Ophthalmologic Outcomes in Zygomaticomaxillary Fracture Repair With and Without Orbital Floor Repair.

Introduction: Orbital floor (OF) fractures accompany all zygomaticomaxillary complex (ZMC) fractures, but guidelines for repair of OF fractures in this setting are unclear. Objectives: To compare ophthalmologic outcomes of ZMC repair with and without concurrent OF repair. Methods: We retrospectively reviewed patients undergoing ZMC fracture repair with and without OF repair between 2016 and 2018. Patients were reviewed for demographics, preinjury characteristics, and ophthalmologic outcomes. Results: Of 61 total patients, 32 underwent concomitant OF repair while the remaining 29 underwent ZMC repair alone. The OF repair group had increased OF fracture size, displacement in the coronal plane, and malar eminence displacement (p < 0.05). Eight patients in the OF repair group had postoperative diplopia compared with no patients in the group without OF repair (p < 0.05). Conclusion: Retrospective analysis of ZMC fracture repair without and with OF repair did not reveal a significant difference in short-term ophthalmologic outcomes while controlling for fracture size.

Skull base ligamentous mineralisation: evaluation using computed tomography and a review of the clinical relevance.

OBJECTIVES: To determine the frequency, morphologic and demographic characteristics, and clinical relevance of the mineralisation of six skull base ligaments (interclinoid, caroticoclinoid, petrosphenoid, posterior petroclinoid, pterygospinous, and pterygoalar). METHODS: This is a retrospective review of 240 CT scans of the paranasal sinuses (ages 6-80 years). A limited systematic review was performed primarily using Embase and Medline databases. RESULTS: Ligamentous mineralisation was well delineated on CT and occurred at ≥ 1 location in 58.3% of patients. There was a nonsignificant trend towards a greater incidence with advancing age. The interclinoid and posterior petroclinoid ligaments were most commonly mineralised (22.1% and 18.3%, respectively); the petrosphenoid and pterygoalar ligaments were least frequently mineralised (10.8% and 6.3%, respectively). The mean age of patients with posterior petroclinoid mineralisation was significantly greater than those with interclinoid and petrosphenoid mineralisation and was not seen in patients aged 6-20 years. The literature review highlighted the clinically relevant potential for mineralised ligaments to cause barriers to surgical access (e.g. to the foramen ovale), increase the risk of neurovascular injury during surgery at the skull base (e.g. during anterior clinoidectomy), and predispose to neural impingement. CONCLUSIONS: Skull base ligamentous mineralisation is commonly encountered on CT imaging. Given the potentially significant clinical implications, an understanding of the morphological appearances is of importance to those planning interventions at the skull base. To the authors' knowledge, this study is the first to comprehensively evaluate such a wide range of skull base ligaments using CT. For some ligaments, the incidence on CT has not been previously described.

Signs in Neuroradiology: A Pictorial Review.

One of the major problems radiologists face in everyday practice is to decide the correct diagnosis, or at least narrow down the list of possibilities. In this context, indicative evidences (signs) are useful to recognize pathologies, and also to narrow the list of differential diagnoses. Despite classically being described for a single disease, or a closely related family of disorders, most indications are not restricted exclusively to their traditional definition. Therefore, using signs for prognosis requires knowledge of the mechanism of their appearance, and which pathologies they are observed in. In this study, we demonstrate some of the more common and useful neuroradiologic signs with relevant images, and discuss their use in differential diagnosis.