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I P, V P, S-E S, P S, M B, L G, A T. Acute orbital compartment syndrome due to traumatic hemorrhage: 4-year case series and relevant literature review with emphasis on its management. Oral Maxillofac Surg 2023; 27:101-116. [PMID: 35083570 DOI: 10.1007/s10006-021-01036-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Blindness in craniomaxillofacial (CMF) injuries may occur due to acute orbital compartment syndrome (AOCS). Primarily, this article aimed to retrospectively review our 4-year experience in the management of patients diagnosed with AOCS secondary to an orbital hematoma (OH). Furthermore, this paper included up-to-date information regarding the prevalence, diagnosis, management, and prognosis of AOCS. MATERIALS AND METHODS We retrospectively screened the medical records of patients who visited our hospital's emergency department (ED) and were examined by an oromaxillofacial surgeon for CMF injuries, between September 1, 2013, and September 31, 2017. The electronic hospital's database was searched to retrieve all cases of CMF trauma admitted or referred to our clinic during this period. RESULTS Over a 49-month period, 3,514 patients were managed for CMF injuries in ED; 9 cases (0.26%) were attributed to OCS caused by an OH. This group comprised 5 males and 4 females aged between 32 and 91 years old (mean 65.7, median 70). Seven out of 9 patients were subjected to lateral canthotomy and inferior cantholysis (LCIC), whereas septolysis was applied in 6 of them. Sight was preserved in 3 out of 8 patients (37.5%), since a patient died from a serious intracranial injury. Seven out of 9 patients (77.7%) of the OCS group had a history of hypocoagulable state. CONCLUSIONS LCIC, septolysis, and careful dissection within inferotemporal orbital quadrant constitute a reliable approach for emergent orbital decompression. CT scan offers differential diagnosis of acute traumatic proptosis, but it should preferably follow LCIC. In case of OHs without pupillary abnormalities and/or impairment of visual acuity, close monitoring allowing for timely interventions is highly recommended to patients with a history of hypocoagulative status, (uncontrolled or severe) hypertension, head trauma, and decreased level of consciousness or in elderly patients suffering from dementia or without rapid access to follow-up medical care. Clinicians dealing with ED services must maintain high skills in AOCS diagnosis and in LCIC execution.
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Affiliation(s)
- Papadiochos I
- Attikon" University General Hospital, Chaidari, Medical School of Athens, Athens, Greece.
| | - Petsinis V
- School of Dentistry, Athens, Greece
- OMFS Clinic of "Evaggelismos" Gereral Hospital, Athens, Greece
| | - Sarivalasis S-E
- Department of Plastic Surgery, Hygeia Hospital, Athens, Greece
| | - Strantzias P
- OMFS Clinic of "Panagiotis and Aglaia Kyriakou" Children's Hospital of Athens, Athens, Greece
| | - Bourazani M
- OMFS Clinic of "Evaggelismos" Gereral Hospital, Athens, Greece
| | - Goutzanis L
- School of Dentistry, Athens, Greece
- OMFS Clinic of "Panagiotis and Aglaia Kyriakou" Children's Hospital of Athens, Athens, Greece
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2
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The Big Five—Lifesaving Procedures in the Trauma Bay. Emerg Med Clin North Am 2023; 41:161-182. [DOI: 10.1016/j.emc.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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3
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Murali S, Davis C, McCrea MJ, Plewa MC. Orbital compartment syndrome: Pearls and pitfalls for the emergency physician. J Am Coll Emerg Physicians Open 2021; 2:e12372. [PMID: 33733246 PMCID: PMC7936795 DOI: 10.1002/emp2.12372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
Orbital compartment syndrome (OCS) is a rare, vision-threatening diagnosis that requires rapid identification and immediate treatment for preservation of vision. Because of the time-sensitive nature of this condition, the emergency physician plays a critical role in the diagnosis and management of OCS, which is often caused by traumatic retrobulbar hemorrhage. In this review, we outline pearls and pitfalls for the identification and treatment of OCS, highlighting lateral canthotomy and inferior cantholysis (LCIC), a crucial skill for the emergency physician. We recommend adequate preparation for the diagnosis and procedure, early consultation to ophthalmology, clear and thorough documentation of the physical examination, avoidance of iatrogenic injury during LCIC, and complete division of the inferior canthal tendon. Emergency physicians should avoid failing to make the diagnosis of OCS, delaying definitive surgical treatment, overrelying on imaging, failing to decrease intraocular pressure, and failing to exclude globe rupture. The emergency physician should be appropriately trained to identify signs and symptoms of OCS and perform LCIC in a timely manner.
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Affiliation(s)
- Shyam Murali
- Mercy Health St. Vincent Medical CenterToledoOhioUSA
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4
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Kim JM. Retrobulbar hematoma following the repair of an orbital wall fracture: a case series. Maxillofac Plast Reconstr Surg 2021; 43:8. [PMID: 33625607 PMCID: PMC7904983 DOI: 10.1186/s40902-021-00289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/01/2021] [Indexed: 11/22/2022] Open
Abstract
Background Retrobulbar hematoma is a rare complication after the repair of an orbital wall fracture, but the caution is required because the condition can cause blindness. Case presentation In this article, 3 cases of retrobulbar hematoma after the surgical repair of an orbital wall fracture are reported. In the first patient, the permanent loss of vision was involved, while in the second patient, the author was able to prevent loss of vision by performing immediate decompression after definite diagnosis and consulting with an ophthalmologist. In the third patient, there was no surgical treatment involved; he recovered on his own without major sequelae. Conclusions Retrobulbar hematoma is a very serious condition that can result in blindness. Thus, when it is recognized, every effort should be made to preserve the patient’s vision and prevent blindness.
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Affiliation(s)
- Jeong-Mo Kim
- Department of Oral and Maxillofacial Surgery, Kangwon National University Hospital, Chuncheon, Korea.
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5
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Coccolini F, Improta M, Picetti E, Vergano LB, Catena F, de ’Angelis N, Bertolucci A, Kirkpatrick AW, Sartelli M, Fugazzola P, Tartaglia D, Chiarugi M. Timing of surgical intervention for compartment syndrome in different body region: systematic review of the literature. World J Emerg Surg 2020; 15:60. [PMID: 33087153 PMCID: PMC7579897 DOI: 10.1186/s13017-020-00339-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/07/2020] [Indexed: 12/28/2022] Open
Abstract
Compartment syndrome can occur in many body regions and may range from homeostasis asymptomatic alterations to severe, life-threatening conditions. Surgical intervention to decompress affected organs or area of the body is often the only effective treatment, although evidences to assess the best timing of intervention are lacking. Present paper systematically reviewed the literature stratifying timings according to the compartmental syndromes which may beneficiate from immediate, early, delayed, or prophylactic surgical decompression. Timing of decompression have been stratified into four categories: (1) immediate decompression for those compartmental syndromes whose missed therapy would rapidly lead to patient death or extreme disability, (2) early decompression with the time burden of 3-12 h and in any case before clinical signs of irreversible deterioration, (3) delayed decompression identified with decompression performed after 12 h or after signs of clinical deterioration has occurred, and (4) prophylactic decompression in those situations where high incidence of compartment syndrome is expected after a specific causative event.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy
| | - Mario Improta
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | | | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Nicola de ’Angelis
- Unit of Digestive and Hepato-biliary-pancreatic Surgery, Henri Mondor Hospital and University Paris-Est Créteil (UPEC), Créteil, France
| | - Andrea Bertolucci
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy
| | - Andrew W. Kirkpatrick
- Departments of Surgery and Critical Care Medicine, Foothills Medical Centre, Calgary, Canada
| | | | - Paola Fugazzola
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy
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Erickson BP, Garcia GA. Evidence-based algorithm for the management of acute traumatic retrobulbar haemorrhage. Br J Oral Maxillofac Surg 2020; 58:1091-1096. [PMID: 32546417 DOI: 10.1016/j.bjoms.2020.05.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Abstract
Retrobulbar haemorrhage (RBH) is a potentially blinding consequence of craniofacial trauma, but timely ophthalmic evaluation is difficult to obtain in some settings and clear standards for canthotomy/cantholysis are lacking. We have sought to develop an algorithm to identify vision-threatening traumatic RBH that requires emergent decompression. We retrospectively reviewed 42 consecutive consultations for RBH at a level-one trauma centre. Charts and imaging studies were analysed with attention to mechanism of injury, comorbid trauma, and ophthalmic findings. A total of 22 eyes were observed without intervention, 13 were treated pharmacologically, and seven by emergent canthotomy/cantholysis. No differences in standard trauma metrics were found among these groups. Lid oedema, ecchymosis, chemosis, subconjunctival haemorrhage, and ocular motility also failed to correlate with a need for surgical intervention. "Tight" eyelids (p<0.001), unilateral proptosis (p<0.001), and relative afferent pupillary defect (RAPD; p=0.029), however, all related to a need for canthotomy/cantholysis (Fisher's exact test). Tenting of the globe, which was the only radiographic finding to predict the need for surgery, was seen in just two of the seven cases that required decompression. Many of the traditionally emphasised clinical signs therefore fail to identify cases of RBH that require decompression. Our data support a simple three-factor decision tool. These are: relative proptosis, eyelids that are difficult to open with finger pressure, and presence of an RAPD in the traumatised eye. If all three are noted or if the patient has proptosis and tight lids in the absence of a large preseptal haematoma, he/she is likely to need surgical decompression. Tenting of the globe on computed tomography (CT), while a relatively rare finding, should also alert the physician of the need for intervention.
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Affiliation(s)
- B P Erickson
- Byers Eye Institute, Stanford University, Palo Alto, CA; Stanford University Hospital, Stanford, CA
| | - G A Garcia
- Byers Eye Institute, Stanford University, Palo Alto, CA; Stanford University Hospital, Stanford, CA.
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7
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A multidisciplinary educational curriculum for the management of orbital compartment syndrome. Am J Emerg Med 2020; 38:1278-1280. [DOI: 10.1016/j.ajem.2019.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/30/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022] Open
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Visual Outcomes of Patients With Retrobulbar Hemorrhage Undergoing Lateral Canthotomy and Cantholysis. Ophthalmic Plast Reconstr Surg 2020; 35:586-589. [PMID: 31693632 DOI: 10.1097/iop.0000000000001401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Evaluate visual outcomes in relation to time from injury to intervention in patients who undergo lateral canthotomy with cantholysis (LCC) for retrobulbar hemorrhage (RBH). METHODS Retrospective study of patients with orbital compartment syndrome (OCS) secondary to RBH who underwent LCC. OCS due to RBH was defined by a combination of decreased vision, proptosis, resistance to retropulsion, increased intraocular pressure, and relative afferent pupillary defect. Time from injury to intervention and change in visual acuity were calculated, with regression analysis identifying predictors of vision recovery. RESULTS Fifteen participants were included. Three (20%) participants presented with no light perception, 7 (47%) with count fingers (CF) to light perception, and 5 (33%) with better than count fingers vision. All 5 participants who had LCC within 3 hours (twice the standard 90 minutes) gained some vision, and 6 of 10 participants who had LCC after 3 hours recovered some vision. The latest intervention with visual acuity improvement was performed 9 hours postinjury. Of 3 participants who presented with no light perception vision, 1 regained vision to 20/40 (intervention 1.7 hours postinjury), and 2 did not regain any vision (interventions at 5 and 8.7 hours postinjury). Duration from injury to intervention was associated with decreased amount of vision recovery (P = 0.03). CONCLUSIONS Increased time to intervention with LCC was associated with less vision recovery after OCS from RBH. However, over half of participants with intervention more than 90 minutes after injury still showed visual acuity improvement. The authors recommend LCC in all patients who present with OCS regardless of the time since injury.Patients with orbital compartment syndrome may see visual recovery after lateral canthotomy and cantholysis, even if performed outside of the previously accepted 3-hour window.
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9
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Visual outcomes after traumatic retrobulbar hemorrhage are not related to time or intraocular pressure. Am J Emerg Med 2019; 38:2308-2312. [PMID: 31784392 DOI: 10.1016/j.ajem.2019.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/07/2019] [Accepted: 10/20/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The paucity of literature regarding the role of time and intraocular pressure (IOP) when treating ocular compartment syndrome (OCS) has resulted in limited guidance for emergency physicians (EP). OBJECTIVES Our goals were to investigate the ideal time frame for lateral canthotomy, to understand the relationship between IOP and visual outcome, and to determine the impact of EP performance on visual acuity (VA). METHODS The study population included patients presenting over an 18-year period with traumatic retrobulbar hemorrhage (RBH) treated with lateral canthotomy. Efficacy was evaluated using visual outcome and IOP. Patients were grouped by time from injury and arrival to canthotomy. Procedures completed in the emergency department (ED) and by EPs were evaluated regarding visual outcome. RESULTS Sixty cases of RBH treated with lateral canthotomy were identified. Over two-thirds (43/60, 71.7%) were discharged with baseline vision. Lateral canthotomy lowered IOP from a median of 50.0 mmHg (IQR: 40.5, 61) preprocedure to 23.0 mmHg (IQR: 18, 27) post-procedure (p-value = 0.000001). No correlation was found between time, IOP, location, specialty of clinician, and visual outcome. CONCLUSION Lateral canthotomy is an effective at lowering IOP. Our data suggest that using time and IOP to predict procedural outcome is flawed. If OCS is suspected, lateral canthotomy should be considered and can be effectively performed by EPs. Neither the time of injury to ED presentation nor degree of IOP elevation should be factored into the decision of when to perform the procedure.
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10
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McCallum E, Keren S, Lapira M, Norris JH. Orbital Compartment Syndrome: An Update With Review Of The Literature. Clin Ophthalmol 2019; 13:2189-2194. [PMID: 31806931 PMCID: PMC6844234 DOI: 10.2147/opth.s180058] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/03/2019] [Indexed: 12/30/2022] Open
Abstract
Orbital compartment syndrome (OCS) is a potentially blinding condition characterized by a rapid increase in intra-orbital pressure. OCS is most commonly seen in the context of intra-orbital hemorrhage secondary to either trauma or surgery. A review of the literature indicates that better visual outcomes are achieved when interventions occur within the first 2 hrs. There are reports of visual recovery after a delay in management and consideration should be given to intervention even when presentation is delayed. Reported interventions include: lateral canthotomy with cantholysis, bony orbital decompression and treatment of the underlying cause.
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Affiliation(s)
- Ewan McCallum
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - Shay Keren
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - Matthew Lapira
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
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11
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Incidence and outcomes of retrobulbar hematoma diagnosed by computed tomography in cases of orbital fracture. Can J Ophthalmol 2019; 54:606-610. [DOI: 10.1016/j.jcjo.2019.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 11/21/2022]
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12
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Kopecky A, Rokohl AC, Nemcansky J, Koch KR, Matousek P, Heindl LM. [Retrobulbar Haematoma - a Complication that May Impair Vision]. Klin Monbl Augenheilkd 2019; 238:609-615. [PMID: 31416097 DOI: 10.1055/a-0958-9584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Retrobulbar haematoma (RBH) is a rare complication that may affect vision after a trauma or a surgical procedure. The diagnosis must be made promptly, as only early surgical intervention can adequately prevent irreversible visual impairment. Because of the bony orbital walls, there is hardly any room for the increasing intraorbital volume due to the retrobulbar haemorrhage. This leads to an increase in intraorbital pressure and subsequently to compression of the optic nerve. Symptoms include disorders in ocular motility, ophthalmoplegia, diplopia, conjunctival chemosis, subconjunctival haemorrhage, proptosis, increased intraocular pressure, deterioration in visual acuity, decreased direct pupillary reflex, and a relative afferent pupillary defect. If the cause is traumatic or iatrogenic, prompt lateral canthotomy with cantholysis is the treatment of choice, and successfully lowers pressure in most cases. It can be performed in the emergency room by an ophthalmologist and may even be indicated without previous imaging. As the reconstruction of cantholysis is generally uncomplicated, we recommend performing the procedure when RBH is suspected. If canthotomy with cantholysis does not lead to adequate improvement, surgical orbital decompression must be performed. Supportive treatment should always include systemic steroids.
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Affiliation(s)
- Adam Kopecky
- Klinik für Augenheilkunde, Universitätskrankenhaus Ostrava, Ostrava, Tschechische Repubik.,Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln
| | | | - Jan Nemcansky
- Klinik für Augenheilkunde, Universitätskrankenhaus Ostrava, Ostrava, Tschechische Repubik.,Medizinische Fakultät, Universität Ostrava, Ostrava, Tschechische Republik
| | - Konrad R Koch
- Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln
| | - Petr Matousek
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Universitätskrankenhaus Ostrava, Ostrava, Tschechische Republik
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln.,Centrum für Integrierte Onkologie (CIO) Aachen - Bonn - Köln - Düsseldorf, Köln
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13
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Amer E, El-Rahman Abbas A. Ocular Compartment Syndrome and Lateral Canthotomy Procedure. J Emerg Med 2019; 56:294-297. [PMID: 30679067 DOI: 10.1016/j.jemermed.2018.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/14/2018] [Accepted: 12/08/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ocular compartment syndrome (OCS) is a serious ophthalmological emergency that should be diagnosed and treated immediately to prevent permanent loss of vision. It is usually caused by a retro-orbital bleed that will subsequently increase intra-orbital pressure and threaten the patient's vision. Lateral canthotomy and cantholysis is a minor bedside procedure using simple equipment that is readily available in emergency departments, and the aim of such a procedure is to free the eye globe from its lateral attachment to the bony orbital wall and allow more eye protrusion and hence reduce intra-orbital pressure and save the patient's sight. The case we present describes a 42-year-old man who presented with facial injuries following an alleged assault and in whom a computed tomography scan of the head showed a retro-orbital hemorrhage. The patient had subtle signs of increased intra-orbital pressure for which lateral canthotomy and cantholysis was indicated. DISCUSSION OCS is an ophthalmological emergency that can present with subtle signs of increased intraocular pressure that can lead to irreversible loss of vision if not treated with a simple bedside operation called lateral canthotomy and cantholysis within a specific time frame. We explore the pathophysiology and presentation of OCS and how to perform the lateral canthotomy with cantholysis procedure. CONCLUSIONS The aim of this case presentation is to highlight the importance of diagnosing OCS as an ophthalmological emergency and discuss how to perform the sight-saving procedure.
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Affiliation(s)
- Esam Amer
- Department of Accident and Emergency, Colchester General Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
| | - Abd El-Rahman Abbas
- Department of Emergency Medicine, Colchester Hospital University Foundation Trust, Colchester, United Kingdom
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14
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Graillon N, Foletti JM, Le Roux MK, Alessandrini M, Benzaquen M, Guyot L. Impact of antithrombotic treatment in orbital haematoma. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:489-492. [PMID: 29792939 DOI: 10.1016/j.jormas.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/27/2018] [Accepted: 05/11/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Orbital haematomas threaten the visual prognosis, but no treatment guidelines have been proposed. Antithrombotics could affect their prognosis and treatment. This study aimed to evaluate the effect of antithrombotics in the management of orbital haematomas and to suggest a standardised protocol. MATERIAL AND METHODS We conducted a retrospective study by sending a standardised questionnaire to 20 French maxillofacial surgery university departments to collect all the cases of orbital haematoma. RESULTS Twenty-five cases from 10 centres were collected, including five patients treated with anticoagulant and one patient treated with dual antiplatelet. Antithrombotics increased the risk of amaurosis and ocular disorders significantly. Surgery was performed for 66.7% of patients treated with antithrombotic and for 89.5% of other patients. Surgical delay was longer in patients treated with antithrombotic. Surgical drainage was used in most of the cases, whereas canthotomy with inferior cantholysis was the least-used technique. CONCLUSION Antithrombotics appear to worsen the functional prognosis of orbital haematomas. A surgical management of orbital haematoma in patients treated with antithrombotics is not contraindicated. Surgical delay must be shortened as much as possible. A lateral canthotomy with inferior cantholysis seems to be an appropriate solution.
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Affiliation(s)
- N Graillon
- Oral and Maxillofacial surgery department, North hospital, assistance publique hôpitaux de Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France.
| | - J M Foletti
- Oral and Maxillofacial surgery department, North hospital, assistance publique hôpitaux de Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - M K Le Roux
- Oral and Maxillofacial surgery department, North hospital, assistance publique hôpitaux de Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - M Alessandrini
- Aix Marseille Université, SPMC EA 3279, 27, boulevard Jean-Moulin, 13385 Marseille, France
| | - M Benzaquen
- Oral and Maxillofacial surgery department, North hospital, assistance publique hôpitaux de Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - L Guyot
- Oral and Maxillofacial surgery department, North hospital, assistance publique hôpitaux de Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France
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15
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Stathopoulos P, Igoumenakis D, Mezitis M, Rallis G. Blindness after facial trauma: epidemiology, incidence and risk factors: a 27-year cohort study of 5708 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:129-133. [PMID: 29673800 DOI: 10.1016/j.oooo.2018.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This was a 27-year study of a cohort of 5708 patients who had sustained maxillofacial fractures. Our purpose was to present the etiology, mechanism of trauma, site, and concomitant injuries that led to visual loss. We hypothesize that fractures caused by high-energy impact of the midface may be associated with blindness. A discussion of the treatment approaches is also included. STUDY DESIGN The study included 5708 patients who had sustained a maxillofacial fracture during the years 1985-2012. Patients' records were reviewed for gender, age, fracture site, etiology of trauma, concomitant injuries, method of treatment, length of hospital stay, and cause of blindness. The relationship of the above variables to blindness was investigated. RESULTS The incidence of loss of vision was 0.34%. A very strong association between firearm injuries and blindness was observed (P < .001). These patients spent much longer time in hospital (P < .01) and suffered serious concomitant injuries involving the brain. CONCLUSIONS Retrobullbar hemorrhage should be treated with lateral canthotomy, whereas in traumatic optic neuropathy, observation seems to be the safest thing to do. In patients with penetrating injuries of the globe, the immediate involvement of an ophthalmic surgeon is of paramount importance.
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Affiliation(s)
- Panagiotis Stathopoulos
- Dublin Dental University Hospital, Consultant Oral and Maxillofacial Surgeon St James and Mater Hospital, Dublin, Ireland.
| | | | - Michalis Mezitis
- Consultant Oral and Maxillofacial Surgeon, KAT General Hospital of Athens, Athens, Greece
| | - George Rallis
- Consultant Oral and Maxillofacial Surgeon, KAT General Hospital of Athens, Athens, Greece
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17
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Efficacy of Intravenous Mannitol in the Management of Orbital Compartment Syndrome: A Nonhuman Primate Model. Ophthalmic Plast Reconstr Surg 2016; 32:187-90. [DOI: 10.1097/iop.0000000000000463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Ocular Injuries in Patients of Zygomatico-Complex (ZMC) Fractures. J Maxillofac Oral Surg 2016; 16:243-247. [PMID: 28439168 DOI: 10.1007/s12663-016-0907-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 04/05/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Mid face injuries commonly destroy the integrity of the orbital skeleton, and are frequently complicated by injury to the eye, ranging between 2.7 and 90.6 % as reported in literature. The eye injuries range from simple subconjunctival haemorrhage to globe rupture. The paper aims to study the types of ocular injuries in patients with ZMC fractures. PATIENTS AND METHODS A study of 67 patients, who had sustained facial trauma sufficient to lead to a facial bone fracture, was undertaken in the department of Oral and Maxillofacial Surgery, Govt Dental College, Srinagar from 2008 to 2014 and the patients received a comprehensive examination by an ophthalmologist within 1 week of injury. All the patients sustaining confirmed ZMC fracture were examined by an ophthalmologist for any associated ocular injury. A thorough ophthalmologic examination included assessment of visual acuity, pupillary reactivity, anterior and posterior segment examination and extraocular motility. The variables reviewed included patient's gender, mechanism of injury, visual acuity, pupillary reactivity, extra ocular motility, presence or absence of diplopia, ocular and orbital findings, and intraorbital hypoesthesia. RESULTS The most common etiology of trauma was RTA (64.1 %), followed by falls (14.9 %) in our study. In our study 83.5 % of the patients were males. Minor ocular injuries such as subconjunctival haemorrhage and corneal injury accounted for most of the cases. Subconjunctival haemorrhage was the most common injury, present in 86.5 % of the cases. Hyphema was present 13.4 %, vitreous haemorrhage 2.98 %, retinal haemorrhage 1.49 %, corneal abrasion 4.47 %, mydriasis 1.49 %, choroidal rupture 5.97 %, retinal detachment 2.98 %, decreased visual activity 13.4 %, retinal tear and angle recession was present 7.46 % times. CONCLUSION ZMC fractures are associated with higher incidence of ocular injuries. The incidence of traumatic optic neuropathy and other ocular injuries warrants a prompt ophthalmologic examination of all patients with ZMC fractures as quickly as possible to prevent morbidity.
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Abstract
We report a case of bilateral orbital hemorrhage as a complication of peribulbar anesthesia in a 78 year old man. Initially, unilateral orbital hemorrhage occurred but quickly spread to the contralateral side. Neuroophthalmological assessment revealed a proptosed tense globe with normal retinovascular findings. Visual acuity was adversely affected and this was conservatively managed with no lasting ophthalmic sequela. This patient’s case was reported as it illustrates an unusual complication of bilateral spread of orbital hemorrhage secondary to peribulbar anesthesia. It highlights how early ophthalmic assessment can ensure a good visual outcome in the setting of appropriate ophthalmic monitoring. The mechanisms of orbital hemorrhage spread and appropriate management options are discussed.
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Affiliation(s)
- Kyla Garft
- Bendigo Eye Clinic, Victoria, Australia; Ophthalmology Education, Monash University Rural Medical School, Melbourne, Australia
| | - Peter Burt
- Bendigo Eye Clinic, Victoria, Australia; Ophthalmology Education, Monash University Rural Medical School, Melbourne, Australia
| | - Benjamin Burt
- Bendigo Eye Clinic, Victoria, Australia; Occuloplastics Department, Royal Victorian Eye and Ear Hospital, Victoria, Australia
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Iserson KV, Luke-Blyden Z, Clemans S. Orbital Compartment Syndrome: Alternative Tools to Perform a Lateral Canthotomy and Cantholysis. Wilderness Environ Med 2015; 27:85-91. [PMID: 26585073 DOI: 10.1016/j.wem.2015.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/31/2015] [Accepted: 09/04/2015] [Indexed: 10/22/2022]
Abstract
Orbital compartment syndrome acutely threatens vision. Lateral canthotomy and cantholysis ameliorate the compartment syndrome and, to save a patient's vision, must be performed in a timely manner. This requires appropriate tools. In resource-poor settings, the straight hemostat and iris scissors that are generally used for this procedure may be unavailable. In such situations, safe alternatives include using a multitool in place of a hemostat and a #11 scalpel blade instead of the iris scissors. As when using hemostats of varying sizes, the pressure applied to the multitool must be carefully modulated. When using a scalpel blade for the lateral canthotomy, the hemostat arm remains beneath the lateral canthus as a "backstop" to protect deeper tissues. For the cantholysis, use the back of the blade to "strum" for the ligaments, reversing its direction only to cut the ligament when it is identified.
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Affiliation(s)
- Kenneth V Iserson
- Department of Emergency Medicine, University of Arizona, Tucson, AZ; GPHC Emergency Medicine Residency, Georgetown, Guyana (Dr Iserson).
| | - Zelda Luke-Blyden
- Department of Emergency Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine, Georgetown Public Hospital Corporation, Georgetown, Guyana (Dr Luke-Blyden)
| | - Scott Clemans
- Department of Emergency Medicine, University of Arizona, Tucson, AZ; Buecher Biological Consulting, Tucson, AZ (Mr Clemans)
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Soare S, Foletti JM, Gallucci A, Collet C, Guyot L, Chossegros C. Update on orbital decompression as emergency treatment of traumatic blindness. J Craniomaxillofac Surg 2015; 43:1000-3. [DOI: 10.1016/j.jcms.2015.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/10/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022] Open
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Zimmerer R, Schattmann K, Essig H, Jehn P, Metzger M, Kokemüller H, Gellrich NC, Tavassol F. Efficacy of transcutaneous transseptal orbital decompression in treating acute retrobulbar hemorrhage and a literature review. Craniomaxillofac Trauma Reconstr 2013; 7:17-26. [PMID: 24624253 DOI: 10.1055/s-0033-1356754] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 01/27/2013] [Indexed: 10/25/2022] Open
Abstract
Decreasing visual acuity secondary to orbital trauma may be caused by sudden space-occupying or expanding intraorbital lesions, including retrobulbar hemorrhage (RBH), herniation, or swelling. RBH must be diagnosed and treated immediately. This article addresses the efficacy of transcutaneous transseptal orbital decompression in a combination with a systematic review of the literature for a comparison of this method with existing treatment options. For this study the department's database was retrospectively screened for patients with acute RBH who were treated between 2009 and 2011 using the authors' approach. Patients presenting with RBH were classified into RBH classes I to III according to three different clinical and radiological manifestations of acute RBH. The efficacy of transcutaneous transseptal orbital decompression was assessed by postoperative visual acuities. The literature review was performed by using the MEDLINE database. The time period for the study was between 2009 and 2011 during which 10 patients were diagnosed with suspected RBH and 9 were treated with the authors' technique. Visual acuities were reconstituted or maintained in almost 86% of patients who were diagnosed and treated according to the authors approach and who survived initial trauma. It was concluded that transcutaneous transseptal orbital decompression provides an efficient and rapid approach for treating patients with acute RBH. By distinguishing three different manifestations of acute RBH, the authors present a diagnostic tool that may facilitate classification of RBH and determination of treatment options.
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Affiliation(s)
- Rüdiger Zimmerer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School
| | - Katrin Schattmann
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Harald Essig
- Department of Oral and Maxillofacial Surgery, Hannover Medical School
| | - Philipp Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School
| | - Marc Metzger
- Department of Oral and Maxillofacial Surgery, University of Freiburg Medical School, Freiburg, Germany
| | - Horst Kokemüller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School
| | | | - Frank Tavassol
- Department of Oral and Maxillofacial Surgery, Hannover Medical School
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Ahmad N, Zahoor A, Elkhamary SM. Periocular hematoma secondary to subperiosteal injury by a short needle. Saudi J Anaesth 2013; 6:412-4. [PMID: 23493094 PMCID: PMC3591565 DOI: 10.4103/1658-354x.105891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bleeding and intraorbital hematoma is one of the most common complications of needle block for ophthalmic local anesthesia. We describe an unusual presentation of hematoma that originated in the subperiosteal space and extended to the subconjunctival and periocular area after a peribulbar block for phacoemulsification in a 55-year-old lady. It required an urgent surgical evacuation in order to reduce the intraocular pressure and save the eye. Detailed management to improve the outcome is discussed.
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Affiliation(s)
- Nauman Ahmad
- Department of Anesthesia, King Khaled Eye Specialists Hospital, Riyadh, Saudi Arabia
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Lethaus B, Weigl S, Kloss-Brandstätter A, Kloss F, Kessler P, Hölzle F, Bangard C. Looking for landmarks in medial orbital trauma surgery. Int J Oral Maxillofac Surg 2013; 42:209-13. [DOI: 10.1016/j.ijom.2012.10.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 08/06/2012] [Accepted: 10/05/2012] [Indexed: 10/27/2022]
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Double consecutive retrobulbar hemorrhage in a high-risk patient in treatment with aspirin and warfarin. J Craniofac Surg 2012; 23:1782-4. [PMID: 23147322 DOI: 10.1097/scs.0b013e31826701f0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Retrobulbar hemorrhage is a vision-threatening emergency that may occur spontaneously or following facial trauma, orbital surgery, endoscopic sinus surgery, and retrobulbar injections. It may determine visual loss because of central retinal artery occlusion, optic neuropathy from direct compression, or compression of the circulation from mechanical tamponade. In addition to a deterioration in visual acuity with total blindness in the most severe cases, several symptoms and signs can be found, such as a sudden onset of severe pain, proptosis, and ophthalmoplegia.The knowledge of past medical history and underlying medical conditions is crucial in patients with retrobulbar hemorrhages. In fact, patients with blood dyscrasias have to be considered high-risk patients due to their increased propensity for uncontrolled bleeding.The aim of this article was to present and discuss the management of a case of double consecutive retrobulbar hemorrhage in a high-risk patient in treatment with aspirin and warfarin.
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Colletti G, Valassina D, Rabbiosi D, Pedrazzoli M, Felisati G, Rossetti L, Biglioli F, Autelitano L. Traumatic and iatrogenic retrobulbar hemorrhage: an 8-patient series. J Oral Maxillofac Surg 2012; 70:e464-8. [PMID: 22793960 DOI: 10.1016/j.joms.2012.05.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 04/25/2012] [Accepted: 05/07/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Giacomo Colletti
- Department of Maxillofacial Surgery, San Paolo Hospital, University of Milan, Milan, Italy
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Abstract
PURPOSE OF REVIEW To examine the proposed mechanisms of vision-threatening injuries occurring secondary to orbital and facial trauma: traumatic optic neuropathy (TON), retrobulbar haemorrhage (RBH) and penetrating eye injury. To evaluate the evidence supporting different management options for traumatic vision-threatening injury. RECENT FINDINGS Despite considerable debate over the roles of surgical decompression and systemic steroid therapy for TON, these interventions have not been proved to be more effective than conservative management and there is limited evidence that the use of steroids may be associated with an adverse outcome. Lateral canthotomy and inferior cantholysis have been proven to be effective treatments for RBH. Orbital exploration and surgical evacuation of haematoma remains a second line intervention. Open globe injuries require immediate primary surgical exploration and repair. Irretrievable devastating globe injuries require either enucleation or evisceration. There is no consensus as to which is the best treatment with recent surveys indicating that enucleation is preferred in the USA and evisceration in the United Kingdom. SUMMARY Conservative management is the first line treatment for TON. The evidence strongly supports lateral canthotomy and inferior cantholysis as best treatment for RBH. There is no consensus as to whether enucleation or evisceration is the best treatment for irretrievable devastating globe injury. The choice of management is currently determined by surgeon preference.
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Klenk G. Blindness caused by retrobulbar hemorrhage (orbital compartment syndrome). Orv Hetil 2010; 151:1537-44. [DOI: 10.1556/oh.2010.28951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A szerző osztályán 2007 augusztusától 2010 márciusáig 199 arcközéptörést szenvedett beteg közül öt betegnél alakult ki a sérülést követően retrobulbaris haematoma (2,5%). Ezen betegek közül négy vesztette el véglegesen és teljesen szeme világát az érintett oldalon. Egy betegnél az időben történt beavatkozás a szemet megmentette. A szerző a különböző osztályokról gyakorlatilag vak állapotban érkezett betegek retrospektív analízisét ismerteti. Az orbitatörés miatt létrejövő, szemgolyó mögötti vérzés – retrobulbaris haematoma – és oedema a kevéssé tágulni képes orbitában gyors nyomásfokozódást okoz – orbitakompartment-szindróma –, és emiatt alakul ki a nervus opticus ischaemiája, nekrózisa és a következményes vakság. A retrobulbaris haematoma tüneteinek (proptosis, chemosis, ecchymosis, ophthalmoplegia, mydriasis), illetve panaszainak észlelésekor (fájdalom, diplopia, látásélesség-csökkenés, majd vakság) azonnal elkezdett gyógyszeres (intravénás szteroid, mannitol, acetazolamid kombináció) és sebészi kezelés (lateralis canthotomia, cantholysis és orbitadekompresszió) esélyt adhat a beteg szemének, látásának megmentéséhez, ellenkező esetben már akár 20 percen túl is irreverzíbilis, végleges vakság alakul ki. A retrobulbaris haematoma leírása és kezelése nem szerepel a magyar egyetemi tankönyvek tananyagában, ezért, sajnos, a betegekkel először találkozó kollégák – amint azt a bemutatott esetek történetei is jelzik – bizonytalanok a diagnózist, a sürgősséget és a tennivalókat illetően. A szerző hiánypótlásként foglalja össze a tünetegyüttest és a kezelés lehetőségeit. A kórkép ismerete mellett elképzelhető, hogy az előfordulás gyakoribb, mint gondolnánk. A korrekt betegellátás céljából lehetséges, hogy az egyetemi, illetve posztgraduális képzésben is szükség lenne a betegség ismertetésére. Orv. Hetil., 2010, 38, 1537–1544.
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Affiliation(s)
- Gusztáv Klenk
- 1 Fővárosi Önkormányzat Szent János Kórháza és Észak-budai Egyesített Kórházai Fül-, Orr-, Gége- és Szájsebészeti Osztály Budapest Diósárok út 1–3. 1125
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When is a retrobulbar haemorrhage not a retrobulbar haemorrhage? Int J Oral Maxillofac Surg 2010; 39:1045-9. [PMID: 20656457 DOI: 10.1016/j.ijom.2010.06.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 04/20/2010] [Accepted: 06/09/2010] [Indexed: 11/22/2022]
Abstract
Retrobulbar haemorrhage (RBH) is a well described condition which is said to be a common cause of acute proptosis following trauma, but the evidence for this is not strong. The authors reviewed 186 publications on the subject, finding 82 cases of RBH related to trauma. This analysis suggests that in over half of the cases described, RBH was never proven conclusively. In the authors' experience RBH is not a common cause of acute proptosis following trauma and other causes need to be considered if patients are to be managed appropriately.
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Gosau M, Schöneich M, Draenert FG, Ettl T, Driemel O, Reichert TE. Retrospective analysis of orbital floor fractures--complications, outcome, and review of literature. Clin Oral Investig 2010; 15:305-13. [PMID: 20165966 DOI: 10.1007/s00784-010-0385-y] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 01/20/2010] [Indexed: 01/03/2023]
Abstract
This retrospective study aimed at investigating indications, surgical approaches, and the materials used for orbital floor reconstructions, as well as the clinical follow-up, particularly with regard to postoperative complications. This study comprised 189 patients who underwent surgery for fractures of the orbital floor between 2003 and 2007. Diagnosis and treatment were based on both physical examination and computed tomography scan of the orbit. Patients were retrospectively analyzed for data, such as mechanism of injury, classification of fracture, and complications. The most common cause of injury was physical assault followed by traffic accidents. Surgery was conducted with a mean delay of 2.9 days after the incident. Mid lower eyelid incision was the most common surgical approach to the orbital floor. For orbital floor reconstruction, polydioxanone sheets (70.5%) were mainly used, followed by Ethisorb Dura (23.3%) and titanium mesh (6.2%). There were 19.0% of patients who showed postoperative complications: 5.8% suffered from persisting motility impairment, 3.7% from enophthalmos, 3.2% from consistent diplopia, 2.6% from ectropion, and 0.5% from orbital infection. Intraorbital hematoma (3.2%) represented the most severe complications, one patient suffered lasting impairment of sight and another one, complete blindness of the affected eye. If postoperative impairment of vision becomes evident, immediate surgical intervention is mandatory. Retrobulbar hematoma is more likely to occur in heavily traumatized patients with comminuted fractures and also in patients taking anticoagulative medication. The subciliary approach to the orbit and repeated operations by the same approach are associated with a higher risk of developing ectropion.
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Affiliation(s)
- Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042 Regensburg, Germany.
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Bossert RP, Girotto JA. Blindness following facial fracture: treatment modalities and outcomes. Craniomaxillofac Trauma Reconstr 2009; 2:117-24. [PMID: 22110805 PMCID: PMC3052657 DOI: 10.1055/s-0029-1215874] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Blindness is an uncommon, yet documented complication of facial trauma. Numerous case studies, series, and retrospective analyses have been published, with a reported incidence around 3%. Hippocrates first noted the association between maxillofacial trauma and blindness; millennia later, this was expounded upon by Berlin, who discovered such trauma may directly lead to fracturing of the optic canal. As diagnostic modalities such as computed tomographic scanning evolved, particularly over the past few decades, more specific, in-depth reports analyzing maxillofacial trauma and subsequent sequelae have emerged. It is the goal of this article to examine the current literature for those publications that have addressed the issue of blindness following facial trauma (including operative interventions) and create a concise review for maxillofacial surgeons.
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Affiliation(s)
| | - John A. Girotto
- Department of Surgery, University of Rochester, Rochester, New York
- Cleft and Craniofacial Anomalies Center, University of Rochester, Rochester, New York
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Perry M, Moutray T. Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 4: ‘Can the patient see?’ Timely diagnosis, dilemmas and pitfalls in the multiply injured, poorly responsive/unresponsive patient. Int J Oral Maxillofac Surg 2008; 37:505-14. [DOI: 10.1016/j.ijom.2007.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 07/29/2007] [Accepted: 11/06/2007] [Indexed: 11/15/2022]
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