Background: An orbital or frontal trauma dislocating the trochlea determines a strabismus by an acquired Brown’s syndrome (BS). The maxillofacial surgeon and ophthalmologist combined management is needed before, during and after the surgical treatment. Methods: a 28yo man with cranial maxillofacial (CMF) trauma involving the left frontal bone and the roof of the left orbit was hospitalized. Clinical ophthalmological and radiological examinations were performed. Computerized Tomography (CT) scan showed medial and caudal dislocation of the left orbital roof together with the left orbital trochlear complex. At the ophthalmological evaluation 4-prism diopters hypotropia of the left eye and reduced convergence were detected. The patient underwent surgical treatment for frontal bone fracture reposition. A pre and postoperative Hess chart was obtained to evaluate the surgical results. Results: Two weeks after surgery the ophthalmological examination showed no diplopia, no muscular impairing, a good eye convergence and no head malposition. Prismatic lens correction was not necessary. Conclusions: Surgical reposition of the frontal bone fracture involving the superomedial orbital bone and the trochlea allowed to successfully solve the acquired diplopia by the BS. The role of the ophtalmologist is a key factor throughout the whole management of the craniomaxillofacial surgical treatment.

Surgical reposition of the trochlea in a case of acquired Brown’s syndrome

Paolo Cecchini;Rossella D’Aloisio;Michele Maglione;Roberto Rizzo
2020-01-01

Abstract

Background: An orbital or frontal trauma dislocating the trochlea determines a strabismus by an acquired Brown’s syndrome (BS). The maxillofacial surgeon and ophthalmologist combined management is needed before, during and after the surgical treatment. Methods: a 28yo man with cranial maxillofacial (CMF) trauma involving the left frontal bone and the roof of the left orbit was hospitalized. Clinical ophthalmological and radiological examinations were performed. Computerized Tomography (CT) scan showed medial and caudal dislocation of the left orbital roof together with the left orbital trochlear complex. At the ophthalmological evaluation 4-prism diopters hypotropia of the left eye and reduced convergence were detected. The patient underwent surgical treatment for frontal bone fracture reposition. A pre and postoperative Hess chart was obtained to evaluate the surgical results. Results: Two weeks after surgery the ophthalmological examination showed no diplopia, no muscular impairing, a good eye convergence and no head malposition. Prismatic lens correction was not necessary. Conclusions: Surgical reposition of the frontal bone fracture involving the superomedial orbital bone and the trochlea allowed to successfully solve the acquired diplopia by the BS. The role of the ophtalmologist is a key factor throughout the whole management of the craniomaxillofacial surgical treatment.
2019
Pubblicato
https://www.minervamedica.it/it/riviste/maxillofacial-surgery/articolo.php?cod=R53Y2020N01A0008
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11368/2959405
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