Letters to the Editor RETROBULAR
HAEMATOMA
admission, diagnosis is ditlicult but WC would suggest that orbital observations are carried out as soon as the patient is admitted. together with postoperative recordings.
Sir. We would like to bring to the attention of your readership concerns that WC now hold following a rcccnt assault trauma case. Following a blow to the left eye. the patient ccchymosis with slight sustamed circumorhital enophthalmos and plain radiographs showed the hanging drop sign of an orbital blow out fracture. A computer&d tomogram was requested in a coronal plant. hut the patient would not co-operate with the radiographer. so the scan was carried out in the sagittal plant. The resultant scan (Figure) showed the prcscnce of a rctrobulbar hcamatoma. Visual acuity was not impaired, there was no diplopia and the patient did not rcquirc further surgery. A number of authors have cited cast reports of rctrobulbar hcamatoma associated bvith facial injurles (Morris & Ward-Booth. 1985: Wood. 1989) and Ord (1981) suggested an incidence ol 0.3% of postoperative haemorrhagc. the complications of which arc well known. Recently. Hayter and Sugar (190 1) have suggested the use of orbital observation charts to detect early postopcratlve changes so that remedial mcasurcs can be taken. Our case was unusual in that sagittal CT scanning was performed for an orbital blow out fracture; coronal scans would not have extended posteriorly enough to demonstrate the hcamatoma. Important issues arc thub ralscd: Is the incidcncc of haematoma grcatcr than was prcviousl!, thought and dots the prcscnce of this haematoma preopcrativcly predispose the patient to a postoperative reblccd? We feel that the answers will only be known if more cxtcnsive coronal and sagittal CT scanning is performed. but we suspect a ‘yes’ to both questions! Short of scanning each fractured ;I!;goma on
John l.lewelyn FDSRCS, Senior Registrar Yick
Renny FDSRCS,
FRCS FRCS
Registrar Dcpartmcnt of Maxillofacial The City Hospital Grccnbunk Drikc Edinburgh EHlO 5SB
Surgery
References Haycr.
(1991). An orbital observation chart Jaurt~al cl Oral and .tfaxdl~/a~~rul Swger~. 29, 77.
J P. Br Sugar. A W
Bririd
Morris. T.
A. & Ward-Booth. R. P. (1985). Delayed spontaneous rctrobulbar haemorrhagc. A case report. Juumd o/ Afasillo-
i%c~id .Sur,geq~.13, I29 Ord, R. A. (1981). Post-operative rctrobulbar haemorrhagc and b’indncss complicating trauma surgery. Rritr.41 Journal c,jOrrrl
.%ugcr,r. 19,202. Wood, C. M. (1989). The medical manapsmcnt of retrohulbar hacmorrhage compllcatme facial fractures: A cast report.
Brirr.sh Journul of Oral and :\~o.~ill~&%~l Swgcry. 21, 29 I
DIVERTICULAR MUCOSA
POUCH
OF THE BLCCAL
Sir,
I was interested to read the recent article by Takcda (1992) reporting a diverticular pouch of the buccal mucosa. As hc points out this is a rare linding with only one previously reported case. I have also recently seen a patient in Norwich with a similar Icsion. a report of which is about to bc published (Rouson. 1992). Our patient. who was 89 years old. prescnted with food packing. Although of uncertain aetiology it was thought that poor muscle tone and chronic food inspissation may have been contributary factors. In this cast there was no demonstrable defect in buccinator. J. E. Rowson, BMedSci, FRCS, FDSRCS Department of Oral and Maxillopdcial Surgery West Norwich Hospital Bowthorpe Road Norwich KR2 3TC
References
Fig. 1 - Sagittal computerised axial tomograph bar hcamatoma in the right orbit.
Rowson. J. E. (1992). Divertwula of the huccal mucosa: report ofa case. Hrrrish Denral Journul. in press. Takcda. Y. (1992). Divcrtlcular pouch of the buccal mucosa: report of a case. Bririxh Jountul n/ Owl onrl .tlu.xdloJociul
showing retrobul-
Surger?. 30, 12X. 347
HAEMATOMA
admission, diagnosis is ditlicult but WC would suggest that orbital observations are carried out as soon as the patient is admitted. together with postoperative recordings.
Sir. We would like to bring to the attention of your readership concerns that WC now hold following a rcccnt assault trauma case. Following a blow to the left eye. the patient ccchymosis with slight sustamed circumorhital enophthalmos and plain radiographs showed the hanging drop sign of an orbital blow out fracture. A computer&d tomogram was requested in a coronal plant. hut the patient would not co-operate with the radiographer. so the scan was carried out in the sagittal plant. The resultant scan (Figure) showed the prcscnce of a rctrobulbar hcamatoma. Visual acuity was not impaired, there was no diplopia and the patient did not rcquirc further surgery. A number of authors have cited cast reports of rctrobulbar hcamatoma associated bvith facial injurles (Morris & Ward-Booth. 1985: Wood. 1989) and Ord (1981) suggested an incidence ol 0.3% of postoperative haemorrhagc. the complications of which arc well known. Recently. Hayter and Sugar (190 1) have suggested the use of orbital observation charts to detect early postopcratlve changes so that remedial mcasurcs can be taken. Our case was unusual in that sagittal CT scanning was performed for an orbital blow out fracture; coronal scans would not have extended posteriorly enough to demonstrate the hcamatoma. Important issues arc thub ralscd: Is the incidcncc of haematoma grcatcr than was prcviousl!, thought and dots the prcscnce of this haematoma preopcrativcly predispose the patient to a postoperative reblccd? We feel that the answers will only be known if more cxtcnsive coronal and sagittal CT scanning is performed. but we suspect a ‘yes’ to both questions! Short of scanning each fractured ;I!;goma on
John l.lewelyn FDSRCS, Senior Registrar Yick
Renny FDSRCS,
FRCS FRCS
Registrar Dcpartmcnt of Maxillofacial The City Hospital Grccnbunk Drikc Edinburgh EHlO 5SB
Surgery
References Haycr.
(1991). An orbital observation chart Jaurt~al cl Oral and .tfaxdl~/a~~rul Swger~. 29, 77.
J P. Br Sugar. A W
Bririd
Morris. T.
A. & Ward-Booth. R. P. (1985). Delayed spontaneous rctrobulbar haemorrhagc. A case report. Juumd o/ Afasillo-
i%c~id .Sur,geq~.13, I29 Ord, R. A. (1981). Post-operative rctrobulbar haemorrhagc and b’indncss complicating trauma surgery. Rritr.41 Journal c,jOrrrl
.%ugcr,r. 19,202. Wood, C. M. (1989). The medical manapsmcnt of retrohulbar hacmorrhage compllcatme facial fractures: A cast report.
Brirr.sh Journul of Oral and :\~o.~ill~&%~l Swgcry. 21, 29 I
DIVERTICULAR MUCOSA
POUCH
OF THE BLCCAL
Sir,
I was interested to read the recent article by Takcda (1992) reporting a diverticular pouch of the buccal mucosa. As hc points out this is a rare linding with only one previously reported case. I have also recently seen a patient in Norwich with a similar Icsion. a report of which is about to bc published (Rouson. 1992). Our patient. who was 89 years old. prescnted with food packing. Although of uncertain aetiology it was thought that poor muscle tone and chronic food inspissation may have been contributary factors. In this cast there was no demonstrable defect in buccinator. J. E. Rowson, BMedSci, FRCS, FDSRCS Department of Oral and Maxillopdcial Surgery West Norwich Hospital Bowthorpe Road Norwich KR2 3TC
References
Fig. 1 - Sagittal computerised axial tomograph bar hcamatoma in the right orbit.
Rowson. J. E. (1992). Divertwula of the huccal mucosa: report ofa case. Hrrrish Denral Journul. in press. Takcda. Y. (1992). Divcrtlcular pouch of the buccal mucosa: report of a case. Bririxh Jountul n/ Owl onrl .tlu.xdloJociul
showing retrobul-
Surger?. 30, 12X. 347
