Post-operative orbital haematomas over a 12-year period. A description of three cases among 280 orbital procedures.

PURPOSE: To evaluate the incidence of orbital haematoma requiring surgical treatment following procedures including fracture repairs and orbital osteotomies over a 12-year period and to discuss their management. METHODS: The records of all the patients who underwent a procedure involving the orbits from 1998 to 2011 were reviewed for evidence of post-operative haematomas. Medical data including clinical presentation, time between diagnosis and treatment, management and subsequent outcome were collected. RESULTS: 280 patients were included, 257 procedures for orbital or zygomato orbital fractures and 23 osteotomies for dysthyroid orbitopathy or malunited orbital fractures. Three cases (1.07%) of post-operative haematomas were observed as follows: 2/257 orbital fractures (0.77%) and 1/23 osteotomies (4.34%). All cases occurred in the early post-operative period of less than 6 h. No spontaneous loss of vision or pain was described by patients. All could be operated on as soon as the diagnosis was established; no CT-scans were required. Orbital drainage was successfully performed in all cases. CONCLUSION: Post-operative orbital haematomas are uncommon complications. Diagnosis is based on a clinical examination, including pain, proptosis and alteration in visual acuity. Surgical treatment should be undertaken immediately following diagnosis.

Transoral approach for Stensen's duct lithiasis.

INTRODUCTION: Extracorporeal lithotripsy (ECL) and interventional sialendoscopy are the classical treatments for Stensen's duct salivary stones, but some cases cannot be treated using these techniques. Another technique is now available, transoral Stensen's duct approach. TECHNICAL NOTE: Transoral Stensen's duct approach can be performed under local anesthesia. The exact location of Stensen's duct is confirmed after introduction of a 0000 probe (Storz(®) ) in the duct that is stopped by the impacted stone. This may be confirmed on preoperative noninjected CT-scan. During this approach, the surgeon passes the mucosa and buccinator muscle, tracts the buccal fat pad laterally, and then finds the duct. During this procedure one must avoid harming the superior buccal branch of the facial nerve by dissecting gently close to the duct. When the duct is found, the stone is easily removed with a ductal lateral incision or better 12 o'clock ductal incision. DISCUSSION: Transoral approach of Stensen's duct salivary lithiasis is an easy, fast, and inexpensive technique that can be recommended in case sialendoscopy surgery fails. Morbidity for patients is much lower than that of classical parotidectomy.