anatomy of the orbit
TRANSCRIPT
ANATOMICAL ASPECTS OF ENT IN RELATION TO EYEDR. SATINDER PAL SINGH
ANTERIOR VIEW OF THE SKULL
RIGHT ORBIT SHOWS THE 7 BONES THAT CONTRIBUTE TO ITS STRUCTURE
MEDIAL WALL OF ORBITStankiewick sign- By pressing the eye check lamina
Related to ethmoidsLamina is 2mm above the maxillary ostium
Lacrimal bone is smallest and most fragile of the cranial bones.
CHANDLER’S CLASSIFICATION OF ORBITAL INFLAMMATION
PRESEPTAL CELLULITIS ORBITAL CELLULITIS
5. CAVERNOUS SINUS THROMBOSIS.
3. SUBPERIOSTEAL ABSCESS
4. ORBITALABSCESS .
PATHOPHYSIOLOGY OF THE SPREAD OF INFECTIONDirect invasion through compromised
bony barriersRetrograde septic thrombophlebitis
(ophthalmic vein via the pterygoid venous plexues).
Erosive osteomyelitis (osteomyelitic bone erosion).
DIRECT INVASION THROUGH COMPROMISED BONY BARRIERS
Infection spreads to the ethmoid labyrinth
Lamina papyracea has two openings Ant./Post. Ethmoid canal
for NV bundle
Orbitalinvolvement
LATERAL VIEW OF THE MEDIAL WALL OF THE RIGHT ORBIT.
Lacrimal bone
Lamina papyracea
Posteriorethmoidalforamen
Anteriorethmoidalforamen
ORBITAL COMPLICATIONS OF SINUSITIS.COMPUTED TOMOGRAPHY SCAN OF A PATIENT WITH A RIGHT ORBITAL ABSCESS.
SEQUENCE OF SPREAD Sinusitis
Orbitalinvasion
Preseptalcellulitis
Subperiostea
l abscess
Orbital cellulitis
Orbital abscess
Superior orbital fissure
syndrome
Orbital apex syndrome
Cavernous sinus
thrombosis
Ophthalmoplegia
blindness
RIGHT ORBIT SHOWS SUPERFICIAL LANDMARKS
A PATIENT WITH CAVERNOUS SINUS THROMBOSIS. THIS IMMUNOCOMPROMISED DIABETIC 76-YEAR-OLD MAN WITH FUNGAL SINUSITIS PRESENTED WITH MARKED PROPTOSIS, CHEMOSIS, OPHTHALMOPLEGIA, AND COMPLETE VISUAL LOSS.
AXIAL CONTRAST (CT) SCAN REVEALING (A) THROMBOSIS OF THE SUPERIOR OPHTHALMIC VEIN (SINGLE ARROW) AND RIGHT CAVERNOUS SINUS (DOUBLE ARROWS) IN AN 11-YEAR-OLD WHO PRESENTED WITH RIGHT ORBITAL PAIN AND PERIORBITAL EDEMA.
AXIAL (H) AND CORONAL (I) CT OF A LEFT ANTERIOR ETHMOIDAL MUCOCELE, DEMONSTRATING THINNING/DEHISCENCE OF THE FOVEA ETHMOIDALIS, CRIBRIFORM PLATE, AND LAMINA PAPYRACEA, AND INVASION OF THE MEDIAL LEFT ORBIT.
Coronal (j) bone and soft tissue algorithmCT of a left anterior ethmoidal mucocele, demonstrating thinning/dehiscence of the fovea ethmoidalis, cribriform plate, and lamina papyracea, and invasion of the medial left orbit.
CORONAL CT OF AN IMMUNOCOMPROMISED PATIENT WITH INVASIVE FUNGAL RHINOSINUSITIS. NOTE THE AGGRESSIVE-APPEARING MORPHOLOGY, WITH INVASION OF ADJACENT STRUCTURES. A HALLMARK OF FUNGAL INFECTION.
A PATIENT WITH LARGE TUMOR PROBABLY ARISING ON THE LATERAL WALL OF THE NOSE AND ETHMOIDS, EXTENDING LATERALLY INTO THE MAXILLARY SINUS AND ANTERIORLY INTO THE SOFT TISSUES OF THE CHEEK, DISPLACING THE EYE LATERALLY AND SUPERIORLY.CORONAL CT SCAN OF THE SAME PATIENT SHOWING A LARGE"ANTROETHMOIDAL" TUMOR.
FRONTAL SINUS TREPHINATIONEYE MOVED DOWNWARDFARWARD LATERALLY
AXIAL (LEFT) AND CORONAL (RIGHT) T1-WEIGHTED CONTRAST-ENHANCED MAGNETIC RESONANCE IMAGES FOR A PATIENT WITH PROGRESSIVE VISION LOSS AND A
LARGE CAVERNOUS HEMANGIOMA OF THE LEFT ORBITAL APEX (WHITE ARROWS).
(CT) SCAN OF THE ORBITS OF A 35-YEAR-OLD FEMALE A MASS IN THE LEFT ORBIT THAT OBLITERATES SUPERIOR AND MEDIAL STRUCTURES OF THE ORBIT, COMPARED WITH NORMAL STRUCTURES IN RIGHT ORBIT. THE MASS ALSO INVOLVES THE LEFT ETHMOID SINUSES.
OPTIC NERVEDECOMPRESSION
Descendingprocess for /.nasal concha
Crest
Lacrimal hamulus
Groove for lacrimal
Articulates withfrontal bone
Left Lacrimal bone
THE LACRIMAL APPARATUS
LANDMARKS FOR DCRAnterior lacrimal crestPosteroir lacrimal crestLacrimal fossaMedial canthus Medial palpebral ligament
GRAVES DISEASE Exophthalmos Proptosis and diplopia Corneal ulceration from exposure and
Keratopathy Visual loss from optic neuropathy. Fusiform swelling of muscles COCA COLA SIGN During endoscopic orbital decompression for
treatment of Graves orbitopathy, the maxillary sinus serves as the gateway to the orbital floor.
Successful endoscopic decompression depends on the creation of a wide maxillary antrostomy.
DALRYMPLE’S SIGN-RETRACTION OF UPPER LID
VON GRAEFE’S SIGN- LID LAG
GIFFORD’S SIGN- DIFFICULTY IN EVERSION OF LID
STELLWAG’S SIGN-INFREQUENT BLINKING
EXTRAOCULAR MUSCLE ENLARGEMENT MARKED WITH WHITE ARROW IN CORONAL SOFT TISSUE CT SCAN (A) AND AXIAL CT SCAN (B). NOTE THE ORBITAL APEX CROWDING.
FACIAL NERVE PARALYSIS Incomplete closer of eye results in Epiphora Exposure keratitis Bells phenomenon ( eyeball turn up and
out) Crocodile tears ( gustatory lacrimation)
SJOGREN’S SYNDROME Xerostomia Keratoconjunctivitis sicca Rhinitis sicca
OTITIC HYDROCEPHALUSo Dilplopiao Papilledeoma and otic atrophyo Nystagmus
TRAUMA PARTNASO-ORBITAL FRACTURES Telecanthus, due to lateral displacement of
medial wall of orbit. Peri orbital ecchymosis Orbital haematoma
FRACTURE OF ZYGOMA (TRIPOD FRACTURE)•Step deformity of infraorbital margin•Oblique palpebral fissue •Restricted ocular movments•Diplopia•Periorbibal Emphysema
FRACTURES OF ORBITAL FLOOR Also known as Blow out fractures Ecchymosis of lid, conjunctiva and sclera Enophthalmos with inferior displacement of eyeball Diplopia due to Inferior rectus trapped Tear drop sign on WATER’S VIEW. Infraorbital/Trasnantral reduction of fracture.
FRACTURES OF MAXILLA Le Fort I (transverse) fracture Le Fort II (pyramidal) fracture Le Fort III (craniofacial dysjunction)
TRAUMATIC FACIAL PALSY OF A CHILD WITH COMPLETE FACIAL PARALYSIS OWING TO BELL’S PALSY, TOP ROW. RESULTS 2 MONTHS AFTER MIDDLE CRANIAL FOSSA DECOMPRESSION OF THE LABYRINTHINE SEGMENT AND GENICULATE GANGLION OF THE FACIAL NERVE, BOTTOM ROW.
CSF RHINORRHOEA
SLEEP APNEA Primary open angle glaucoma P.O.A.G. Due to decreased oxygenation of optic nerve
during sleep apnea.
LABYRINTHITIS• Vestibular imbalance• Nystagmus
COGAN’S SYNDROME• Episodic vertigo• Interstitial keratitis• SNHL • -ve serology for syphilis.
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA Frog-Face Deformity It extend to inferior orbital fissure and
destroy Apex of orbit. Enter the orbit via Superior orbital fissure
Nasopharyngeal carcinoma• Squint and diplopia due to C.N. VI m/c.• Ophthalmoplegia C.N. III, IV and VI• Reduced corneal reflex invasion of C.N. V
through F. Lacerum.• Exophthalmos and blindness due to direct
invasion of C.N. II.• C.N. IX, X and XI Jugular foramen syndrome
OPTIC CANAL AND SUPERIOR ORBITAL FISSURE.
CT (C) AND MRI (D) DEMONSTRATI NG DIRECT SKULL BASE AND ORBITAL INVASION OF AN ADENOID CYSTIC CARCINOMA. NOTE THE INTRINSIC T2 HYPERINTENSITY OF THE LESION, UNUSUAL AMONG SINONASAL SOFT TISSUE MALIGNANCIES.
OCULOMOTOR (III) NERVE DAMAGE
AT REST•LATERAL STRABISMUS DUE TO PARALYZE MEDIALRECTUS• PTOSIS-DROOPING EYELID
ABDUCENS (VI): AT RESTMEDIAL STYLABISMUS(CROSS-EYED) DUE TODAMAGE/PARALYZELATERAL RECTUS
A. ABDUCENS(VI) NERVEDAMAGE
WALLENBERG SYNDROME (PICA) Vertigo, nausea and vomiting Horner’s syndrome Dysphaiga Dysphoina Ataxia with tendency to fall to involved side Loss of pain and temperature sensations on
same side of face and contralateral sides of limibs.
GARDENIGO SYNDROME EAR DISCHARGE (S.O.M.) DIPLOPIA(C.N. VI paralysis) RETRO-ORBITAL PAIN (C.N. V involve)
LATERAL SINUS THROMBOPHLEBITIS
•Papilledema •Blurring of disc margins•Retinal hemorrhage•Crowe-Beck test
ALLERGIC RHINITIS
o EDEMA OF LIDSo CONGESTIONo COBBLESTONE CONJUNCTIVAo ALLERGIC SHINERS (dark circles under the
eyes)
USHER’S SYNDROME Hearing loss Retinitis pigmentosa
RACOON SIGN• Ecchymosis around eye’s in case of head injuries
VAN DER HOEVE SYNDROME OSTEOGENESIS IMPERFECTA OTOSCLEROSIS AND BLUE SCLERA
THANK YOU