Mehmet Manisali

Orbital emphysema – the need for surgical intervention ☆

INTRODUCTION Orbital emphysema is a recognised complication of fractures of the orbit and only rarely poses a threat to vision. PATIENTS AND METHODS We present three patients with threatened vision secondary to orbital emphysema that required an immediate surgical decompression. RESULTS Visual function was preserved in all three patients. CONCLUSION Clinical awareness of pneumo-orbitism is vital as immediate orbital decompression may be necessary to preserve visual function.

Silent sinus syndrome

Silent sinus syndrome is defined as a spontaneous and progressive enophthalmos and hypoglobus with hypoplasia of the maxillary sinus and resorption of the orbital floor. It is caused by atelectasis of the maxillary sinus in the presence of ipsilateral chronic hypoventilation of the sinus. The problem may be idiopathic, but the term is now also used to describe cases that follow operation or trauma. We describe three cases, each with a different aetiology, and discuss the clinical and radiographic evaluation of the condition, theories regarding its pathophysiology, and surgical correction.

Retrospective analysis of nasal soft tissue profile changes with maxillary surgery.

PURPOSE The aim of this study was to analyze the changes in the position of the nasal and labial soft tissue profile of patients undergoing bimaxillary orthognathic surgery, with special emphasis on the effect on the nasal tip projection. MATERIALS AND METHODS The lateral cephalometric radiographs of 27 consecutive patients (16 female and 11 male patients; mean age, 22 years) who had undergone maxillary advancement and mandibular setback were studied. The pretreatment and end-of-treatment lateral cephalometric radiographs were selected. The pretreatment and end-of-treatment radiographs were superimposed on the sella-nasion plane, and the case was only included if there had been no change in sella-nasion length (ie, no growth). Analyses of Pearson correlation coefficient and stepwise linear regression tests were used to compare the cephalometric measurements at the beginning and at the end of treatment. Paired-sample t tests were also performed to analyze changes in nasolabial angle (NLA) and columella-lobular angle (CLA). RESULTS The correlations between vertical movement of nasal tip, A-point, and maxillary incisal tip were important. Although there was an important correlation between nasal and incisal tip, interestingly, there was no correlation between nasal tip and A-point in horizontal movement. According to stepwise linear regression analysis, the best model for horizontal movement of nasal tip was as follows: Nasal anteroposterior movement = 0.241 + 0.188 × Incisal tip anteroposterior movement + 0.153 × Incisal tip superoinferior movement. For vertical movement of nasal tip, the best model was as follows: Nasal superoinferior movement= -1.117 + 0.399 × Incisal tip superoinferior movement + 0.323 × A-point anteroposterior movement. There was no significant relation in angular measurements of NLA and CLA before and after treatment. CONCLUSION The results of our study suggest that both horizontal and vertical movements of nasal tip were related to incisal tip and A-point movements; however, angular changes in CLA and NLA did not affect the nasal tip.

A cadaveric study of the cranio-orbital foramen and its significance in orbital surgery.

Background: The cranio-orbital foramen is an osseous anatomical landmark located adjacent to the superior orbital fissure. It is a potential source of hemorrhage during deep orbital dissection because it is the location of an anastomosis between the lacrimal artery and the middle meningeal artery. The purpose of this study was to determine the incidence, location, and number of cranio-orbital foramina within a Caucasian population. Methods: Forty-seven orbits from 24 formalin-fixed Caucasian cadavers were exenterated. If the cranio-orbital foramen was present within an orbit, its distance from the frontozygomatic suture, supraorbital notch, and Whitnalls tubercle was measured. The gender variations and asymmetric presentations of foramina were studied. Results: The cranio-orbital foramen was present in 26 orbits (55 percent). The average distance from the frontozygomatic suture, supraorbital notch, and Whitnalls tubercle was 30.92 mm (±4.37 mm), 37.77 mm (±3.55 ±), and 29.69 mm (±3.89 mm), respectively. In nine orbits (19 percent), an additional accessory cranio-orbital foramen was identified. The average distance from the frontozygomatic suture, supraorbital notch, and Whitnalls tubercle was 28.56 mm (±5.00 mm), 32.64 mm (±3.20 mm), and 27.78 mm (±5.24 mm), respectively. Conclusion: The presence of the cranio-orbital foramen and other accessory foramina represents a source of hemorrhage that surgeons should be aware of when operating along the lateral orbital wall.

REVIEW OF NASAL CHANGES WITH MAXILLARY ORTHOGNATHIC SURGERY

This article reviews the literature on nasal changes with maxillary orthognathic surgery. Understanding such changes is vital for surgical planning and for obtaining appropriate informed consent, and there are medico-legal implications. During orthognathic surgical planning a prediction of the effects of the different surgical movements is possible and this forms part of the basis of the planning stage. The predicted changes need to be identified and their desirability or not for each individual patient determined. Some techniques for managing undesirable nasal changes are discussed, including adjunct measures to minimize these potential effects (e.g. cinch sutures), and additional surgical procedures to manage the undesired nasal changes once they are produced.

Unilateral parotid mass as an unusual presentation of lupus erythematosus profundus

Unilateral parotid swelling or mass in the lupus erythematosus profundus person is a rare or under reported clinical scenario in existing literature. This is a case of a 49-year-old man with such presentation for whom medical management of the underlying condition led to the resolution of the swelling. Lupus erythematosus profundus must be considered as a differential diagnosis of unexplained parotid swelling to prevent incorrect diagnosis, unnecessary surgical intervention (eg, parotidectomy) and the morbidity that comes with it (eg, facial nerve weakness, Freys syndrome etc).

Mesiodens: An Unusual Cause of a Facial Sinus

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