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For a safe sclerotherapy session to be completed in the orbital low-flow malformation (namely lymphovenous malformation or venolymphatic malformation), accurate identification of the target lesion for the drug injection is crucial. Regarding the dependability and viability of the injection approach, the authors have discussed their experiences with image-guided percutaneous sclerotherapy on a few patients. [ABSTRACT FROM AUTHOR]

Purpose: Despite mounting evidence indicating that aquaporin-4 antibody-positive optic neuritis (AQP4-ON) presents a less favorable prognosis than other types of optic neuritis, there exists substantial heterogeneity in the prognostic outcomes within the AQP4-ON cohort. Considering the persistent debate over the role of MRI in assessing the prognosis of optic neuritis, we aim to investigate the correlation between the MRI appearance and long-term visual prognosis in AQP4-ON patients. Methods: We retrospectively reviewed the ophthalmological and imaging data of AQP4-ON patients admitted to our Neuro-ophthalmology Department from January 2015 to March 2018, with consecutive follow-up visits for a minimum of 3 years. Results: A total of 51 AQP4-ON patients (59 eyes) meeting the criteria were enrolled in this research. After assessing the initial orbital MR images of each patient at the first onset, we observed the involvement of the canalicular segment (p < 0.001), intracranial segment (p = 0.004), optic chiasm (p = 0.009), and the presence of LEON (p = 0.002) were significantly different between recovery group and impairment group. For quantitative measurement, the length of the lesions is significantly higher in the impairment group (20.1 ± 9.3 mm) than in the recovery group (12.5 ± 5.3 mm) (p = 0.001). Conclusion: AQP4-ON patients with involvement of canalicular, intracranial segment and optic chiasm of the optic nerve, and the longer range of lesions threaten worse vision prognoses. Timely MR examination during the initial acute phase can not only exclude the intracranial or orbital mass lesions but also indicate visual prognosis in the long term. [ABSTRACT FROM AUTHOR]

Sinocyclocheilus guiyang, a new troglobitic species from a subterranean tributary of the upper Yangtze Basin in Guiyang City, Guizhou Province, China is described in the present study. The new species is distinguishable from its congeneric species by a combination of the following characters: tip of maxillary barbel reaching to posterior edge of orbit; forehead horn absent; eye absent (or highly reduced) and tip of pectoral fins not significantly extending beyond the base of the pelvic fin. Molecular evidence, based on the mitochondrial cytochrome b (cytb) gene, further supports the validity of the species and also reveals its close relationship with S. cyphotergous, S. multipunctatus, S. punctatus and S. sanxiaensis. In addition, the new species faces a high risk of extinction, underscoring the urgency for habitat protection measures within its limited range. [ABSTRACT FROM AUTHOR]

Vision is one of the most important senses for animals, allowing them to interact with their environment and with further implications for evolutionary histories. However, relevant soft tissues, such as the eye and associated structures, are not preserved in fossil vertebrates, limiting our knowledge of their visual capabilities. Here, we quantified absolute and relative orbit size for 400 species of dinosaurs and other extinct archosaurs using linear measurements of the preserved skeletal elements as a proxy for visual capabilities. Our results demonstrate that the orbit makes up on average 20% of skull size with a strong and consistent correlation across all sampled groups. This trend is largely independent of temporal distribution, species richness, and phylogeny. In fact, relative orbit size is narrowly constrained and did not surpass 45% of skull size, suggesting physiological and functional controls. Estimated eye size was found to be absolutely larger in herbivores, whereas carnivores tended to have smaller eyes absolutely and compared with skull size. Relatively large eyes only occurred in small-bodied species and vice versa. However, eye size alone was not sufficient to discriminate between different activity patterns or to characterize visual capabilities in detail. [ABSTRACT FROM AUTHOR]

In all vertebrates, visual signals from each visual field project to the opposite midbrain tectum (called the superior colliculus in mammals). The tectum/colliculus computes visual salience to select targets for context-contingent visually guided behavior: a frog will orient toward a small, moving stimulus (insect prey) but away from a large, looming stimulus (a predator). In mammals, visual signals competing for behavioral salience are also transmitted to the visual cortex, where they are integrated with collicular signals and then projected via the dorsal visual stream to the parietal and frontal cortices. To control visually guided behavior, visual signals must be encoded in body-centered (egocentric) coordinates, and so visual signals must be integrated with information encoding eye position in the orbit—where the individual is looking. Eye position information is derived from copies of eye movement signals transmitted from the colliculus to the frontal and parietal cortices. In the intraparietal cortex of the dorsal stream, eye movement signals from the colliculus are used to predict the sensory consequences of action. These eye position signals are integrated with retinotopic visual signals to generate scaffolding for a visual scene that contains goal-relevant objects that are seen to have spatial relationships with each other and with the observer. Patients with degeneration of the superior colliculus, although they can see, behave as though they are blind. Bilateral damage to the intraparietal cortex of the dorsal stream causes the visual scene to disappear, leaving awareness of only one object that is lost in space. This tutorial considers what we have learned from patients with damage to the colliculus, or to the intraparietal cortex, about how the phylogenetically older midbrain and the newer mammalian dorsal cortical visual stream jointly coordinate the experience of a spatially and temporally coherent visual scene. [ABSTRACT FROM AUTHOR]

Enophthalmos is a severe complication of primary reconstruction following orbital floor fractures, oncological resections, or maxillo-facial syndromes. The goal of secondary orbital reconstruction is to regain a symmetrical globe position to restore function and aesthetics. In this article, we present a method of computer-assisted orbital floor reconstruction using a mirroring technique and a custom-made titanium or high-density polyethylene mesh printed using computer-aided manufacturing techniques. This reconstructive protocol involves four steps: mirroring of the healthy orbit computer tomography files at the contralateral affected site, virtual design of a customized implant, computer-assisted manufacturing (CAM) of the implant using Direct Metal Laser Sintering (DMLS) or Computer Numerical Control (CNC) methods, and surgical insertion of the device. Clinical outcomes were assessed using 3dMD photogrammetry and computed tomography measures in 13 treated patients and compared to a control group treated with stock implants. An improvement of 3.04 mm (range 0.3–6 mm) in globe protrusion was obtained for the patients treated with patient-specific implants (PSI), and no major complications have been registered. The technique described here appears to be a viable method for correcting complex orbital floor defects needing delayed reconstruction. [ABSTRACT FROM AUTHOR]

The skull of Plioplatecarpus possesses large orbits and a large parietal foramen. Although the large orbits suggest that Plioplatecarpus possessed large eyes with enhanced visual performance, none of the previously described skulls include a sclerotic ring, and so it has been impossible in the past to reconstruct their size or optical properties. A recently collected skull with a sclerotic ring preserved in situ provides for the first time the data to do so. The dimensions of the sclerotic ring demonstrate that, although the f-number of the eyeball was not low enough to support the hypothesis that Plioplatecarpus was adapted to low light conditions, the eyeball was nevertheless large and possessed increased visual acuity and sensitivity that enabled the mosasaur to operate efficiently in both light-rich and light-poor conditions and possibly other conditions of reduced visibility. Proportions of this skull also suggest that Plioplatecarpus possessed a relatively wide binocular field of vision, providing stereoscopic vision, and further increasing both acuity and sensitivity, enhancing its ability to effectively detect and track quickly moving objects under a wide range of light conditions. A greatly enlarged parietal foramen implies the presence of a large parietal eye, the significance of which is uncertain, but it may have enhanced the ability to regulate migratory behavior. [ABSTRACT FROM AUTHOR]

Simple Summary: Breast cancer remains a leading cause of cancer-related mortality and morbidity worldwide. Ocular and periocular metastasis present as a rare but clinically significant manifestation. This study is crucial for understanding the rare occurrence of ocular and periocular metastasis in breast cancer. By exploring demographics and clinical aspects, we aim to improve the management of this condition. Our focus is on enhancing treatment strategies, predicting outcomes, and ultimately improving the quality of life for breast cancer patients with ocular metastasis. This study addresses the gaps in knowledge regarding the intricacies of this manifestation, driving progress toward more effective interventions and better patient outcomes. Background: Breast cancer remains a leading cause of cancer-related mortality and morbidity worldwide. Ocular and periocular metastasis present as a rare but clinically significant manifestation. This study aims to explore demographics and clinical aspects of ocular and periocular metastasis in breast cancer patients. Methods: A retrospective cohort study comprising 45 breast cancer patients with ocular or periocular metastasis treated between 2013 and 2023. Patient demographics, tumor characteristics, diagnostic methods, treatment modalities, visual outcomes, and survival data were analyzed. Results: Among 9902 breast cancer patients, 0.5% developed ocular or periocular metastasis, constituting 2.4% of metastatic cases. The median age was 50 years. Ocular metastasis timing varied: 5% before breast cancer, 24% concurrent, 22% within a year, and 49% after. The most common presentations included incidental MRI findings (42%) and vision decline (31%). Metastasis involved the orbit (47%), choroid (40%), optic nerve (11%), and iris (2%), with 44% having bilateral involvement. Predictive factors included invasive lobular carcinoma (ILC) (p < 0.0001) and brain metastasis (p < 0.0001), with ILC exhibiting a sixfold higher likelihood of ocular metastasis than invasive ductal carcinoma (IDC). Primary treatment was radiation therapy (89%), yielding a 55% maintenance of excellent vision (<0.5), with 93% developing dry eye disease. Patients with ocular metastasis faced an increased risk of disease-related mortality (p < 0.0001), with 71% succumbing within 10 months post-diagnosis. Conclusions: Ocular metastasis in breast cancer is rare (0.5%) but signifies poor outcome. It is linked to ILC and concurrent brain metastasis. Primary treatment involves radiation therapy, with a favorable visual prognosis. [ABSTRACT FROM AUTHOR]

This study presents phosphenotron, a device for enhancing the sensory spatial resolution of phosphenes in the visual field (VF). The phosphenotron employs a non-invasive transcranial alternating current stimulation (NITACS) to modulate brain activity by applying weak electrical currents to the scalp or face. NITACS's unique application induces phosphenes, a phenomenon where light is perceived without external stimuli. Unlike previous invasive methods, NITACS offers a non-invasive approach to create these effects. The study focused on assessing the spatial resolution of NITACS-induced phosphenes, crucial for advancements in visual aid technology and neuroscience. Eight participants were subjected to NITACS using a novel electrode arrangement around the eye orbits. Results showed that NITACS could generate spatially defined phosphene patterns in the VF, varying among individuals but consistently appearing within their VF and remaining stable through multiple stimulations. The study established optimal parameters for vibrant phosphene induction without discomfort and identified electrode positions that altered phosphene locations within different VF regions. Receiver Operating characteristics analysis indicated a specificity of 70.7%, sensitivity of 73.9%, and a control trial accuracy of 98.4%. These findings suggest that NITACS is a promising, reliable method for non-invasive visual perception modulation through phosphene generation. [ABSTRACT FROM AUTHOR]

Advancements in optical communications have increasingly focused on leveraging spatial-structured beams such as orbital angular momentum (OAM) beams for high-capacity data transmission. Conventional electronic convolutional neural networks exhibit constraints in efficiently demultiplexing OAM signals. Here, we introduce a hybrid optical-electronic convolutional neural network that is capable of completing Fourier optics convolution and realizing intensity-recognition-based demultiplexing of multiplexed OAM beams under variable simulated atmospheric turbulent conditions. The core part of our demultiplexing system includes a 4F optics system employing a Fourier optics convolution layer. This optical spatial-filtering-based convolutional neural network is utilized to realize the training and demultiplexing of the 4-bit OAM-coded signals under simulated atmospheric turbulent conditions. The current system shows a demultiplexing accuracy of 72.84% under strong turbulence scenarios with 3.2 times faster training time than all electronic convolutional neural networks. Optical beams carrying orbital angular momentum (OAM) are promising candidates for free-space optical communication. The authors devise a hybrid optical-electronic convolutional neural network approach reaching a 4-bit OAM-coded signal demultiplexing accuracy of 72.84% under strong atmospheric turbulence conditions with 3.2 times faster training time than all electronic convolutional neural network. [ABSTRACT FROM AUTHOR]

Background: Diplopia often follows orbital floor fractures, yet comprehensive, long-term outcome-focused clinical audit data are lacking, especially in countries like Pakistan where diplopia and its treatment after orbital floor fractures are uncommon. This study aimed to assess the correction of diplopia following surgical repair of orbital floor fractures using titanium mesh. Methodology: A retrospective clinical audit was conducted at the Oral and Maxillofacial Surgery Department, Mayo Hospital, Lahore, from January 2015 to December 2019. Consecutive patient records admitted for orbital fracture correction were analyzed. A total of 202 patients of both genders with diplopia who underwent orbital floor reconstruction using titanium mesh were included. Results: Among the 202 patients meeting inclusion criteria, the mean age was 32.60 years (+/- 12.44 SD). Of these, 73.3% (n=148) were male, and 26.7% (n=54) were female. Persistent diplopia was experienced by 11.6% (n=18) of operated cases. Post-operative complications included ectropion/entropion (3.0%, n=6), numbness (2.5%, n=5), and infection (4.5%, n=9). Conclusion: Titanium mesh, a readily accessible synthetic material, demonstrates optimal efficacy in correcting post-traumatic enophthalmos and can be utilized to reconstruct orbital floor defects in orbito-zygomatic complicated fractures. These findings are expected to lay a foundation for future research, enhancing patient care and outcomes in maxillofacial trauma in Pakistan and beyond. [ABSTRACT FROM AUTHOR]

Purpose: Nasal chondromesenchymal hamartomas (NCMH) are rare, predominantly benign tumors of the sinonasal tract. The distinction from higher grade malignancy may be challenging based on imaging features alone. To increase the awareness of this entity among radiologists, we present a multi-institutional case series of pediatric NCMH patients showing the varied imaging presentation. Methods: Descriptive assessment of imaging appearances of the lesions on computed tomography (CT) and magnetic resonance imaging (MRI) was performed. In addition, we reviewed demographic information, clinical data, results of genetic testing, management, and follow-up data. Results: Our case series consisted of 10 patients, with a median age of 0.5 months. Intraorbital and intracranial extensions were both observed in two cases. Common CT findings included bony remodeling, calcifications, and bony erosions. MRI showed heterogeneous expansile lesion with predominantly hyperintense T2 signal and heterogenous post-contrast enhancement in the majority of cases. Most lesions exhibited increased diffusivity on diffusion weighted imaging and showed signal drop-out on susceptibility weighted images in the areas of calcifications. Genetic testing was conducted in 4 patients, revealing the presence of DICER1 pathogenic variant in three cases. Surgery was performed in all cases, with one recurrence in two cases and two recurrences in one case on follow-up. Conclusion: NCMHs are predominantly benign tumors of the sinonasal tract, typically associated with DICER1 pathogenic variants and most commonly affecting pediatric population. They may mimic aggressive behavior on imaging; therefore, awareness of this pathology is important. MRI and CT have complementary roles in the diagnosis of this entity. [ABSTRACT FROM AUTHOR]

Purpose: Although CT-guided biopsies of the calvarium, skull base, and orbit are commonly performed, the best approaches, efficacy, and safety of such procedures remain scantly described in the literature. This retrospective review of percutaneous biopsies illustrates several approaches to challenging biopsy targets and provides a review of procedural planning considerations and histopathologic yield. Methods: A retrospective review of CT-guided biopsies of the skull base, calvarium, and orbit between 1/1/2010 and 10/30/2020 was conducted. Patient demographics and procedural factors were recorded, including lesion size and location, biopsy approach, and needle gauge. Outcomes were also noted, including CT dose length product, complications, and histopathologic yield. Results: Sixty-one CT-guided biopsies were included in the final analysis: 34 skull base, 23 calvarial, and 4 orbital lesions. The initial diagnostic yield was 32/34 (94%) for skull base lesions, with one false-negative and one non-diagnostic sample. Twenty-one of twenty-three (91%) biopsies in the calvarium were initially diagnostic, with one false-negative and one non-diagnostic sample. In the orbit, 4/4 biopsies were diagnostic. The total complication rate for the cohort was 4/61 (6.6%). Three complications were reported in skull base procedures (2 immediate and 1 delayed). A single complication was reported in a calvarial biopsy, and no complications were reported in orbital biopsies. Conclusion: Percutaneous CT-guided core needle biopsies can be performed safely and with a high diagnostic yield for lesions in the skull base, calvarium, and orbit. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate eye and orbital injuries in non-powered scooter, electric-scooter (e-scooter), and hoverboard riders in the United States (US) between 2014 and 2019. Methods: The National Electronic Injury Surveillance System (NEISS) was queried for head and neck injuries by body part codes related to non-powered scooters and powered scooters/hoverboards from 2014 to 2019. The NEISS complex sampling design was used to obtain US population projections of injuries and hospital admissions. Keywords were queried in case narratives to analyze trends in location, type, and mechanism of eye and orbit injuries. Results: Since their introduction, a 586% (p=0.01) increase in e-scooter injuries and 866% (p< 0.001) increase in hoverboard injuries were observed with an increase in hospital admissions seen in young adults (18– 34) in urban areas (e-scooter: 5980% and hoverboard: 479%). Descriptive narratives of the trauma noted eye injuries in 242 unweighted NEISS cases with only 30 cases appropriately documented under body part code 77: eyeball. Eye injuries increased 96.9% during the study period (p=0.23). Specifically, the most common ophthalmic injuries reported included eyebrow (40.9%) and eyelid (11.3%) lacerations, periorbital contusions (18.7%), orbit fractures (6.6%), and corneal abrasions (5.1%). Conclusion: There was a significant increase in both head and neck injury cases and hospital admissions related to e-scooters. Eye and orbit injuries similarly increased but were underreported by body part code compared to injury narratives. Orbital fractures were reported more frequently in injuries from e-scooters than non-powered scooters. Plain Language Summary: From 2014 to 2019, there were significant increases in both head and neck injuries and hospital admissions related to e-scooters, with eye and orbital injuries similarly increased but underreported by body part code compared to the injury narratives. [ABSTRACT FROM AUTHOR]

Purpose. This study was designed to review the primary sites, clinical manifestations, imaging features, treatments, and outcomes of 36 patients with orbital metastasis in North China. Methods. This was a retrospective review of 36 patients with orbital metastasis at Tianjin Eye Hospital between January 2010 and December 2020 in North China as well as a review of the literature. Results. Thirty-six patients were included in the study; 17 were male, and 19 were female, with an age range of 1–82 years (average 54.9 ± 19.8 years). All the tumours were unilateral. The mean duration from the onset of orbital signs to presentation at the hospital was 2.4 months (range 1–10 months). Breast carcinoma, gastrointestinal tract carcinoma, and lung carcinoma were the most common histological types. Proptosis, ocular pain, and diplopia were the most common clinical manifestations. The superior orbit was the most common quadrant involved. All patients received comprehensive therapy, including surgery, radiotherapy, or chemotherapy. The average follow-up time was 2.45 years (range 7 months to 5.5 years). Ten patients in this study died as a result of disseminated metastasis from the primary tumour. Conclusions. In North China, the most common primary cancer that metastasizes to the orbit is breast cancer, followed by gastrointestinal tract carcinoma and lung cancer. The increasing trend of orbital gastrointestinal tract metastases in North China in recent years is noteworthy. The survival rate of patients with orbital metastasis of neuroblastoma is low. [ABSTRACT FROM AUTHOR]

This article, titled "Endoscopic Transorbital Approach for Left Spheno-orbital Meningioma Resection and Optic Canal Decompression," discusses a case study of a 59-year-old patient who presented with vision loss in her left eye, exophthalmos, and constant ocular pressure. The patient was diagnosed with a spheno-orbital meningioma, which was causing a hyperostotic lesion in the left lesser and greater sphenoid wings, with extension to the optic canal and anterior clinoid. The article describes the successful use of an endoscopic transorbital approach through the superior eyelid to partially remove the lesion, perform an anterior clinoidectomy, and decompress the optic canal. The authors of the article are Tristan Brunette-Clément, Charles Gervais, Stephan Tobalem, Evan Kalin, and Pascal Lavergne. [Extracted from the article]

This article discusses the challenges of reconstructing the spheno-orbital region after the surgical removal of spheno-orbital meningiomas. The authors present a case series of three patients who underwent virtual surgical planning (VSP) for their surgeries. The VSP involved using custom cutting guides and patient-specific polyetheretherketone (PEEK) implants. The outcomes of the surgeries closely matched the virtual surgical plans, demonstrating the potential benefits of multidisciplinary collaboration and the use of new technology in reconstructive surgery. The authors suggest that future research should focus on evaluating the neurosurgical, ophthalmologic, and aesthetic outcomes of this approach. [Extracted from the article]

This article describes a surgical technique called the no-drill single-piece fronto-orbito-zygomatic (FOZ) craniotomy, which is used to treat skull base lesions. The technique was developed in a low-resource African neurosurgery practice where powered surgical drills and other advanced tools are not available. The article outlines the manual tools used in the procedure, including the Hudson brace, Cushing's skull perforator blades, Gigli saws, and osteotomes/mallets. The technique has been successfully used in 12 patients to treat various skull base lesions, with minimal postoperative complications and good outcomes. The authors emphasize the effectiveness and low cost of this technique in a resource-constrained setting. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, presents a case study of a rare and aggressive neoplasm called dentinogenic ghost cell tumor (DGCT). DGCTs are uncommon benign odontogenic neoplasms, with less than 100 cases reported in the literature. While they are classified as benign, they can be locally aggressive and even undergo malignant transformation. The case report follows a 24-year-old male with a recurrent DGCT in the right maxilla, which caused significant facial deformity. The patient underwent a complex craniofacial resection and reconstruction. The article also reviews the existing literature on these rare cases and discusses future research considerations. [Extracted from the article]

This article, titled "Facial Reconstruction following the Resection of Familial Gigantiform Cementoma Adjacent to the Skull Base: Technical Note," describes a case of familial gigantiform cementoma (FGC), a rare benign neoplasm that can cause significant facial disfigurement. The article discusses the successful reconstruction of a 36-year-old female patient's face after multiple prior surgeries performed at outside facilities. The surgical team used a combination of open trans-fascial resection and a complex fibular free flap to achieve both oncologic control and cosmesis. The article emphasizes the complexity of FGC operations and the importance of multidisciplinary planning for resection and reconstruction. [Extracted from the article]

This article provides a detailed description of both microsurgical and endoscopic approaches to the orbit, aimed at trainees in skull base surgery. The study utilized six cadaveric head specimens to perform various approaches, including endoscopic transorbital approaches, endoscopic endonasal approaches, the Caldwell-Luc approach, and orbitotomies and cranio-orbitotomies. The results highlight the distinct anatomical landmarks and advantages of each approach, such as improved aesthetics, reduced scarring, and enhanced visibility. The article aims to enhance the understanding and learning experience for trainees in skull base surgery. [Extracted from the article]

This article discusses a case report of a patient who underwent a surgical procedure called transorbital neuroendoscopic surgery (TONES) to treat a frontal epidural hematoma. TONES is a minimally invasive approach that has been shown to have better cosmetic outcomes and shorter hospital stays compared to other skull base surgeries. The article highlights that there are no reported cases of managing epidural hematomas through TONES and no reports of the local experience and results in Latin America. The authors conclude that TONES is a safe and effective approach for treating skull base pathologies, including traumatic brain injuries, and should be encouraged in Latin America. [Extracted from the article]

Background: Orbital floor fractures involve damage to the orbital floor but not the infraorbital margin. Despite intensive research, they remain a controversial topic. The aim of this study was to investigate the relationship between parameters gathered by means of computed tomography (CT), the clinical presentation, and treatment outcomes, in patients suffering from orbital floor fractures. Methods: Forty patients with orbital floor fractures were included in this study. Information regarding diplopia, impaired ocular mobility, asymmetric eyeball placement, and infraorbital paresis was gathered from the medical records. Nine CT-based parameters were assessed. Two parameters were calculated, based on them. The follow-up data of 30 patients were analyzed. The results were statistically evaluated. The significance level was p < 0.05. Results: Statistical evaluation revealed multiple correlations between CT-based findings, symptoms, and treatment results. Among others, the hernia into the maxillary sinus was significantly larger in patients without improvement in infraorbital paresis (p = 0.0031) and without improvement in assymetric eyeball placement (p = 0.0037). There was no correlation between the entrapment of the rectus inferior muscle and impaired ocular mobility (p = 0.664431; p = 0.420289) and between the direct fracture of the infraorbital canal and infraorbital paresis (p = 0.371102). Conclusions: The widely assumed thesis that impaired ocular mobility in orbital fractures is caused by entrapment of the rectus inferior muscle is disproved by CT-based data. CT-based findings, symptoms, and treatment results in patients with orbital floor fractures were significantly correlated. A large hernia may be a negative prognostic factor. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the accuracy of the degree of fracture reduction after open reduction and internal fixation of Zygomaticomaxillary Complex (ZMC) fractures in the Saudi population of the Al-Baha region, using Gillies approach. Further comparison with preoperative and postoperative standardized computed tomography (CT) views with the calculation of residual deformity percentage, which remained after the ZMC rehabilitation. Methods: A 5-year retrospective CT-based study on preoperative and postoperative axial CT scans of 46 male patients with ZMC fractures. The CT measurements were made (in millimeters) at the fracture site of maximum displacement through the anterior orbital rim and orbital floor, posterolateral wall of the maxillary sinus, zygomatic arch, and zygomaticofrontal suture. For the zygomatic arch, measurements were made (in mm) by drawing a tangent to the fractured arch segments and dropping a perpendicular to the inward displaced fractured arch. The total difference in all measured parts between preoperative and postoperative displacement was calculated in percentages. Results: Upon comparison of preoperative and postoperative zygomaticomaxillary complex CTs, three-point fixation at the regions of infraorbital rim, frontozygomatic suture, and posterolateral wall of the maxilla results in a reduction of the fracture sites in the range of 72.85% to 85%. Maximum reduction was noted at the zygomatic arch, that is, 85%, and minimum at the infraorbital rim, that is, 72.85%. The reduction obtained at all four sites was statistically significant, with P values ranging from.011 to.039. Conclusion: Gillies temporal approach and three-point fixation at the regions of the infraorbital rim, frontozygomatic suture, and posterolateral wall of the maxilla results in satisfactory treatment of ZMC fractures and improves patients oral health and quality of life. [ABSTRACT FROM AUTHOR]

We describe reconstruction of the orbital floor following suprastructure maxillectomy for resection of maxillary squamous cell carcinoma utilizing an osteocutaneous radial forearm free flap and palmaris longus tendon. [ABSTRACT FROM AUTHOR]

A 4-year-old boy was referred to our tertiary hospital after a penetrating adnexal injury by a large-breed dog to the left orbital area. There was an increase in lacrimation, which was thought to be due to an inflammatory reaction. However, it was discovered that the lacrimation increased in the reverse-Trendelenburg position and with the Valsalva maneuver. Halo sign and beta transferrin test were positive, which led to the diagnosis of cerebrospinal fluid (CSF) fistula, and the patient was operated using a supraorbital craniotomy. A dural tear was visualized and sutured appropriately, then fibrin glue and an autologous galeal graft were applied to the tear. The CSF oculorrhea stopped postoperatively, and the patient was discharged after 10 days of follow-up. The patient had no recurrent CSF leakage at 4-year follow-up. Although CSF oculorrhea is rare and may be difficult to discern from lacrimation, the presence of pneumocephalus and halo sign should suggest fistula repair. : [ABSTRACT FROM AUTHOR]

Anatomical variations are a common feature of the human anatomy. Variation can explain some pathological conditions and is important to keep them in mind during surgical procedures. The relations between nerves and their adjacent arteries have been proposed to play a role in the generation of peripheral trigger migraines. Close opposition between nerves and arteries can lead to vascular compression of the nerve that triggers episodes of pain. We did a routine dissection of the infratemporal fossa and orbital floor by opening the maxillary sinus. Here we report a case where the infraorbital nerves form a nervous loop entrapping the infraorbital artery in the infraorbital channel. Similar cases of close nervous and arterial apposition are described for the auriculotemporal and occipital nerves. We think that accumulating knowledge of these rare variations could expand our understanding of rare conditions such as primary infraorbital neuralgia. [ABSTRACT FROM AUTHOR]

Simple Summary: Short-headed dogs exhibit shallow orbits and forward-facing eyes, while their medium- and long-headed counterparts have deep orbits with relatively laterally oriented eyes; these traits are classified by skull index (SI) value. In this study, we employed landmark-based morphometric analysis based on computed tomography scan data of 50 adult dogs to investigate the correlation between the SI and optic chiasm, and orbital shape. We found a consistent placement of the optic chiasm at the anterior neurocranial margin across all breeds. However, short-headed breeds exhibit a wider angle between the bilateral optic canals, and the anterior margin of the zygomatic bone-forming orbit was wider in the anterior direction compared to medium- and long-headed breeds. Breed-specific orbital differences were determined by the zygomatic bone, which connects the face to the neurocranium. The orbital margin of the zygomatic bone projects outward and forward, correlating with the degree of facial shortening. Taken together, our findings suggest that the zygomatic bone influences breed-specific orbital formation, especially in cases of facial shortening. This study's CT scan-based morphometric analysis of 50 adult dogs explored the relationship between skull shape variations (determined by the skull index, SI), optic chiasm, optic canals, and orbital shape. Dogs were classified as brachycephalic (SI ≥ 59), mesocephalic (SI ≥ 51 but <59), and dolichocephalic (SI < 51). No significant age or weight differences were observed. Skull lengths (brachycephalic: 11.39 ± 1.76 cm, mesocephalic: 15.00 ± 2.96 cm, dolichocephalic: 17.96 ± 3.44 cm) and facial lengths (brachycephalic: 3.63 ± 1.00 cm, mesocephalic: 6.46 ± 1.55 cm, dolichocephalic: 8.23 ± 1.03 cm) varied significantly, with shorter orbital depths (brachycephalic: 2.58 ± 0.42 cm, mesocephalic: 3.19 ± 0.65 cm, dolichocephalic: 3.61 ± 0.77 cm) in brachycephalic dogs. The optic chiasm-to-inion horizontal length ratio to cranial horizontal length positively correlated with the SI (r = 0.883, p < 0.001), while the ratio to neurocranial length showed no SI correlation (range: 55.5–75.0). Brachycephalic breeds had a significantly wider optic canal angle (93.74 ± 16.00°), along with broader lacrimal-zygomatic and zygomatic frontal process angles. These findings highlight the zygomatic bone's role in influencing breed-specific orbital variations by connecting the face to the neurocranium, projecting the orbital rim outward and forward with facial shortening. [ABSTRACT FROM AUTHOR]

Intracranial pressure measurement is frequently used for diagnosis in neurocritical care but cannot always accurately predict neurological deterioration. Intracranial compliance plays a significant role in maintaining cerebral blood flow, cerebral perfusion pressure, and intracranial pressure. This study's objective was to investigate the feasibility of transferring external pressure into the eye orbit in a large-animal model while maintaining a clinically acceptable pressure gradient between intraorbital and external pressures. The experimental system comprised a specifically designed pressure applicator that can be placed and tightly fastened onto the eye. A pressure chamber made from thin, elastic, non-allergenic film was attached to the lower part of the applicator and placed in contact with the eyelid and surrounding tissues of piglets' eyeballs. External pressure was increased from 0 to 20 mmHg with steps of 1 mmHg, from 20 to 30 mmHg with steps of 2 mmHg, and from 30 to 50 mmHg with steps of 5 mmHg. An invasive pressure sensor was used to measure intraorbital pressure directly. An equation was derived from measured intraorbital and external pressures (intraorbital pressure = 0.82 × external pressure + 3.12) and demonstrated that external pressure can be linearly transferred to orbit tissues with a bias (systematic error) of 3.12 mmHg. This is close to the initial intraorbital pressure within the range of pressures tested. We determined the relationship between intraorbital compliance and externally applied pressure. Our findings indicate that intraorbital compliance can be controlled across a wide range of 1.55 to 0.15 ml/mmHg. We observed that external pressure transfer into the orbit can be achieved while maintaining a clinically acceptable pressure gradient between intraorbital and external pressures. [ABSTRACT FROM AUTHOR]

Cavernous hemangioma, currently known as "cavernous venous malformation," is a common, benign, noninfiltrative, slowly progressive vascular malformation of the orbit presenting in adults. We report the case of a 9-year-old girl who presented with a painless palpable mass over the right upper eyelid of 7 years' duration. A computed tomography scan of the orbits revealed a heterogeneously enhancing, well-circum-scribed mass in the right upper eyelid with no orbital extension. A transcutaneous excisional biopsy with histopathology disclosed cavernous venous malformation. The majority of cavernous venous malformations are intraconal and present in the fourth to fifth decade of life. [ABSTRACT FROM AUTHOR]

Introduction: Maxillary ameloblastoma is a rare, slow-growing odontogenic tumor that can recur after surgical excision, be locally aggressive, and rarely develop systemic metastases. We describe the course and management of a patient with recurrent maxillary ameloblastoma with orbital invasion and systemic metastases, the fourth case of its kind to be described in the literature. Case Presentation: A 50-year-old female presented with left hyperglobus. A diagnosis of maxillary ameloblastoma was made based on biopsy and neuroimaging with MRI and CT. Surgical management included partial maxillectomy with orbital floor reconstruction, given the orbital invasion. Three years later, left hyperglobus recurred, and the patient was found to have orbital recurrence and lung metastases on PET imaging. The lung and orbital lesions have responded well to chemoradiation therapy without surgical intervention. Conclusion: Maxillary ameloblastoma is a rare tumor that typically arises from odontogenic tissues. Though considered benign, they can recur and in the case of our patient, metastasize. Complete surgical excision with wide surgical margins is associated with a shorter average time to recurrence and a lower incidence of metastasis. Cases of metastasis are managed with chemotherapy with or without adjuvant radiotherapy. Precision medicine may play a role in managing this entity in the future, given the discovery of differing profiles of maxillary ameloblastoma compared to mandibular. Ophthalmologists should be aware of this tumor as it can invade the orbit, resulting in significant ocular morbidity and mortality. [ABSTRACT FROM AUTHOR]

Microichthys grandis n. sp. from off southwest Ireland, northeastern Atlantic Ocean, is described on the basis of a single specimen and compared with the other species of the genus. The new species is characterized by the following combination of characters: dorsal-fin rays VII–I, vii, 1; total pectoral-fin rays 18; total gill rakers 25; pyloric caeca 3; pored lateral-line scales 41 + 2; vomerine teeth 6, in a single row; denticles on posterior margin of preopercle 3, on lower margin 3; nape not humped; bony rim of orbit raised above dorsal profile; ridge present in interorbital region; lateral line gradually running towards midline of body, crossing last dark lateral bar above its centre; oblique dark lateral bars 20, lower counter-bars 12; vertical black bar on caudal peduncle present, together with another black bar below the end of the second dorsal fin; peritoneum silvery; pelvic fin short than head length; pelvic fins black. With 54.5 mm SL, this is the largest species of the genus. A revised key to the species of Microichthys is presented. [ABSTRACT FROM AUTHOR]

Ocular and Orbital trauma has become common nowadays. The determination of the extent of trauma to the eye and the orbit, with their precise localization is crucial to the successful management of the patients. The different methods which are used include plain Xray film, computed tomographic scan(CT scan), Ultrasonography, Magnatic Resonance is quite Imaging (MRI), Anterior Segment OCT (AS-OCT), and Ultrasound Biomicroscopy (UBM). ASOCT and UBM are less commonly available in developing countries. Sometimes, a number of modalities are used together to obtain maximum information, for optimum management. [ABSTRACT FROM AUTHOR]

A 45-year-old woman presented with sudden complete vision loss in her left eye and retroorbital pain worsened by eye movements. A previous milder episode of vision loss had occurred in the same eye 1 year before, with complete recovery after high-dose intravenous methylprednisolone. She had no light perception in the left eye with a swollen optic disc, but with a normal right optic disc. There were no systemic manifestations or infections. MR scan of the brain showed extensive enlargement and enhancement of the left optic nerve and optic chiasm. After excluding infections and autoimmune markers, a left optic nerve biopsy confirmed non-caseating granulomas, leading to a diagnosis of neurosarcoidosis. [ABSTRACT FROM AUTHOR]

Background: Presently, the management of patients with maxilla bone defects of the Cawood V or VI class is achieved using zygomatic or individual implants or through augmentation of the bone. For zygomatic implants, the ORIS criteria represent the most common factor in helping practitioners register success rates. The zygomatic anatomy-guided approach (ZAGA)and zygomatic orbital floor (ZOF) are factors that are crucial to examining the anatomy of a particular patient before the procedure. The aim of thisarticle is to find the statistical relationship between the abovementioned terms and other factors. Methods: A total of 81 patients underwent zygomatic implant procedures in different configurations. The ORIS, ZAGA, and ZOF parameters were compared with other factors such as type of surgery, sex, age, and the anatomy of the zygomatic bone. Results: Most patients in this article were classified as ZAGA Class 2. The relationships between type of surgery and ZAGA classification, and ZAGA and sinus/maxilla zygomatic implant localization were statistically significant. Conclusions: The ZAGA and ZOF scales are practical and valuable factors that should be taken into account before surgery, whereas to date, criteria better than the ORIS scale have not been described in terms of the success of zygomatic implants. The ZOF scale might omit perforation of the orbit because this parameter warns a practitioner to be aware of the anatomy of the orbit. [ABSTRACT FROM AUTHOR]

Objective: To describe a novel method of medial fixation of titanium mesh with a right‐angled screwdriver for orbital floor and maxillary reconstruction and to compare the reconstruction outcome of orbital floor reconstruction with modified and traditional methods. Methods: The data of 23 patients who underwent maxillectomy and orbital floor defect reconstruction by individualized titanium mesh in Peking University School and Hospital of Stomatology between 2018 and 2021 were retrospectively reviewed. While eight patients received modified orbital floor reconstruction with titanium mesh and angled screwdriver (group A), 15 patients received traditional orbital floor reconstruction (group B). The contact area with buccal flap for titanium mesh in groups A and B was calculated. Titanium mesh deformation, fracture or exposure was recorded. Postoperative ophthalmic function and success of esthetic restoration were assessed. Results: Mean follow‐up was for 15.7 months (range, 9–22 months). The contact area with buccal flap for the modified titanium mesh in group A (13.11 ± 1.41 cm2) was significantly less than that of the traditional titanium mesh in group B (21.83 ± 1.23 cm2; p <.05). The exposure of titanium mesh occurred in two patients in group B. The self‐evaluation of facial symmetry for 23 patients showed no significant difference between group A (7.75 ± 0.71) and group B (6.68 ± 1.30; p >.05). No specific complications were reported. Conclusion: We propose a novel method of zygomatic medial fixation of titanium mesh with a right‐angled screwdriver for orbital floor and maxillary reconstruction, which has the potential to prevent the postoperative exposure of titanium mesh. Level of Evidence: Level III (Retrospective comparative study). [ABSTRACT FROM AUTHOR]

Two-line element sets (TLE) released by the 18th Space Control Squadron are the most complete source of information for space situational awareness in the public domain. They are used in a wide range of contexts that include navigation of nanosatellites and ground communication. However, the TLE data are known for having significant bias and errors. Predicting the bias of TLE can be a way to correct them automatically and hence optimize the systems that rely on them at low cost, for instance for reentry calculations and mission analysis. This paper shows the performance of a neural network trained on more than 4500 inactive resident space objects (RSO) on 10 months of orbital data, on all types of orbits. It is shown that the state vector errors are corrected by at least 40% for 70% of the TLE and that the residual error distributions are well described by a Student's t-distribution for which covariance elements are defined consistently. The performance of the trained neural network are shown to be similar for multiple active satellites. [ABSTRACT FROM AUTHOR]

Dermacentor nitens Neumann is the most common tick species infesting horses in the main Brazilian biomes. It has a predilection to attach to horse the ears, the nasal diverticulum, perineal and perianal regions. The infestations can generate severe damage in the ears, anemia, and the tick also acts as vector of Babesia caballi (Nuttall and Strickland), the causative agent of equine babesiosis. Our study describes unusual parasitism site of D. nitens on a female cross breed horse, approximately ten years old that presented high parasitism by ticks on the perineal and perianal region, ears, and the left eye orbit region, where an enucleation process had been performed a few years earlier. To our knowledge this is the first report of D. nitens parasitism on a formerly enucleated eye orbit. [ABSTRACT FROM AUTHOR]

Simple Summary: The popularity that transorbital approaches (TOAs) gained in recent years has allowed their diffusion into skull base surgery. However, for their correct application, it is essential to know the potential and the limits of this group of transorbital routes, as well as the knowledge of anatomy from this relatively new surgical perspective. In this paper, the authors illustrate step-by-step the superior eyelid transorbital approach from a macroscopic and endoscopic perspective, highlighting the main anatomical relationships to understand the application of this surgical route for the treatment of skull base pathologies. Surgical cases are provided to illustrate indications for this approach. Background: The transorbital approaches (TOAs) have acquired growing notoriety, thanks to their ability to offer alternative corridors to the skull base. However, the limited access and the unfamiliarity with this surgical perspective make recognition of key landmarks difficult, especially for less experienced surgeons. The study wants to offer a detailed description of the anatomy to comprehend the potential and limitations of TOAs. Methods: Measurements of the orbit region and the surrounding areas were performed on two hundred high-resolution CT scans and thirty-nine dry skulls. Five specimens were dissected to illustrate the TOA, and one was used to perform the extradural clinoidectomy. Three clinical cases highlighted the surgical applications. Results: A step-by-step description of the key steps of the TOA was proposed and a comparison with the transcranial anterior clinoidectomy was discussed. The mean work distance was 6.1 ± 0.4 cm, and the lateral working angle increased 20 ± 5.4° after removing the lateral orbital rim. Conclusions: TOAs are indicated in selected cases when tumor involves the lateral portion of the cavernous sinus or the middle skull base, obtaining a direct decompression of the optic nerve and avoiding excessive manipulation of the neurovascular structures. Comprehension of surgical anatomy of the orbit and its surrounding structures is essential to safely perform these approaches. [ABSTRACT FROM AUTHOR]

The transorbital approach (TOA) can provide immediate access to the lateral ventricles by piercing the roof of the orbit (ROO) with a spinal needle and without the need of a drill. Reliable external landmarks for the TOA ventriculostomy have been described, however, the necessary spinal needle gauge and other relevant parameters such as the thickness of the ROO have not been evaluated. Nineteen formalin-fixed adult cadaveric heads underwent the TOA. Spinal needles of different gauges were consecutively used in each specimen beginning with the smallest gauge until the ROO was successfully pierced. The thickness of the ROO at the puncture site and around its margins was measured. Other parameters were also measured. The TOA was successfully performed in 14 cases (73.68%), where the most suitable needle gauge was 13 (47.37%), followed by a 10-gauge needle (36.84%). The mean thickness of the ROO at the puncture site, and the mean length of the needle to the puncture site were 1.7 mm (range 0.2–3.4 mm) and 15.5 mm (range 9.2–23.4 mm), respectively. A ROO thickness of greater than 2.0 mm required a 10-gauge needle in seven cases, and in five cases, a 10-gauge needle was not sufficient for piercing the ROO. The presence of hyperostosis frontalis interna (HFI) (21.05%) was related to the failure of this procedure (80%; p < 0.00). Using a 13/10-gauge spinal needle at Tubbs' point for TOA ventriculostomy allowed for external ventricular access in most adult specimens. The presence of HFI can hinder this procedure. These findings are important when TOA ventriculostomy is considered. [ABSTRACT FROM AUTHOR]

Background: Little attention has been paid to combined orbital floor and medial wall fractures with the involvement of the inferomedial orbital strut. Managing this particular fracture can prove challenging. However, various innovative techniques have been introduced to assist with the process. Our study focuses on sharing our approach to orbital wall reconstruction using navigation guidance and titanium-reinforced porous polyethylene plates, specifically cases involving the inferomedial orbital strut. We believe that implementing a navigation system can effectively lead surgeons to the fracture site with utmost safety. Also, we hypothesized that this navigation system is beneficial to use singe fan titanium-reinforced porous polyethylene plates with orbital wall fractures involving IOS while minimizing possible complications. Methods: We retrospectively reviewed 131 patients with medial orbital wall and orbital floor fractures with or without combined other facial bone fractures who underwent orbital wall reconstruction by a single surgeon from May 2021 to May 2023. Amongst, we identified fourteen orbital wall fractures involving the inferomedial orbital strut. We used a subciliary incision as the only approach method for performing titanium-reinforced porous polyethylene plates for navigation-guided orbital wall reconstruction. Patients were followed up for at least three months. Results: All cases were effectively resolved using titanium-reinforced porous polyethylene plates. There were no complications during the patient's complete recovery, confirmed clinically and radiologically. Based on the serial CT results, it was discovered that implanted titanium-reinforced porous polyethylene plates successfully covered the defect. Conclusion: Based on our retrospective analysis, it has been determined that among the 131 recorded cases of orbital fractures, 14 of them (or 10.7%) involved the inferomedial orbital strut. Navigation-guided reduction using titanium-reinforced porous polyethylene (TR-PPE) plates can lead to predictable, reliable, and excellent outcomes for treating orbital fractures involving the inferomedial orbital strut without complications. [ABSTRACT FROM AUTHOR]

Introduction Orbital floor fractures are routinely encountered in facial trauma. Many factors influence the final outcome of the orbital floor surgery, time interval and the extent of other facial bone fractures are the two factors which can significantly influence the postoperative outcome following orbital floor reconstruction. Our study aims to find the ideal time for intervention and the association of other factors in the final outcome of orbital floor reconstruction. Methods A retrospective and prospective cohort study of patients who were operated at Pondicherry Institute of Medical Sciences for orbital floor fractures, between 2011 January and 2017 July. All the data were entered on an Excel work sheet and statistically analyzed. Results In our study 8 patients (8/29, 27.58%) had diplopia prior to surgery, 5 patients (5/29, 17.24%) had complete recovery following surgery and 3 patients (3/29, 10.34%) had persistence of diplopia postoperatively. Patients with diplopia operated prior to 7 days were found to have significant improvement in postoperative diplopia. Patients with 5 or more facial fractures were found to have persistence of diplopia, infraorbital numbness, and enophthalmos postoperatively. Conclusion Our study suggests that early intervention, before 7 days improves the outcome in patients with diplopia and provides a better result postoperatively. In our study preoperative diplopia and infraorbital numbness and postoperative persistence of enophthalmos, diplopia, and paresthesia were found more in patients with 5 or more facial bone fractures. Our study suggests a poor postoperative outcome when 5 or more facial bones are fractured. [ABSTRACT FROM AUTHOR]

Aims: Comparative data between the HAS‐BLED, GARFIELD‐AF and ORBIT score are limited in anticoagulated Asian patients with atrial fibrillation (AF). We compared the performance of the 3 scores in a nationwide registry. Methods: AF patients treated with oral anticoagulants in the COOL‐AF registry were studied. We fitted the variables of the HAS‐BLED, GARFIELD‐AF and ORBIT score to major bleeding in Cox model. We explored a modified HAS‐BLED by addition of sex and body weight. Discrimination, calibration, net reclassification index (NRI) and decision curve analysis were used to compare the performance of the 3 models. Results: Of 3402 patients in the registry, 2568 patients who received oral anticoagulant at baseline were studied. Majority of patients (91.1%) received warfarin. The rate of major bleeding was 2.11 per 100 person‐years. The C‐statistics of the GARFIELD‐AF, HAS‐BLED, modified HAS‐BLED and ORBIT score were 0.65 (95% confidence interval [CI] 0.63–0.67), 0.66 (95%CI 0.64–0.68), 0.69 (95%CI 0.67–0.71) and 0.64 (95%CI 0.62–0.66) respectively. There was good agreement between predicted and observed bleeding in the deciles of HAS‐BLED and GARFIELD‐AF scores, while the modified HAS‐BLED score and ORBIT score overestimated the risk in the last decile. The modified HAS‐BLED score had superior NRI than the HAS‐BLED score (26.9%, 95%CI 9.7%–42.2%) and the ORBIT score (31.9%, 95%CI 9.0–53.6%). The NRI between the modified HAS‐BLED and GARFIELD‐AF score was similar. The net benefit curve of the 4 models were overlapping among different thresholds. Conclusions: The clinical utility for bleeding prediction of GARFIELD‐AF, HAS‐BLED, modified HAS‐BLED and ORBIT scores were similar in anticoagulated Asian patients with AF participating in the COOL‐AF registry. We found no advantage of the ORBIT over HAS‐BLED score for bleeding risk prediction, even in direct oral anticoagulant users. [ABSTRACT FROM AUTHOR]

Orbital apex syndrome (OAS) is a rare condition that usually occurs due to damage to surrounding inner and surrounding bone tissue. Orbital apex syndrome may result from a variety of conditions that cause damage to the superior orbital fissure and to the optic canal leading to optic nerve (II) dysfunction. We recently experienced a rare case of sphenoidal Aspergillosis, which damaged the adjacent cavernous sinus structures and led to the definite symptom of bilateral OAS in a 77-year-old male. We present this rare case with a brief review of these disease's entities. [ABSTRACT FROM AUTHOR]

Granulomatosis with polyangiitis (GPA), formerly referred to as Wegener's disease, is a form of ANCA-associated vasculitis. It manifests mainly in the kidneys and the upper respiratory tract, but ocular involvement is not uncommon. In this article, four cases with ocular manifestations are presented with comprehensive photographic documentation. We describe the way to proper diagnosis, which may be long, the possible treatment, and the final outcomes. Our patients had the following ocular manifestations of GPA: retinal vasculitis, anterior necrotizing scleritis, medial orbital wall and orbital floor erosion with middle face deformation, compressive optic neuropathy due to retrobulbar inflammatory mass, and the abscess of the eyelids, inflammatory intraorbital mass causing exophthalmos and diplopia. This manuscript includes the description of severe forms of GPA, the initial signs and symptoms, relapses, and difficulties in achieving remission. The extraocular involvement is described with diagnostic modalities and laboratory findings. One of the reported cases was diagnosed by an ophthalmologist on the basis of ocular symptoms in the early stages of the disease. Our outcomes are compared with those discussed in the literature. [ABSTRACT FROM AUTHOR]

Introduction: Orbital fractures constitute one of the common injuries of the maxillofacial region. They may occur either as isolated fractures, as blowout fractures, or as part of the more complex zygoma fractures. The management of orbital fractures has always been a challenging task for oral and maxillofacial surgeons in terms of access, perfect alignment, and fixation. Only a few randomized prospective studies have compared the incisions, according to a meta-analysis on incisions for orbital floor exploration. Hence this study was undertaken, and all the parameters affecting the choice of the incision were evaluated and compared between the incisions, which were not available in other comparative studies such as scleral show and chronic lid edema. Materials and Methods: This comparative randomized study was conducted on 30 patients with zygomatic maxillary complex fractures or isolated infraorbital rim fractures in whom open reduction and internal fixation of the infraorbital rim was planned. The patients were divided into three groups randomly, with 10 patients in each group. In Group I, patients were treated with subciliary incision, in Group II with subtarsal incision, and in Group III with infraorbital incision. Results: The infraorbital incisions produced the most visible scar, followed by the subtarsal (P = 0.002). The subtarsal and infraorbital incisions provided very good exposure to the fracture site compared to the subciliary (P = 0.004). Statistics revealed that the relationship between the scleral scar and the incisions was not statistically significant six months postoperatively (P = 0.355). The subciliary incision had a higher chance of ectropion. Discussion and Conclusion: The infraorbital incision was less time consuming, but it had the disadvantage of a visible scar and chronic lid edema. The subciliary approach had an imperceptible scar but had higher chances of scleral show and ectropion. Hence, in conclusion, the results of the current study suggest that the subtarsal approach is superior compared to the subciliary and infraorbital approaches as it combines the advantages of the subciliary and subtarsal approaches with minimal complications. [ABSTRACT FROM AUTHOR]

The main aims of the current research were: (1) to analyze in detail the tensile modulus and ultimate tensile strength (UTS) of orbital wall bones separately for the left and right orbit of the same cadaver and (2) to compare the obtained results with a flexural modulus of the left and right orbit reported earlier by A. C. van Leeuwen et al. [14]. A set of 54 specimens of orbital superior and/or medial walls harvested from 16 human skulls (4 female, 12 male) were tensioned at 0.01 mm/s till fracture. The samples were taken always from both orbits of the same cadaver. For each sample, cross-section area, apparent density, tensile modulus, and UTS were identified. For pooled female and male group apparent density for right and left orbit was identified to be 1.59 ± 0.52 SD) g/cm³ and 1.51 ±0.48 SD) g/cm³, tensile modulus of 2028 ±1729 SD) MPa and of 2706 ±2812 SD) MPa, and UTS of 14.17 ±15.00 SD) MPa and of 15.03 ±11.44 SD) MPa, respectively. For tensile tests, there were no statistical differences between the left and right orbit for pooled male and female groups for (a) apparent density (Student's t-test p = 0.567), (b) UTS (Mann-Whitney U-test p = 0.350) and (c) tensile modulus (Mann-Whitney U-test p = 0.716). For bending tests, there were no statistical differences between the left and right orbit for the pooled male and female group for (a) orbital wall thickness (Student's t-test p = 0.811) and (b) flexural modulus (Mann-Whitney U-test p = 0.206). The comparative analysis between tensile and flexural moduli for pooled left and right groups (with no distinction for male and female) revealed no statistically significant difference (Mann-Whitney U-test p = 0.074). The maximum tensile modulus was 7279 MPa and 9913 MPa for the right and left orbit, respectively, and was similar to the maximum flexural modulus of 6870 MPa and 9170 MPa reported in an earlier study, for the right and left orbit, respectively. [ABSTRACT FROM AUTHOR]

The early tetrapod Crassigyrinus scoticus was a large aquatic predator known from the lower- to mid-Carboniferous (upper Tournasian to upper Visean/lower Serpukovian, approximately 350–330 Ma) of Scotland and Canada. Crassigyrinus is enigmatic in terms of its phylogenetic position due to its unusual morphology, which features a mixture of primitive and derived characters. Previous reconstructions, based on five incomplete and deformed specimens, have suggested a dorsoventrally tall skull with a short and broad snout, large orbits and external nares, and an extended postorbital region. In this study, we scanned four specimens using computed tomography and segmented imaging data to separate bone from matrix and individual bones from each other. Based on these data, we present a revised description of the upper and lower jaws, including sutural morphology and abundant new anatomical information. Damage was repaired and the skull retrodeformed to create a hypothetical three-dimensional reconstruction of the skull of Crassigyrinus that is dorsoventrally flatter than earlier reconstructions, yet still morphologically unique amongst early tetrapods. Overall skull shape, the size and distribution of the teeth, sutural morphology, and the specialized anatomy of the jaw joint and mandibular symphysis all suggest that Crassigyrinus was a powerful aquatic predator capable of hunting and subduing large prey. [ABSTRACT FROM AUTHOR]

A partial skull of a pachycephalosaurid from the Upper Cretaceous Hell Creek Formation, Montana, is interpreted as a new taxon, Platytholus clemensi gen. et sp. nov. MOR 2915 does not fit into an ontogenetic continuum of known pachycephalosaurids from the Hell Creek Formation, Montana, and contemporaneous sediments from the Western Interior. Comparisons to known ontogimorphs of Sphaerotholus and Pachycephalosaurus preclude including this specimen into an ontogenetic series of either taxon. We hypothesize that MOR 2915 is a new species based on a relatively low, broad dome at this advanced ontogenetic age that is neither round nor oval in dorsal view, distinct but fused lateral cranial elements fully incorporated into the dome without any dorsal lobe differentiation, and individual tab-like tubercle ornamentation dorsolaterally. Phylogenetic analysis posits that Platytholus clemensi is a Prenocephale-grade taxon deeply nested within Pachycephalosaurinae, but it is not a member of Pachycephalosaurini. Platytholus clemensi is intermediate in size between the other contemporaneous pachycephalosaurids in the Hell Creek Formation and suggests a diverse set of taxa-partitioned ecological niches by body size. We confirm a well organized, major internal vascular network using high resolution computed tomography. Foramina present on the orbital roofs indicate these canals penetrated the entire ceiling of the orbits within the frontal and supraorbital bones. Abundant neurovascular canals passing through the dome to the ectocranial surface indicate a keratinous structure of some kind, possibly with a vertical structural framework, was present on the dome. We review the history of the head-butting hypothesis and associated behavioral implications. [ABSTRACT FROM AUTHOR]

The abducens nerve (AN; cranial nerve VI) exits the brainstem at the inferior pontine sulcus, pierces the dura of the posterior cranial fossa, passes through the cavernous sinus in close contact to the internal carotid artery (ICA) and traverses the superior orbital fissure to reach the orbit to innervate the lateral rectus muscle. At its exit from the brainstem, the AN includes only axons from lower motor neurons in the abducens nucleus. However, as the AN crosses the ICA it receives a number of branches from the internal carotid sympathetic plexus. The arrangement, neurochemical profile and function of these sympathetic axons running along the AN remain unresolved. Herein, we use gross dissection and microscopic study of hematoxylin and eosin-stained sections and sections with tyrosine hydroxylase immunolabeling. Our results suggest the AN receives multiple bundles of unmyelinated axons that use norepinephrine as a neurotransmitter consistent with postganglionic sympathetic axons. [ABSTRACT FROM AUTHOR]