Supraorbital craniotomy in the treatment of skull base subdural empyema as the result of sinusitis

Sinusitis is a common problem in otorhinolaryngological practice. In the absence of appropriate treatment, intracranial complications may occur. Subdural empyema of skull base is a rare and dangerous complication. The authors present a case of 25-year old female in postpartum period, who was under interdyscyplinary treatment because of subdural empyema which was the result of acute sinusitis. Proper diagnostic procedures and early employed treatment prevented long lasting disorders and consequences of the disease. The complex and integrated therapeutic process that the patient required proved successful.Zapalenie zatok przynosowych jest częstym problemem w praktyce otolaryngologicznej. W przypadku braku odpowiedniego leczenia może dojść do powikłań wewnątrzczaszkowych. Ropniak podtwardówkowy podstawy czaszki jest rzadkim i groź- nym powikłaniem zapalenia zatok. Autorzy opisują przypadek 25-letniej chorej, będącej w połogu, leczonej interdyscyplinarnie z powodu ropniaka podtwardówkowego podstawy czaszki, do powstania którego doszło w przebiegu ostrego zapalenia zatok przynosowych. Odpowiednio przeprowadzona diagnostyka oraz wdrożone leczenie uchroniło pacjentkę przed trwałymi następstwami choroby. Chora wymagała zintegrowanego leczenia, które zakończyło się pomyślnie

Validation of Hydraulic Mechanism during Blowout Trauma of Human Orbit Depending on the Method of Load Application

The more we know about mechanisms of the human orbital blowout type of trauma, the better we will be able to prevent them in the future. As long as the buckling mechanism’s veracity is not in doubt, the hydraulic mechanism is not based on equally strong premises. To investigate the correctness of the hydraulic mechanism’s theory, two different methods of implementation of the hydraulic load to the finite element method (FEM) model of the orbit were performed. The intraorbital hydraulic pressure was introduced as a face load applied directly to the orbit in the first variant, while in the second one the load was applied to the orbit indirectly as a set of nodal forces transferred from the external surface of the eyeball via the intraorbital tissues to the orbital walls within the contact problem. Such an approach is aimed at a better understanding of the pattern for the formation of blowout fractures during the indirect load applied to the orbital bones. The nonlinear dynamic analysis of both numerical models showed that the potential fracture was observed in the second variant only, embracing a relatively large area: both medial and lower wall of the orbit. Interestingly, the pressure generated by the intraorbital entities transferred the energy of the impact to the orbital sidewalls mainly; thus, the nature of the mechanism known as the hydraulic was far from the expected hydraulic pressure. According to the eyeball’s deformation as well as the areas of the greatest Huber-Mises-Hencky (H-M-H) stress within the orbit, a new term of strut mechanism was proposed instead of the hydraulic mechanism as more realistic regarding the investigated phenomenon. The results of the current research may strongly influence the development of modern implantology as well as affect forensic medicine

Numerical and clinical analysis of an eyeball injuries under direct impact

Objectives The objective of this study was to develop a numerical model of the eyeball and orbit to simulate a blunt injury to the eyeball leading to its rupture, as well as to conduct a comparative analysis of the results obtained using the finite element method against the clinical material concerning patients who had suffered an eyeball rupture due to a blunt force trauma Material and Methods Using available sclera biometric and strength data, a numerical model of the eyeball, the orbital contents, and the bony walls were developed from the ground up. Then, 8 different blunt force injury scenarios were simulated. The results of numerical analyses made it possible to identify possible locations and configurations of scleral rupture. The obtained results were compared against the clinical picture of patients hospitalized at the Department of Ophtalmology, Medical University of Gdańsk in 2010–2016 due to isolated blunt force trauma to the eyeball. Results It has been demonstrated that the extent of damage observed on the numerical model that indicated a possible location of eyeball rupture did not differ from the clinically observed configurations of the scleral injuries. It has been found that the direction of the impact applied determines the location of eyeball rupture. Most often the rupture occurs at the point opposite to the clock-hour/positions of the impact application. The eyeball rupture occurs in the first 7–8 ms after the contact with the striking rigid object. It has been established that the injuries most often affected the upper sectors of the eyeball. Men are definitely more likely to sustain such injuries. Eyeball ruptures lead to significant impairment of visual acuity. Conclusions This study may contribute to a better understanding of injury mechanisms and better treatment planning. It may also contribute to the development of eyeball protection methods for employees exposed to ocular injuries. Int J Occup Med Environ Health. 2023;36(2):263–7