Pediatric orbital blowout fractures can include pathologies that seem mild but require urgent release; serious sequelae can occur with standby surgery or conservative treatment. We sought to validate an algorithm for the treatment of pediatric orbital blowout fractures. This retrospective cohort study included 61 pediatric patients, aged 18 years or younger, treated for pure orbital blowout fractures according to the algorithm from April 1, 2000, to August 31, 2020, at the Japanese Red Cross Asahikawa Hospital. There were 52 males (85%). Median age was 14 years (range, 5–18 years). There were 9 patients categorized as needing urgent release, 16 as needing repair, and 36 as needing conservative treatment. Mean follow-up ocular movement was 98.0 (95% Confidence Interval [95% CI], 96.8–99.2). Postoperative diplopia was not observed in 96% (79.6%–99.9%) of patients, better than in previous studies. A higher proportion of patients aged 0–12 years needed urgent repair than those aged 13–18 years (Odds Ratio [OR] = 14.2; 95% CI 1.6–683.4; p = 0.0046). There were no differences in Hess area ratio by age group. Clinical results with the algorithm were satisfactory. The algorithm is suitable for treatment of pediatric orbital blowout fractures. 4.

Purpose: No definitive procedures have been proposed for orbital floor fractures extending to the slope of the posterior end, which is a challenging problem. This study demonstrates the effectiveness of an orbital reconstruction procedure based on anatomical landmarks that we developed, called the three landmarks procedure (TLP). Methods: This study is a single-center retrospective cohort study conducted by the Department of Otorhinolaryngology, Japanese Red Cross Asahikawa Hospital. Data were collected from April 2000 to December 2023. The effect of TLP and the balloon procedure (BP) on ocular movement was compared. The prevalence of postoperative enophthalmos after TLP was examined. Results: The study included 17 patients who underwent TLP and 25 patients who underwent BP. Postoperative mean Hess area ratio (HAR%) was 98.3 (95% confidence interval (CI), 97.0–99.6) in the TLP group and 88.6 (95% CI 83.2–94.0) in the BP group. Among study patients with fractures extending to the posterior slope, 14 underwent TLP and 16 underwent BP. Postoperative mean HAR% was 98.5 (95% CI 97.3–99.7) in the TLP group and 89.2 (95% CI 82.4–95.8) in the BP group. Among all patients who underwent TLP, mean postoperative enophthalmos was 0.06 mm (95% CI − 0.32 to 0.44). It was 0.14 mm (95% CI − 0.31 to 0.59) among patients with fractures extending to the posterior slope. Conclusion: TLP resulted in better postoperative ocular movements than BP. Furthermore, TLP is an effective technique for treating fractures extending to the posterior slope, which are challenging to reconstruct.

Background: In orbital floor reconstruction, fractures involving the slope of the posterior end of the orbital floor make it difficult to determine the best location for implant placement. Therefore, landmarks for reconstruction are desirable to perform safe and reproducible reconstruction surgery. Methods: We developed a surgical procedure that focuses on three orbital landmarks: the infraorbital nerve, the inferior margin of the greater wing of the sphenoid bone, and the posterior superior wall of the maxilla. Conclusions: Landmark-based orbital floor fracture reconstruction enables accurate reconstruction of fractures that extend to the slope of the posterior end of the orbital floor.

Background: Due to the complexity of reconstructing wide inferomedial orbital wall fractures, silicone sheets are the preferred choice of reconstructive material. Nevertheless, it is crucial to remove the silicone sheet postoperatively due to the risk of delayed complications associated with its placement. Methods: We developed a procedure in which a silicone sheet implanted in the orbit can be extracted through the nasal cavity by removing the fractured portion of the medial orbital wall. Conclusion: This procedure enables the utilization of silicone sheets, which are suitable for intricate orbital reconstruction, without any concerns regarding delayed complications.

Preoperative diagnosis with multimodal approaches might lead to overtreatment. Cautious understanding of cytology and dynamic contrast‐enhanced magnetic resonance imaging is required when a Kuttner tumor is cited as differential diagnosis.

In the diagnosis of olfactory neuroblastoma (ONB), the presence of S-100–positive sustentacular cells surrounding the tumor is important; however, these are also present in normal nasal sinus epithelium. Although ONB often has a different final diagnosis, complete resection of the tumor has a good prognosis and minimally affects the patient’s treatment plan. When the tumor extends around the internal carotid artery (ICA), complete resection is difficult due to the high risk of vascular injury; revascularization using high-flow bypass can avoid this complication. In the present case, the tumor was located in the left sphenoid sinus and extended around the ICA. Preoperative biopsy tissue was positive for neuroendocrine markers and slightly positive for S-100 protein, leading to a diagnosis of ectopic ONB. High-flow bypass revascularization with trapping of the ICA allowed complete tumor resection. The postoperative histopathological diagnosis was neuroendocrine carcinoma, showing no S-100 protein-positive cells. There was no sign of recurrence at 30 months after surgery without additional treatment. This case demonstrates that the presence of S-100 protein-positive cells in ONB may be misleading. Although misdiagnosis of ectopic ONB should be anticipated, a complete resection of the tumor is an effective treatment strategy.