• The Korean Journal of Pain
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• 제19권1호
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• pp.104-106
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• 2006

Tolosa-Hunt syndrome is a rare self-limiting disease that's characterized by painful ophthalmoplegia. It has a relapsing and remitting course, and the pain responds promptly to systemic corticosteroid therapy. Yet it is diagnosed by the exclusion of other major causes involving the superior orbital fissure or cavernous sinus, including trauma, neoplasm, aneurysm and inflammation. Further, the associated ophthalmoplegia may follow days to weeks after the onset of orbital or hemifacial pain. Hence, this condition is often misdiagnosed as atypical facial pain, and so improper management could result in unnecessary suffering of the patient. The following case describes a patient suffering with hemifacial pain associated with ipsilateral abducens nerve palsy, which was evident 2 weeks after the onset of pain, and this was misdiagnosed as trigeminal neuralgia and atypical facial pain.

• Archives of Craniofacial Surgery
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• 제21권6호
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• pp.345-350
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• 2020

Background: This study evaluated the efficacy of the endoscopic medial orbital wall repair by comparing it with the conventional transcaruncular method. This surgical approach differs from the established endoscopic technique in that we push the mesh inside the orbit rather than placing it over the defect. Methods: We retrospectively reviewed 40 patients with isolated medial orbital blowout fractures who underwent medial orbital wall reconstruction. Twenty-six patients underwent endoscopic repair, and 14 patients underwent external repair. All patients had preoperative computed tomography scans taken to determine the defect size. Pre- and postoperative exophthalmometry, operation time, the existence of diplopia, and pain were evaluated and compared between the two methods. We present a case showing our procedure. Results: The operation time was significantly shorter in the endoscopic group (44.7 minutes vs. 73.9 minutes, p= 0.035). The preoperative defect size, enophthalmos correction rate, and pain did not significantly differ between the two groups. All patients with preoperative diplopia, eyeball movement limitation, or enophthalmos had their symptoms resolved, except for one patient who had preexisting strabismus. Conclusion: This study demonstrates that endoscopic medial orbital wall repair is not inferior to the transcaruncular method. The endoscopic approach seems to reduce the operation time, probably because the dissection process is shorter, and no wound repair is needed. Compared to the previous endoscopic method, our method is not complicated, and is more physiological. Larger scale studies should be performed for validation.

• Archives of Craniofacial Surgery
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• 제25권1호
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• pp.27-30
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• 2024

Fungal sinusitis is relatively rare, but it has become more common in recent years. When fungal sinusitis invades the orbit, it can cause proptosis, chemosis, ophthalmoplegia, retroorbital pain, and vision impairment. We present a case of an extensive orbital floor defect due to invasive fungal sinusitis. A 62-year-old man with hypertension and a history of lung adenocarcinoma, presented with right-side facial pain and swelling. On admission, the serum glucose level was 347 mg/dL, and hemoglobin A1c was 11.4%. A computed tomography scan and a Waters' view X-ray showed right maxillary sinusitis with an orbital floor defect. On hospital day 3, functional endoscopic sinus surgery was performed by the otorhinolaryngology team, and an aspergilloma in necrotic inflammatory exudate obtained during exploration. On hospital day 7, orbital floor reconstruction with a Medpor Titan surgical implant was done. In principle, the management of invasive sino-orbital fungal infection often begins with surgical debridement and local irrigation with an antifungal agent. Exceptionally, in this case, debridement and immediate orbital floor reconstruction were performed to prevent enophthalmos caused by the extensive orbital floor defect. The patient underwent orbital floor reconstruction and received intravenous and oral voriconazole. Despite orbital invasion, there were no ophthalmic symptoms or sequelae.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제46권6호
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• pp.428-434
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• 2020

Orbital floor blowout fractures can result in a variety of signs and symptoms depending on the severity of the bone defect. Large defects often result in enophthalmos and restriction of ocular movement; yet the timing of surgery can be delayed up to two weeks with good functional outcomes. In contrast, an orbital trapdoor defect with entrapment of the inferior rectus muscle usually elicits pain with marked restriction of the upward gaze and activation of the oculocardiac reflex without significant dystopia or enophthalmos. When autonomic cardiac derangement is diagnosed along with an orbital floor fracture, it has been suggested that the fracture should be treated immediately. Otherwise, it will result in continued hemodynamic instability and muscular injury and may require a second surgery. This article reports the management of an unusual presentation of a trapdoor blowout orbital floor fracture surgery with oculocardiac response in an adult, with emphasis on its pathophysiology, management, and differential diagnosis.

• The Korean Journal of Pain
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• 제22권3호
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• pp.241-244
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• 2009

Retrobulbar hematoma can arise from orbital trauma and periorbital or intraorbital procedures, and it can result in several morbidities including vision loss. Making the immediate diagnosis and performing decompression of the retrobulbar hematoma are crucial for preventing serious morbidities such as permanent vision loss. We present here a case of temporary vision loss that was due to iatrogenic retrobulbar hematoma in a patient who received infraorbital nerve block for the treatment of trigeminal neuralgia. A 70-year-old woman with trigeminal neuralgia was treated with infraorbital nerve block. Just after the procedure she experienced acute periorbital swelling, proptosis and worsening visual acuity. Immediate orbital computed tomography was done, and this revealed a retrobulbar hematoma. The patient underwent lateral canthotomy with cantholysis and administration of dexamethasone and mannitol. Improvement of visual acuity began 3 hours after these procedures. Her visual acuity was greatly improved 12 days after admission.

• The Korean Journal of Pain
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• 제2권2호
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• pp.198-202
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• 1989

The Tolosa-Hunt syndrome is one of the rare disease with facial, especially peri-orbital pain, and ophthalomoplegia associated mostly with granulomatous lesions in cavernous sinus or superior orbital fissure. In addition to ophthalmoplegia by multiple cranial nerve involvement, the sympathetic nervous system may also be involved leading to Horner's syndrome. A typical Tolosa-Hunt syndrome has a neuro-radiologic finding of an increased density in the involved region, and a laboratory finding of an elevated ESR, as well as a dramatic response to systemic corticosteroid therapy. An unusual case of the Tolosa-Hunt syndrome with normal radiologic and laboratory findings, unresponsive to systemic corticosteroid, and some response of pain relief to a stellate ganglion block, is presented.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.489-491
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• 2010

Purpose: Retrobulbar hemorrhage is a rare complication followed by blepharoplasty, trauma, orbital reconstruction, and so on. Most of the cases occur within 24 hours, half of them in the first 6 hours. Some authors have reported delayed retrobulbar hemorrhage after blepharoplasty and trauma within 1 day to 9 days. However, there have been few reports of delayed retrobulbar hemorrhage resulting from the complication of orbital reconstruction. Methods: A 22-year-old male underwent orbital floor reconstruction due to the orbital floor fracture. In 84 hours after the surgery, he complained sudden onset orbital pain and decreased visual acuity immediately after defecation. Intraocular pressure was unmeasurable due to the swelling at that time. Emergency computed tomography was performed. Results: Computed tomography revealed subperiosteal hematoma on inferior orbital wall extended to the apex. Emergency decompressive surgery was performed within 1 hour. After evacuation of hematoma, orbital symptom was improved and visual acuity was restored. Conclusion: Delayed retrobulbar hemorrhage is rare but vision-threatening. Therefore early diagnosis and treatment of delayed retrobulbar hemorrhage is thought to be crucial. The cause of delayed hemorrhage was not clear, however, valsalva maneuver might be the cause of hemorrhage.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• 제16권1호
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• pp.220-225
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• 2003

The Tolosa-Hunt syndrome is a symptom complex with unilateral painful ophthalmoplegia associated with retro-orbital pain, proptosis and Ⅲ, Ⅳ, Ⅴ-1, Ⅵ cranial nerves palsy due to nonspecific granulomatous inflammation in the superior orbital fissure or cavernous sinus. We experienced a 50 years old female patient with Tolosa-Hunt syndrome who had several clinical signs and symptoms such as ocular pain, headache, sensory loss of face, diplopia, and visual disturbance. In the point of Differentiation of Syndrome(辨證). this subject was diagnosed as Deficiency of yin in liver and kidney(肝腎陰虛), and was administrated with Yangyeummyungmoktang-Gamibang. After treatment of acupuncture and herbal medicine above symptoms were improved.

• Journal of Korean Neurosurgical Society
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• 제44권3호
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• pp.156-158
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• 2008

Intraorbital hemorrhage is a rare clinical condition caused by orbital trauma, surgery around the orbit, intraorbital vascular abnormalities, and neoplasm. It was reported to occur spontaneously without any known causes and in association with orbital pseudotumor in a very few cases. A 59-year-old, female patient admitted with sudden onset of severe exophthalmos and pain on the left eye. Orbital CT and MR imaging suggested hemorrhage in the upper part of retrobulbar area of the left orbit. Cerebral angiography was taken to rule out any possible vascular abnormalities. On the left carotid cerebral angiography, the run-off of the distal ophthalmic artery was not seen and the engorgement of the supraophthalmic artery was noted. Systemic administration of corticosteroid did not improve the clinical status and craniectomy was done and retrobulbar hematoma was removed, and the clinical symptoms and signs were improved. Authors report a case of spontaneous intraorbital hemorrhage with the clinical features similar to those of orbital pseudotumor, requiring surgical decompression.

• Pediatric Infection and Vaccine
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• 제12권2호
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• pp.178-185
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• 2005

Purpose : Ocular adnexal and orbital infections are broadly divided into preseptal(periorbital) and postseptal(orbital) cellulitis by orbital septum. In this study, we investigated the difference between periorbital and orbital cellulitis regarding their pathogenesis, clinical manifestations, treatments, and prognosis. Methods : We reviewed medical records of 50 cases who were hospitalized in the Severance hospital due to orbital cellulitis from May 1995 to April 2004. Results : There were 32 males and 18 females. The mean age was $3.2{\pm}3.5$ year. According to the result of orbital computerized tomography, 36 cases were periorbital cellulitis, 10 cases orbital cellulitis and 4 cases not diagnosed. The clinical manifestations of periorbital cellulitis are periorbital swelling(100%), fever(19%), orbital pain(6%), and chemosis(22%). On the other hand, those of orbital cellulitis are periorbital swelling(100%), fever(80%), orbital pain(60%), proptosis(20%), chemosis(70%) and limitation of eye movement(20%). The etiologies of periorbital cellulitis are sinusitis(14%), upper respiratory infection(8%), conjunctivitis (19%), skin wound(14%) and unknown(44%). The etiologies of orbital cellulitis are sinusitis (50%), upper respiratory infection(20%), and unknown(30%). The first line antibiotics used in the majority of cases were combinations of cefoxitin+aminoglycoside. 5 patients with orbital cellulitis taking cefoxitin+aminoglycoside had to change the medication into vancomycin or clindamycin. 3 patients with orbital cellulitis underwent operation while 1 patient developed bacterial meningitis. Conclusion : According to invasion of orbit, ocular adnexal and orbital infections are quite different in their pathogenesis, treatment and prognosis. As atypical cases may confound the diagnosis, prompt orbital computerized tomography is required for an accurate diagnosis.