Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
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28-JULY-2011 ALAA MAHER AL-SHAREEF 17 YEARS
INTRAORBITAL MASS BELOW AND BEHIND THE GLOBE LEFT EYE.
Anamnesis
The
patient came to the clinic 10-July-2011
complaining of exophthalmus left eye 1 month
with feeling of heaviness of the eye.
MRI
brain and orbits done 10-July-2011 showing
retrobulbar mass below the globe of the left
eye, pushing the optic nerve up and the globe
anterior.
On
examination: the patient has weak left upper and
lower limbs with hypalgesia below C3, for what
MRI cervical MRI was requested and done
16-July-2011 which was normal. There was slight
changes in the visual fields of the left eye.
The oculomotor nerves and movements were normal.
Upon palpation of the left eye, it was possible
to palpate the mass under the globe when the
patient flexing the head down, but when he look
up the mass disappear.
Lateral canthotomy for the
left eye was done. The incision was extended 20
mm laterally. Osteotomy of the lateral wall of
the orbit was done, so that the lower edge is
flush with the inferior margin of the orbit. The
periorbita was opened below the lateral rectus
muscle projection. The mass was explored and it
was a cluster of venous walls with capillary
feeders coming from all the surrounding
structures. The hemangioma was coagulated
stepwise and sharp dissection was necessary to
prevent trauma to the globe and lateral rectus
muscle. Fresh frozen biopsy was done confirming
the hemangioma. The vascular mass was followed
all over and dissected off the optic nerve and
the inferior rectus muscle. It was followed, so
the the dissection was carried out until the
medial wall of the orbit was identified.
Practical total resection was achieved.
Inspection of the optic nerve and all the
surrounding anatomical structures were carried
out to rule out presence of any remnants.
Routine
closure of the wound. Smooth postoperative
recovery with preservation of vision left eye.
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Comments
Exophthalmus is the fist sign of benign
intraorbital masses.
The disappearance of the mass when the face up
and exaggeration when looking down make the
vascular malformation more favorable.
The lateral approach is the most superior
approach in such case, since the surgeon can
bring under visual control 3-4 of the anatomical
structures.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
