This contribution gives basic information about the mechanical behavior of the facial part of the human skull cranium, i.e., the splanchnocranium, associated with external loads and injuries caused mainly by brachial violence. The main areas suffering from such violence include the orbit, frontal, and zygomatic bones. In this paper, as a first approach, brachial violence was simulated via quasi-static compression laboratory tests, in which cadaveric skulls were subjected to a load in a testing machine, increasing till fractures occurred. The test skulls were also used for research into the dynamic behavior, in which experimental and numerical analyses were performed. A relatively high variability in forces inducing the fractures has been observed (143-1403 N). The results lay the basis for applications mainly in forensic science, surgery, and ophthalmology.

Background and Objectives: The aim of this study was to study the prevalence of ocular findings in patients with orbital fractures in a tertiary center in Saudi Arabia. Materials and methods: A cross-sectional observational study was performed. The participants were patients who presented with orbital trauma to the emergency department of King Saud Medical City (Riyadh, Saudi Arabia). Subjects included those diagnosed with isolated orbital fracture using clinical evaluation and CT examination. We performed direct evaluation of ocular findings for all patients. Variables studied included age, gender, site of ocular fracture, cause of trauma, side of fracture, and ocular findings. Results: In total, 74 patients with orbital fractures were included in this study (n = 74). Of the 74 patients, 69 (93.2%) were males and only 5 patients (6.8%) were females. The age range was 8-70 years, with a median age of 27 years. The 27.5-32.6-year age group was the most affected (95.0%). The left orbital bone was involved in the majority of bone fractures 48 (64.9%). The orbital floor (n = 52, 41.9%) and lateral wall (n = 31, 25.0%) were the most prevalent sites of bone fracture among the study patients. Road traffic accidents (RTAs) were the most common causes (64.9%) of orbital fractures, followed by assaults (16.2%) and then sports injuries and falls (9.5% and 8.1%, respectively). Animal attacks were the least cause of trauma (only 1 patient, 1.4%). The occurrence of ocular findings, either alone or in combination, showed that subconjunctival hemorrhage had the highest percentage (52.0%), followed by edema (17.6%) and ecchymosis (13.6%). A statistically significant correlation was reported between the site of bone fracture and orbital findings, with r = 0.251 * and p < 0.05. Conclusions: Subconjunctival bleeding, edema, and ecchymosis were the most frequent ocular abnormalities, in that order. There were a few instances of diplopia, exophthalmos, and paresthesia. Other ocular discoveries were incredibly uncommon. The location of bone fractures was found to be significantly correlated with ocular results.

It has been 15 years since repetitive transcranial magnetic stimulation (rTMS) targeting the dorsolateral prefrontal cortex (DLPFC) was approved by the FDA for clinical depression treatment. Yet, the underlying mechanisms for rTMS-induced depression relief are not fully elucidated. This study analyzes TMS-electroencephalogram (EEG) data from 64 healthy control (HC) subjects and 53 patients with major depressive disorder (MDD) before and after rTMS treatment. Prior to treatment, patients with MDD have lower activity in the DLPFC, the hippocampus (HPC), the orbitofrontal cortex (OFC), and DLPFC-OFC connectivity compared with HCs. Following active rTMS treatment, patients with MDD show a significant increase in the DLPFC, HPC, and OFC. Notably, the increase in HPC activity is specifically associated with amelioration of depressive symptoms but not anxiety or sleep quality. The orbitofrontal-hippocampal pathway plays a crucial role in mediating depression relief following rTMS treatment. These findings suggest potential alternative targets for brain stimulation therapy against depression (chictr.org.cn: ChiCTR2100052007).

OBJECTIVE: This study describes the microbiology of bacterial orbital cellulitis (OC) over an 11-year period and its clinical associations at three tertiary institutions in Adelaide, South Australia.
METHODS: Multi-centre retrospective study of the microbiology of bacterial OC between January 2012 and August 2022. Pre-septal cellulitis was excluded. Differences in means were determined by the Independent Samples t-test, and categorical data was analysed via Pearson\'s Chi square. A P-value < 0.05 was statistically significant.
RESULTS: 99 patients (male: 69, mean age: 22.0 ± 23.8 years old), of which 70.7% were aged ≤ 18 years. Sinus and orbital abscess cultures had the greatest positive yield (73.7%). Frequency of organisms: Streptococcus species (34.3%), Staphylococcus aureus (28.3%), Haemophilus species (5.1%), mixed anaerobes (3.0%), Enterobacter cloacae (2.0%), Moraxella catarrhalis (1.0%), Pseudomonas aeruginosa (1.0%), Corynebacterium species (1.0%), Klebsiella pneumoniae (1.0%), Proteus mirabilis (1.0%), Citrobacter koseri (1.0%), and Enterococcus species (1.0%). Streptococcus species predominated in the paediatric population, with a statistically significant difference in mean age between Streptococcus species and Staphylococcus aureus (14.1 ± 16.5 vs 27.6 ± 24.6 years old, respectively) (P = 0.028). No organism was cultured in 32.3% of cases. Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 28.6% of all Staphylococcus aureus isolates, with 50% occurring between 2021 and 2022.
CONCLUSIONS: Yearly microbiological trends have remained largely constant in South Australia. The causative organism was not identified in 32.3% of cases, further emphasising appropriate empirical antibiotics, and obtaining microbiology from various sources. MRSA OC remains of increased clinical and public health concern and may be associated with a more aggressive disease course.

Ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (OAML) is the most common type of ocular lymphoma with a higher prevalence in Asia than in Western countries. OAML represents 1%-2% of all non-Hodgkin\'s lymphoma, 5%-15% of extranodal lymphomas, and approximately 55% of orbital malignancies. \"Watch and wait\" after biopsy or surgical resection, radiation therapy, and systemic treatment, including antibiotics administration and chemotherapy with various combinations of regimens can be considered for OAML treatment. Radiotherapy is adapted for limited-stage disease with excellent clinical outcomes of 85-100% complete remission and relatively superior local control efficacy and treatment duration. In contrast, chemotherapy has rarely been tested as frontline therapy. Nonetheless, several studies have reported a favorable response and long duration of progression-free survival using chemotherapy adaptations. When the disease involves both eyes or spreads beyond the conjunctiva, the risk of recurrence increases and limited-stage OAML has a recurrence rate of approximately 25% following radiotherapy only. Therefore, although recent consensus in the literature is that patients with limited-stage OAML recommended treating with radiation, physicians may choose the treatment modality not only by its efficiency but also by its adverse events profile and patients\' well-being. Herein, we present a large single-center study on OAML that included 292 patients who were followed up for up to 237 months. We collected and analyzed real-world data focusing on treatment outcomes and the role of radiotherapy as frontline therapy, and aimed to compare outcomes and complication profiles of chemotherapy, especially in limited-stage OAML, to identify an optimal treatment strategy.

OBJECTIVE: To study the clinical profile and magnetic resonance imaging (MRI) features in patients of COVID-19-associated rhino-orbital-cerebral mucormycosis (CA-ROCM) with orbital involvement and perform a clinicoradiological correlation.
METHODS: A cross-sectional study was performed at a tertiary care center in north India from May 2021 to June 2021. Consecutive patients with clinical, nasal endoscopic, and/or microbiological evidence of CA-ROCM underwent MRI of paranasal sinuses, orbit, and brain as per the study protocol. Orbital MRI findings were studied in detail and were correlated with clinical signs.
RESULTS: Two hundred and seventy patients were studied. The mean age was 48.4 (± 16.82) years. A male predilection was noted (male:female = 1.77). Orbital involvement was seen in 146 (54%) patients on clinical evaluation and in 184 (68%) patients on MRI. Unilateral orbital involvement was more common (134; 92%). The most common presenting symptom was periorbital and/or facial pain (141; 52.2%) and the most common clinical sign was periorbital edema (116; 43%). The most common MRI finding was suggestive of orbital cellulitis (160; 59%). Orbital compartment syndrome was found in 17 (6.3%) patients. The inter-rater agreement between clinical and radiological assessments to detect the involvement of infraorbital nerve and frontal nerve was found to be 85.56%, (κ 0.621) and 93.70% (κ 0.776), respectively. The diagnostic accuracy, sensitivity, and specificity of MRI to detect medial orbital wall defect were found to be 87.9%, 65%, and 97%, respectively.
CONCLUSIONS: Orbital imaging features of a cohort of ROCM patients have been presented with clinicoradiological correlation.

Basal cell carcinoma (BCC) is a common skin cancer often curable by excision; however, for patients with BCC around the eye, excision places visual organs and function at risk. In this article, we test the hypothesis that use of the hedgehog inhibitor vismodegib will improve vision-related outcomes in patients with orbital and extensive periocular BCC (opBCC).
In this open-label, nonrandomized phase IV trial, we enrolled patients with globe- and lacrimal drainage system-threatening opBCC. To assess visual function in the context of invasive periorbital and lacrimal disease, we used a novel Visual Assessment Weighted Score (VAWS) in addition to standard ophthalmic exams. Primary endpoint was VAWS with a score of 21/50 (or greater) considered successful, signifying globe preservation. Tumor response was evaluated using RECIST v1.1. Surgical specimens were examined histologically by dermatopathologists.
In 34 patients with opBCC, mean VAWS was 44/50 at baseline, 46/50 at 3 months, and 47/50 at 12 months or postsurgery. In total, 100% of patients maintained successful VAWS outcome at study endpoint. Compared with baseline, 3% (95% confidence interval [CI], 0.1-15.3) experienced major score decline (5+ points), 14.7% (95% CI, 5 to 31.1) experienced a minor decline (2-4 points), and 79.4% experienced a stable or improved score (95% CI, 62.1-91.3). A total of 56% (19) of patients demonstrated complete tumor regression by physical examination, and 47% (16) had complete regression by MRI/CT. A total of 79.4% (27) of patients underwent surgery, of which 67% (18) had no histologic evidence of disease, 22% (6) had residual disease with clear margins, and 11% (3) had residual disease extending to margins.
Vismodegib treatment, primary or neoadjuvant, preserves globe and visual function in patients with opBCC. Clinical trail identification number.NCT02436408.
Use of the antihedgehog inhibitor vismodegib resulted in preservation of end-organ function, specifically with regard to preservation of the eye and lacrimal apparatus when treating extensive periocular basal cell carcinoma. Vismodegib as a neoadjuvant also maximized clinical benefit while minimizing toxic side effects. This is the first prospective clinical trial to demonstrate efficacy of neoadjuvant antihedgehog therapy for locally advanced periocular basal cell carcinoma, and the first such trial to demonstrate end-organ preservation.

Malignant orbito-ocular tumors are major causes of morbidity and mortality in the developing countries. Their presentation, morphologic type, and management are challenging, and earlier reports were mostly retrospective surveys. Histological analysis is essential in making correct diagnosis. Here, we determined the clinical presentations and histopathologic types of orbito-ocular tumors in some tertiary hospitals in Kano, Nigeria.
This was a prospective cross-sectional multicenter clinical and pathologic study conducted between June 2012 and May 2013. A structured pro forma was used to record findings, patient\'s biodata, clinical presentation, type of surgical intervention, and histological diagnosis. Data were analyzed with STATA version 11.0.
Sixty-seven eye tumors were observed among 61 patients. There were 43 males and 18 females (male-to-female ratio = 2.4:1). Patients had a mean of 13.4 ± 18.3 with a median of 4.0 (0.5-70) years with a double peak in age distribution. The most common features were visual loss (90.2%), leukocoria (59%), proptosis (55%), and fungating mass (49.2%). The symptoms were for ≥6 months in 57.4% and unilateral in 82.1%. B-scan showed retinal masses and calcifications in 13.5% and 4.5%, respectively. Confirmation by histology was achieved in 91% with the most common tumor being retinoblastoma, conjunctival squamous cell carcinoma (SCC), and rhabdomyosarcoma with frequencies of 38 (56.6%), 11 (16.4%), and 6 (9.0%), respectively. Six patients were HIV positive and all had SCC.
Retinoblastoma was the most common malignant orbito-ocular tumor observed in this study. Patients often present late to the hospital with visual loss.
Résumé Contexte: Les tumeurs malignes orbito-oculaires sont des causes majeures de morbidité et de mortalité dans les pays en développement. Leur présentation, type morphologique et la gestion sont difficiles, et les rapports précédents étaient principalement des enquêtes rétrospectives. L\'analyse histologique est essentielle en faisant un diagnostic correct. Ici, nous avons déterminé les présentations cliniques et les types histopathologiques de tumeurs orbito-oculaires dans certaines hôpitaux tertiaires à Kano, au Nigeria. Matériels et méthodes: Il s\'agissait d\'une étude clinique et pathologique multicentrique prospective transversale. menée entre juin 2012 et mai 2013. Un formulaire pro forma a été utilisé pour enregistrer les résultats, les données biographiques du patient, la présentation clinique, type d\'intervention chirurgicale et diagnostic histologique. Les données ont été analysées avec STATA version 11.0. Résultats: Soixante-sept tumeurs oculaires étaient observés chez 61 patients. Il y avait 43 hommes et 18 femmes (ratio hommes / femmes = 2,4: 1). Les patients avaient une moyenne de 13,4 ± 18,3 avec un médiane de 4,0 (0,5 à 70) années avec un double pic dans la répartition par âge. Les caractéristiques les plus courantes étaient la perte de vision (90,2%), la leucocorie (59%), proptosis (55%) et masse fongative (49,2%). Les symptômes étaient ≥ 6 mois chez 57,4% et unilatéraux chez 82,1%. B-scan a montré rétinienne masses et calcifi cations dans 13,5% et 4,5%, respectivement. La confirmation histologique a été réalisée dans 91% des cas. étant un rétinoblastome, un carcinome épidermoïde conjonctival (SCC) et un rhabdomyosarcome avec des fréquences de 38 (56,6%), 11 (16,4%), et 6 (9,0%), respectivement. Six patients étaient séropositifs et tous étaient atteints de SCC. Conclusions: Le rétinoblastome était le cancer le plus courant tumeur orbito-oculaire observée dans cette étude. Les patients se présentent souvent tardivement à l\'hôpital avec une perte de vision.

Despite extensive debate and publications in the management of blowout fracture (BOF), there are still considerable differences in the surgeons\' management of BOF due to a lack of reliable evidence-based studies. This article aimed to evaluate which BOF patients require surgical treatment due to functional and/or cosmetic deformities; evaluate which computed tomography (CT) scan findings predict these problems; and provide an algorithm in the management of BOF. Seventy-nine patients with BOF were treated conservatively and followed up prospectively regarding functional and cosmetic deformities for at least 1 year. The patients\' CT scans were analyzed and several measurements were performed. Patients\' symptoms and the clinical findings were correlated to the CT scan measurements. We found visible deformity in 37% of the patients, but only 10% chose to proceed to surgery due to cosmetic deformities. In patients with inferior BOF and a herniation < 1.0 mL, a visible deformity was found when the ratio between fracture and the fractured orbital wall areas was ≥42%, or the total area of the fracture was ≥ 2.3 cm 2 . In patients with inferior BOF and a herniation ≥ 1.0 mL, a visible deformity was found when the distance from the inferior orbital rim to the posterior edge of the fracture was ≥ 3.0 cm. In patients with inferomedial fracture, a visible deformity was found when the herniation was ≥ 0.9 mL. Diplopia improved significantly and remained in only 3% of the patients in nonoperated group. Hypoesthesia of the infraorbital nerve improved significantly, but 23% of the nonoperated and 50% of the operated patients still experienced loss of sensation at final control. In this prospective study, we found that not only herniated orbital volume but also other CT scan findings in BOF were crucial to predict late visible deformities. Based on these findings, we propose an algorithm for the prediction of late visible deformity with 83% accuracy. There are indications that diplopia without ocular motility disorder is due to edema and we recommend observation as long as the diplopia improves gradually.

Iatrogenic injury to the trochlea is a potential complication of the Draf III or endoscopic modified Lothrop procedure; however, the location of the trochlea from within the sinus cavity has yet to be clearly characterized. We performed the first cadaveric study assessing the position of the trochlea in relation to the first olfactory neuron, a commonly identified landmark during the Draf III procedure.
Thirteen external dissections of the trochlea were performed on 7 disarticulated cadaveric heads via an extended Lynch type incision. An endoscopic Draf III procedure was then performed on all cadavers. A burr hole was then created at the trochlear fovea. A straight vector between the trochlear attachment and the ipsilateral first olfactory neuron was then created. The vector was then viewed from within the sinuses using a 30-degree endoscope. The endoscope was maneuvered to create an upright midline view centered on the olfactory neurons. An image was subsequently captured and analyzed using ImageJ software to calculate a vector angle. The linear distance between the 2 structures was also recorded.
Relative to the first olfactory neuron, the trochlea was found to be 19.52 ± 4.68 mm away and at an angle of 39.42 ± 8.54 degrees in the anterolateral, superior direction along the frontal bone.
We report the first anatomical dissection characterizing the position of the trochlea relative to the ipsilateral first olfactory neuron. Intraoperative recognition of this relationship during Draf III procedures can prevent potential injury to the trochlea.