Image guidance removal of a foreign body in the orbital apex

Endoscopic transnasal approach to remove an intraorbital bullet: systematic review and case report

Introduction

Intraorbital foreign bodies (IOFBs) represent a clinical challenge: surgical management can be controversial and different strategies have been proposed. When removal is recommended, depending on the location and nature of the IOFB both external and endoscopic approaches have been proposed, with significantly different surgical corridors to the orbit and different morbidities.

Methods

We performed a literature review of cases of IOFBs that received exclusive endoscopic transnasal surgical treatment to evaluate the role of this surgery in these occurrences. We also present a case of an intraorbital intraconal bullet that was successfully removed using an endoscopic transnasal approach with good outcomes in terms of ocular motility and visual acuity.

Results

A limited number of cases of IOFBs have been treated with an exclusive endoscopic transnasal approach. When in the medial compartment, this approach appears to be safe and effective. In our case, two months after surgery the patient showed complete recovery with no significant long-term sequelae.

Conclusions

When feasible, an endoscopic transnasal approach for intraorbital foreign bodies represents a valid surgical technique with optimal outcomes and satisfactory recovery.

Sino-orbital foreign body caused by a slingshot injury in a young boy

Slingshots or hand catapults, historically used as a military or hunting weapon, are common toys among children and young teenagers. Their use can be dangerous as a strike to the eye or orbit can result in significant injuries including blindness. We describe a rare case of a sino-orbital foreign body caused by a slingshot injury in a young boy. The case was managed by a multidisciplinary team involving ear, nose and throat, ophthalmology and paediatrics, and the foreign body of a metal ball bearing was removed using an endoscopic transnasal approach. Although the patient made a good recovery, the case highlights the danger of slingshot devices misused by children.

Concurrent impalement of two orbits in a child: A case report

Introduction

Orbital impalement is a serious and potentially life-threatening trauma if the brain or vessels at the base of the skull are affected. The authors report the results and aftermath of the management of a case of post-traumatic retention of an intra-orbital metallic foreign body.

Case presentation

A 5-year-old boy was struck by a motorcycle while crossing a road. His head struck the handlebars of the motorcycle with a left facial-orbital impact point. The examination revealed a foreign body penetrating the orbit at the level of the left upper eyelid with limitation of adduction. The radiological assessment confirmed the intra-orbital presence of the foreign body with probable fracture of the inner wall of the eyeball. Surgical exploration through the palpebral wound revealed an intact eyeball and an incarceration of the medial rectus muscle by a fracture of the internal wall. After delicate and meticulous removal of the foreign body, hemostasis was ensured and the wound was sutured. The evolution was satisfactory, without sequelae or visual prejudice.

Discussion

Imaging, i.e. a CT scan and a standard X-ray, is necessary to evaluate the lesions before adapting a therapeutic attitude. The choice of the approach for extraction must meet two cardinal concerns: extraction of the foreign body and minimal dissection or manipulation of the noble structures of the eye and its adnexa.

Conclusion

Intra-orbital foreign bodies are rare but potentially serious. The type of the foreign substance, its intra-orbital extension and related lesions, as well as the extraction process, all influence the prognosis.

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Orbital impalements are rare but potentially serious.

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It is exceptional to find impalement concerning the 2 orbits without ocular damage.

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It requires careful management to avoid damage to the noble structures and frequent postoperative complications.

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The type of the foreign substance, its intra-orbital extension, and related lesions, as well as the extraction process, all influence the prognosis.

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There is a need for an alternative means of exploration that can replace MRI to evaluate soft tissue lesions.

Computer-assisted navigation in orbitofacial surgery

The purpose of this systematic review is to investigate the most common indications, treatment, and outcomes of computer-assisted surgery (CAS) in ophthalmological practice. CAS has evolved over the years from a neurosurgical tool to maxillofacial as well as an instrument to orbitofacial surgeries. A detailed and organized scrutiny in relevant electronic databases, journals, and bibliographies of the cited articles was carried out. Clinical studies with a minimum of two study cases were included. Navigation surgery, posttraumatic orbital reconstruction, computer-assisted orbital surgery, image-guided orbital decompression, and optic canal decompression (OCD) were the areas of interest. The search generated 42 articles describing the use of navigation in facial surgery: 22 on orbital reconstructions, 5 related to lacrimal sac surgery, 4 on orbital decompression, 2 articles each on intraorbital foreign body and intraorbital tumors, 2 on faciomaxillary surgeries, 3 on cranial surgery, and 2 articles on navigation-guided OCD in traumatic optic neuropathy. In general, CAS is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were related to trauma. Treatment of complex orbital fractures was greatly improved by the use of CAS compared with empirically treated control groups. CAS seems to add a favourable potential to the surgical armamentarium. Planning details of the surgical approach in a three-dimensional virtual environment and execution with real-time guidance can help in considerable enhancement of precision. Financial investments and steep learning curve are the main hindrances to its popularity.

Two Soft Contact Lenses Retained in the Superior Fornix for 15 Years in a Patient With Unique Orbital Anatomy

A 70-year-old white woman presented to her ophthalmologist with bacterial conjunctivitis resistant to treatment. The relationship between the patient's globe and superior orbital rim prompted high clinical suspicion of an occult foreign body as the cause. The following article describes the office visits preceding the discovery of two adhered soft contact lenses lodged in the superior fornix of the right eye that had been hidden for 15 years. We discuss the role her unique orbital anatomy played in successfully concealing these foreign bodies for over a decade. In addition, we present an algorithm to practice when an occult foreign body is suspected, which includes effective clinical techniques.

Removal of an Unusual Neglected Foreign Body in Infratemporal Region Using Navigation

A 19-year-old male presented with complaint of a bluish mass in the hard palate since 3 months. The patient had a history of trauma 8 years back in the left zygomatic area with a pen. It was lodged in the wound and removed at that time. Computed tomography scan was revealed a linear heterogenous dense structure extending from left infratemporal fossa to oral cavity, traversing through left maxillary sinus, with bone defect seen in lateral and medial wall of maxilla, and in the hard palate, most likely a neglected foreign body. The foreign body was removed by navigation-assisted endoscopic surgery and the palatal perforation repaired using local rotation flap. There were no intraoperative or postoperative complications. Navigation-guided removal of foreign body in proximity to vital structures, in the infratemporal region, is a valuable option with minimal morbidity.

Image-Guided Endoscopic Combined With Deep Lateral Orbitotomy Removal of a Small Foreign Body at the Deep Lateral Orbital Apex

To remove a small foreign body located at the deep orbit apex presents an extremely challenging problem. Small foreign bodies located in shallow lateral orbital and nasal orbital apex have been reported successfully removing in endoscopic surgery with the help of surgical navigation system. Here, the authors first describe successfully removal of a small foreign body at the deep lateral orbital apex with the help of image-guided endoscopic. A 56-year-old man presented with blurred vision and eye movement pain of the left eye while grinding metal 4 days prior to admission. A computed tomography scan showed a small metallic foreign body lodged in the deep lateral orbital apex. The foreign body was smoothly removed without any complications by endoscopic surgery under the help of surgical navigation system combined with deep lateral orbitotomy. Eye movement pain was disappeared and visual acuity was improved after surgery.

Image-guided surgical navigation for removal of foreign bodies in the deep maxillofacial region

PURPOSE

Most trauma surgeons encounter numerous penetrating injuries. Some foreign bodies can cause pain, infection, and discomfort to the patient. Serious functional disorders also are likely to occur. Foreign bodies in critical areas must be removed. This report describes the use of image-guided technology for the removal of foreign bodies deep in the maxillofacial region.

PATIENTS AND METHODS

From 2008 through 2011, 5 patients with foreign bodies in the maxillofacial area underwent image-guided removal at the authors' department. The STN navigation system (Stryker-Leibinger, Freiburg, Germany) was used for surgical planning and intraoperative navigation. Preoperatively, computerized tomography and digital subtraction angiography were used to create 3-dimensional views of the region to aid surgeons in more accurately defining the spatial location of the foreign object. During surgery, the foreign objects and surgical instruments were visualized on the screen.

RESULTS

In all 5 cases, the foreign bodies were removed by minimally invasive access without any complications. Surgical time was approximately 40% shorter compared with the conventional technique of not using image-guided navigation. A 1-year postoperative evaluation showed that the patients' complaints and symptoms had resolved, function was restored, and esthetics were remarkably improved.

CONCLUSION

Navigation-guided removal of foreign bodies in the complex, deep maxillofacial region in proximity to vital areas can be regarded an ideal and valuable option for these potentially complicated procedures.