Orbital fractures, particularly of the medial and inferior walls, often require precise reconstruction to restore orbital volume and prevent enophthalmos, diplopia, and facial deformity. The selection of repair material, ranging from titanium meshes and porous polyethylene to resorbable polymers and tissue-engineered scaffolds, is therefore central to surgical success, yet a clinically oriented synthesis of the available options remains lacking. This study combines a bibliometric mapping with a focused review of repair materials to chart how the field has evolved and to clarify the relationship between material properties, fracture pattern, and treatment strategy. Literature published from 1990 to 2025 was retrieved from the Web of Science Core Collection and analyzed using VOSviewer, CiteSpace, and the R package "bibliometrix"; 1156 articles were included. The USA contributed the largest number of publications (272), followed by South Korea (124) and China (118), with the University of Helsinki (58 articles) and the Journal of Craniofacial Surgery (H-index 32) being the most productive institution and journal, respectively. Six thematic clusters were identified: biomaterial types, outcome prediction, complications, absorbable polymers, allografts, and surgical approaches. Keyword burst analysis highlighted emerging interests in "floor" (2021-2025) and "intraoperative navigation" (2022-2025). We further map these clusters onto concrete clinical scenarios: small orbital floor defects may be managed with resorbable polymers, whereas extensive, comminuted fractures or cases with severe enophthalmos require the rigid support of titanium or patient-specific implants (PSI). The field is progressing from conventional fixation toward computer-assisted planning, PSI, and bioactive tissue-engineered constructs. Future efforts should prioritize validating navigation-guided implantation for orbital floor reconstruction while advancing novel biomaterials that promote osteogenesis and minimize complications.

BackgroundA petrous apex mucocele is a rare benign cystic lesion that can present with symptoms due to pressure on surrounding structures, including the internal carotid artery, Meckel's cave and the fifth and sixth cranial nerves, as well as the cavernous sinus region and inner ear.MethodsA 36-year-old male presented with 8 months of diplopia when looking to the right, a right-sided temporoparietal headache, and paresthesia in the right half of his face. An MRI revealed a 26 × 32 × 37 mm lesion in the right petrous apex. The lesion's signal characteristics were most consistent with a mucocele. We performed an endoscopic endonasal transclival marsupialization and created a wide drainage opening, which we supported by inserting a stent containing mometasone furoate.ResultsThe postoperative course was marked by transient arterial hypertension, which required antihypertensive treatment. Postoperative imaging studies revealed no intracranial complications and confirmed that the drainage pathway remained patent.ConclusionIn the differential diagnosis of lesions in the medial portion of the petrous apex, a mucocele should be considered. In appropriately selected cases, endoscopic endonasal marsupialization can be an effective option. To maintain postoperative patency of the drainage pathway, an implant containing mometasone furoate may also be used.

BackgroundThyroid eye disease is a common chronic autoimmune ocular disorder. Relevant quality of life studies are limited in socioeconomically and medically distinct regions of Western China. The present study aimed to address the regional gap and support targeted clinical public health strategies for long-term thyroid eye disease management.MethodsThis cross-sectional survey was conducted among 306 patients with thyroid eye disease from 12 provinces, municipalities, and autonomous regions in Western China. Data were collected using a general demographic questionnaire, Graves' Ophthalmopathy Quality of Life (GO-QOL) questionnaire, Huaxi Emotional-Distress Index, and Athens Insomnia Scale. Multivariate linear regression was performed to identify independent factors.ResultsThe mean total GO-QOL score was 41.19 ± 19.38. Multivariate analysis revealed that GO-QOL of patients with diplopia, photophobia/epiphora, restricted eye movement, and other ocular symptoms were lower by 9.024, 8.867, 9.416, and 4.159 points, respectively, than those of individuals without these symptoms (all p < 0.001, except for "other symptoms" where p = 0.006). For each 1-point increase in the Huaxi Emotional-Distress Index and Athens Insomnia Scale scores, the GO-QOL score decreased by 0.810 points (p < 0.001) and 0.543 points (p = 0.007), respectively. Compared with patients with a Clinical Activity Score <3, those with a Clinical Activity Score ≥3 had a mean GO-QOL score that was 5.626 points lower (p = 0.041). The GO-QOL of patients with junior high school education was 5.434 points higher than that of those with a bachelor's degree or higher (p = 0.028).ConclusionThe quality of life of patients with thyroid eye disease in Western China remains relatively low. Low educational level, ocular symptoms (diplopia, photophobia/epiphora, and restricted motility), disease activity, emotional distress (anxiety/depression), and sleep disorders are independent risk factors for poorer quality of life. These findings support a shift from single-modality ophthalmic care approach to a multidimensional, multidisciplinary strategy, integrating ocular symptom control, psychological support, and sleep improvement for long-term regional care of patients with thyroid eye disease.

Frontal sinus mucoceles are benign expansile lesions that may progressively erode the surrounding bone and extend toward the orbit or intracranial compartment. When expansion occurs anteriorly, however, they may present as an apparently superficial forehead swelling and be mistaken for a cutaneous abscess. A 77-year-old woman with chronic sinusitis developed recurrent left paramedian frontal swelling over several months, with only transient improvement following antibiotic treatment. The lesion was initially interpreted as a cutaneous abscess and incised in an outpatient setting. Clear, nonpurulent fluid was obtained instead of pus. Two days later, she presented with persistent frontal inflammation and newly developed left periorbital cellulitis. Despite the extent of the disease, she remained afebrile and had no headache, neurological symptoms, diplopia, or visual impairment. CT and MRI demonstrated a left frontal sinus mucocele with erosion of both the anterior and posterior frontal sinus tables, in close proximity to the superomedial orbit and dura mater. After control of the acute inflammatory process, the mucocele was treated with endoscopic endonasal marsupialization through a Draf IIc frontal sinusotomy. Complete clinical resolution was achieved, with no documented recurrence during one year of follow-up. This case illustrates an important diagnostic pitfall: the superficial appearance of a frontal swelling may conceal extensive underlying sinus disease and bony erosion. Recurrent paramedian frontal swelling, transient responses to antibiotics, clear rather than purulent drainage, or associated periorbital inflammation should prompt CT or MRI before any further incision.

This prospective, multicenter clinical study evaluated patient-reported outcomes, functional recovery, and quality of life following orbital floor reconstruction using ultra-high-molecular-weight-polyethylene (UHMWPE) implants. The study emphasized both subjective recovery and the clinical performance of the implant material. Between June 2022 and July 2023, 46 adult patients (≥ 18 years of age) with radiologically confirmed orbital floor fractures requiring surgical reconstruction were enrolled and completed the full follow-up protocol. Surgical reconstruction was performed according to standardized procedures using UHMWPE implants. Pre- and postoperative CT or CBCT imaging was obtained when clinically indicated; radiological outcomes of this cohort have been reported separately. Pre- and postoperative evaluations included an assessment of pain, swelling, ocular motility, diplopia, sensory function, foreign body sensation, overall satisfaction and orbital volume, which was measured using three-dimensional imaging. Intraoperative parameters were also recorded. Patient-reported outcomes were collected through validated questionnaires and visual analogue scales, repeated at each visit, follow-up examinations were performed approximately one day, ten weeks, six months, and twelve months after surgery. Overall, clinical and patient-reported outcomes improved over the follow-up period. Pain intensity declined markedly within the first week after surgery and remained consistently low thereafter. Swelling, numbness, and the sensation of a foreign body gradually subsided, with almost complete resolution after one year. Furthermore, imaging confirmed stable anatomical reconstruction without implant displacement or volume loss. In general patient satisfaction increased steadily throughout the observation period, reaching near-maximal levels after twelve months. No cases of infection, inflammatory reaction or implant-related complication were recorded. In this prospective cohort, orbital floor reconstruction using UHMWPE was associated with favorable functional, aesthetic and patient-reported recovery over 12 months. These findings support the value of incorporating patient-centered outcomes into the assessment of recovery after orbital trauma, while comparative effectiveness and long-term safety require further controlled studies.

Intracranial mesenchymal tumor, FET::CREB fusion-positive is a provisional tumor type in the 2021 World Health Organization (WHO) classification of central nervous system tumors, typically seen in children and young adults. Herein, we describe a patient with intracranial mesenchymal tumor, FET::CREB fusion-positive arising at a rare site, that is, lateral ventricle in a young girl with complaints of headache and diplopia. The mass was excised and sent for histopathological examination wherein, a possibility of intracranial myxoid mesenchymal tumor with FET::CREB fusion was suggested. Subsequently, the diagnosis was confirmed on demonstration of EWSR1 gene rearrangement by break apart fluorescence in situ hybridization (FISH). Owing to its rarity, there are very few published reports in the literature and hence their clinical course is not well known. On review of the world literature, it is documented to be a locally aggressive tumor with a high recurrence rate. It is imperative that pathologists are aware of the full clinicopathologic spectrum of this rare entity, as the differential diagnosis can be challenging.

Background Skull base chondrosarcomas are rare and locally aggressive tumors with heterogeneous biology accounting for 0.1-0.2% of all intracranial tumors. Dedifferentiated chondrosarcoma is an exceptionally uncommon and aggressive variant, seldom seen at the skull base. We report a recurrent clival chondrosarcoma with a small, dedifferentiated component, and an unusually long latency after initial treatment. Case Report A 66-year-old woman was referred with a recurrent progressive clival lesion, initially suspected to be a chordoma. She had undergone subtotal resection followed by single-fraction radiosurgery (25 Gy) 32 years earlier. Surveillance imaging demonstrated interval growth compared with imaging 5 years earlier, prompting repeat subtotal resection. Histopathology revealed a conventional chondrosarcoma with a dedifferentiated component comprising <5% of tumor area and an isocitrate dehydrogenase 1 (IDH1) R132 mutation. The patient declined adjuvant radiotherapy. Three years later, she developed worsening diplopia, new right oculomotor palsy, and headache with radiologic progression, prompting repeat subtotal resection. She currently awaits postoperative proton beam radiotherapy. Conclusion This case highlights a key diagnostic challenge of distinguishing chondrosarcoma from chordoma, and underscores the importance of meticulous histologic sampling to detect small dedifferentiated foci that may otherwise result in undergrading and undertreatment. The heterogeneity in clinical behavior observed across histopathological subtypes further underscores the necessity for grade/subtype-driven treatment regimens. Therefore, accurate subtype classification and molecular annotation may better inform treatment strategy and follow-up. Lastly, the rarity of dedifferentiated skull base chondrosarcoma reinforces the need for multicenter registries to further understand the behavior and vulnerabilities of this rare disease.

Immune checkpoint inhibitors (ICIs) can lead to immune-related adverse events, including myocarditis with myositis and/or myasthenia gravis overlap syndrome (IM3OS). This syndrome poses notable management challenges and has high mortality rates. Due to limited data, its clinical features and optimal treatment strategies remain poorly understood. The present study aims to clarify these aspects and share clinical management experiences. A total of 6 patients with IM3OS were retrospectively analyzed, collecting demographic, clinical, laboratory, electrophysiological, therapeutic and outcome data. Additionally, the relevant literature was reviewed to contextualize the findings. The 6 patients, all male, with a median age of 70.5 years (range, 63-83 years), developed symptoms a median of 30.5 days post-ICI initiation. Common symptoms included fluctuating ptosis, neck weakness, fatigue, myalgia, diplopia, dysphagia, dysarthria and limb weakness. Of the 6 patients, 3 required ventilation support. Elevated creatine kinase (CK) and cardiac troponin I (cTnI) were observed in all patients, with CK and cTnI levels decreasing rapidly post-treatment. Cardiac troponin T levels remained elevated for 3 months. Myotonic discharge and increased jitter were noted in 2 patients. Treatments included corticosteroids, intravenous immunoglobulin (IVIG), plasmapheresis and rituximab. Pyridostigmine was discontinued in 2 out of 4 patients due to severe cardiac adverse effects. Despite interventions, 2 patients died and 1 was bedridden, with only 3 showing favorable outcomes. In conclusion, IM3OS has a high fatality rate, highlighting the need for prompt intervention in ICI-treated patients with neuromuscular symptoms. Serum cTnI is a reliable cardiac injury marker, and early treatment with IVIG, plasmapheresis and high-dose methylprednisolone is recommended. Pyridostigmine should be administered with caution in patients with IM3OS, particularly in the presence of bradyarrhythmic ICI-related myocarditis. Given the high mortality and disability rates associated with IM3OS, novel biological targeted therapies such as eculizumab and efgartigimod may reduce fatal outcomes.

Epstein-Barr virus (EBV)-positive nonkeratinizing squamous cell carcinoma (NKSCC), formerly referred to as lymphoepithelioma or lymphoepithelioma-like carcinoma, most commonly arises in the nasopharynx. However, it has been reported in multiple extra-nasopharyngeal sites. Orbital involvement is exceedingly rare, with most reported cases occurring in the ocular adnexa. We present the case of a 67-year-old Asian male with EBV-positive NKSCC of the medial periorbital area who developed right-sided diplopia and periocular edema. Recognition of this rare entity and its diagnostic features is essential for accurate diagnosis and appropriate management.