phenylephrine-hydrochloride and Optic-Nerve-Diseases

Frontobasal fractures occur in up to 24% of head injuries and often require a multidisciplinary approach. Besides the common bone fractures, the complex anatomy can cause damage to the sense of vision and smell. Further possibly lethal complications such as cerebrospinal fluid leak followed by meningitis or internal carotid bleeding can follow. Diagnostic and treatment options are reviewed with a focus on the endoscopic endonasal approach.

Topics: Carotid Artery Injuries; Carotid Artery, Internal; Cerebrospinal Fluid Leak; Cranial Nerve Injuries; Facial Bones; Frontal Sinus; Humans; Natural Orifice Endoscopic Surgery; Nose; Olfaction Disorders; Optic Nerve Diseases; Skull Fracture, Basilar

Topics: Eye Diseases; Humans; Neurosurgical Procedures; Nose; Ophthalmologic Surgical Procedures; Optic Nerve Diseases

To report a patient with traumatic orbital apex syndrome, who fully recovered visual and extraocular function following surgery. A 34-year-old male presented with visual and extraocular function disorders in his right eye following traffic accident, who was referred to our hospital 5 weeks after accident. The patient underwent endoscopic optic nerve and orbital apex decompression with topical and systemic application of nerve growth factor and steroids after a failed trial of mega-dose intravenous corticosteroids. Visual acuity improved to 20/20 at 3 weeks after surgery, and the right eye globe moved in most directions at 1 year, which remained stable at 3 years. Surgical decompression should be considered even when symptoms have been present for over a month.

Topics: Adult; Decompression, Surgical; Eye Injuries; Follow-Up Studies; Humans; Male; Natural Orifice Endoscopic Surgery; Nose; Optic Nerve Diseases; Orbit; Syndrome; Time Factors; Tomography, X-Ray Computed; Visual Acuity; Visual Fields

Topics: Dacryocystitis; Endoscopy; Humans; Nose; Nose Diseases; Optic Nerve Diseases

To evaluate the safety and efficacy of transnasal orbital decompression for severe Graves' ophthalmopathy.. Retrospective noncomparative case series with extended clinical follow-up.. Seventy-eight consecutive subjects who were operated on for compressive optic neuropathy with loss of visual acuity or visual field defects after failure of medical and radiation therapy.. Strictly transnasal, endoscopic-controlled bilateral decompression of the medial and inferomedial wall of the orbit.. Preoperative and postoperative examination, including vision, Hertel exophthalmometry, ocular motility, visual fields, Goldmann perimetry, and notification of complications, intranasal signs of inflammation, and subjects' assessment of the procedure.. One hundred forty-five endonasal decompressions were performed on 78 subjects (63 women, 15 men, 52.2 +/- 10.3 years) during a 10-year period. Sixty five patients were bilaterally operated on; 15 required only unilateral decompression. Four of 78 needed repeat surgery. Visual acuity increased from a preoperative average of 0.50 +/- 0.27 (range, 0.01-1.25) to 0.75 +/- 0.21 (range, 0.01-1.25) postoperatively. An average reduction of proptosis of 3.94 +/- 2.73 mm (range, -1.0-11.0 mm) was achieved with a mean preoperative Hertel measurement of 22.19 +/- 3.13 mm (range, 15-34 mm). Ocular motility was corrected by recession of the medial rectus muscle in 58 of 78 cases. Twenty-six of these 58 cases were simultaneously operated on in the same surgical session immediately after the transnasal decompression, and the others after a period of 2 to 3 months.. The transnasal orbital decompression procedure improved vision, decreased proptosis in a range comparable to more invasive techniques, and had favorable cosmetic results without additional disfiguration by scars. Morbidity was far less than with other approaches. Postdecompression strabismus was successfully managed by recession of both medial orbital muscles in the same surgical session.

Topics: Adult; Aged; Aged, 80 and over; Decompression, Surgical; Exophthalmos; Eye Movements; Female; Follow-Up Studies; Graves Disease; Humans; Male; Middle Aged; Nose; Optic Nerve Diseases; Orbit; Retrospective Studies; Safety; Visual Acuity; Visual Field Tests; Visual Fields

Surgical decompression of the optic canal is indicated in patients with traumatic optic neuropathy who fail to respond to corticosteroids. Traditional surgical approaches to the orbital apex have been effective in achieving optic nerve decompression but require either a craniotomy, provide limited exposure with late identification and protection of the optic nerve, or require external incisions. The combined transconjunctival/intranasal endoscopic approach to the optic canal offers sufficient exposure, allows early identification and protection of the optic nerve, provides space for the use of multiple surgical instruments, obviates a craniotomy and external incisions, and can be performed quickly with minimal morbidity. The technique of combined transconjunctival/intranasal endoscopic optic nerve decompression will be described and the experience with nine cases will be presented.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Blood Loss, Surgical; Conjunctiva; Craniotomy; Electrocoagulation; Endoscopes; Endoscopy; Female; Humans; Lacrimal Apparatus; Male; Middle Aged; Nerve Compression Syndromes; Nose; Optic Nerve; Optic Nerve Diseases; Optic Nerve Injuries; Orbit; Retrospective Studies; Skull Fractures; Sphenoid Bone; Sphenoid Sinus; Time Factors; Turbinates; Vision Disorders

A new endonasal microsurgical technique for decompression after traumatic optic neuropathy is presented. Compared to the external transethmoidal, the transfrontal or the pterional approach, the main benefit of this method is the superb stereoscopic vision of the medial aspect of the optic canal. The nerve is approached from a 60 degree to 90 degree angle and continuous suction irrigation allows for safe removal of the bony shell. This surgery is done via the endonasal route and therefore has fewer serious complications compared to intracranial, extradural or intradural approaches. Additional trauma due to retraction of the brain is avoided. The anterior ethmoidal cells and the nasofrontal duct remain untouched, avoiding late mucocele formation.

Topics: Endoscopy; Humans; Microsurgery; Nerve Compression Syndromes; Nose; Optic Nerve Diseases; Orbital Fractures

An unusual case is described of multiple congenital facial anomalies, including proboscis lateralis, microphthalmos, and cystic degeneration of the optic nerve. This child's condition did not seem to fall into a previously described classification.

Topics: Adult; Cysts; Female; Humans; Infant; Infant, Newborn; Male; Microphthalmos; Nose; Optic Nerve Diseases; Orbital Diseases

Topics: Disease; Eye; Neoplasms; Nose; Optic Nerve; Optic Nerve Diseases; Wounds and Injuries

Topics: Disease; Eye; Humans; Myelitis; Nose; Optic Nerve; Optic Nerve Diseases

Topics: Avitaminosis; Disease; Eye; Humans; Nose; Optic Nerve; Optic Nerve Diseases; Pharynx; Xerophthalmia