• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.4
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• pp.428-437
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• 1994

Optic nerve injury serious enough to result in blindness had been reported to occur in 3% of facial fractures. When blindness is immediate and complete, the prognosis for even partial recovery is poor. Progressive or incomplete visual loss may be ameliorated either by large dosage of steroid or by emergency optic nerve decompression, depending on the mechanism of injury, the degree of trauma to the optic canal, and the period of time that elapses between injury and medical intervention. We often miss initial assessment of visual function in management of facial fracture patients due to loss of consciousness, periorbital swelling and emergency situations. Delayed treatment of injuried optic nerve cause permanent blindness due to irreversible change of optic nerve. But by treating posttraumatic optic nerve injuries aggressively, usable vision can preserved in a number of patients. The following report concerns three who suffered visual loss due to optic nerve injury with no improvement after steroid therapy and/or optic nerve decompression surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.3
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• pp.324-331
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• 1991

Ocular injuries often accompany midfacial trauma Blindness related to indirect optic nerve injury in midfacial fractures is an uncommon and usually permanent complication. Opic nerve blindness is secondary to an indirect optic nerve injury due to the skeletal distortion that occurs in a facial fracture and almost all are caused by frontal, nasoethmoido-frontal or Le Fort III type fractures. When the loss of vision following midfacial fractures is complete and immediate, the prognosis is poor in spite of treatment. Computed tomography revealed compressin of the optic nerve by bony fragments. And so if injury to the optic nerve is suspected, a CT-scan must be performed and massive steroid therapy must be started as soon as possible. Surgery must be performed if there are hematoma or bony fragments injuring the nerve. The following report concerns two patients who suffered immediate and total loss of vision due to a midfacial fracture with no improvement after massive steroid therapy and surgial decompression.

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.389-392
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• 2005

A case of visual loss following cranio-maxillofacial trauma is reported. The patient had acute optic nerve injury associated with a fracture of the right zygomaticomaxillary and fronto-naso-ethmoido-orbital bone and epidural hematoma on the right temporal lobe of brain. Bony fragments compressing the optic nerve on lateral side was identified on computed tomography. Decompression of the optic nerve combined with evacuation of epidural hematoma has been performed via transfrontal craniotomy. The patient had complete recovery of visual acuity without any complications. The role of optic nerve decompression in the management of patients with traumatic optic neuropathy is discussed. Surgical indication is controversial and the procedure should be considered only within the context of the specific indication of the individual patient.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.6
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• pp.677-680
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• 2000

Orbital injuries are common with facial trauma. Direct injuries to the globe are not rare but it can result in complications such as chemosis, subconjunctival hemorrhage and hyphema. Periorbital trauma or injuries to the extraocular muscles and blow-out fracture may result in lid edema, ecchymosis & ptosis and diplopia or limitation of ocular motion respectively. Indirect injuries to the optic nerve come up without any injuries but its complication is irreversible and severe such as loss of vision. The aim of this study is to review the literature on blindness or ptosis following facial trauma and present the cases of blindness after facial trauma and ptosis after mandibular fracture without specific clinical findings.

• Applied Microscopy
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• v.44 no.1
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• pp.21-29
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• 2014

Retinal glial responses to hypertensive glaucomatous injury were spatiotemporally surveyed. Retinas as a whole or vertical sections were processed for anti-glial fibrillary acidic protein (GFAP), anti-Iba1, anti-nerve growth factor (NGF), and anti-tumor necrosis factor (TNF)-${\alpha}$ immunohistochemistry for confocal microscopic analyses. The optic nerve head of paired controls was processed for electron microscopy. GFAP positive astrocytes appeared in the nerve fiber layer in the glaucomatous and control retinas, changing from fine protoplasmic to stout fibrous parallel to glaucomatous duration. Iba1 positive microglia appeared in both retinas, and enormous reaction appeared at the latest glaucomatous. M$\ddot{u}$ller reaction detected by GFAP reactivity expanded from the end feet to whole profile following to duration in the glaucomatous. NGF reactivity expended from the end feet to the proximal radial processes of the M$\ddot{u}$ller cells in both retinas according to glaucomatous duration. TNF-${\alpha}$ immunoreactivity in the nerve fiber layer was stronger in both the glaucomatous and controls than in the normal, and exceptionally at the latest glaucomatous was even lower than the normal. The astrocytes in the optic nerve head are interconnected with each other via gap junction. These results demonstrate that astrocyte reaction propagates to the contralateral via physical links, and TNF-${\alpha}$ is correlated with NGF production for neuroprotection in response to hypertensive glaucomatous injury.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.28-32
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• 2010

Purpose: In accordance with the increasing number of accidents caused by various reasons and recently developed fine diagnostic skills, the incidence of orbital blow-out fracture cases is increasing. As it causes complications, such as diplopia and enophthalmos, surgical reduction is commonly required. This article reports a retrospective series of 5 blow-out fracture cases that had unusual nerve injuries after reduction operations. We represents the clinical experiences about treatment process and follow-up. Methods: From January 2000 to August 2009, we treated total 705 blow-out fracture patients. Among them, there were 5 patients (0.71%) who suffered from postoperative neurologic complications. In all patients, the surgery was performed with open reduction with insertion of $Medpor^{(R)}$. Clinical symptoms and signs were a little different from each other. Results: In case 1, the diagnosis was oculomotor nerve palsy. The diagnosis of the case 2 was superior orbital fissure syndrome, case 3 was abducens nerve palsy, and case 4 was idiopathic supraorbital nerve injury. The last case 5 was diagnosed as optic neuropathy. Most of the causes were extended fracture, especially accompanied with medial and inferomedial orbital blow-out fracture. Extensive dissection and eyeball swelling, and over-retraction by assistants were also one of the causes. Immediately, we performed reexploration procedure to remove hematomas, decompress and check the incarceration. After that, we checked VEP (visual evoked potential), visual field test, electromyogram. With ophthalmologic test and followup CT, we can rule out the orbital apex syndrome. We gave $Salon^{(R)}$ (methylprednisolone, Hanlim pharmaceuticals) 500 mg twice a day for 3 days and let them bed rest. After that, we were tapering the high dose steroid with $Methylon^{(R)}$ (methylprednisolon 4 mg, Kunwha pharmaceuticals) 20 mg three times a day. Usually, it takes 1.2 months to recover from the nerve injury. Conclusion: According to the extent of nerve injury after the surgery of orbital blow-out fracture, the clinical symptoms were different. The most important point is to decide quickly whether the optic nerve injury occurred or not. Therefore, it is necess is to diagnose the nerve injury immediately, perform reexploration for decompression and use corticosteroid adequately. In other words, the early diagnosis and treatment is most important.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.1
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• pp.81-85
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• 2009

As panfacial fractures are involved multiple fracture, there are possibility of many pre-operative & postoperative complications. It is necessary to do exact pre-operative evaluation, appropriate operation and care, for preventing and treating these complications, especially related to optic nerve injury. The complication occurs rarely after periorbital facial bone fracture, and indirect injuries may occur as a result of impact shearing force transmitted into the optic nerve axons or to the nutrient vessels of the optic nerve. Also indirect injuries may occur after the force of impact because of vasospasm and swelling of the optic nerve within the confines of the nonexpansile optic canal. It is necessary to active evaluation and treatments involving decompression of the orbit surgically and high dose steroid therapy in relation to panfacial fracture. But sometimes this treatments are limited due to severe swelling of the face and related multiple bone fractures in the body. This case showed the delayed neuropathy, at last visual loss, in spite of megadose methylprednisolone administration. The purpose of this article is to present indirect traumatic optic neuropathy that is one of many complications in panfacial bone fracture.

• Journal of Korean Neurosurgical Society
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• v.40 no.6
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• pp.455-458
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• 2006

The incidence of blindness after aneurysm surgery is very rare. We experienced a case of unilateral blindness after internal carotid artery[ICA] aneurysm wrapping. A 43-year-old male immediately developed ipsilateral ocular pain and visual loss in his left eye after the treatment of a lateral ICA aneurysm by wrapping with muscle pieces. He had also multiple aneurysms, which were multilobulated anterior communicating artery [A-com], middle cerebral artery[MCA] and posterior communicating artery [P-com] aneurysms. Coilings were done for a part of A-com artery aneurysm and P-com artery aneurysm on admission. The remaining A-com artery aneurysm was clipped and ICA aneurysm was wrapped with temporal muscle piece. A retrobulbar optic neuropathy might have resulted from either direct injury or damage to small dural vessels of the posterior optic nerve. Actually, the optico-carotid space was tight and the optic nerve was compressed by swollen muscle piece. Despite releasing of compression of the optic nerve on second day, his visual loss was irreversible.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.1 no.2
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• pp.61-72
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• 2006

Objectives: The aim of this study is to investigate chiropractic spinal manipulation and internal diseases in articles. Methods: It was investigated how many articles had been searched for spinal manipulation applied to internal disease in Pubmed Database Results: 1. There are 19 articles of chiropractic spinal manipulation and internal diseases were investigated. 2. It was reported that there are improvements of spinal manipulative therapy on asthma, injury of the optic nerve, hypertension, vertigo, tinnitus, hearing loss, etc. Conclusions: There are several reports on effectiveness of spinal manipulative therapy on asthma, injury of the optic nerve, hypertension, vertigo, tinnitus, hearing loss, etc. And It is considered that spinal manipulative therapy shows improvement on the internal diseases.

• Journal of Trauma and Injury
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• v.30 no.4
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• pp.140-144
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• 2017

Purpose: The optic nerve sheath diameter (ONSD) measured by ultrasonography is among the indicators of intracranial pressure (ICP) elevation. However, whether ONSD measurement is useful for initial treatment remains controversial. Thus, this study aimed to investigate the relationship between ONSD measured by computed tomography (CT) and ICP in patients with traumatic brain injury (TBI). Methods: A total of 246 patients with severe trauma from January 1, 2015 until December 31, 2015 were included in the study. A total of 179 patients with brain damage with potential for ICP elevation were included in the TBI group. The remaining 67 patients comprised the non-TBI group. A comparison was made between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of ONSD when used as a screening test for the TBI group including those with TBI with midline shift (with elevated ICP). Results: The mean injury severity score (ISS) and glasgow coma scale (GCS) of all patients were $24.2{\pm}6.1$ and $5.4{\pm}0.8$, respectively. The mean ONSD of the TBI group ($5.5{\pm}1.0mm$) was higher than that of the non-TBI group ($4.7{\pm}0.6mm$). Some significant differences in age ($55.3{\pm}18.1$ vs. $49.0{\pm}14.8$, p<0.001), GCS ($11.7{\pm}4.1$ versus $13.3{\pm}3.0$, p<0.001), and ONSD ($5.5{\pm}1.0$ vs. $4.7{\pm}0.6$, p<0.001) were observed between the TBI and the non-TBI group. An ROC analysis was used to assess the correlation between TBI and ONSD. Results showed an area under the ROC curve (AUC) value of 0.752. The same analysis was used in the TBI with midline shift group, which showed an AUC of 0.912. Conclusions: An ONSD of >5.5 mm, measured on CT, is a good indicator of ICP elevation. However, since an ONSD is not sensitive enough to detect an increased ICP, it should only be used as one of the parameters in detecting ICP along with other screening tests.