Naslov
Dynamic-reconstruction of a metallic retrobulbar foreign body

Autori
Klapan Ivica, Rišavi Ranko, Šimičić Ljubimko, Bešenski Nada, Štiglmajer Neda

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Abstract Book: European Rhinologic Siociery and ISIAN Meeting, Ulm 2002 / Rettinger G. - Ulm, 2002

Skup
European Rhinologic Siociery and ISIAN Meeting, Ulm 2002

Mjesto i datum
Ulm, Njemačka, 15.06.2002. - 21.06.2002

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
3D-reconstruction; metallic foreign body; retrobulbar space

Sažetak
A 28-year-old healthy man, suffered a penetrating injury in the region of the left palpebral fissure while working on a metal object, which caused a 3-mm laceration of the eyelid edge and eyeball penetration, involving entire cornea diameter and continuing into the orbit by 4 mm. The foreign body was almost completely retained in the orbit, with a minor segment protruding to the region of posterior ethmoid sinus cells. CT imaging revealed a metal particle in the posterior segment of lamina papyracea. The foreign body partially protruded into the posterior ethmiodal cells, while the other part was located in the orbit. Dislocated and compressed med. rectus m., and inf.rectus.m. Other muscles and the optic nerve were intact. Pronounced chronic inflammatory changes with signs of OMC block were observed in the region of ethmoidal cells and left maxillary sinus. Standard CT scans in coronal and transverse sections of 3-mm thickness were performed on a Sytec 2000+ (General Electric). Five-mm transverse CT sections were performed in a plane parallel with the hard palate and the patient in supine position, whereas 3-mm coronal CT sections were performed in a plane perpendicular to the hard palate with the patient in prone position with neck hyperextension. These CT images were used to design the static and dynamic 3D models of paranasal sinuses. Two-dimensional coronal and transverse sections were compared with 3D models. The static and dynamic 3D models and VE of the sinuses were used in surgerical planning and were available to the surgeon in the operating room throughout the procedure. All CT images obtained were stored on film and in digital form on a magnetic medium (hard disk). The main reason for insisting on precise determination of the shape, position, and number of foreign bodies (?) was the unfavorable location of the foreign body. With its proximal part, the foreign body was in tight contact with the dislocated and compressed med. rectus m., and inf.rectus.m. Other muscles and the optic nerve were intact, however, the distal, bent edge of the foreign body was very close to the optic nerve. The use of static 3D models, elaborated from 2D CT sinus section, obtained relative relationships of the borderline areas that are important for the diagnosis of pathologic conditions in the region, and showed significant improvement in comparison with 2D visualization in the form of stratified images. With the use of computer techniques of segmentation and presentation of various tissues with different colors as dynamic 3D models, we allowed visualization of various anatomical structures in real time , as well as of their spatial interactive relationships from all aspects possible. Close contact of the distal part of the foreign body with the optic nerve posed an additional problem. On rotating, utmost care was taken not to move the distal part of the foreign body even by a millimeter, to prevent damage to the optic nerve. Using the technique of VE, we simulated the endoscope tip penetration through the orbit, nose and paranasal sinuses which cannot be explored by the existing endoscopic methods, i.e. using only the “ standard FESS” approach.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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