Despite being a rare entity, it stills catches the attention of the ENT, OMF surgery and Ophthalmologist. The diagnosis is mainly radiological, due to the late clinical manifestations and symptomatology. The treatment should be individualised and based on the symptoms and the individual decision of each patient, firstly by Functional Endoscopic sinus surgery, and once sinus permeability is restored, it may require augmentation surgery of the orbital floor, either with autologous bone implant, titanium or other material. It is important to be aware of this pathology, to know and to suspect it, avoiding misdiagnosis.

Alteraciones estéticas faciales en el síndrome de seno silente / Facial aesthetic alterations in silent sinus syndrome / Alterações estéticas faciais na síndrome do seio silencioso

Introducción: el Síndrome de Seno Silente (SSS) es una entidad rara, siendo poco frecuente el hundimiento del maxilar superior como motivo de consulta. El trabajo pretende realizar una revisión de la bibliografía del SSS con el hundimiento del maxilar superior como principal manifestación. Material y método: Se realizó una revisión bibliográfica de artículos publicados desde el año 2008 a la actualidad. Se revisaron las historias clínicas de los pacientes diagnosticados con SSS, intervenidos quirúrgicamente. Como criterios diagnósticos se tuvieron en cuenta: asimetría facial, ausencia de síntomas rinosinusales, tomografía de macizo cráneo facial (TC MCF) con velamiento del seno maxilar y disminución de su volumen, y aumento del volumen orbitario. Se evaluó el seguimiento postoperatorio y sus resultados. Resultados: El SSS se debe a un proceso inflamatorio en el seno maxilar que genera aumento de las presiones negativas. Clínicamente se caracteriza por asimetría facial. El diagnóstico se confirma por tomografía, siendo lo más característico la presencia, en el plano coronal, de un seno maxilar ocupado y atelectásico y el descenso del piso orbitario con disminución del volumen del mismo y aumento del volumen de la órbita. El tratamiento quirúrgico se basa en mejorar las presiones dentro del seno maxilar, reservando el tratamiento del piso de la órbita a aquellos pacientes en los que persisten las alteraciones estéticas. Conclusiones: La asimetría facial es el principal motivo de consulta del paciente. Sin embargo el hundimiento del seno maxilar no es la causa más frecuente de asimetría.

Introduction: silent Sinus Syndrome (SSS) is a rare entity, and the subsidence of the upper jaw is rare. The paper aims to review the SSS literature with the upper jaw collapse as the main manifestation. Material and method: A bibliographic review of articles published from the year 2008 to the present time was carried out. Were viewed the medical records of patients diagnosed with SSS, whounder went surgery. As diagnostic criteria were taken into account: facial asymmetry, absence of rhinosinusal symptoms, massive facial cranial tomography with maxillary sinus veil and diminished volume, and increased orbital volume. Postoperative follow-up and results were evaluated. Results: The SSS is due to an inflammatory process in the maxillary sinus that generates an increase of the negative pressures. Clinically it is characterized by facial asymmetry. The diagnosis is confirmed by tomography being the most characteristic the presence, in the coronal plane, of a occupied maxillary sinus and atelectatic and the descent of the orbital floor with decrease of the volume of the same and increase of the volume of the orbit. The surgical treatment is based on improving the pressure inside the maxillary sinus, reserving the treatment of the floor of the orbit to those patients who persist the aesthetic alterations. Conclusions: Facial asymmetry is the main reason for patient consultation. However, sagging of the maxillary sinus is not the most frequent cause of asymmetry.

Introdução: síndrome do Sinus Silencioso (SSS) é uma entidade rara, e o maxilar inferior não é freqüente como motivo de consulta. O artigo pretende rever a literatura SSS com o colapso do maxilar superior como principal manifestação. Material e método: Foi realizada uma revisão bibliográfica de artigos publicados de 2008 para o presente. Revisamos os registros médicos de pacientes diagnosticados com SSS, que foram submetidos a cirurgia. Como critérios de diagnóstico foram tidos em conta: assimetria facial, ausência de sintomas rinossinusais, tomografia craniana facial maciça com velamento maxilar superior e volume diminuído e aumento do volume orbital. O acompanhamento pós-operatório e os resultados foram avaliados. Resultados: SSS é devido a um processo inflamató- rio no seio maxilar que gera um aumento nas pressões negativas. Clinicamente, é caracterizada por assimetria facial. O diagnóstico é confirmado pela tomografia sendo a mais característica a presença, no plano coronal, de um seio maxilar ocupado e atelectásico e a descida do piso orbital com diminuição do volume do mesmo e aumento do volume da órbita. O tratamento cirúrgico baseia-se na melhoria da pressão dentro do seio maxilar, reservando o tratamento do piso da órbita aos pacientes que persistem as alterações estéticas. Conclusões: A assimetria facial é o principal motivo para a consulta do paciente. No entanto, a flacidez do seio maxilar não é a causa mais frequente de assimetria.

Accessory Extraocular Muscle as a Cause of Restrictive Strabismus.

Restrictive strabismus resulting from the presence of an accessory extraocular muscle has rarely been reported in the literature. Most articles written on this topic are isolated case reports. The purpose of this paper is to describe a series of 7 similar patients presenting with atypical restrictive strabismus associated with enophthalmos in the affected eye, which was found to be caused by an accessory extraocular muscle attached to the posterior globe near the optic nerve. The medical records of 7 patients who shared these clinical characteristics were retrospectively analyzed. Orbital imaging was obtained in the 7 cases, which were compared. Three of the patients were females and four were males. The left eye was affected in all 4 males and the right eye was affected in the 3 females. The 7 patients presented with the following clinical characteristics: enophthalmos, restriction to eye movements in most fields of gaze, and presence of an anomalous orbital structure that was interpreted on magnetic resonance imaging (MRI) to be an accessory extraocular muscle inserting onto the posterior surface of the globe in the affected eye. The fellow eye was normal in all cases. Five of the 7 patients underwent surgical correction with partial improvement in only one patient. The presence of an accessory extraocular muscle should be included in the differential diagnosis of patients with atypical restrictive strabismus. Orbital computed tomography or MRI are essential for correct diagnosis in these cases.

Enoftalmia causada por uso tópico unilateral de Bimatoprost / Unilateral enophthalmos induced by the unilateral use of topical Bimatoprost

RESUMO O autor descreve o caso de uma paciente que apresenta o olho direito com o sulco palpebral profundo e enoftalmia deste lado, tratado durante uma década com Bimatoprost tópica. Concluem que os achados clínicos são provavelmente efeitos colaterais do medicamento.

ABSTRACT The author describes a case report of a patient with unilateral enophthalmia and deep palpebral sulcus probably induced by the topical use of Bimatoprost on the side of the collateral effects described.

Association of Titanium Mesh and Bovine Pericardium Membrane in the Treatment of Severe Enophthalmos.

The blowout fractures may be classified as pure or impure depending on the associated structures. There are 2 main theories attempting to describe the mechanism of injury, the hydraulic, and blocking mechanism. The complications of this type of fracture may involve diplopia, enophthalmos, and ocular movement restriction. Several materials are available for the reconstruction of orbital floor, including the titanium mesh, which present great properties, such as easy modeling and stabilization, small thickness, and shape maintenance. There, however, are disadvantages such as the possibility of adherence formation. The aim of this report is to describe the case of a patient with an 8-month blowout fracture sequel, presenting extensive enophthalmos and treated by affixing a titanium mesh associated with bovine pericardium membrane in the orbital floor. Therefore, based on a 2-year follow-up, it was possible to observe how effective the association between these 2 materials in solving the case was.

Aplicação da lipoenxertia nas deformidades craniofaciais: experiência do INTO-RJ / Application of fat grafting in craniofacial deformities: an INTO-RJ experience

INTRODUÇÃO: O enxerto de gordura, atualmente, é usado amplamente na cirurgia plástica estética e reparadora como um preenchimento natural. Na cirurgia crânio-maxilofacial há uma diversidade de pacientes com deformidades congênitas e adquiridas que podem ser muito beneficiados com a lipoenxertia. MÉTODOS: Os pacientes foram submetidos à lipoenxertia para reconstrução e correção de defeitos da face no INTO em 2012 e 2013 utilizando uma técnica padronizada. Nossa avaliação foi clínica e subjetiva, levando em conta a opinião do paciente. Especificamente nos pacientes com enoftalmo tardio secundário à sequela de trauma, realizamos exoftalmometria com o exoftalmômetro de Hertel e tomografia no pré e no pós-operatório para avaliar objetivamente nossos resultados. RESULTADOS: Vinte e dois pacientes receberam tratamento. A maioria foi do gênero feminino (77%). O volume do gordura aplicado variou de 1 ml até 37 ml, com média de 15 ml por sessão. A quantidade de sessões variou de 1 a 4. A lipoenxertia foi usada como tratamento único em apenas 30% dos casos. Fizemos lipoenxertia retrobulbar variando de 6 a 10 ml o volume enxertado, sendo que em um paciente realizamos duas sessões. Houve um ganho de 3 a 7 mm de projeção do globo ocular. Na avaliação tomográfica constatamos também aumento da projeção ocular de 4 mm e 2,2 mm. O resultado clínico foi pobre. CONCLUSÃO: A lipoenxertia é um procedimento simples, barato e reprodutível que deve fazer parte do armamentário do cirurgião plástico e do cirurgião craniofacial. Pode ser uma alternativa nos difíceis casos de enoftalmo tardio.

INTRODUCTION: The fat graft is currently widely used in aesthetic plastic and reconstructive surgery as a natural filler. In cranio-maxillofacial surgery, fat grafting can be very beneficial for patients with various congenital and acquired deformities. METHODS: We included patients who had undergone fat grafting for reconstruction and correction of defects in the face during 2012 and 2013 by using a standard technique. Our assessment was both clinical and subjective, taking into account the patient's opinion. In patients with late enophthalmos secondary to trauma sequelae, we conducted exophthalmometry with an exophthalmometer (Hertel) and preoperative and postoperative CT to objectively evaluate our results. RESULTS: Twenty-two patients were treated. Most were female (77%). The volume of fat grafted varied from 1 ml to 37 ml, with a mean of 15 ml per session. The number of sessions ranged from 1 to 4. Fat grafting was used as a single treatment in only 30% of cases. We performed retrobulbar fat grafting ranging from 6 to 10 ml in volume; in one patient, the grafting was carried out over two sessions. There was a gain of 3 to 7 mm in projection of the eyeball. In tomographic evaluation, an increased eye projection of between 2.2 mm and 4 mm was found. However, the clinical outcome was poor. CONCLUSION: Fat grafting is a simple, inexpensive and reproducible procedure that should be part of the plastic and craniofacial surgeons' inventory. It may be an alternative in difficult cases of late enophthalmos.

Cavidades anoftálmicas atípicas en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" / Atypical anophthalmic cavities observed in patients seen at "Ramón Pando Ferrer" Cuban Institute of Ophthalmology

OBJETIVO: describir el comportamiento de las cavidades anoftàlmicas atípicas. MÉTODOS: se realizó un estudio descriptivo prospectivo en pacientes con cavidades anoftálmicas atípicas atendidos en la consulta de Cirugía Plástica Ocular, en el período de enero de 2009 a julio de 2010. Se analizaron diferentes variables como sexo, edad, alteraciones de la cavidad y tratamiento quirúrgico. RESULTADOS: del total de los pacientes vistos en la consulta, 57 % pertenecían al sexo masculino. El 43 % se encontraba entre los 30 y 49 años. El 90,2 % presentó alteraciones conjuntivales, y la de mayor representatividad fue la retracción del fornix inferior, con el 33,8 %. Dentro de las técnicas quirúrgicas, la reinserción conjuntival del fondo de saco fue la más utilizada y se realizó en el 38 % de los pacientes. CONCLUSIONES: el mayor número de pacientes vistos pertenecen al sexo masculino y al grupo de edades entre 30 y 49 años. Predominaron las alteraciones conjuntivales y dentro de ellas la retracción del fornix inferior. La técnica más utilizada fue la reinserción de la conjuntiva.

OBJECTIVE: to describe the behavior of atypical anophthalmic cavities. METHODS: aprospective and descriptive study was conducted in patients with atypical anophthalmic cavities seen in the ocular plastic surgery service from January 2009 to July 2010. The analyzed variables were sex, age, cavity abnormalities, and surgical treatment. RESULTS: of all patients seen, 57 % were males and 43 % were 30 to 49 years-old. In this group, 90,2 % had conjunctival anomalies, being the inferior fornix retraction the most significant with 33.8 %. Among the surgical techniques used, the conjunctival reinsertion of the fornix was the most performed in 38% of cases. CONCLUSIONS: the highest number of patients was males and the predominant age group was 30-49 years; conjunctival alterations were predominant, mainly the inferior fornix retraction. The most used technique was the reintegration of the conjunctiva.

[Enophthalmos secondary to an orbital varix]. / Enoftalmos unilateral por várice orbitaria.

The enophthalmos is a rare cause of consultation in medical practice. The majority of cases are due to orbital space enlargement of traumatic origin. We report the case of a 63 year old patient with progressive enophthalmos of the left eye, with twelve years of evolution. Ophthalmologic examination revealed the presence of a marked enophthalmos on the left side, which improved significantly with Valsalva maneuvers. A CT scan and an MRI of the orbit allowed diagnosing uncomplicated orbital varices. Orbital varices are rare and usually manifest by episodes of intermittent exophthalmos. However, on rare occasions, repeated distension and collapse can lead to progressive enophthalmos by orbital fat atrophy.

Enoftalmos unilateral por várice orbitaria / Enophthalmos secondary to an orbital varix

El enoftalmos es un motivo de consulta poco frecuente en la práctica médica. La mayor parte de los casos se debe a un aumento de la cavidad ósea orbitaria de origen traumático. Presentamos el caso de una mujer de 63 años que consultó por enoftalmos progresivo de su ojo izquierdo, de doce años de evolución. El examen oftalmológico reveló la presencia de un marcado enoftalmos del lado izquierdo, que mejoraba notablemente con maniobras de Valsalva. Una tomografía computarizada y una resonancia magnética de la órbita permitieron diagnosticar una várice orbitaria no complicada. Las várices orbitarias son infrecuentes y por lo general se manifiestan por episodios de exoftalmos intermitente. Sin embargo, en raras ocasiones, la distensión y colapso repetidos pueden llevar a un enoftalmos progresivo por atrofia de la grasa orbitaria.

The enophthalmos is a rare cause of consultation in medical practice. The majority of cases are due to orbital space enlargement of traumatic origin.We report the case of a 63 year old patient with progressive enophthalmos of the left eye, with twelve years of evolution. Ophthalmologic examination revealed the presence of a marked enophthalmos on the left side, which improved significantly with Valsalva maneuvers. A CT scan and an MRI of the orbit allowed diagnosing uncomplicated orbital varices. Orbital varices are rare and usually manifest by episodes of intermittent exophthalmos. However, on rare occasions, repeated distension and collapse can lead to progressive enophthalmos by orbital fat atrophy.

Fratura Blow Out tratada com acesso transconjuntival e cantotomia lateral: relato de caso / Blow Out Fracture treated with transconjunctival approach and lateral canthotomy: case report

O acesso transconjuntival com cantotomia lateral possibilita ao cirurgião adequada exposição do rebordo infraorbitário, margem lateral da órbita e assoalho orbitário, com baixo índice de complicações e excelentes resultados estéticos. Essa abordagem elimina a necessidade de incisões cutâneas na pálpebra inferior assim como suas complicações. Este trabalho tem por objetivo apresentar um caso clínico e discutir detalhes da técnica bem como suas indicações e possíveis complicações... (AU)

Transconjunctival approach with lateral canthotomy enables the surgeon adequate exposure of the infraorbital rim, the lateral margin of the orbit and orbital floor, with a low complication rate and excellent cosmetic results. This approach eliminates the need for skin incisions in the lower eyelid, as well as its complications. This work aims to present a case and discuss the technical details, as well as its indications and possible complications... (AU)

Unusual ocular manifestations of silent sinus syndrome / Manifestações oculares incomuns na síndrome do seio silencioso

Silent sinus syndrome is an acquired condition in which there is a gradual collapse of the orbital floor and inward retraction of the maxillary sinus (atelectasis of the maxillary sinus). This in turn may cause associated ocular occurrences of enophthalmos and hypotropia. This is a report of an 8 year-old boy with silent sinus syndrome and associated ocular motility disorders. The association between silent sinus syndrome and ocular motility disturbance has been recently described in the literature. However, this is an infrequent association, mainly in childhood.

A síndrome do seio silencioso é uma afecção adquirida em que há colapso gradual do assoalho orbital e do seio maxilar (atelectasia do seio maxilar), o que pode acarretar alterações orbitárias e oculares associadas, como enoftalmia e hipotropia. Relatamos o caso de um paciente de 8 anos de idade com síndrome do seio silencioso e distúrbios da motilidade ocular. A associação entre a síndrome do seio silencioso e alterações da motilidade ocular extrínseca tem sido descrita na literatura. No entanto, esta é uma associação pouco frequente, principalmente na infância.

Management of pure medial orbital wall fracture with autogenous bone graft.

The orbit is an irregular conical cavity formed from 7 bones including the frontal, sphenoid, zygomatic, maxillary, ethmoid, lacrimal, and palatine bones. Fractures of the internal orbit can cause a number of problems, including diplopia, ocular muscle entrapment, and enophthalmos. Although muscle entrapment is relatively rare, diplopia and enophthalmos are relatively common sequelae of internal orbital fractures. Medial orbital wall fracture is relatively uncommon and represents a challenge for its anatomical reconstruction. In this context, autogenous bone graft has been the criterion standard to provide framework for facial skeleton and orbital walls. Therefore, it is possible to harvest grafts of varying size and contour, and the operation is performed through the bicoronal incision, which is the usual approach to major orbital reconstruction. Thus, this article aimed to describe a patient with a pure medial orbital wall fracture, and it was causing diplopia and enophthalmos. The orbital fracture was treated using autogenous bone graft from calvarial bone. The authors show a follow-up of 12 months, with facial symmetry and without diplopia and enophthalmos. In addition, a computed tomography scan shows excellent bone healing at the anterior and posterior parts of the medial orbital wall reconstruction.

La diplopía que bajó de un cocotero: trauma por coco / Diplopia falling from one coconut tree: trauma by coco

Se presenta el caso clínico de un paciente a quien la caída de un coco y el consecuente traumatismo sobre su cara. produjo una fractura del piso orbitario con atrapamiento muscular, diplopía no diagnosticada y confundida con un aneurisma cerebral. Se hacen consideraciones sobre este tipo de accidentes en playas arenosas donde abundan cocoteros. La comparación de su frecuencia con ataques de tiburón y acerca de cómo un artículo médico puede ser tergiversado por el autor y convertido en noticia de prensa como para obtener el Ig Premio Nobel de Medicina con base a "una investigación que no puede o no debe ser duplicada" logros que primero hacen reir y después pensar e intertan celebrar lo inusual, imaginativo y espolear el interés por la ciencia, la medicina y la tecnología

We present the clinical case of a patient who, after being hit the face by a falling coconut, with consequent trauma to his face, fractured his orbital floor with muscle entrapment and undiagnosed diplopia which was mistaken for a brain aneurysm. We make considerations about such accidents on sandy beaches where coconut trees abound, compare its frequency with shark attacks and discuss how a medical article can be misrepresented by its autor and become news in order to obtain the nomination for the Ig Nobel Prize for medicine based on "research that cannot or should not be duplicated; achievements that first make you laugh and then make you and try to celebrate the unusual, imaginative and spur interest in science, medicine and technology

Metástasis enoftalmiantes de la órbita: una excepción a la regla / Enophthalmos due to orbit metastasis: an exception to the rule

De los tipos de cáncer que metastatizan la órbita, el de la mama, el pulmon y la próstata ocupa un lugar preeminente. En ocasiones el diagnóstico del tumor primario permanece elusivo a pesar de una evaluación exhaustiva. La mayoría de las veces producen proptosis ocular y son fácilmente detectados. En otras producen todo lo contrario, enoftalmía, haciendo entonces el problema menos aparente y el diagnóstico elusivo. La metástasis mamaria enoftalmiante de la órbita es un raro evento y debe ser considerada como un diagnóstico diferencial inicial en mujeres maduras con enoftalmía no traumática. En elpresente trabajo presentamos una serie de ocho pacientes con carcimona lobulillar infiltrante y escirroso de la órbita productor de enoftalmía, describimos sus características clínicas y hacemos notar su mal pronóstico vital

Of the types of cancer that metastatize the orbit, the breast, lung and prostate occupy a pre-eminet place. Sometimes the diagnosis of the primary tumor remains elusive despite a thorough assessment. Most of the times produce eye proptosis and are easily detected. In other cases they produce just the oppsite, enophthalmos, then doing the problem least apparent and the diagnosis elusive. Enopthalmos and breast metastasis are a rare event and should be considered as an initial differential diagnosis in especially in mature women with non-traumatic enophthalmos. In this paper we present a series of eight patients with infiltrating lobulillar and scirrous carcinoma of the orbit producing enophthalmos, we described their clinical features and do note their poor vital prognosis

Calcium phosphate cement in orbital reconstructions.

Treatment of facial trauma sequelae is a complex and challenging process. There is still controversy over suitable materials for orbital wall reconstruction. This study evaluated calcium phosphate cement (CPC) implants manufactured by rapid prototyping in the repair of orbital wall defects secondary to trauma. Computed tomographic scans of 5 patients were used for surgery planning and production of CPC implants. Implants were used to restore orbital wall anatomy, ocular alignment, and facial contour. Benefits resulting from the use of implants, such as a reduced operating time, patient response to biomaterial implantation, biomaterial integrity and stability, and patient satisfaction with treatment, were analyzed qualitatively. Our results suggest that CPC is an effective and safe material for orbital reconstruction because of its biocompatibility and easy production and placement.