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A Journal on Surgery

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Chirurgia 1999 October;12(5):363-6

language: Italian

Post-traumatic blindness due to orbital fracture. Description of a clinical case and diagnostic and therapeutic approaches

Nocini P. F., Dolci M., D'Agostino A., Bedogni A., Carminati R.

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A case report concerning a post-traumatic blindness following an orbital trauma in a 43 year-old woman is described. After a survey of the epidemiology and pathogenesis of these traumas, the importance of this complication in high-energy traumas associated with a dislocation of the orbitary complex is remarked. The report contains a detailed description of the case and a complete review of the literature. Attention is focused on the explanation of the most accepted surgical techniques for an efficient optic nerve decompression. Goal of this report is also to describe the fundamental steps for a correct diagnosis, to propose a medical therapy and the management of these patients. The diagnosis is founded on the use of Visual Evocated Potentials (VEP) and the interrelation with ''imaging-techniques''. The therapy is based on administration of ''mega-dose'' of corticosteroid (the authors present a model for the use of ''mega-dose'') and a rapid management of the patient in the first 8 hours after the trauma. It is possible to perform the decompression by a trans-facial, trans-craniofacial or intra-cranic approach. Particularly the trans-facial approach by the trans-ethmoidal route is described. This technique is particularly important for the maxillo-facial surgeon, while it is possible to perform the other surgical approach at the same time with the neurosurgeon.

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