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Sakkas A, Weiß C, Pietzka S, Wilde F, Thiele OC, Mischkowski RA. Evaluation of Different Patterns of Zygomaticoorbital Complex Fractures. Craniomaxillofac Trauma Reconstr 2024; 17:92-103. [PMID: 38779395 PMCID: PMC11107820 DOI: 10.1177/19433875231161906] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Study Design Very few studies exist regarding the fracture pattern variability of the zygomaticoorbital (ZMO) complex. The retrospective evaluation of a large series of surgically treated unilateral ZMO fractures would in certain circumstances help intraoperative predictability and define sensitive indicators for open reduction and internal fixation. Objective The aim of this study was to investigate the different fracture patterns after ZMO complex injury regarding the 5 anatomic sutures of the zygoma as well as the concomitance of the paranasal buttress and maxillary sinus wall fracture. Methods The medical records of all patients with unilateral ZMO fractures who underwent surgical intervention in a single trauma center department between April 2015 and June 2020 were retrospectively reviewed. Demographic and anamnesis data, radiologic findings, and surgical reports were evaluated. According to the preoperative radiologic evaluation, ZMO fractures were classified as unisutural, bisutural, trisutural, tetrasutural, and complete based on the number of zygomatic sutures. The prevalence of various fracture patterns was analyzed. The impact of patient's age and trauma etiology on the fracture pattern was evaluated using descriptive statistical analysis. Results The study included 492 patients with unilateral ZMO fractures, with a mean age of 49.93 years (SD = 20.66) and a male:female ratio of 2.23:1. The most affected age group was 19-44 years (41.67%) and tripping falls were the most common etiology (27.24%). Trisutural (57.32%) and unisutural fractures (23.17%) were the most common, followed by tetrasutural (8.94%), bisutural (8.54%), and complete fractures (2.03%). A trisutural fracture involving the zygomaticomaxillary suture, the infraorbital rim, and the zygomaticosphenoidal suture was the most common fracture pattern (52.03%). Most fractures were observed in the zygomaticosphenoidal suture (86.99%), followed by the infraorbital rim (74.59%) and the zygomaticomaxillary suture (68.29%). Fractures of the maxillary sinus wall and the paranasal buttress co-existed in 9.55% and 31.30% of all cases, respectively. No correlation was detected between age and fracture pattern (P = .4111). Tripping falls and bicycle accidents significantly influenced the fracture pattern (P < .0001). Conclusions According to the results, knowledge of the fracture pattern variability of the ZMO complex could in certain circumstances designate CT or CBCT as mandatory before operating on ZMO fractures. Consequently, unnecessary incisions could be avoided. The high concomitance of paranasal buttress fracture also suggests its intraoperative surgical exploration. Further studies should correlate the clinical findings with indication for surgery and postoperative outcome for the different fracture patterns described.
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Affiliation(s)
- Andreas Sakkas
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, University Hospital Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, Germany
| | - Christel Weiß
- Medical Statistics and Biomathematics, University Medical Centre Mannheim, Heidelberg University, Germany
| | - Sebastian Pietzka
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, University Hospital Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, Germany
| | - Frank Wilde
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, University Hospital Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, Germany
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Er S, Hassan B, Yoon J, Resnick E, Yusuf C, Lagziel T, Liang F, Ptak T, Redett R, Yang R, Grant M. Orbital Fracture Characteristics and Outcomes in Baltimore. J Craniofac Surg 2024:00001665-990000000-01420. [PMID: 38534184 DOI: 10.1097/scs.0000000000010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/11/2024] [Indexed: 03/28/2024] Open
Abstract
Fracture characteristics and postoperative outcomes of patients presenting with orbital fractures in Baltimore remain poorly investigated. The purpose of our study was to determine the fracture patterns, etiologies, and postoperative outcomes of patients treated for orbital fractures at 2 level I trauma centers in Baltimore. A retrospective cohort study was conducted on patients who underwent orbital fracture repair at the R Adams Cowley Shock Trauma Center and the Johns Hopkins Hospital from January 2015 to December 2019. Of 374 patients, 179 (47.9%) had orbital fractures due to violent trauma, 252 (67.4%) had moderate to near-total orbital fractures, 345 (92.2%) had orbital floor involvement, and 338 (90.4%) had concomitant neurological symptoms/signs. Almost half of the patients had at least one postoperative ocular symptom/sign [n = 163/333 (48.9%)]. Patients who had orbital fractures due to violent trauma were more likely to develop postoperative ocular symptoms/signs compared with those who had orbital fractures due to nonviolent trauma [n = 88/154 (57.1%), n = 75/179 (41.9%); P = 0.006]. After controlling for factors pertaining to injury severity, there was no significant difference in patient throughput or incidence of any postoperative ocular symptom/sign after repair between the two centers. Timely management of patients with orbital fractures due to violent trauma is crucial to mitigate the risk of postoperative ocular symptoms/signs.
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Affiliation(s)
- Seray Er
- School of Medicine, University of Maryland
| | - Bashar Hassan
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Joshua Yoon
- Department of Surgery, George Washington University, Washington, DC
| | | | - Cynthia Yusuf
- School of Medicine, University of Maryland
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Tomer Lagziel
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Fan Liang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Thomas Ptak
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD
| | - Richard Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Michael Grant
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center
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Abukhder M, Onions E, Flaherty E, Tarassoli S, Hassan MR, Whelan R. A systematic literature review and narrative synthesis on the use of autologous cartilage in the repair of orbital fractures. Ann Med Surg (Lond) 2024; 86:968-974. [PMID: 38333240 PMCID: PMC10849358 DOI: 10.1097/ms9.0000000000001598] [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: 08/22/2023] [Accepted: 11/27/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Fractures of the orbit are common injuries within the maxillofacial skeleton, and can often result in restrictions to ocular movement, diplopia, and enophthalmous if herniation of globe content occurs. Various studies have demonstrated the use of autologous cartilage grafts in the reconstruction of orbital fractures. Methods A systematic review protocol was registered with PROSPERO, and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies of four databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers. Results Seven thousand one hundred seventy-one articles were identified following a comprehensive literature search. These articles were filtered for relevance and duplication, which reduced the number of articles to 16. A total of 259 patients underwent orbital reconstruction with the use of autologous cartilage. Conchal cartilage was harvested in 148 patients, auricular cartilage in 22 patients, nasoseptal cartilage in 72 patients, and costal cartilage in 17 patients. Thirty, seven, twelve, and four complications were observed in patients where cartilage was harvested from the concha, auricle, nasoseptum and rib, respectively. Most common complications included diplopia (n=23), infra-orbital para/anaesthesia (n=27), and enophthalmos (n=7). No failure of graft or donor site morbidity were observed in the studies. Conclusion Autogenous materials such as cartilage can be used as an alternative for orbital reconstruction. Cartilage was considered by the authors to provide adequate structural support to the orbital contents, and that it was easy to harvest, shape, and position.
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Affiliation(s)
| | | | - Erin Flaherty
- School of Medicine, Cardiff University, Neuadd Meirionnydd, Cardiff
| | - Sam Tarassoli
- Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea
| | | | - Rhys Whelan
- Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea
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Lein IÅ, Bjørnland T, Loro LL. Retrospective Study of Orbital and Orbitozygomaticomaxillary Complex Fractures Treated at Aalesund Hospital Between 2002 and 2017. Craniomaxillofac Trauma Reconstr 2023; 16:292-300. [PMID: 38047149 PMCID: PMC10693266 DOI: 10.1177/19433875221135932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Study Design Retrospective study. Objective To evaluate patient demographics, surgical management, and complications of orbital and orbitozygomaticomaxillary complex (OZMC) fractures treated at a district hospital in Norway. Methods The medical records of patients with orbital fractures treated at Aalesund hospital between January 2002 and July 2017 were reviewed. Data on demographics, signs and symptoms, cause of injury, fracture type, associated fractures, surgical management, and complications were collected. Results A total of 36 patients were reviewed. Males predominated (1:4.1), and fractures occurred mostly in patients 40-59 years (mean 41.8 years). Interpersonal violence was the leading cause of injury, followed by falls. Alcohol was significantly associated with assault caused fractures (P = .001). Orbitozygomaticomaxillary fractures were the most frequent, followed by pure orbital fractures. Clinical findings included periorbital ecchymosis (72%), swelling (56%), sensory nerve dysfunction (53%), diplopia (22%), and restricted eye motility (22%). Commotio cerebri was observed in more than half of our sample and 47% had other facial bone fractures. Referral to tertiary hospitals was done in 19% of the cases. The main treatment done was open reduction and internal fixation (ORIF) (45%). Infection was diagnosed in 17% and managed with antibiotics. Conclusions The incidence of orbital and OZMC fractures in Moere and Romsdal county in western Norway was low, occurring mainly in males over 40 years. The mechanism of injury was predominantly interpersonal violence and falls. A high proportion of the sample had minor traumatic brain injury (mTBI).
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Affiliation(s)
- Ingvild Årøen Lein
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tore Bjørnland
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Lado Lako Loro
- Section of Maxillofacial Surgery, Department of Clinical Surgery, Aalesund Hospital, Moere and Romsdal Hospital Trust, Aalesund, Norway
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Morita D, Kawarazaki A, Koimizu J, Tsujiko S, Soufi M, Otake Y, Sato Y, Numajiri T. Automatic orbital segmentation using deep learning-based 2D U-net and accuracy evaluation: A retrospective study. J Craniomaxillofac Surg 2023; 51:609-613. [PMID: 37813770 DOI: 10.1016/j.jcms.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/25/2023] [Accepted: 09/05/2023] [Indexed: 10/11/2023] Open
Abstract
The purpose of this study was to verify whether the accuracy of automatic segmentation (AS) of computed tomography (CT) images of fractured orbits using deep learning (DL) is sufficient for clinical application. In the surgery of orbital fractures, many methods have been reported to create a 3D anatomical model for use as a reference. However, because the orbit bone is thin and complex, creating a segmentation model for 3D printing is complicated and time-consuming. Here, the training of DL was performed using U-Net as the DL model, and the AS output was validated with Dice coefficients and average symmetry surface distance (ASSD). In addition, the AS output was 3D printed and evaluated for accuracy by four surgeons, each with over 15 years of clinical experience. One hundred twenty-five CT images were prepared, and manual orbital segmentation was performed in all cases. Ten orbital fracture cases were randomly selected as validation data, and the remaining 115 were set as training data. AS was successful in all cases, with good accuracy: Dice, 0.860 ± 0.033 (mean ± SD); ASSD, 0.713 ± 0.212 mm. In evaluating AS accuracy, the expert surgeons generally considered that it could be used for surgical support without further modification. The orbital AS algorithm developed using DL in this study is extremely accurate and can create 3D models rapidly at low cost, potentially enabling safer and more accurate surgeries.
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Affiliation(s)
- Daiki Morita
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Ayako Kawarazaki
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jungen Koimizu
- Department of Plastic and Reconstructive Surgery, Omihachiman Community Medical Center, Shiga, Japan
| | - Shoko Tsujiko
- Department of Plastic and Reconstructive Surgery, Saiseikai Shigaken Hospital, Shiga, Japan
| | - Mazen Soufi
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Yoshito Otake
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Yoshinobu Sato
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Toshiaki Numajiri
- Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Tomic J, Wiederstein-Grasser I, Schanbacher M, Weinberg AM. Newly Developed Resorbable Magnesium Biomaterials for Orbital Floor Reconstruction in Caprine and Ovine Animal Models-A Prototype Design and Proof-of-Principle Study. J Funct Biomater 2023; 14:339. [PMID: 37504834 PMCID: PMC10381438 DOI: 10.3390/jfb14070339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND orbital floor fractures have not been reconstructed using magnesium biomaterials. METHODS To test technical feasibility, ex vivo caprine and ovine heads (n = 5) were used. Head tissues were harvested from pubescent animals (n = 5; mean age: 3.2 years; mean mass: 26.3 kg) and stored below 11 degrees for 7-10 days. All procedures were performed in a university animal resource facility. Two experienced maxillofacial surgeons performed orbital floor procedures in both orbits of all animals in a step-by-step preplanned dissection. A transconjunctival approach was chosen to repair the orbital floor with three different implants (i.e., magnesium implants; titanium mesh; and polydioxanone or PDO sheets). The position of each implant was evaluated by Cone-beam computed tomography (CBCT). RESULTS Axial, coronal, and sagittal plane images showed good positioning of the magnesium plates. The magnesium plates had a radiographic visibility similar to that of the PDO sheets but lower than that of the titanium mesh. CONCLUSIONS The prototype design study showed a novel indication for magnesium biomaterials. Further testing of this new biomaterial may lead to the first resorbable biomaterial with good mechanical properties for extensive orbital wall defects.
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Affiliation(s)
- Josip Tomic
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Iris Wiederstein-Grasser
- Core Facility Experimental Biomodels, Division of Biomedical Research, Medical University of Graz, 8036 Graz, Austria
| | - Monika Schanbacher
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Annelie Martina Weinberg
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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Singh AK, Khanal N, Chaulagain R, Sharma N, Thieringer FM. Is the Pre-Shaping of an Orbital Implant on a Patient-Specific 3D-Printed Model Advantageous Compared to Conventional Free-Hand Shaping? A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12103426. [PMID: 37240532 DOI: 10.3390/jcm12103426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
This study aimed to perform a systematic review and meta-analysis to compare pre-shaped implants on a patient-specific 3D-printed (3DP) model to manual free-hand shaping (MFS) for orbital wall reconstruction. The PRISMA protocol was followed in this study, and the review was registered in the PROSPERO database (CRD42021261594). A search was conducted in MEDLINE (PubMed), Embase, Cochrane Library, Clinicaltrials.gov, Google Scholar, and the grey literature. Ten articles were included, and six outcomes were analyzed. In total, 281 patients were in the 3DP group and 283 were in the MFS group. The studies had an overall high risk of bias. 3DP models resulted in a better accuracy of fit, anatomical angle reproduction, and defect area coverage. The correction of orbital volume was also superior with statistical significance. There was a higher percentage of the correction of enophthalmos and diplopia in the 3DP group. Intraoperative bleeding and hospital stay were reduced in the 3DP group. The meta-analysis of operative time showed a reduction in the average operative time by 23.58 min (95% CI: -43.98 to -3.19), which was statistically significant (t(6) = -2.8299, p = 0.0300). The 3DP models appear advantageous for an accurate orbital wall reconstruction, with fewer complications than those for conventional free-hand-shaped implants.
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Affiliation(s)
- Ashutosh Kumar Singh
- Department of Oral and Maxillofacial Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu 44600, Nepal
| | - Nikita Khanal
- Department of Population Health Sciences, University of Bristol, Bristol BS8 1QU, UK
| | - Rajib Chaulagain
- Department of Oral Biology, Chitwan Medical College, Bharatpur 44200, Nepal
| | - Neha Sharma
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, CH-4123 Allschwil, Switzerland
| | - Florian M Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, CH-4123 Allschwil, Switzerland
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Obayemi A, Arunkumar A, Long S, Spielman D, Pereira N, Liu K, Sclafani MS, Kacker A, Reeve G, Stewart MG, Sclafani AP. Critical Degree of Orbital Floor Displacement Drives Operative Repair of Zygomaticomaxillary Complex Fractures: Findings from a 10-Year Retrospective Study. Facial Plast Surg 2023. [PMID: 37023771 DOI: 10.1055/a-2047-66406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Among zygomaticomaxillary complex (ZMC) fractures presenting to a tertiary urban academic center, the authors hypothesized the presence of both clinical and radiographic predictors of operative management. The investigators conducted a retrospective cohort study of 1,914 patients with facial fractures managed at an academic medical center in New York City between 2008 and 2017. The predictor variables were based on both clinical data and features of pertinent imaging studies, and the outcome variable was an operative intervention. Descriptive and bivariate statistics were computed and the p-value was set at 0.05. In total, 196 patients sustained ZMC fractures (5.0%) and 121 (61.7%) ZMC fractures were treated surgically. All patients who presented with globe injury, blindness, retrobulbar injury, restricted gaze, or enophthalmos and a concurrent ZMC fracture were managed surgically. The most common surgical approach was the gingivobuccal corridor (31.9% of all approaches), and there were no significant immediate postoperative complications. Younger patients (38.9 ± 18 years vs. 56.1 ± 23.5 years, p < 0.0001) and patients with greater than or equal to 4 mm of orbital floor displacement were more likely to receive surgical treatment than observation (82 vs. 56%, p = 0.045), as were patients with comminuted orbital floor fractures (52 vs. 26%, p = 0.011). In this cohort, patients more likely to undergo surgical reduction were young patients with ophthalmologic symptoms on presentation and at least 4 mm displacement of the orbital floor. Low kinetic energy ZMC fractures may warrant surgical management as often as high-energy ZMC fractures. While orbital floor comminution has been shown to be a predictor for operative reduction, in this study we also demonstrated a difference in the rate of reduction based on the severity of orbital floor displacement. This may have significant implications in both the triage and selection of patients most suitable for operative repair.
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Affiliation(s)
- Adetokunbo Obayemi
- Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, New York
| | - Amit Arunkumar
- Department of Otolaryngology-Head & Neck Surgery, Joan and Sanford I Weill Medical College of Cornell University, New York, New York
| | - Sallie Long
- Department of Otolaryngology-Head & Neck Surgery, Joan and Sanford I Weill Medical College of Cornell University, New York, New York
| | - Daniel Spielman
- Department of Otolaryngology-Head & Neck Surgery, Joan and Sanford I Weill Medical College of Cornell University, New York, New York
| | - Nicola Pereira
- Department of Otolaryngology-Head & Neck Surgery, Joan and Sanford I Weill Medical College of Cornell University, New York, New York
| | - Katie Liu
- Department of Otolaryngology-Head & Neck Surgery, Joan and Sanford I Weill Medical College of Cornell University, New York, New York
| | - Matthew S Sclafani
- Department of Otolaryngology-Head & Neck Surgery, Joan and Sanford I Weill Medical College of Cornell University, New York, New York
| | - Ashutosh Kacker
- Department of Otolaryngology-Head & Neck Surgery, Joan and Sanford I Weill Medical College of Cornell University, New York, New York
| | - Gwendolyn Reeve
- Department of Surgery, Cornell University Joan and Sanford I Weill Medical College, New York, New York
| | - Michael G Stewart
- Department of Otolaryngology-Head & Neck Surgery, Joan and Sanford I Weill Medical College of Cornell University, New York, New York
| | - Anthony P Sclafani
- Department of Otolaryngology-Head & Neck Surgery, Joan and Sanford I Weill Medical College of Cornell University, New York, New York
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Takahashi Y, Vaidya A, Kono S, Miyazaki H, Yokoyama T, Kakizaki H. The relationship between orbital floor fracture patterns around the infraorbital groove and development of infraorbital nerve hypoesthesia: a computed tomographic study. Graefes Arch Clin Exp Ophthalmol 2023; 261:841-848. [PMID: 36076041 DOI: 10.1007/s00417-022-05822-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/20/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To examine the relationship between patterns of orbital floor fracture around the infraorbital groove and development of infraorbital nerve hypoesthesia. METHODS This retrospective, observational study included 200 patients (200 sides) of pure orbital floor fracture with or without medial orbital wall fracture. Data on the presence or absence of infraorbital nerve hypoesthesia were collected from medical records. Based on coronal computed tomographic images, patients were classified into 3 groups: a fracture extending medially to (medial group), into (in-groove group), and laterally to the infraorbital groove (lateral group). RESULTS Infraorbital nerve hypoesthesia was found in 72 patients (36.0%). A fracture extended into or laterally to the infraorbital groove in 86.2% of patients with infraorbital nerve hypoesthesia, while a fracture was limited to the portion medial to the infraorbital groove in 77.3% of patients without infraorbital nerve hypoesthesia (P < 0.001). A logistic regression analysis demonstrated that patients in the lateral and in-groove groups were highly associated with development of infraorbital nerve hypoesthesia, with an odds ratio of 134.788 in the lateral group (95% confidence interval, 30.496-595.735; P < 0.001) and that of 20.323 in the in-groove group (95% confidence interval, 6.942-59.499; P < 0.001) with the medial group as the reference. CONCLUSIONS This study indicates that patients with orbital floor fracture extending into or laterally to the infraorbital groove have a high risk of infraorbital nerve hypoesthesia, compared to those with orbital floor fracture limited to the portion medial to the infraorbital groove.
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Affiliation(s)
- Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.
| | - Aric Vaidya
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.,Department of Oculoplastic, Orbital & Lacrimal Surgery, Kirtipur Eye Hospital, Kathmandu, Nepal
| | - Shinjiro Kono
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan
| | - Hidetaka Miyazaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan
| | - Tatsuro Yokoyama
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan
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Mancera N, Do DP, Griepentrog GJ, Esmaili N. Assault-related Orbital Trauma at an Urban Level I Trauma Center: Racial Segregation and Other Neighborhood-level Social Determinants. Ophthalmic Plast Reconstr Surg 2023; 39:182-186. [PMID: 36190913 DOI: 10.1097/iop.0000000000002286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE To report the demographics of assault-related orbital fractures over a 7-year period treated at a level I urban trauma center, as well as describe and analyze the variation in assault rates across different racial/ethnic neighborhoods for patients residing in Milwaukee County. METHODS A retrospective chart review was conducted for patients who sustained assault-related orbital fractures from January 1, 2013, through December 31, 2019, at the Froedtert & Medical College of Wisconsin, in Milwaukee, Wisconsin. A series of negative binomial regression models evaluating the association of neighborhood (i.e., US census tract) racial/ethnic composition, poverty, unemployment, percentage female head-of-household, and education level with neighborhood rate of orbital trauma was conducted. RESULTS A total of 410 adult patients with orbital fractures attributed to assault were identified during the seven-year period, of whom 326 (80%) resided in Milwaukee County. Among these patients, 242 (74%) were male, 260 (81%) were single, and 206 (63%) were non-Hispanic Black. Majority non-Hispanic Black, Hispanic, and Other-type minority neighborhoods have 5.30, 3.35, and 3.94 times higher incidence rates of orbital assault, respectively, compared with the majority of non-Hispanic White neighborhoods. The elevated incidence rates were significantly attenuated across all minority neighborhoods after accounting for neighborhood factors of poverty, unemployment, and low education level. Low education had the strongest association with the incidence of assault-related orbital fractures, followed by unemployment. CONCLUSIONS Results indicate that minority neighborhoods suffer from compounded burdens of both social and economic disadvantage as well as violent assaults. Additional resources allocated to poor minority communities are needed.
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Affiliation(s)
- Norberto Mancera
- Section of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - D Phuong Do
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, U.S.A
| | - Gregory J Griepentrog
- Section of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Neda Esmaili
- Section of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Incidence of Orbital Side Effects in Zygomaticomaxillary Complex and Isolated Orbital Walls Fractures: A Retrospective Study in South Italy and a Brief Review of the Literature. J Clin Med 2023; 12:jcm12030845. [PMID: 36769492 PMCID: PMC9918000 DOI: 10.3390/jcm12030845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
Zygomaticomaxillary complex and isolated orbital walls fractures are one of the most common fractures of the midface, often presenting orbital symptoms and complications. Our study was born with the aim of understanding the trend in the incidence of orbital presurgical symptoms, specifically diplopia, enophthalmos and exophthalmos, in the Campania Region in southern Italy. We conducted a retrospective, monocentric observational study at the Maxillofacial Surgery Unit of the Federico II University Hospital of Naples, enrolling 402 patients who reported a fracture of the zygomaticomaxillary complex and orbital floor region from 15 June 2021 to 15 June 2022. Patients were evaluated by age, gender, etiology, type of fracture, preoperative orbital side effects and symptoms. Pre-surgical side effects were studied, and 16% of patients (n = 66) developed diplopia. Diplopia was most common in patients previously operated on for orbital wall fractures (100%), and least common in patients who reported trauma after interpersonal violence (15%) and road traffic accidents (11%). Exophthalmos appeared only in 1% (six cases); whereas it did not appear in 99% (396 cases). Enophthalmos was present in 4% (sixteen cases), most commonly in interpersonal violence cases (two cases). The frequency of orbital complications in patients with zygomaticomaxillary complex and isolated orbital walls fractures suggests how diplopia remains the most common pre-surgical orbital side effect.
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12
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Crozet A, Lebranchu P, Vabre B, Paillé C, Bourry M, Corre P, Bertin H. Management of orbital floor fractures in France: Results of a national online survey. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101389. [PMID: 36669743 DOI: 10.1016/j.jormas.2023.101389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Orbital floor fractures (OFF) are common facial trauma injuries, and there are no official guidelines for their medical and surgical management. The aim of this study was to provide an overview of the management of OFF in France. MATERIALS AND METHODS An online questionnaire was sent to 144 surgeons at the 88 French centers involved in the management of OFF (2019 data from the National Health Insurance Body). The questions related to the preoperative clinical and radiographic examinations, the criteria for surgical indication, the materials used, and the elements of the postoperative period. RESULTS Ultimately, 42 questionnaires were analyzed (32 from oral and maxillofacial surgeons (OMFS), 8 from ophthalmologists, and 2 from ENT or plastic surgeons). For 69% of the surgeons, a systematic ophthalmological examination was carried out, 3-7 days after the trauma, and based on a Lancaster test or visual acuity (97.6% and 83.3% of the responders, respectively). The most important criteria for the therapeutic decision were diplopia or oculomotor disorder that persisted for more than 7 days (76.2%), clinical enophthalmos (54.8%), a large fracture (52.4%), and ptosis of the orbital content on CT scan (38.1%). The mean surgical delay was 7-15 days for 54.8% of the responders. Resorbing sheets were the preferred materials to repair small fractures, while larger fractures required alloplastic implants (titanium mesh). CONCLUSION This survey confirms the diversity of practices in France regarding the management of OFF. Further studies are needed before guidelines can be developed.
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Affiliation(s)
- Audrey Crozet
- Service d'ophtalmologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France
| | - Pierre Lebranchu
- Service d'ophtalmologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France; Laboratoire des Sciences du Numérique de Nantes (UMR 6004), Faculté des Sciences et des Techniques, 2 rue de la Houssinière Cedex 03, 44322 Nantes, France.
| | - Bertrand Vabre
- Service d'ophtalmologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France.
| | - Cécile Paillé
- Unité Evaluation et Risques Cliniques (ERiC), service d'Evaluation Médicale et d'Epidémiologie (SEME), Hôpital Saint-Jacques, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France.
| | - Mae Bourry
- Service de chirurgie maxillo-faciale et stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France.
| | - Pierre Corre
- Service de chirurgie maxillo-faciale et stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France; Regenerative medicine and skeleton (RMeS), Faculté de Chirurgie Dentaire, 1 Place Alexis Ricordeau, 44042 Nantes, France.
| | - Hélios Bertin
- Service de chirurgie maxillo-faciale et stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France; Centre de recherche en cancérologie et immunologie intégrée Nantes Angers (CRCI(2)NA), équipe 9 (CHILD), faculté de médecine, 1 rue Gaston Veil, 44035 Nantes, France.
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Orbital bone fractures: 10 years' experience at the Rome trauma centre: retrospective analysis of 543 patients. Br J Oral Maxillofac Surg 2022; 60:1368-1372. [PMID: 36266195 DOI: 10.1016/j.bjoms.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/29/2022] [Accepted: 09/21/2022] [Indexed: 12/31/2022]
Abstract
Orbital fractures are among the most frequent facial traumas. This study retrospectively analysed patients treated in Umberto I Hospital Trauma-Centre, Sapienza University of Rome from 1 January 2010 to 31 December 2020. The inclusion criteria were as follows: diagnosis of pure/impure orbital bone fracture, complete clinical and radiological records, and a minimum 12-month follow up. Gender, age, aetiology, fracture type, treatment, and associated complications were analysed using IBM SPSS Statistics, and p values of <0.05 were considered significant. In total, 1393 patients presented with orbital trauma, 543 of whom met the inclusion criteria and underwent surgery (394 males (72.6%) and 149 females (27.4%); mean (range) age 39.2 (7-90) years). Assault (n = 165, 30.4%) was the most common cause of trauma, followed by road traffic accidents and sports-related incidents. Diplopia was the major symptom at diagnosis (n = 183, 33.6%). Open reduction and internal fixation via a sub-eyelid approach was the preferred treatment, achieving a significant reduction in the functional changes induced by fracture (p < 0.05). Our data will aid future studies of maxillofacial traumatology and suggest that education and prevention measures could reduce the incidence of this type of trauma.
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Han SW, Kim JH, Kim SW, Kim SH, Kang DR, Kim J. Sensory change and recovery of infraorbital area after zygomaticomaxillary and orbital floor fractures. Arch Craniofac Surg 2022; 23:262-268. [PMID: 36596749 PMCID: PMC9816633 DOI: 10.7181/acfs.2022.01011] [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: 10/21/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To compare the sensory change and recovery of infraorbital area associated with zygomaticomaxillary and orbital floor fractures and their recoveries and investigate the factors that affect them. METHODS We retrospectively reviewed 652 patients diagnosed with zygomaticomaxillary (n= 430) or orbital floor (n= 222) fractures in a single center between January 2016 and January 2021. Patient data, including age, sex, medical history, injury mechanism, Knight and North classification (in zygomaticomaxillary fracture cases), injury indication for surgery (in orbital floor cases), combined injury, sensory change, and recovery period, were reviewed. The chi-square test was used for statistical analysis. RESULTS Orbital floor fractures occurred more frequently in younger patients than zygomaticomaxillary fractures (p< 0.001). High-energy injuries were more likely to be associated with zygomaticomaxillary fractures (p< 0.001), whereas low-energy injuries were more likely to be associated with orbital floor fractures (p< 0.001). The sensory changes associated with orbital floor and zygomaticomaxillary fractures were not significantly different (p= 0.773). Sensory recovery was more rapid and better after orbital floor than after zygomaticomaxillary fractures; however, the difference was not significantly different. Additionally, the low-energy group showed a higher incidence of sensory changes than the high-energy group, but the difference was not statistically significant (p= 0.512). Permanent sensory changes were more frequent in the high-energy group, the difference was statistically significant (p= 0.043). CONCLUSION The study found no significant difference in the incidence of sensory changes associated with orbital floor and zygomaticomaxillary fractures. In case of orbital floor fractures and high-energy injuries, the risk of permanent sensory impairment should be considered.
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Affiliation(s)
- Sang Woo Han
- Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Jeong Ho Kim
- Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Sug Won Kim
- Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Sung Hwa Kim
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Dae Ryong Kang
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Jiye Kim
- Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine, Wonju,
Korea
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15
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Is Surgery Needed for Diplopia after Blowout Fractures? A Clarified Algorithm to Assist Decision-making. Plast Reconstr Surg Glob Open 2022; 10:e4308. [PMID: 35558136 PMCID: PMC9084434 DOI: 10.1097/gox.0000000000004308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
Diplopia is a common symptom after blowout fractures, with an incidence of 43.6%–83%. Although there is some consensus toward surgical correction, diplopia is not always resolved by surgery. Thus, there is a clinical dilemma for surgeons with regard to performing surgery at a specific time. This review aimed to create an algorithm to support accurate and effective decision-making.
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Quantitative assessment of increase in orbital volume after orbital floor fracture reconstruction using a bioabsorbable implant. Graefes Arch Clin Exp Ophthalmol 2022; 260:3027-3036. [PMID: 35262763 DOI: 10.1007/s00417-022-05610-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To assess the postoperative changes in the orbital volume and the degree of enophthalmos after orbital floor fracture reconstruction using a bioabsorbable implant and to determine the predictors of postoperative orbital volume change. METHODS Single-center, retrospective case series of 16 patients who underwent orbital floor fracture reconstruction using a bioabsorbable implant [poly(L-lactic acid)-poly(glycolic acid)/β-tricalcium phosphate; Biobsorb β®] were included. Three-dimensional volumetric calculations of orbit were determined using computed tomography scans and the degree of enophthalmos was assessed via Hertel exophthalmometry. Postoperative changes in the orbital volume and the degree of enophthalmos and their correlation were assessed. RESULTS The mean volume of fractured orbits immediately after surgery was 22.26 ± 1.98 cm3, increasing to 23.67 ± 2.00 cm3 at 6-month follow-up (p < 0.001); the increased orbital volume was associated with postoperative deformation of the implant. The mean degree of enophthalmos was 0.09 ± 0.27 mm at 1-month follow-up, which increased to 0.66 ± 0.30 mm at 6-month follow-up (p = 0.001). Increase in orbital volume and enophthalmos progression showed a linear correlation (R = 0.682, p = 0.004). Patients with more herniated orbital tissue preoperatively showed increased postoperative orbital volume change (p = 0.015), whereas the size of the fracture area was not predictive of postoperative orbital volume change (p = 0.442). CONCLUSION Increase in orbital volume by deformation of the bioabsorbable implant resulted in progressive enophthalmos during the postoperative follow-up period after orbital floor fracture reconstruction. Thus, careful selection of proper implants before surgery and close postoperative follow-up is needed for an optimal outcome.
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Rocha-Filho MAS, Studart-da-Fonseca-Filho MR, Studart-da-Fonseca MC, Brito da Silva H, Studart-da-Fonseca MR. Surgical resection of a cutaneous squamous cell carcinoma invading the infraorbital maxillary nerve. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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Zorn M, Liekfeld A, Bode-Hofmann M, Gabel-Pfisterer A. [Orbital Trauma]. Klin Monbl Augenheilkd 2021; 238:1345-1360. [PMID: 34798667 DOI: 10.1055/a-1669-0770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Orbital trauma is a common medical emergency with potentially sight-threatening complications. Due to the confined orbital conditions, any direct injury or space-consuming lesion may cause serious tissue damage. Possible complications are orbital fractures, foreign body injuries, development of orbital compartment syndrome and traumatic optic neuropathy. Clinical signs include periorbital hematoma or emphysema, subconjunctival hemorrhage, proptosis, decreased ocular mobility, decreased vision, increased intraocular pressure and relative afferent pupillary defect. Ophthalmic status and low-dose CT-imaging provide key information regarding the therapeutic decision. Treatment options include surgical exploration, reconstruction or decompression or a conservative approach with anti-inflammatory or anti-glaucomatous medication. Rapid interdisciplinary diagnostics and therapy is critical for early detection and prevention of irreversible functional loss respectively. Considering the frequent association with life-threatening comorbidities diagnosis may be complicated.
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19
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Zorn M, Liekfeld A, Bode-Hofmann M, Gabel-Pfisterer A. Trauma der Orbita. AUGENHEILKUNDE UP2DATE 2021. [DOI: 10.1055/a-1311-7793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungDie Behandlung orbitaler Verletzungen gehört zum Alltag der medizinischen Akutversorgung. Bei 10 – 25% aller Gesichtsverletzungen ist die Orbita beteiligt. Dieser Beitrag gibt einen Überblick über die möglichen Pathologien nach Orbitatrauma sowie das primärdiagnostische Vorgehen und die therapeutischen Optionen.
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20
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Correlation between surgical timing and postoperative ocular motility in orbital blowout fractures. Graefes Arch Clin Exp Ophthalmol 2021; 260:319-325. [PMID: 34402963 DOI: 10.1007/s00417-021-05327-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/14/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The study reports the correlation between surgical timing and postoperative ocular motility in orbital blowout fractures. METHODS This was a retrospective study of 191 patients that underwent surgical repair for unilateral orbital fractures. All patients included in the study had symptomatic diplopia from the fracture. Patients were classified into one of three groups according to the time of surgery after injury: (1) Early (within 14 days of surgery), (2) intermediate (between 15 and 30 days), and (3) late (greater than 30 days). Ocular motility was measured presurgery and at 3 and 6 months postsurgery by Hess chart with calculation of the Hess area ratio (HAR%). RESULTS Surgery was conducted at a mean of 24.7 ± 45.0 days (range: 1-283 days) postinjury. There were 120 patients in the early surgery group (surgery at 6.8 ± 3.8 days), 38 in the intermediate surgery group (20.7 ± 4.1 days), and 33 in the late surgery group (95.1 ± 75.0 days). Overall the HAR% improved significantly from a mean of 74.2% preoperatively to 90.8% at 6 months postoperatively (p < 0.01). In the early and intermediate groups, the postoperative HAR% improved significantly with all fracture regions (orbital floor, medial wall, and combined orbital medial wall and floor) (p < 0.05). However, in the late groups, the postoperative HAR% only improved significantly with orbital floor fractures. CONCLUSION Pre- and postoperative the HAR% give objective evidence of ocular motility improvement with early orbital floor fracture repair surgery. However, observation can be deployed, as a significant improvement in ocular motility can also be achieved with reconstructive surgery conducted 30 days or more after depressed floor-fragment fractures. Early intervention should be prioritized for symptomatic medial wall fractures, as late surgery does not improve motility.
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21
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Gooris PJJ, Jansen J, Bergsma JE, Dubois L. Evidence-Based Decision Making in Orbital Fractures: Implementation of a Clinical Protocol. Atlas Oral Maxillofac Surg Clin North Am 2021; 29:109-127. [PMID: 33516533 DOI: 10.1016/j.cxom.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Peter J J Gooris
- Department of Oral and Maxillofacial Surgery, University of Washington Seattle, WA, USA; Department of Oral and Maxillofacial Surgery, University Medical Centre Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amphia Hospital Breda, Molengracht 21, Breda 4818 CK, the Netherlands.
| | - Jesper Jansen
- Department of Oral and Maxillofacial Surgery, University Medical Centre Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - J Eelco Bergsma
- Department of Oral and Maxillofacial Surgery, Amphia Hospital Breda, Molengracht 21, Breda 4818 CK, the Netherlands
| | - Leander Dubois
- Department of Oral and Maxillofacial Surgery, University Medical Centre Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
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22
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Zeller AN, Zimmerer RM, Springhetti S, Tavassol F, Rahlf B, Neuhaus MT, Gellrich NC. CAD/CAM-based referencing aids to reduce preoperative radiation exposure for intraoperative navigation. Int J Med Robot 2021; 17:e2241. [PMID: 33554449 DOI: 10.1002/rcs.2241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND All intraoperative navigation systems need a referencing procedure prior to utilization, usually requiring an additional computed tomography (CT) or cone beam computed tomograph (CBCT) scan. As new techniques in the field of Computer-aided design / Computer-aided manufacturing (CAD/CAM) have evolved, it seemed favourable to develop a new referencing method not relying on additional CT or CBCT scans. METHODS A digital maxillary dental scan was used to create a referencing splint by CAD/CAM containing four reference points. By matching scanned dental model and initial trauma-CT, the splints position and thus the reference points were digitally simulated. These splints data were imported into the navigation system in Standard Tessellation Language (STL) format. These data were also 3D printed and the resulting piece was placed on the anatomical models' teeth. The methods accuracy was then assessed in vitro. CONCLUSION Our method for referencing of intraoperative navigation can be feasible to avoid an additional CT or CBCT prior to navigation.
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Affiliation(s)
| | - Rüdiger M Zimmerer
- Department of Oral and Maxillofacial Surgery, Leipzig University, Leipzig, Germany
| | - Sina Springhetti
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Frank Tavassol
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Björn Rahlf
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Michael-Tobias Neuhaus
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.,Department of Oral and Maxillofacial Surgery, Leipzig University, Leipzig, Germany
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
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Yamanaka Y, Watanabe A, Rajak SN, Nakayama T, Sotozono C. The trend of recovery period on postoperative eye movement in orbital blowout fractures. J Craniomaxillofac Surg 2021; 49:688-693. [PMID: 33608201 DOI: 10.1016/j.jcms.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/09/2020] [Accepted: 02/07/2021] [Indexed: 11/25/2022] Open
Abstract
To investigate the trend of restoration of postoperative eye movements after orbital blowout fractures by analyzing the percentage of Hess area ratio (HAR%). This was a retrospective study of patients who underwent orbital blow out reconstruction surgery within 28-days post injury. Eye movements were measured preoperatively and 3, 6, and 12 months post operatively by Hess chart. Orbital fractures were classified into three shapes: trap-door fracture with muscle entrapment, trap-door fracture with incarcerated tissue, and depressed fracture. Correlations between fracture shapes, regions, reconstruction implant, age and HAR% were analyzed. This study involved 125 eyes (64 right eyes and 61 left eyes) of 125 isolated orbital fracture cases (95 males, 30 females, mean age: 27.2, range 4-85 years old). Of the total 125 cases, 96 patients had orbital floor fractures, 18 had orbital medial wall fractures, and 11 had combined orbital medial wall and floor fractures. Three had trap-door fractures with muscle entrapment, 42 had trap-door fractures with incarcerated tissue, and 80 had orbital depressed fractures. The overall mean HAR% improved significantly from 76.0 pre-operatively to 95.5 post-12 months (P < 0.01). The mean HAR% in orbital floor fracture improved significantly from 76.7 pre-operatively to 92.9 and 94.7 at 3, 6 months respectively. There was a non-significant improvement in the HAR% in medial wall fractures from 83.2 pre-operatively to 89.5 at 3 months and a significant improvement to 93.2 at 6 months (p < 0.05). Orbital fractures were reconstructed with either Unsintered hydroxyapatite particles/poly l-lactide composite sheet (u-HA/PLLA composite sheet) (91 patients), a silicone silastic sheet (20 patients) a combination of sheets (7 patients) or without an implant (7 patients). There was no significant difference in the HAR% improvement between the different implants. The HAR% improvement was significantly greater in patients <18 years old than in those aged 18 or over. The HAR% is an effective method of the objective assessment of recovery after orbital fracture. Patients and surgeons should be aware that the recovery after medial wall fractures is slower than after floor fractures and continues after three months post-surgery and that a longer period of observation without further intervention may be required for medial wall fractures, whilst floor fractures are likely to have achieved their maximal recovery by three months.
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Affiliation(s)
- Yukito Yamanaka
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan; Department of Ophthalmology, Meiji University of Integrative Medicine, Kyoto, Japan
| | - Akihide Watanabe
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan.
| | - Saul N Rajak
- The Sussex Eye Hospital, Brighton and Sussex University Hospital, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK
| | - Tomomichi Nakayama
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan
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Vaanmugil J, Jimson S, Bhanumurthy L, Arunprakash M, Kandasamy R. Conchal Cartilage in Surgical Reconstruction of Orbital Floor Fracture. Cureus 2021; 13:e13223. [PMID: 33728173 PMCID: PMC7946607 DOI: 10.7759/cureus.13223] [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] [Indexed: 11/05/2022] Open
Abstract
According to Kim and Jeong (2016), isolated orbital fractures are encountered in 4-16% of all facial fractures, and orbital fractures composed approximately 30--55% of the zygomaticomaxillary complex (ZMC) and naso-orbital-ethmoid (NOE) fractures. The ideal material for orbital floor fracture repair is one that is resorbable, osteoconductive, resistant to infection, minimally reactive, does not induce capsule formation, has a half-life that allows significant bone in-growth to occur, and is cheap and readily available. In this article, we report a case of a young female with an orbital floor fracture managed surgically using conchal cartilage and a review of literature.
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Affiliation(s)
- Jayapaul Vaanmugil
- Oral and Maxillofacial Surgery, Tagore Dental College & Hospital, Chennai, IND
| | - Samson Jimson
- Oral and Maxillofacial Surgery, Tagore Dental College & Hospital, Chennai, IND
| | - Lokesh Bhanumurthy
- Oral and Maxillofacial Surgery, Tagore Dental College & Hospital, Chennai, IND
| | - M Arunprakash
- Oral and Maxillofacial Surgery, Tagore Dental College & Hospital, Chennai, IND
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25
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Watanabe A, Yamanaka Y, Rajak SN, Nakayama T, Ueda K, Sotozono C. Assessment of a Consecutive Series of Orbital Floor Fracture Repairs With the Hess Area Ratio and the Use of Unsintered Hydroxyapatite Particles/Poly l-Lactide Composite Sheets for Orbital Fracture Reconstruction. J Oral Maxillofac Surg 2021; 79:420-428. [DOI: 10.1016/j.joms.2020.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022]
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Blumer M, Pejicic R, Gander T, Johner JP, Held U, Wagner ME. Customized Titanium Reconstruction of Orbital Fractures Using a Mirroring Technique for Virtual Reconstruction and 3D Model Printing. J Oral Maxillofac Surg 2021; 79:200.e1-200.e9. [DOI: 10.1016/j.joms.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
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Zeller AN, Neuhaus MT, Gessler N, Skade S, Korn P, Jehn P, Gellrich NC, Zimmerer RM. Self-centering second-generation patient-specific functionalized implants for deep orbital reconstruction. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:372-380. [PMID: 33385579 DOI: 10.1016/j.jormas.2020.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/24/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
Deep and complete reconstruction of the orbital cavity has been shown to be essential for preventing enophthalmos and hypoglobus in patients with orbital defects or deformities. Additively manufactured patient-specific titanium implants provide unlimited options in design. However, implant malpositioning can still occur, even when intraoperative imaging and navigation are used. In this study, we investigated novel orbital implants containing features facilitating self-centering. Accuracy of implant placement and reconstruction of the orbital dimensions were compared retrospectively between self-centering second-generation patient-specific functionalized orbital implants (study group) and CAD-based individualized implants (control group). Design features of implants in the study group included functionalization with navigation tracks, a preventive design, and flanges - so called stabilizers - towards opposite orbital walls. Implant position was evaluated by fusion of preoperative virtual plans and the post-therapeutic imaging. Aberrances were quantified by 3D heatmap analysis. 31 patients were assigned to the study group and 50 to the control group, respectively. In the study group, most implants were designed with either one (n = 18, 58.06%) or two (n = 10, 32.26%) stabilizers. Twice (6.45%), one stabilizer had to be shortened intraoperatively. Implant fit analysis revealed a significantly more precise (p < 0.001) positioning in the study group (n = 22/31) than in the control group (n = 42/50). Self-centering second-generation patient-specific functionalized orbital implants showed significantly more accurate implant positioning, facilitating the transformation of virtual plans into patient's anatomy. The presented design provides an additional instrument for intraoperative quality control besides intraoperative imaging and navigation.
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Affiliation(s)
| | - Michael Tobias Neuhaus
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nora Gessler
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Sandra Skade
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Philippe Korn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Philipp Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Rüdiger M Zimmerer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
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Blumer M, Essig H, Steigmiller K, Wagner ME, Gander T. Surgical Outcomes of Orbital Fracture Reconstruction Using Patient-Specific Implants. J Oral Maxillofac Surg 2020; 79:1302-1312. [PMID: 33524325 DOI: 10.1016/j.joms.2020.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Patient-specific implants (PSIs) are known to yield reliable outcomes in orbital wall fracture reconstruction (high precision, smoother operating techniques, and shorter surgical duration). This study analyzed the surgical error and clinical and esthetic outcomes of orbital reconstructions with PSIs. METHODS This ambispective cohort study enrolled patients who underwent orbital reconstruction using PSIs between October 2016 and January 2018. The study end points were surgical error, indication and duration of surgery, long-term sequelae, revision surgeries, and surgical complications. Surgical error was analyzed by superimposing the postoperative implant position onto the preoperative virtual plan. Both qualitative (heat map) and quantitative (distance) measurements were obtained. RESULTS Three patients were enrolled prospectively, and 23 were enrolled retrospectively. Indications for surgery were defect size (25 patients), diplopia (10 patients), impaired eye motility (4 patients), and significant enophthalmos (6 patients). At the last patient visit, there were 5 cases of diplopia, 1 case of exophthalmos, and 6 cases of slight enophthalmos of incremental degree. In terms of surgical error, a mean distance of 0.6 mm (95% confidence interval, 0.49 to 0.76), with a mean maximal distance of 3.4 mm (95% confidence interval, 2.79 to 4.02), was noted. No revision surgery was necessary. Lid malposition complications were not observed. However, 1 case each of symblepharon and scleral show were observed. No time-saving component was observed. CONCLUSIONS PSI use in orbital reconstruction guarantees a preplanned 3-dimensional anatomical shape with a mean surgical error of just 0.6 mm. Our clinical results were similar to those of other protocols; however, warranting a complex 3-dimensional anatomical shape also in large orbital fractures with a low mean surgical error is feasible by using PSIs.
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Affiliation(s)
- Michael Blumer
- Consultant, Department Oral & Maxillofacial Surgery, University Hospital, Zurich, Switzerland.
| | - Harald Essig
- Consultant, Department Oral & Maxillofacial Surgery, University Hospital, Zurich, Switzerland
| | - Klaus Steigmiller
- Researcher, Department of Biostatistics and Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Thomas Gander
- Consultant, Department Oral & Maxillofacial Surgery, University Hospital, Zurich, Switzerland
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Scolozzi P, Bachelet JT, Courvoisier DS. Are Inferior Rectus Muscle Displacement and the Fracture's Size Associated With Surgical Repair Decisions and Clinical Outcomes in Patients With Pure Blowout Orbital Fracture? J Oral Maxillofac Surg 2020; 78:2280.e1-2280.e10. [DOI: 10.1016/j.joms.2020.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 11/27/2022]
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Bourry M, Hardouin JB, Fauvel F, Corre P, Lebranchu P, Bertin H. Clinical evaluation of the efficacy of materials used for primary reconstruction of orbital floor defects: Meta-analysis. Head Neck 2020; 43:679-690. [PMID: 33145908 DOI: 10.1002/hed.26518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/12/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aim of this network meta-analysis (NMA) was to compare the clinical results obtained after primary reconstruction of orbital floor fractures (OFF) using different materials. METHODS PubMed, Cochrane, and Google Scholar databases were screened from 1989 to 2019. For a study to be eligible, it had to evaluate two or more materials and report the following clinical parameters: diplopia and/or enophthalmos and/or other complications. RESULTS Nine studies involving 946 patients presenting with an OFF were included. After the surgical procedure, 105 patients (11%) had diplopia, while 43 patients (4.5%) suffered from enophthalmos. The NMA revealed that less postoperative diplopia and enophthalmos were obtained either by using polydioxanone (PDS), or a polymer of l-lactic acid and dl-lactic acid (P[L/DL]LA), or porous polyethylene, or titanium mesh compared with the use of autologous bone grafts. CONCLUSION P(L/DL)LA and PDS seem to be the best options for small and intermediate defects, whereas the association of porous polyethylene and titanium should be preferred for larger defects.
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Affiliation(s)
- Maeva Bourry
- Department of Maxillofacial Surgery, Nantes University Hospital, Nantes Cedex 1, France
| | | | - Fabien Fauvel
- Department of Maxillofacial Surgery, Saint-Nazaire Hospital, Saint-Nazaire, France
| | - Pierre Corre
- Department of Maxillofacial Surgery, Nantes University Hospital, Nantes Cedex 1, France.,Regenerative Medicine and Skeleton (RMeS), Faculty of Dental Sciences, Nantes, France
| | - Pierre Lebranchu
- Department of Ophthalmology, Nantes University Hospital, Nantes, France.,UMR 6597 CNRS, Image and Video Communication Team, Polytech-Nantes, Nantes, France
| | - Hélios Bertin
- Department of Maxillofacial Surgery, Nantes University Hospital, Nantes Cedex 1, France.,Bone sarcoma and remodeling of calcified tissues (PhyOs, UMR 1238), Faculty of Medicine, Nantes Cedex, France
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Seen S, Young S, Lang SS, Lim TC, Amrith S, Sundar G. Orbital Implants in Orbital Fracture Reconstruction: A Ten-Year Series. Craniomaxillofac Trauma Reconstr 2020; 14:56-63. [PMID: 33613837 DOI: 10.1177/1943387520939032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design Retrospective comparative interventional series of all patients who had undergone orbital fracture repair by 2 senior orbital surgeons in a single tertiary trauma center from January 2005 to December 2014. Objective To compare the outcomes of different implants used for various types of orbital fractures. Methods Patients were evaluated by age, gender, etiology of fracture, clinical findings, type of fractures, and implant used. Main outcome measures included restoration of premorbid state without morbidity and complications including enophthalmos, diplopia, infraorbital hypoesthesia, and ocular motility restriction 1 year after fracture repair. Implant-related complications were collected for analysis. Results There were a total of 274 patients with 307 orbits reconstructed. Thirty-three (12.0%) patients sustained bilateral injuries; 58.0% (n = 178) of orbits had simple fractures (isolated orbital floor, medial wall, or combined floor and medial wall). The distribution of implants used were bioresorbable (n = 117, 38.1%) and prefabricated titanium plates (n = 98, 31.9%) depending upon the nature of fracture. Bioresorbables, titanium plate, and porous polyethylene were used significantly more than titanium mesh for simple fractures, and prefabricated anatomic titanium implants were used significantly more than the other implants for complex fractures. There was a statistically significant improvement in diplopia, enophthalmos, ocular motility, and infraorbital hypoesthesia (p-value < 0.001) 1 year following orbital fracture reconstruction. Conclusions When used appropriately, diverse alloplastic materials used in orbital fracture repair tailored to the indication aid orbital reconstruction outcomes with each material having its own unique characteristics.
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Affiliation(s)
- Sophia Seen
- Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore
| | - Stephanie Young
- Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore
| | | | - Thiam-Chye Lim
- Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore.,Division of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital Singapore, Singapore
| | - Shantha Amrith
- Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore
| | - Gangadhara Sundar
- Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore
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Iftikhar M, Canner JK, Hall L, Ahmad M, Srikumaran D, Woreta FA. Characteristics of Orbital Floor Fractures in the United States from 2006 to 2017. Ophthalmology 2020; 128:463-470. [PMID: 32659309 DOI: 10.1016/j.ophtha.2020.06.065] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To examine the incidence, characteristics, and economic burden of orbital floor fractures in the United States. DESIGN Retrospective, longitudinal study of the Nationwide Emergency Department Sample (NEDS). PARTICIPANTS Patients in the Emergency Department (ED). METHODS The NEDS, a representative sample of all hospital-based EDs in the US, was used to identify and describe ED visits with a primary diagnosis of orbital floor fracture from 2006 to 2017. Linear regression was used to estimate the trends in annual incidence and inflation-adjusted ED charges. Logistic regression was used to assess variables associated with inpatient admission. MAIN OUTCOME MEASURES Incidence, injury mechanisms, demographics, clinical characteristics, disposition, and economic burden. RESULTS From 2006 to 2017, there were an estimated 350 379 ED visits in the US with a primary diagnosis of orbital floor fracture. The incidence increased by 47% over the study period (P < 0.001): from 7.7 (95% confidence interval [CI], 6.9-8.5) to 11.3 (95% CI, 10.0-12.6) per 100 000 population. The majority were male (67%), aged 21 to 44 years (46%), and from low-income households (32%). The most common cause was assault (43%), which was most frequent in young adults (65%) and increased modestly over time (3.5 to 4.5 per 100 000 population; P = 0.02). The second most common cause was falls (26%), most frequent in patients aged ≥65 years (86%) and more than doubled over time (1.6 to 3.5 per 100 000 population; P < 0.001). The rate of inpatient admission was 14%, with a higher likelihood for patients aged ≥65 years (odds ratio [OR], 2.21; 95% CI, 1.99-2.46; P < 0.001) and falls (OR, 1.54; 95% CI, 1.27-1.86; P < 0.001). The total inflation-adjusted ED charges over the study period exceeded $2 billion, with the mean charge per visit increasing 48% (P < 0.001): from $5881 (95% CI, 5499-6263) to $8728 (95% CI, 8074-9382). CONCLUSIONS Orbital floor fractures are becoming an increasingly common and costly injury in the United States. Preventive strategies aimed at reducing assault and falls will be crucial to mitigate the burden of orbital floor fractures on the healthcare system.
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Affiliation(s)
- Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Leangelo Hall
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Meleha Ahmad
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Incidence and seasonality of major ocular trauma: a nationwide population-based study. Sci Rep 2020; 10:10020. [PMID: 32572124 PMCID: PMC7308360 DOI: 10.1038/s41598-020-67315-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/15/2020] [Indexed: 11/09/2022] Open
Abstract
We designed this study to identify the epidemiological characteristics and trends of various types of ocular trauma in the population of the Republic of Korea. We conducted a nationwide, population-based, cross-sectional study using the Korean National Health Insurance claims database for January 2010 to December 2018. We compiled the monthly numbers of patients diagnosed with hyphema and those who received open reduction surgery due to orbital blowout fracture (BOF), primary closure of the cornea or sclera (PCCS), or intraocular foreign body (IOFB) removal. We obtained annual and monthly incidence rates, and differences according to age, sex, yearly trends, and seasonal variations. The incidence rate (per 100,000 person-years) was high in the order of hyphema (18.43), BOF (11.58), PCCS (1.99) and IOFB removal (0.39). Male predominance was evident in all types of major ocular trauma, but the age distribution varied with the type: hyphemas were most prevalent at 10–14 years of age, BOFs at 25–29 years of age, and open globe injuries (OGIs) at age 60 and older. Although all types of trauma showed significant seasonality, hyphemas (amplitude: 174.81) and BOFs (23.17) showed higher amplitudes compared to OGIs (PCCS: 11.96; IOFB removal: 6.72). While the incidence of blunt trauma injuries, including hyphemas and orbital BOFs, decreased steadily from 2010 to 2018, that of OGIs showed no remarkable change.
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Jansen J, Dubois L, Maal TJ, Mourits MP, Jellema HM, Neomagus P, de Lange J, Hartman LJ, Gooris PJ, Becking AG. A nonsurgical approach with repeated orthoptic evaluation is justified for most blow-out fractures. J Craniomaxillofac Surg 2020; 48:560-568. [DOI: 10.1016/j.jcms.2020.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/28/2020] [Accepted: 03/19/2020] [Indexed: 11/28/2022] Open
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Blumer M, Rostetter C, Johner JP, Ebner JJ, Wiedemeier D, Rücker M, Gander T. Associated Ophthalmic Injuries in Patients With Fractures of the Midface. Craniomaxillofac Trauma Reconstr 2020; 13:168-173. [PMID: 33456682 DOI: 10.1177/1943387520922056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose Concomitant ophthalmic injuries are common in patients with facial fractures, though frequency varies widely in the literature. Major ophthalmic injuries can have drastic consequences for patients, and permanent visual impairment cannot be prevented in all cases. This study analyzed the frequency and distribution pattern of associated ophthalmic injuries in patients who received operative treatment for fractures of the midface. Material and Methods The clinical information system was searched for patients with midface fractures that were treated operatively between December 2014 and November 2017. Demographic, fracture-related, and ophthalmic data were assessed and statistically analyzed. Results This study included 282 patients. The most common fracture types were zygomaticomaxillary complex fractures and orbital floor fractures. Falls and violence were the most common causes of fractures (43.3% and 24.5%, respectively). Chemosis and subconjunctival bleeding were the most common associated eye injuries. The most prevalent long-term eye injury was diplopia, which was identified in 18.4% of cases preoperatively. Postoperative diplopia persisted in 36 cases (12.8%) at 3-month follow-up. Optic neuropathy, enophthalmos, exophthalmos, and retrobulbar hematomas were identified infrequently. Conclusion Minor ophthalmic injuries, including chemosis and subconjunctival bleeding, are more frequently associated with midface trauma. These minor injuries tend to heal quickly and without sequela. Major ophthalmic injuries, including retinal detachment, optic neuropathy, and retrobulbar hematomas, are identified less frequently. Special attention should be paid to patients with diplopia, as this condition may persist and have long-term occupational consequences. Therefore, close interdisciplinary collaboration is essential when treating patients with fractures of the midface to prevent permanent visual impairment.
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Affiliation(s)
- Michael Blumer
- Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Switzerland
| | - Claudio Rostetter
- Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Switzerland
| | - Jean-Pierre Johner
- Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Switzerland
| | - Julian J Ebner
- Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Switzerland
| | - Daniel Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Switzerland
| | - Martin Rücker
- Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Switzerland
| | - Thomas Gander
- Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Switzerland
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Lin Q, Hong X, Zhang D, Jin H. Involvement of orbit in maxillofacial fractures: "Evaluation of its spectrum, characteristics, and treatment in 200 patients"-Prospective study. J Cosmet Dermatol 2020; 19:3302-3306. [PMID: 32227574 DOI: 10.1111/jocd.13385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/26/2020] [Accepted: 03/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate the orbital involvement epidemiology in facial fractures, the clinical distribution and effects of orbital involvement in these patients, the frequency and nature of treatment procedures performed for these involvements, and the immediate- and intermediate-term effects of these treatment procedures. METHODS Two hundred patients with hard tissue maxillofacial injuries were included in this study. Clinical examination was performed in-depth. Images were taken to determine and confirm clinical observations and to finalize treatment modality. Orbital involvement in patients was noted as present or absent. The clinical effects and features in postoperative imaging studies were noted until 3 months after trauma in each patient. RESULTS Out of 200 patients, about one-third patients (58;29%) had orbital involvement and out of which 49 were males. Regarding clinical-radiological signs in orbit involved fractures, the incidences were variable, that is, periorbital ecchymosis (77.6%), periorbital edema (74.1%), subconjunctival hemorrhage (67.2%), palpable step/crepitus in orbital rim (62.1%), infraorbital nerve paresthesia (46.6%), restricted globe movement (5.2%), orbital rim discontinuity/step (72.4%), maxillary sinuses (51.7%), orbital wall/floor/roof rupture (55.2%), and infraorbital foramen involvement (36.2%). Palpable step/crepitus in orbital rim was recovered remarkably earlier in patients of open reduction internal fixation (ORIF) group, and features of restricted globe movements, orbital rim discontinuity/step, orbital wall/floor/roof rupture, and infraorbital foramen involvement in patients were recovered immediately after open reduction and internal fixation treatment. CONCLUSION Early repair of the maxillofacial injuries with orbital involvement has better functional and esthetic outcome.
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Affiliation(s)
- Quan Lin
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Xingyu Hong
- Department of Vascular Surgery, China Japan Hospital of Jilin University, Changchun, China
| | - Duo Zhang
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Hongjuan Jin
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
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Kim JH, Lee IG, Lee JS, Oh DY, Jun YJ, Rhie JW, Shim JH, Moon SH. Restoration of the inferomedial orbital strut using a standardized three-dimensional printing implant. J Anat 2019; 236:923-930. [PMID: 31852015 DOI: 10.1111/joa.13136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 12/13/2022] Open
Abstract
The inferomedial orbital strut (IOS) is the thin bony junction of the orbital medial wall and floor. Its fracture is common and leads to serious complications, including enophthalmos, globe dystopia and diplopia. However, anatomical restoration of the IOS is challenging owing to reduced structural support; sound anatomical background and accurate implants are therefore essential. The aim of the present study was to incorporate data from cadaveric orbit anatomy into three-dimensional (3D) printing technology and to reconstruct the complex orbital fracture elaborately. After averaging the data from computed tomography (CT) images of 100 adult cadavers, the dimensions of the IOS were extracted, and a tangent sphere was created using a computer-aided design program. The curves were compared with the CT data of 10 adult patients from the simulation test. Based on these data, a standardized 3D implant, 1.15 mm thick, was designed using polycaprolactone. The implant was placed in five patients with complex orbital fractures. The radius of the sphere in contact with the orbit, measuring 33.54 mm, was confirmed to be appropriate. A comparison between the normal side volume (V0) and the postoperative volume (Vpost ) showed that they were statistically similar. Furthermore, a comparison between V0 and the preoperative volume (Vpre ), and Vpost compared with Vpre also showed a statistically significant difference (P < 0.05). On follow-up, the preoperative ocular symptoms were resolved. The orbital data obtained from 100 cadavers provided standardized orbital anatomy, and 3D printed implants were created. The implants were anatomically accurate with regard to the orbital cavity and adequately covered the simulation model. The implant also showed satisfactory results when applied clinically in actual patients.
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Affiliation(s)
- Jun Hyeok Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - In-Gyu Lee
- Department of Mechanical Engineering, Korea Polytechnic University, Siheung, Korea
| | - Jeong-Seok Lee
- Department of Mechanical Engineering, Korea Polytechnic University, Siheung, Korea
| | - Deuk Young Oh
- Department of Plastic and Reconstructive Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Young Joon Jun
- Department of Plastic and Reconstructive Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Jong Won Rhie
- Department of Plastic and Reconstructive Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Jin-Hyung Shim
- Department of Mechanical Engineering, Korea Polytechnic University, Siheung, Korea
| | - Suk-Ho Moon
- Department of Plastic and Reconstructive Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea
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Is the pure and impure distinction of orbital fractures clinically relevant with respect to ocular and periocular injuries? A retrospective study of 473 patients. J Craniomaxillofac Surg 2019; 47:1935-1942. [DOI: 10.1016/j.jcms.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/17/2019] [Accepted: 10/13/2019] [Indexed: 11/21/2022] Open
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Incidence and Prevention of Cicatricial Scleral Show in the Subciliary Access in Patients With Orbital Fractures. J Craniofac Surg 2019; 30:1782-1786. [PMID: 31449214 DOI: 10.1097/scs.0000000000005461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
: Orbital fractures can involve floor, lateral and medial wall. Surgical access depends on fracture's severity, ocular trauma and patient's age. Subciliary, subtarsal, infraorbital or transconjunctival approaches are the main access to the orbit. Surgical interventions in the eyelid may induce scar tissue formation and, consequently, the cicatricial scleral show. The authors present a study with the aim to evaluate the incidence of cicatricial scleral show in patients treated for orbital fractures with or without simultaneous Tarsal Sling Canthopexy in our Plastic Surgery Department. METHODS The authors evaluated 50 patients divided in 2 groups: Group 1, subciliary approach and reconstruction of orbital floor without simultaneous Canthopexy Tarsal Sling; Group 2: reconstruction of orbital floor through subciliary approach with simultaneous Canthopexy Tarsal Sling. RESULTS Patients, who underwent Canthopexy Tarsal Sling, did not have any scleral show. Instead patients, who did not undergo this prevention technique, had scleral show even if a minor entity. DISCUSSION Although there was no muscle or skin removed, in our procedure, but only cutaneous incision, scleral show can appear as a complication. Canthal ligament and tarsus' elasticity influence the incidence of post-surgical scleral show, which is more frequent in elderly patients. Therefore, the authors suggest to prevent it routinely with Tarsal Sling Canthopexy. CONCLUSION Canthopexy Tarsal Sling is procedure that stretch tarsal structure and it may help to prevent scleral show.
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Cooper T, Schmutz B, Hsu E, Lynham A. Magnetic resonance imaging for three-dimensional printing of the bony orbit: is clinical use imminent? Int J Oral Maxillofac Surg 2019; 49:483-490. [PMID: 31402077 DOI: 10.1016/j.ijom.2019.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/28/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study was to examine the accuracy of three dimensionally (3D) printed models of the bony orbit derived from magnetic resonance imaging (MRI) for the purpose of preoperative plate bending in the setting of orbital blowout fracture. Retrospective computed tomography (CT) and MRI data from patients with suspected orbital fractures were used. Virtual models were manually generated and analysed for spatial accuracy of the fracture margins. 3D-printed models were produced and orbital fan plates bent by a single operator. The plates were then digitized and analysed for spatial discrepancy using reverse engineering software. Seven orbital blowout fractures were evident in six orbits. Analysis of the virtual models revealed high congruence between blowout fracture margins on CT and MRI (n=7, average deviation 0.85mm). Three zygomaticomaxillary complex fractures were seen, for which MRI did not demonstrate the same accuracy. For plates bent to the 3D-printed models of blowout fractures (n=6), no significant difference was found between those bent to CT versus those bent to MRI when compared for average surface and average border deviation (Wilcoxon signed rank test). Orbital blowout fractures can be defined on MRI with clinically acceptable accuracy. 3D printing of orbital biomodels from MRI for bending reconstructive plates is an acceptable and accurate technique.
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Affiliation(s)
- T Cooper
- Department of Oral and Maxillofacial Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
| | - B Schmutz
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - E Hsu
- Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - A Lynham
- School of Medicine, University of Queensland, Brisbane, Australia
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41
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Abstract
Orbital fractures pose specific challenge in its surgical management. One of the greatest challenges is to obtain satisfactory reconstruction by correct positioning of orbital implant. Intraoperative computed tomography (CT) scan may facilitate this procedure. The aim of this study was to describe the early use of intraoperative CT in orbital fractures repair in our center. The authors assessed the revision types and rates that have occurred with this technique. With the use of pre-surgical planning, optical intraoperative navigation, and intraoperative CT, the impact of intraoperative CT on the management of 5 cases involving a total number of 14 orbital wall fractures were described. There were 6 pure orbital blowout wall fractures reconstructed, involving both medial and inferior wall of the orbit fracturing the transition zone and 8 impure orbital wall fractures in orbitozygomaticomaxillary complex fracture. 4 patients underwent primary and 1 had delayed orbital reconstruction. Intraoperative CT resulted in intraoperative orbital implant revision, following final navigation planning position, in 40% (2/5) of patients or 14% (2/14) of the fractures. In revised cases, both implant repositioning was conducted at posterior ledge of orbit. Intraoperative CT confirmed true to original reconstruction of medial wall, inferior wall and transition zone of the orbit. Two selected cases were illustrated. In conclusion, intraoperative CT allows real-time assessment of fracture reduction and immediate orbital implant revision, especially at posterior ledge. As a result, no postoperative imaging was indicated in any of the patients. Long-term follow-ups for orbital fracture patients managed with intraoperative CT is suggested.
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Hartwig S, Nissen MC, Voss JO, Doll C, Adolphs N, Heiland M, Raguse JD. Clinical outcome after orbital floor fracture reduction with special regard to patient's satisfaction. Chin J Traumatol 2019; 22:155-160. [PMID: 31040039 PMCID: PMC6543183 DOI: 10.1016/j.cjtee.2019.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/23/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Primary reconstruction via transconjunctival approach is a standardized treatment option for orbital floor fractures. The aim of this study was to compare the findings of specific ophthalmologic assessment with the patient's complaints after fracture reduction. METHODS A retrospective medical chart analysis was performed on patients who had undergone transconjunctival orbital floor fracture reduction for fracture therapy with resorbable foil (ethisorb sheet or polydioxanone foil). A follow-up assessment including ophthalmological evaluation regarding visual acuity (eye chart projector), binocular visual field screening (Bagolini striated glasses test) and diplopia (cover test, Hess screen test) was conducted. Additionally, a questionnaire was performed to assess patients' satisfaction. RESULTS A total of 53 patients with a mean follow-up of 23 months (ranging from 11 to 72) after surgical therapy were included. Diplopia was present preoperatively in 23 (43.4%) and reduced in follow-up examination (n = 12, 22.6%). Limitations in ocular motility reduced from 37.7% to 7.5%. The questionnaire about the patient's satisfaction revealed excellent outcomes in relation to the functional and esthetical parameters. CONCLUSION Transconjunctival approach is a safe approach for orbital fracture therapy. Postoperative diplopia is nearly never perceptible for the individual and differs to pathologic findings in the ophthalmic assessment.
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Affiliation(s)
- Stefan Hartwig
- Department for Oral and Maxillofacial and Facial Plastic Surgery, Johannes Wesling Hospital Minden, University Hospital of the Ruhr University Bochum, Germany,Corresponding author.
| | - Marie-Christine Nissen
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Jan Oliver Voss
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Christian Doll
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Nicolai Adolphs
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Max Heiland
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Jan Dirk Raguse
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
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43
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Permanent Versus Bioresorbable Implants in Orbital Floor Blowout Fractures. Ophthalmic Plast Reconstr Surg 2019; 34:536-543. [PMID: 29419638 DOI: 10.1097/iop.0000000000001077] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the outcomes of bioresorbable and permanent implants in the reconstruction of isolated orbital floor blowout fractures. METHODS Retrospective series of all patients who had orbital floor fracture repair in a single tertiary trauma center from January 2005 to December 2014. The authors reviewed the case notes and CT scans of patients with orbital floor fracture repair with either bioresorbable or permanent implants. Main outcome measures were enophthalmos, diplopia, and ocular motility restriction 1.5 years after fracture repair. Implant-related complications were collected for analysis. RESULTS There were a total of 88 patients in our study. Bioresorbable implants were used in 48 patients (54.5%) while 40 patients had permanent implants (45.5%). The authors analyzed the implants used in various sizes of orbital fractures: small (<13.3 mm), medium (13.3-20 mm), and large (>20 mm). One and a half years after fracture repair, both groups had comparable clinical outcomes (n = 2 and n = 0 for diplopia for permanent and bioresorbable implant groups, respectively, n = 0 for enophthalmos for both groups and n = 1 for ocular motility limitation for both groups) overall and across all fracture sizes. CONCLUSION Bioresorbable implants degrade after fracture healing through hydrolysis and promote the gradual transfer of functional forces to healing bone during its disintegration. The clinical outcomes of diplopia, enophthalmos, and ocular motility restriction associated with the use of resorbable implants are comparable to that of permanent implants for all fracture sizes. Their study shows that bioresorbable and permanent implants are equally safe and effective for the treatment of patients with isolated orbital floor blowout fractures.
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44
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Does vertical incomitance predict the diplopia outcome in orbital fracture patients? A prospective study of 188 patients. J Craniomaxillofac Surg 2019; 47:305-310. [DOI: 10.1016/j.jcms.2018.11.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 11/29/2018] [Indexed: 11/18/2022] Open
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45
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Assessment of Infraorbital Hypesthesia Following Orbital Floor and Zygomaticomaxillary Complex Fractures Using a Novel Sensory Grading System. Ophthalmic Plast Reconstr Surg 2019; 35:53-55. [DOI: 10.1097/iop.0000000000001162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Xia Q, Wang Z, Yan J. Surgical Management of Strabismus in Patients With Orbital Fracture. J Craniofac Surg 2018; 29:1865-1869. [DOI: 10.1097/scs.0000000000004731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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47
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Doll C, Thieme N, Schönmuth S, Voss JO, Nahles S, Beck-Broichsitter B, Heiland M, Raguse JD. Enhanced radiographic visualization of resorbable foils for orbital floor reconstruction: A proof of principle. J Craniomaxillofac Surg 2018; 46:1533-1538. [PMID: 29983307 DOI: 10.1016/j.jcms.2018.05.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/08/2018] [Accepted: 05/24/2018] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Despite the advantages and broad applications of alloplastic resorbable implants, postoperative radiological control is challenging due to its radiolucency. The aim of the present study was to evaluate the radiographic visibility of newly developed materials for orbital floor reconstruction. MATERIALS AND METHODS The radiographic visibility of four different material combinations consisting of poly-(L-lactic acid)/poly-glycolic acid (PLLA/PGA) or poly(D,L-lactic acid) (PDLLA) enriched with magnesium (Mg), hydroxyapatite (HA) or β-tricalcium phosphate (β-TCP) with various layers of thicknesses (0.3, 0.6, and 1 mm), surgically placed above the orbital floor of a human head specimen, was evaluated using computed tomography (CT) and cone beam computed tomography (CBCT). The visibility was rated on a scale of 0-10 in CT/CBCT and by Hounsfield Units in CT for each subject. RESULTS All of the materials were clearly detectable in CT scans. Visibility was significantly higher (p < 0.001) in the standard soft tissue window (mean score: 7.3, ranging from 2 to 10) in comparison to the standard bone window (mean score: 5.2, ranging from 1 to 10). In CBCT (mean score: 3.3, ranging from 0 to 7), there was significantly lower but still sufficient visibility of the materials compared to the CT soft tissue window (p < 0.001) and CT bone window (p < 0.001). Comparing the different materials' visibility among the group of same layer thicknesses with each other, in the majority of cases, PDLLA enriched with β-TCP appeared to be most visible in both CT and CBCT. CONCLUSION The incorporation of radiopaque elements to PLLA/PGA and PDLLA polymers is a promising strategy to improve their visibility in CT and CBCT. Our data suggest that the reconstruction of the orbital floor with these new materials could provide an advantageous postoperative radiographic control.
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Affiliation(s)
- Christian Doll
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany.
| | - Nadine Thieme
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Germany
| | - Stefanie Schönmuth
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Jan Oliver Voss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Susanne Nahles
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Benedicta Beck-Broichsitter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Max Heiland
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Jan-Dirk Raguse
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
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48
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Bregman JA, Vakharia KT, Idowu OO, Vagefi MR, Grumbine FL. Outpatient Surgical Management of Orbital Blowout Fractures. Craniomaxillofac Trauma Reconstr 2018; 12:205-210. [PMID: 31428245 DOI: 10.1055/s-0038-1661355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/29/2018] [Indexed: 10/28/2022] Open
Abstract
There is ample investigation into the optimal timing and approach to orbital blowout fracture (OBF) repair; however, less attention has been directed toward postoperative care. This is a multicenter IRB-approved retrospective review of patients with OBF presenting to our study sites between November 2008 and August 2016. Those with isolated OBF, over 18 years of age, and who had not suffered additional facial injuries or globe trauma were included. A total of 126 surgical cases of isolated OBF repair were identified that met our inclusion and exclusion criteria; 42.1% were outpatient repairs while the remaining 57.9% were admitted for overnight monitoring. Time elapsed prior to repair differed between the two groups at a mean of 8.4 days versus 5.2 days for the outpatient and inpatient cohorts, respectively ( p = 0.001). A majority of inpatient cases underwent immediate repair, while a majority of outpatient cases were delayed. There were two cases of RBH in the outpatient cohort resulting in an overall incidence of 1.6%. In both instances, a significant change in clinical exam including decreased visual acuity, diplopia, and eye pain prompted repeat evaluation and immediate intervention for hematoma evacuation. Estimated hospital charges to the patient's insurance for key components of an inpatient versus outpatient isolated OBF repair amounted to a total cost of $9,598.22 for inpatient management and $7,265.02 for outpatient management without reflexive postoperative imaging. Reflexive postoperative CT scans were obtained in 76.7% of inpatient cases and only two led to a reoperation. No outpatient repairs included reflexive postoperative imaging. Outpatient OBF repair is an attractive alternative to inpatient management. The potential cost savings of outpatient management of OBF, which do not detract from quality or safety of patient care, should not be ignored. Our results will hopefully contribute to updated shared practice patterns for all subspecialties that participate in the surgical management of OBF.
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Affiliation(s)
- Jana A Bregman
- Department of Ophthalmology and Visual Sciences, University of Maryland Medical Center, Baltimore, Maryland
| | - Kalpesh T Vakharia
- Department of Otolaryngology - Head and Neck Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - F Lawson Grumbine
- Department of Ophthalmology and Visual Sciences, University of Maryland Medical Center, Baltimore, Maryland
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49
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Abstract
Orbital floor fractures of varying sizes commonly occur after orbital injuries and remain a serious challenge. Serious complications of such fractures include enopthalmos, restriction of extraocular movement, and diplopia. There is a dearth of literature that can be applied widely, easily, and successfully in all such situations, and therefore there is no consensus on the treatment protocol of this pathology yet. Autogenous grafts and alloplastic and allogenic materials with a wide variety of advantages and disadvantages have been discussed. The value of preoperative and postoperative ophthalmological examination should be standard of care in all orbital fracture patients. An ideal reconstructed orbital floor fracture should accelerate the restoration of orbital function with acceptable cosmetic results. Management parameters of orbital fractures such as timing of surgery, incision type, and implant materials, though widely discussed, remain controversial. In this study, 55 patients with orbital floor fractures surgically reconstructed with conchal cartilage grafts between 2008 and 2014 were retrospectively evaluated. Complications and long-time follow-up visit results have been reported with clinical and radiographic findings. The aim of this study was to present the authors' clinical experiences of reconstruction of blow-out fractures with auricular conchal graft and to evaluate the other materials available for use.
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50
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Johnson NR, Singh NR, Oztel M, Vangaveti VN, Rahmel BB, Ramalingam L. Ophthalmological injuries associated with fractures of the orbitozygomaticomaxillary complex. Br J Oral Maxillofac Surg 2018; 56:221-226. [PMID: 29506872 DOI: 10.1016/j.bjoms.2018.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 02/12/2018] [Indexed: 11/26/2022]
Abstract
Our aim was to evaluate ophthalmological injuries associated with fractures of the orbitozygomaticomaxillary complex that required operative treatment, and we collected data retrospectively over a period of five years (2012-2016 inclusive). Of the 190 patients, 162 were male with a median age of 31 (IQR 25 -39) years. Assault was the most common mechanism of injury (125/190, 66%). Minor ophthalmic injuries (those unlikely to cause permanent visual disturbance) and major ophthalmic injuries (those with the potential to cause permanent visual disturbance) were recorded. The common minor ophthalmic injuries were: diplopia, enophthalmos, proptosis, subconjunctival haemorrhage, and restriction of the extraocular muscles. Commotio retinae, traumatic mydriasis, retro-orbital haemorrhage, and hyphaema were the common major ophthalmic injuries. All 13 different major ophthalmic injuries were recorded in the group who had had orbital fractures reconstructed, which suggested that more intraocular damage can be caused by this type of fracture than by others. Visual acuity was reduced in 26/190 patients with only four having persistent postoperative changes at six weeks. The odds ratio for those patients who had a major ophthalmological injury and were unable to drive was 0.07 (95% CI 0.02 to 0.21, p=0.001), which was highly significant. Ophthalmological assessment is strongly recommended for patients with fractures of the orbitozygomaticomaxillary complex.
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Affiliation(s)
- Nigel R Johnson
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.
| | - Navin R Singh
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Mehmet Oztel
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Venkat N Vangaveti
- James Cook University, College of Medicine and Dentistry, Townsville, Queensland, Australia
| | - Benjamin B Rahmel
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Lakshmi Ramalingam
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia
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