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Fulltext Gunshot-like wound caused by sling shot injury - a case report

Vinuthinee N, Azreen-Redzal A, Juanarita J, Zunaina E

Int Med Case Rep J, 2015;8:47-50.
PMID: 25709507 DOI: 10.2147/IMCRJ.S75198

We report a rare case of sling shot injury that presented with a gunshot-like wound with preseptal cellulitis, in a toddler. An 11-month-old Malay child presented with a gunshot-like wound over the forehead following sling shot injury. On examination, he had a deep circular laceration wound over the forehead, measuring 2.0 cm in diameter, with minimal bleeding. There was no obvious foreign body seen inside the wound and no palpable foreign body surrounding the wound. The gunshot-like wound was associated with left preseptal cellulitis. A skull X-ray showed a white opaque foreign body in the left frontal bone. Computed tomography (CT) scan of orbit and brain revealed a left comminuted fracture of the left orbital roof, and left frontal brain contusion with prelesional edema. Wound exploration was performed and revealed a 0.5 cm unshattered marble embedded in the left frontal bone. The marble and bone fragments were removed. The left preseptal cellulitis responded well to intravenous antibiotic and topical antibiotic.

Matched MeSH terms: Orbit
Fulltext Posterior intraorbital metallic foreign body: a case discussion

Vinodh VP, Sellamuthu P, Harun RH, Zenian MS

Med J Malaysia, 2014 Apr;69(2):89-91.
PMID: 25241819 MyJurnal

Intraorbital foreign body (IOFB) has been a rare phenomenon in the cases of gunshot wounds and always represents a dilemma in medical management. In Sabah, this scenario is becoming common as there is still certain population in the interiors who owns self made guns for hunting. They either present with self inflicted gunshot injuries or after being mistakenly shot while hunting. There are very few articles on this topic especially when it is located posteriorly in the orbit and occurs without visual impairment. This case reports the challenges faced in the management of the patient with a posteriorly located metallic IOFB. The appropriate management of the patient is discussed based on several international literatures. Author describes a 37 years old male farmer, who was referred from a nearby district hospital after he sustained gunshot injuries to his face and scalp. Urgent computed tomography (CT) scan showed that bullet pellets were at the left orbital floor, the left mandible and the left frontal bone. All bullet pellets were located extracranially only without intracranial involvement. Patient clinically does not have any neurologic deficit and without any visual impairment, thus he refused any surgical intervention. As there is no proper guideline in managing such cases, decision was made based on evidences from international literatures. It was concluded that metallic IOFB located in the posterior orbit may be conservatively managed with observation and regular follow-ups as they are well-tolerated and does not cause much impact on visual deterioration unless inflammation, infection, optic neuropathy or functional deficit occurs. This avoids unnecessary surgery and prevents risk of iatrogenic injury to the eye.

Matched MeSH terms: Orbit; Orbital Diseases
Fulltext Post dental extraction basal skull osteomyelitis with cranial nerve palsy

Tan, Ciang Sang, Haiza Hani Hamidon, Zainah Shaikh Hedra

Malaysian Journal of Paediatrics and Child Health, 2016;22(101):0-0.
MyJurnal

Background: A 9 year old boy presented with history of persistent headache and recurrent vomiting for 1 month post dental extraction. CT brain was performed for the possibility of space occupying lesion but it was normal. Subsequently, he was treated as migraine after exclusion of meningitis and intracranial lesion. Unfortunately, he developed 3rd, 4th and 6th cranial nerve palsy two weeks later. Repeated CT brain showed subtle finding and inconclusive. MRI brain performed at the time showed features suggestive of basal skull osteomyelitis with congestion of right orbit and optic nerve swelling. Case was referred to Paediatric Neurologist and he was diagnosed to have cranial nerve palsy secondary to basal skull osteomyelitis, post dental extraction.

Conclusion: Dental procedure is common among children, however basal skull osteomyelitis with cranial nerve palsy is a rare complication. Adequate treatment of dental infection post dental procedure is important to prevent this complication.

Matched MeSH terms: Orbit
Fulltext Masquerade syndrome: an ocular involvement of lung cancer

Umi Kalthum, M. N., Wan Haslina Wah

Medicine & Health, 2013;8(1):47-51.
MyJurnal

We report a case of a 37-year-old smoker who presented with painless and sudden onset of loss of upper field vision of the right eye, associated with one month history of dry cough which was unresponsive to antibiotic and subsequent anti- tuberculosis therapy. Visual acuity at presentation was counting finger. There was bullous retinal detachment on examination. Radiological imaging revealed multiple lung opacities, involving the brain and the right orbit. Bronchoscopy and biopsy confirmed the diagnosis of adenocarcinoma of the lung. This case illustrates masquerade syndrome of which a lung carcinoma harbours behind a seemingly innocent retinal detachment. It also highlights the importance of entertaining lung carcinoma as a differential diagnosis in suspected tuberculosis among heavy smokers.

Matched MeSH terms: Orbit
Fulltext Enucleation in a Cownose Ray (Rhinoptera bonasus)

Abraham Gabriel A, Yee-Nin ST, Adamu L, Hassan HMD, Wahid AH

Case Rep Vet Med, 2018;2018:5048948.
PMID: 29955436 DOI: 10.1155/2018/5048948

Trauma is a common problem in Cownose Ray during mating season in both wild and captive rays. Enucleation is indicated when there is an ocular trauma. A 5-year-old female Cownose Ray (Rhinoptera bonasus) from Aquaria of Kuala Lumpur Convention Centre (KLCC) was presented to University Veterinary Hospital (UVH), Universiti Putra Malaysia, with a complaint of protruding left eye, which resulted from crushing into artificial coral during mating season. There were a hyphema in the traumatic left eye, periorbital tissue tear, exposed left eye socket, and multiple abrasions on both pectoral fins. The Cownose was anaesthetized and maintained with isoeugenol and on-field emergency enucleation of the left eye was performed. It was managed medically with postoperative enrofloxacin, tobramycin ointment, and povidone iodine. No suture breakdown and secondary infection were observed at day 7 after enucleation during revisit. At day 24 after enucleation, the Cownose responded well to treatment with excellent healing progression and no surgical complication was observed.

Matched MeSH terms: Orbit
Fulltext Secondary mucoepidermoid carcinoma of the orbit

Siuw CP, Tan SW, Abdul Wahid AB, Vasudevan S

Indian J Ophthalmol, 2016 Mar;64(3):238-41.
PMID: 27146939 DOI: 10.4103/0301-4738.181748

A 40-year-old man presented with right eye axial proptosis and ophthalmoplegia for 3 months. Imaging study showed a right intraconal mass with the erosion of the orbital floor. Incisional biopsy revealed mucoepidermoid carcinoma. Nasal endoscopy was normal and systemic tumor screening was negative for a primary source. The patient underwent right orbital exenteration, uncinectomy, nasal and maxillary mucosal biopsy. Malignant cells were found present in the mucosa of maxillary sinus roof and uncinate bone. The postoperative positron emission tomography scan showed residual active lesion in right orbital apex and maxilla but no primary lesion elsewhere. The patient subsequently underwent 35 cycles of postoperative radiotherapy. Primary mucoepidermoid carcinoma of the orbit is rare and typically arises from the lacrimal gland or sac. Those tumors not arising from lacrimal apparatus should be presumed metastatic in origin, and the thorough systemic survey should be undertaken in the search for the primary tumor.

Matched MeSH terms: Orbit/surgery; Orbital Neoplasms/diagnosis*; Orbital Neoplasms/surgery; Orbit Evisceration
Fulltext Sensitive dependence on initial conditions for an example of markov map: skewed doubling map

Ummu Atiqah Mohd Roslan

MATEMATIKA, 2018;34(1):13-21.
MyJurnal

Markov map is one example of interval maps where it is a piecewise expanding
map and obeys the Markov property. One well-known example of Markov map is the
doubling map, a map which has two subintervals with equal partitions. In this paper, we
are interested to investigate another type of Markov map, the so-called skewed doubling
map. This map is a more generalized map than the doubling map. Thus, the aims of this
paper are to find the fixed points as well as the periodic points for the skewed doubling
map and to investigate the sensitive dependence on initial conditions of this map. The
method considered here is the cobweb diagram. Numerical results suggest that there exist
dense of periodic orbits for this map. The sensitivity of this map to initial conditions is
also verified where small differences in initial conditions give different behaviour of the
orbits in the map.

Matched MeSH terms: Orbit
Fulltext Severe Orbital Myiasis Caused by Chrysomya bezziana: A Case Report

Ng YS, Gan YK, Tupang L

Turk J Ophthalmol, 2021 Feb 25;51(1):62-65.
PMID: 33631919 DOI: 10.4274/tjo.galenos.2020.00225

An 88-year-old woman was brought to the hospital immediately after her neighbours noticed that she was bleeding from her right eye. On examination, her right eye was phthisic with maggot infestation of her right orbit. Over a hundred live maggots were extracted using forceps. Computed tomography scan revealed the infestation was confined to the right orbit. The patient underwent exenteration of the right orbit under general anaesthesia. The species was identified by an entomologist as Chrysomya bezziana, which has aggressive larvae that eat living tissue. This case report demonstrates that orbital myiasis caused by C. bezziana poses a very real risk of intracranial invasion as they feed on living tissues. Adjacent tissue destruction can be very rapid and definitive treatment involves urgent removal of its larvae via surgical debridement. To our knowledge, we are reporting the first case of orbital myiasis from a patient in Malaysia. Therefore, our case report may be helpful in the management of similar case of orbital myiasis.

Matched MeSH terms: Orbit
Fulltext Recurrent optic neuritis as early presentation of idiopathic hypertrophic cranial pachymeningitis

Norhayaty Samsudin, Tai, Evelyn Li Min, Chui, Yain Chen, Kumar, Lakana, Azhany Yaakub, Adil Hussein, et al.

Journal of Biomedical and Clinical Sciences, 2017;2(1):23-26.
MyJurnal

44-year-old Malay lady presented with drooping of the right eyelid and worsening of left eye vision for one week duration. There was associated headache, periorbital discomfort and diplopia on left gaze. She previously had a history of recurrent optic neuritis affecting both eyes over a period of 12 years. On examination, there was right-sided partial ptosis and left exotropia. The adduction, abduction, elevation and depression of the right eye was limited. Left eye extraocular movements were full. The right eye visual acuity was 6/9, while the left eye visual acuity was perception to light, with a positive relative afferent papillary defect and a pale optic disc. The right optic disc was normal. There was reduced sensation in the trigeminal nerve distribution over the right side of the face. Neurological examination was otherwise normal. Magnetic resonance imaging of the brain and orbit revealed meningeal thickening with involvement of the right orbital apex and cavernous sinus. Blood investigations for infectious and autoimmune causes were unremarkable. She was diagnosed to have idiopathic hypertrophic cranial pachymeningitis and treated with systemic corticosteroids. The right eye extraocular motility improved, while the left eye visual acuity improved to counting finger. This case demonstrates that idiopathic hypertrophic cranial pachymeningitis may present as recurrent optic neuritis in the early phase, before radiological evidence of the disease is present. A high index of suspicion for the underlying cause is essential to prevent irreversible optic nerve damage due to recurrent optic neuritis.

Matched MeSH terms: Orbit
Fulltext Corticosteroid Therapy in Optic Neuropathy Secondary to Nasopharyngeal Carcinoma

Wahab Z, Tai E, Wan Hitam WH, Sonny Teo KS

Cureus, 2021 Mar 06;13(3):e13735.
PMID: 33842113 DOI: 10.7759/cureus.13735

INTRODUCTION: Nasopharyngeal carcinoma (NPC) is a tumor arising from the epithelial cells of the nasopharynx. NPC can spread and invade the base of skull, nasal cavity, paranasal sinuses, pterygopalatine fossa, and apex of the orbit. However, the involvement of the optic nerve in NPC is rare. The purpose of this case report is to report the efficacy of corticosteroid therapy in optic neuropathy secondary to NPC.
CLINICAL CASE: A 56-year-old Chinese woman, an active smoker, presented with a hearing deficit, persistent tinnitus and nasal congestion. Examination and investigations revealed the presence of a mass in the nasopharynx. Tissue biopsy revealed nasopharyngeal carcinoma. However, the Epstein-Barr virus was not tested. She was counseled for chemotherapy, but refused and was subsequently lost to follow up. She presented one year later with right eye ptosis associated with progressive worsening of diplopia and blurring of vision. Examination revealed multiple (second, third, fourth and sixth) cranial nerve involvement. Systemic examination and investigations revealed cervical lymphadenopathy and liver metastasis. Repeated imaging showed that the mass had invaded the base of the skull, cavernous sinus and orbital apices. Pulse dosing of corticosteroid therapy was commenced, resulting in dramatic improvement of vision.
CONCLUSION: Optic neuropathy may be the presenting sign of NPC. Corticosteroid therapy can offer immediate visual improvement.

Matched MeSH terms: Orbit
Ethnic variation in deep lateral orbital anatomy and its implications on decompression surgery

Kumaran A, Chan A, Yong K, Shen S

Orbit, 2019 Apr;38(2):95-102.
PMID: 29482415 DOI: 10.1080/01676830.2018.1441316

AIM: To describe differences in the deep lateral orbital wall (specifically, trigone) between Chinese, Malay, Indian and Caucasian subjects Methods: Single-centre retrospective Computed Tomogram (CT)-based study; 20 subjects of each ethnicity were used from existing databases, matched for gender, average age and laterality. Subjects below 16 years of age were excluded. DICOM image viewing software CARESTREAM Vue PACS (Carestream Health Inc., USA) and OsiriX version 7.5 (Pixmeo., Switzerland) were used to measure deep lateral wall length, thickness and volume, as well as orbital depth and statistical analyses performed using Statistical Package for Social Sciences version 21 (IBM, USA).
RESULTS: In each group, there were 12 males (60%) and average age was not significantly different (p = 0.682-0.987). Using Chinese subjects as a reference, in Chinese, Malay, Indian and Caucasian subjects, mean trigone thickness was 13.68, 14.02, 11.60 (p orbital depth was 27.54, 24.97, 22.12 (p = 0.001) and 25.93 mm and diagonal orbital depth was 34.19, 33.27, 29.48 (p = 0.01) and 34.63 mm respectively.
CONCLUSIONS: Indian and, to a lesser extent, Caucasian subjects have smaller trigones compared to their Chinese and Malay counterparts. Indian subjects also have shallower orbits and due care should be taken during decompression surgery.

Matched MeSH terms: Orbit/anatomy & histology*; Orbit/surgery
Fulltext Endoscopic orbital decompression for Graves' ophthalmopathy

Tang IP, Prepageran N, Shashinder S

Med J Malaysia, 2008 Mar;63(1):67-8.
PMID: 18935740

We report a male patient of Graves' Disease with bilateral exophthalmos who had undergone bilateral transnasal endoscopic orbital decompression with subsequent improvement of 3 mm in orbital proptosis bilaterally without any complications. Transnasal endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques especially for purely cosmetic reasons.

Matched MeSH terms: Orbit
Frontoethmoidal encephalocele: treatment and outcome

Arshad AR, Selvapragasam T

J Craniofac Surg, 2008 Jan;19(1):175-83.
PMID: 18216685 DOI: 10.1097/scs.0b013e3181534a77

This is a study on 124 patients who were treated by the authors over a 19-year period. There were 48 male and 76 female patients. The age range of these patients at the time of treatment was between 4 months and 32 years. There was no family history of similar deformity. All of these patients come from a socially low-income group. Fourteen patients had accompanying congenital amputation of fingers, toes, or limbs. Two had oral cleft lip and palate. The surgical treatment was medial orbital wall osteotomy and excision of encephalocele. There were two mortalities and five patients who had complications that needed secondary surgical intervention. Thirty-eight patients are still under follow up without any complaints.

Matched MeSH terms: Orbit/surgery
Current and conductance modulation at elevated temperature in siliconand InAs-based spin field-effect transistors

Osintsev D, Sverdlov V, Makarov A, Selberherr S

Sains Malaysiana, 2013;42:205-211.

Spin field-effect transistors (SpinFETs) are promising candidates for future integrated microelectronic circuits. A SpinFET is composed of two ferromagnetic contacts (source and drain), which sandwich a semiconductor channel. Current modulation is achieved by electrically tuning the gate voltage dependent strength of the spin-orbit interaction in the semiconductor region. We investigated the properties of SpinFETs for various parameters - the band mismatch, the barrier height between the contacts and the channel and the strength of the spin-orbit coupling, for various temperatures. We demonstrated that the creation of Schottky barriers between the channel and the contacts guarantees a pronounced modulation of the magnetoresistance sufficient to open a possibility to operate SpinFETs at room temperature. We also demonstrated that silicon fins with [100] orientation exhibit a stronger dependence on the value of the spin-orbit interaction and are thus preferable for practical realization of silicon-based SpinFETs.

Matched MeSH terms: Orbit
Fulltext A rare complication of MRSA lid abscess and orbital abscess following strabismus surgery in a child

Kenneth Teow, K. L., Nor Akmal, B., Jamalia, R., Safinaz, M. K.

Journal of Surgical Academia, 2018;8(1):32-35.
MyJurnal

Strabismus is one of the most common ocular problems affecting the preschool population and the aim of strabismus surgery is to correct abnormal alignment of the eyes. A 5-year-old girl with strabismus underwent an uneventful surgery and was discharged on the same day with topical medications. Two days later, she returned with a painful right lower eyelid swelling, eye discharge and fever which started 1 day post-surgery. She was admitted for intravenous (IV) antibiotic. Symptoms initially improved after 24 hours of treatment, but later she had worsening eyelid swelling. An urgent CT scan of the orbit showed a right lower lid abscess with orbital cellulitis. Subsequently an examination under anaesthesia (EUA) and incision and drainage (I&D) of the lower lid abscess were performed. Culture from the pus grew Community Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA), sensitive to Vancomycin. At day 2 post I&D she subsequently developed another episode of localised right lower lid swelling. Another EUA was done but showed the lower lid and wound was free of pus. She was later found to have a toxic reaction to topical Gentamicin and hence this medication was stopped. She responded well to treatment and was discharged after completing her IV antibiotics. At 14 months outpatient follow up, she was well and orthophoric in primary gaze. While treating a disease, we should be opened to all possibilities and not to treat with multiple antibiotics once susceptibility is known

Matched MeSH terms: Orbit; Orbital Cellulitis
Fulltext Orbital cellulitis from untreated conjunctival wound

Aimy Mastura, Z.Y., Norshamsiah, M.D., Hazlita, M.I., Othmaliza, O., Ropilah A.R.

Medicine & Health, 2017;12(1):94-98.
MyJurnal

Selulitis orbital merupakan jangkitan tisu di sekitar mata di dalam ruangan orbit yang
termasuk saraf mata. Ia boleh menyebabkan komplikasi yang membawa kematian
sekiranya merebak melalui saraf mata dan ke otak. Penyebab utama jangkitan
adalah termasuk perebakan jangkitan sinusitis dari ruangan paranasal atau melalui
selulitis preseptal. Kes ini menggambarkan jangkitan di luar kebiasaan mengenai
jangkitan orbital selulitis yang berlaku akibat luka torehan pada konjunktiva mata
yang disebabkan oleh kemalangan. Rawatan antibiotik sistemik yang agresif
mengurangkan risiko komplikasi penglihatan. Kesemua luka pada atau sekelililng
mata haruslah dirawat dengan sebaiknya bagi mengelakkan berlakunya komplikasi
yang membahayakan.

Matched MeSH terms: Orbit
Hospital Universiti Sains Malaysia experience in orbital floor reconstruction: autogenous graft versus Medpor

Wajih WA, Shaharuddin B, Razak NH

J Oral Maxillofac Surg, 2011 Jun;69(6):1740-4.
PMID: 21272979 DOI: 10.1016/j.joms.2010.07.053

A normally restored orbital structure after reconstructive surgery would accelerate the return of orbital function. The aim of the present study was to compare the outcomes of 2 orbital implants: autogenous grafts and porous polyethylene (Medpor).

Matched MeSH terms: Orbit/surgery*; Orbital Fractures/complications; Orbital Fractures/diagnosis; Orbital Fractures/surgery*
Fulltext Enucleation of Extraconal Frontomucocele: A Tripple-Window Approach

Irfan, M., Dinsuhaimi, S., Roselinda, A.R., Rani, A.S.

International Medical Journal Malaysia, 2009;8(1):45-47.
MyJurnal

Mucoceles are expansile masses originating in the sinuses. They are relatively unusual, occurring most frequently at fronto-ethmoidal region. They are locally destructive. This expansile lesion caused bony erosion and displaces the adjacent structures. We report a case of a patient who presented to our clinic with bulging of his left eye and worsening of the left vision. This was preceded by history of sport injury to his left supraorbital ridge. CT scan revealed that there was an extraconal lesion at the superolateral part of the left orbital cavity which pushed the orbit inferomedially, which consistent with left frontomucocele. He underwent enucleation of the lesion via 3 windows created namely at the left supraorbital ridge, anterior table of left frontal sinus and through the septum separating the frontal sinuses.

Matched MeSH terms: Orbit
Three-dimensional quantitative evaluation of facial morphology in adults with unilateral cleft lip and palate, and patients without clefts

Othman SA, Ahmad R, Asi SM, Ismail NH, Rahman ZA

Br J Oral Maxillofac Surg, 2014 Mar;52(3):208-13.
PMID: 24342372 DOI: 10.1016/j.bjoms.2013.11.008

The aims of this study were to assess the quantitative values of measurements using proportion indices in the craniofacial region in patients with repaired, non-syndromic, complete unilateral cleft lip and palate (UCLP), and compare them with a control group who did not have clefts using the non-invasive systems of 3-dimensional technology. Three-dimensional measurements of the facial surfaces of 15 Malay patients who had UCLP repaired and 100 Malay control patients aged 18-25 years were analysed. The 3-dimensional images of the respondents' faces were captured using the VECTRA-3D Stereophotogrammetry System. Eleven craniofacial proportions were assessed using a combination of 18 linear measurements obtained from 21 anthropometric soft tissue landmarks. These measurements were used to produce proportion indices to find the differences in the morphological features between the groups, and assessed using the independent sample t test and z scores. There were significant differences between the groups in 7 out of 11 craniofacial proportion indices (p=0.001-0.044). Z scores of 2 indices were disproportionate. They were nasal index (which was severely supernormal) and upper lip index (which was moderately supernormal). Patients with UCLP had higher mean z scores, indicating that patients with UCLP tended to have larger faces than the control group. There were clinically important differences mainly in the nasolabial area, where the nose and the upper lip were wider, larger, or flatter in patients with UCLP.

Matched MeSH terms: Orbit/pathology
Fulltext Langerhans cell histiocytosis of maxillary sinus

Azreen AB, Kwan CY, Prepagaren N

Med J Malaysia, 2012 Dec;67(6):627-8.
PMID: 23770962 MyJurnal

Langerhan cell histiocytosis is a rare disease and usually occurs in paediatric age group. This disease may involve single or multiple organs system and has an unpredictable course of disease. The involvement of head and neck region are almost 90% of cases, however maxillary sinus involvement is very rare. We report a case of 2 year old boy presented with multi organ LCH (orbit, skull, sinus and liver). The mainstay treatment for this high risk multi organ LCH group is chemotherapy. Unfortunately, although with the advancement of treatment, their mortality rate is still high.

Matched MeSH terms: Orbit

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