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Meisgeier A, Pienkohs S, Moosdorf L, Neff A. Impact of the COVID-19 pandemic on maxillofacial trauma surgery in Germany - implications from the national DRG database. Oral Maxillofac Surg 2024; 28:1241-1250. [PMID: 38600413 PMCID: PMC11330376 DOI: 10.1007/s10006-024-01248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The COVID-19 pandemic has affected the personal and social lives of millions of people and also impacted the etiological factors of midfacial trauma such as falls, interpersonal violence or traffic accidents. The aim of this study was to analyze the influence of the COVID-19 pandemic on maxillofacial trauma surgery in the German healthcare system. METHODS Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system used in all German hospitals was received from the German Federal Statistical Office. Various trauma-associated procedures of the Operation and Procedure Classification System (OPS), a German modification of the International Classification of Medical Procedures (ICPM), were statistically associated with different epidemiological factors between 2012 and 2021. RESULTS A statistically significant decrease (p < 0.05) in surgeries regarding maxillofacial fractures was registered during the years 2020 and 2021. Young male patients had the largest decline in maxillofacial trauma surgeries during this period (p < 0.05). In contrast. elderly patients 80 years and older showed a dramatic increase in the frequency of fractures in both the midface and the mandible (p < 0.05). CONCLUSIONS During the COVID 19 pandemic there has been a shift in the number, composition and etiology of maxillofacial fracture surgeries. Measures of social distancing and personal risk avoidance had a societal positive effect on the frequency of facial injuries. This stands in contrast to the drastic increase in fractures of elderly people who should be protected primarily by the measures taken. These results can help to understand these influences better in future pandemics. TRIAL REGISTRATION German Clinical Trials Register No: DRKS00032778.
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Affiliation(s)
- Axel Meisgeier
- Department of Oral and Craniomaxillofacial Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, 35043, Marburg, Germany.
| | - Simon Pienkohs
- Department of Oral and Craniomaxillofacial Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, 35043, Marburg, Germany
| | - Laura Moosdorf
- Center for Orthopaedics and Trauma Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, Marburg, Germany
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, Faculty of Medicine, UKGM GmbH, University Hospital Marburg, Philipps University, 35043, Marburg, Germany
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Wang X, Kang Y, Zhang Y, An J, Chen S, He Y. Recovery of the Infraorbital Nerve Following Open Reduction and Fixation Surgery of Zygomaticomaxillary Complex Fractures-A Prospective Cohort Study Based on Quantitative Sensory Testing. J Craniofac Surg 2024:00001665-990000000-01787. [PMID: 39105680 DOI: 10.1097/scs.0000000000010481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/19/2024] [Indexed: 08/07/2024] Open
Abstract
This study aimed to assess the sensory function of the infraorbital nerve in patients with fractures of the zygomatic complex who underwent open reduction and internal fixation at different time points using quantitative sensory testing, which was established by the German Neuropathic Pain Research Network, comprising a 7-item mechanical and thermal sensory test. A total of 21 patients (age range 17-46 y, 14 males) with unilateral zygomatic complex fractures were included. Quantitative sensory testing was conducted before the operation and at 1 week, 3 months, and 6 months operatively, with cold detection threshold, warmth detection threshold, cold pain threshold, heat pain threshold, mechanical detection threshold, mechanical pain threshold, pressure pain threshold, and vibration detection threshold being measured in bilateral infraorbital regions. Notable changes in sensitivity were observed in all values except for the mechanical pain threshold. In the majority of patients with zygomaticomaxillary complex fractures, infraorbital hypoesthesia was significantly improved within 3 months postoperatively, and almost complete recovery could be achieved by 6 months postoperatively.
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Affiliation(s)
- Xiyue Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology
| | - Yanfeng Kang
- Department of Prosthodontics Center for Oral Functional Diagnosis, Treatment and Research, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology
| | - Jingang An
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology
| | - Shuo Chen
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology
| | - Yang He
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology
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Meisgeier A, Pienkohs S, Dürrschnabel F, Moosdorf L, Neff A. Epidemiologic Trends in Maxillofacial Trauma Surgery in Germany-Insights from the National DRG Database 2005-2022. J Clin Med 2024; 13:4438. [PMID: 39124705 PMCID: PMC11313596 DOI: 10.3390/jcm13154438] [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: 07/03/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Maxillofacial trauma (MFT) caused by falls, interpersonal violence or traffic accidents leading to fractures of different facial regions, including the midface and the mandible, are common clinical conditions requiring open reduction and internal fixation. The aim of this study was to analyze the incidence and time trends in MFT-associated surgeries regarding different facial regions in the German healthcare system over time. Materials and methods: Nationwide data regarding the national diagnosis-related group (DRG) inpatient billing system was received from the German Federal Statistical Office for the years 2005-2022. We estimated the age-gender standardized incidence of MFT-associated procedures classified by the Operation and Procedure Classification System (OPS) and evaluated age- and gender-adjusted time trends using Poisson regression analysis. Results: The total standardized incidence rate of MFT-associated procedures in the observational period 2005-2022 was 25.1 (♀13.3; ♂37.5) per 100,000 person-years within a slight significant annual decrease of 0.5%. A significant increase in the incidence of MFT-related procedures within the observational period was found in older adults from 60 to 79 years (+55.1%; ♀+54.8%; ♂+56.3%) and elderly patients over 80 years (+66.7%; ♀+59.1%; ♂+85.1%). Other significant trends are decreases in MFT-related procedures performed in children from 0-14 years (-28.1%; ♀-30.3%; ♂-27.3%) and young adults between 15 and 35 years (-20.4%; ♀-7.3%; ♂-22.5%). Conclusions: MFT-associated surgery is a persisting challenge in the German healthcare system. There is an ongoing transition in MFT-associated surgeries from younger to older patients beyond the scope of demographic change, highlighting the increasing importance of interdisciplinary treatment of patients with pre-existing conditions in maxillofacial surgery. Implementation of injury prevention measures might be beneficial in this population.
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Affiliation(s)
- Axel Meisgeier
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (S.P.); (F.D.); (A.N.)
| | - Simon Pienkohs
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (S.P.); (F.D.); (A.N.)
| | - Florian Dürrschnabel
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (S.P.); (F.D.); (A.N.)
| | - Laura Moosdorf
- Center for Orthopaedics and Trauma Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043 Marburg, Germany;
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043 Marburg, Germany; (S.P.); (F.D.); (A.N.)
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Dubron K, Yang LH, Jacobs R, Politis C, Willaert R, Shaheen E. Symmetry recovery in zygomaticomaxillary complex fractures compared to normal unfractured population: A new reliable 3D evaluation. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101857. [PMID: 38556166 DOI: 10.1016/j.jormas.2024.101857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE This study aims to quantify the facial symmetry of surgically treated zygomaticomaxillary complex (ZMC) fractures through a new reliable three-dimensional evaluation method, which is crucial for improving post-operative aesthetic and functional outcomes. MATERIAL AND METHODS Healthy patients and patients with surgically treated ZMC fractures were retrospectively reviewed. Using Brainlab Elements® the zygomatic bone and the orbit of each patient was segmented and mirrored. Subsequently, the mirrored side was matched with the other side via volume-based registration, using the segmented orbit as reference. Volumetric asymmetry was measured using 3-matic software, and a surface-based matching technique was used to calculate the mean absolute differences (MAD) between the surfaces of the two sides of the ZMC. The reliability of this novel method using volume-based registration was tested, and the intra-class correlation coefficient was assessed. RESULTS The MAD between the surfaces of the left and right sides in the control group was 0.51 mm (±0.09). As for the ZMC fracture group, MAD was 0.78 mm (±0.20) and 0.72 mm (±0.15) pre- and post-operatively, respectively. The MAD showed statistically significant differences between pre- and post-operative groups (p = 0.005) and between control and post-operative groups (p < 0.001). The intra-class correlation coefficient was high (≥0.99). CONCLUSIONS This evaluation method using mirroring and volume-based registration to determine the symmetrical position of the ZMC is reliable. The surface-based measurements revealed an improved symmetry after surgery. However, the symmetry of the treated patients remained lower than the control group.
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Affiliation(s)
- K Dubron
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
| | - L H Yang
- Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals Leuven, Belgium
| | - R Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - C Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
| | - R Willaert
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
| | - E Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Belgium
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Ates O, Gocmen G, Kiv MC. Closed Reduction of an Isolated Zygomatic Arch Fracture Under Local Anesthesia: A Case Report. Cureus 2024; 16:e60987. [PMID: 38910678 PMCID: PMC11193938 DOI: 10.7759/cureus.60987] [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] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
The zygomatic bone is one of the most prominent bones in the facial region. It forms the most anterolateral projection on each side of the middle face and is articulated with the maxilla, frontal, and temporal bones. Isolated zygomatic arch fractures can occur when a direct force is applied to the zygoma. A variety of intraoral and extraoral techniques have been used as closed reduction techniques for isolated fractures of the zygomatic arch. In this case report, we aim to present our approach for the treatment of a 40-year-old patient with an isolated right zygomatic arch fracture. We used the Keen technique for the closed reduction of the fracture under local anesthesia due to its practicality and effectiveness.
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Affiliation(s)
- Ozan Ates
- Oral and Maxillofacial Surgery, Marmara University, Istanbul, TUR
| | - Gokhan Gocmen
- Oral and Maxillofacial Surgery, Marmara University, Istanbul, TUR
| | - Metin C Kiv
- Oral and Maxillofacial Surgery, Marmara University, Istanbul, TUR
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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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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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Shabbir M, Shah R, Ahmad M, Issrani R, Khan Z, Nazal Alotha S, Mousa Alsiyat B, Alqarni MS, Albalawi AS, Prabhu N, Alam MK, Qayyum Z. Frequency of Diplopia in Zygomatic Complex Fractures-A Cross-Sectional Descriptive Study. Int J Dent 2023; 2023:7631634. [PMID: 38021347 PMCID: PMC10651328 DOI: 10.1155/2023/7631634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/11/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background The zygomatic complex is the second most common fracture of the facial bones after the nasal bone. The prominent convex shape of the zygoma makes it vulnerable to traumatic injury. Diplopia is one of the serious complications of zygomatic complex fracture and is a common subjective complaint. Objective To determine the frequency of diplopia in zygomatic complex fractures. Methodology. A cross-sectional descriptive study was conducted at the Oral and Maxillofacial Surgery Ward, Civil Hospital, Karachi, Pakistan. The duration of the study was 1 year (March 1, 2021 to February 28, 2022). A total of 126 patients having zygomatic complex fractures were included in this study. After recording the patient's complete history, like demographic details and cause for fracture, diplopia was examined clinically. If, during the examination, the patient complained of double vision, this was labeled as diplopia positive (Yes) and negative (No) if the patient did not have any such complain. Data were statistically analyzed. Results The mean (±SD) age of patients was 33.42 (±9.27), with 91 (72.2%) male patients and 35 (27.8%) female patients. The frequency of diplopia in zygomatic complex fractures was observed in 52 (41.3%) patients. The rate of diplopia was significantly high in patients aged between 31 and 40 years (P-value=0.0005). Conclusion The frequency of diplopia among patients having zygomatic complex fractures was high in this study. Thus, forming a strategy to properly diagnose and treat it and to prevent persistent morbidity to improve patient's quality of life is recommended.
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Affiliation(s)
- Maria Shabbir
- Department of Oral & Maxillofacial Surgery, Shaheed Muhtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan
| | - Ruqaya Shah
- Department of Oral & Maxillofacial Surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Muhtada Ahmad
- Department of Oral & Maxillofacial Surgery, Dow Dental College, Dow University of Health Sciences, Karachi, Pakistan
| | - Rakhi Issrani
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| | - Zafar Khan
- Frontier Medical and Dental College, Abbottabad, Pakistan
| | | | | | - Mohammed Saad Alqarni
- Department of Oral & Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| | | | - Namdeo Prabhu
- Department of Oral & Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| | - Mohammad Khursheed Alam
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
- Department of Dental Research Cell, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, India
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | - Zahid Qayyum
- Department of Oral & Maxillofacial Surgery, Khyber Girls Medical College, Hayatabad Medical Complex, Peshawar, Pakistan
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Shome D, Surana M, Male SR, Kumar V, Vyavahare SS, Abrol A, Kapoor R. Patterns and Trends of Facial Fractures at a Tertiary Care Trauma Center in India - A 13 years Retrospective Study. Craniomaxillofac Trauma Reconstr 2023; 16:112-120. [PMID: 37222983 PMCID: PMC10201195 DOI: 10.1177/19433875221084172] [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: 09/20/2023] Open
Abstract
Study Design Retrospective study. Objective The purpose of this study was to retrospectively analyze the prevalence, pattern, diagnosis, and treatment of the facial fractures falling under ambit of facial plastic surgery in a multi-specialty hospital at India from the year 2006-2019. Methods This retrospective study analyzed 1508 patients, having orbital fractures (from 2006 to 2019) for demographic data, cause of trauma, type of fracture, and the treatment given. The data were compiled in excel and analyzed by using SPSS version 21.0. Results Out of these 1508 patient (1127 (74.73%)-males and 381 (25.27%)-females), the etiology of injuries was Road traffic accident (RTA) (49.20%), assault (26.52%), and sports injuries (11.47%). The most common fracture pattern was Isolated Orbit and/or Orbital Floor fracture in 451 patients (32.08%), followed by Mid-facial fractures (21.93%). Also, 105 patients (6.96%) experienced ocular/retinal trauma along with other fractures. Conclusions Orbit, peri-ocular, and mid-face trauma comprised a large position of this study. It requires a great deal of expertise to treat such complex trauma, which is not covered in one specialty alone. Hence, a holistic approach of craniofacial fracture management, rather than limiting these skills to water-tight craniofacial compartments becomes necessary. The study highlights the critical need of multidisciplinary approach for predictable and successful management of such complex cases.
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Affiliation(s)
- Debraj Shome
- Department of Facial Plastic
Surgery & Facial Cosmetic Surgery & Director, The Esthetic Clinics, India
| | - Monika Surana
- Fellow, Facial Plastic Surgery
& Facial Cosmetic Surgery, The Esthetic Clinics, India
| | - Shiva Ram Male
- PhD research scholar, Optometry and
vision sciences, School of Medical sciences, University of Hyderabad, India
| | - Vaibhav Kumar
- Clinical Research Coordinator, The Esthetic Clinics, India
| | - Supriya S. Vyavahare
- Faculty, Late Shri Yashwantrao Chavan Memorial
Medical & Rural Development Foundation’s Dental
College, Ahmednagar, India
| | - Arundha Abrol
- Fellow, Dermatology, Cosmetic
Dermatology & Dermato-Surgery, The Esthetic Clinics, India
| | - Rinky Kapoor
- Department of Dermatology, Cosmetic
Dermatology & Dermato-Surgery & Director, The Esthetic Clinics, India
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10
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Reddy SK, Colakoglu S, Yoon JS, Bhoopalam M, Merbs SL, Manson PN, Grant MP. Treatment of Persistent Post-traumatic Diplopia - An Algorithmic Approach to Patient Stratification and Operative Management. Craniomaxillofac Trauma Reconstr 2023; 16:89-93. [PMID: 37222975 PMCID: PMC10201187 DOI: 10.1177/19433875221083084] [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: 09/20/2023] Open
Abstract
Study Design Retrospective chart review of revisional orbital surgery outcomes in patients with diplopia from prior operative treatment of orbital trauma. Objective Our study seeks to review our experience with management of persistent post-traumatic diplopia in patients with previous orbital reconstruction and present a novel patient stratification algorithm predictive of improved outcomes. Methods A retrospective chart review was performed on adult patients at Wilmer Eye Institute at Johns Hopkins Hospital and at the University of Maryland Medical Center who underwent revisional orbital surgery for correction of diplopia for the years 2005-2020. Restrictive strabismus was determined by Lancaster red-green testing coupled with computed tomography and/or forced duction. Globe position was assessed by computed tomography. Seventeen patients requiring operative intervention according to study criteria were identified. Results Globe malposition affected fourteen patients and restrictive strabismus affected eleven patients. In this select group, improvement in diplopia occurred in 85.7% of cases with globe malposition and in 90.1% of cases with restrictive strabismus. One patient underwent additional strabismus surgery subsequent to orbital repair. Conclusions Post-traumatic diplopia in patients with prior orbital reconstruction can be successfully managed in appropriate patients with a high degree of success. Indications for surgical management include (1) globe malposition and (2) restrictive strabismus. High resolution computer tomography and Lancaster red-green testing discriminate these from other causes that are unlikely to benefit from orbital surgery.
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Affiliation(s)
- Sashank K. Reddy
- Department of Plastic and
Reconstructive Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Biomedical
Engineering, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Salih Colakoglu
- Department of Plastic and
Reconstructive Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Joshua S. Yoon
- Department of Plastic,
Reconstructive, and Maxillofacial Surgery, R. Adams Cowley Shock Trauma
Center, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Myan Bhoopalam
- Department of Plastic and
Reconstructive Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Shannath L. Merbs
- Department of Ophthalmology, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Paul N. Manson
- Department of Plastic and
Reconstructive Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Michael P. Grant
- Department of Plastic,
Reconstructive, and Maxillofacial Surgery, R. Adams Cowley Shock Trauma
Center, University of Maryland School of
Medicine, Baltimore, MD, USA
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11
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Wilkat M, Karnatz N, Schrader F, Schorn L, Lommen J, Parviz A, Möllmann HL, Rana M. Usage of Object Matching Algorithms Combined with Mixed Reality for Enhanced Decision Making in Orbital Reconstruction-A Technical Note. J Pers Med 2023; 13:922. [PMID: 37373911 DOI: 10.3390/jpm13060922] [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] [Received: 04/28/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
This technical note describes the usage of object matching to virtually compare different modes of reconstruction in orbital trauma and display the results to the surgeon and the patient pre-operatively via mixed reality devices for enhanced surgical decision making and immersive patient education. A case of an orbital floor fracture is presented for which surface and volume matching were implemented to compare orbital reconstruction utilizing pre-fabricated titanium meshes versus patient-specific implants. The results could be visualized by mixed reality devices to further enhance surgical decision-making. The data sets were demonstrated to the patient in mixed reality for immersive patient education and enhanced shared decision making. The advantages of the new technologies are discussed in view of the new possibilities of improved patient education and informed consent processes, as well as new ways of teaching medical trainees.
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Affiliation(s)
- Max Wilkat
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Nadia Karnatz
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Felix Schrader
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Lara Schorn
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Julian Lommen
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Aida Parviz
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Henriette Louise Möllmann
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Majeed Rana
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
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12
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Palavalli MH, Huayllani MT, Gokun Y, Lu Y, Janis JE. Surgical Approaches to Orbital Fractures: A Practical and Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4967. [PMID: 37197012 PMCID: PMC10185000 DOI: 10.1097/gox.0000000000004967] [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: 10/06/2022] [Accepted: 03/03/2023] [Indexed: 05/19/2023]
Abstract
Orbital fractures constitute a significant percentage of all midface injuries. Here, we present a contemporary evidence-based review of the major surgical approaches for orbital wall fractures and analyze the literature to compare all major surgical procedures and their complication rates. Method A systematic review was conducted to compare surgical approaches (subciliary, transcaruncular, transconjunctival, subtarsal, and endoscopic) and postoperative complications in patients who underwent surgical fixation of orbital wall fractures. A database search in PubMed (PubMed Central, MEDLINE and Bookshelf) was performed for all articles containing the terms "orbital," "wall," "fracture," and "surgery" with different combinations. Results A total of 950 articles were obtained and 25 articles were included, representing an analysis of 1137 fractures. The most frequent surgical approach was the endoscopic (33.3%) followed by the external surgical approaches, specifically transconjunctival (32.8%), subciliary (13.5%), subtarsal (11.5%), and transcaruncular (8.9%). The transconjunctival approach had a statistically significantly higher rate of complications (36.19%), followed by the subciliary (21.4%), and endoscopic approach (20.2%, P < 0.0001). The subtarsal approach had a statistically significantly lower rate of complications (8.2%) followed by the transcaruncular approach (14.0%, P < 0.0001). Conclusion The subtarsal and transcaruncular approaches were observed to have the lowest rates of complications, whereas the transconjunctival, subciliary, and endoscopic approaches were reported to have higher rates of complications.
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Affiliation(s)
| | | | - Yevgeniya Gokun
- From the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yurong Lu
- From the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey E. Janis
- From the Ohio State University Wexner Medical Center, Columbus, Ohio
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13
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Lin YC, Yim CK, Wu AY, Hwang DK. Orbital floor fractures in Taiwan: A 10-year nationwide population-based study. Taiwan J Ophthalmol 2023; 13:203-209. [PMID: 37484620 PMCID: PMC10361428 DOI: 10.4103/tjo.tjo-d-23-00005] [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: 01/16/2023] [Accepted: 03/13/2023] [Indexed: 07/25/2023] Open
Abstract
PURPOSE To characterize the epidemiology, associated complications, and risk factors of orbital floor fractures in a nationwide longitudinal health insurance database. MATERIALS AND METHODS Claims data from a million randomly selected registered residents from the Taiwan National Health Insurance Research Database were analyzed between 2001 and 2011 as part of a retrospective cohort review. Patients were identified using the International Classification of Disease-9 diagnosis codes for orbital floor fracture (closed: 802.6; open: 802.7). The cases were categorized as surgical or nonsurgical based on the procedure codes and compared statistically. RESULTS From 2001 to 2011, 663 patients were diagnosed with orbital floor fractures out of a total population at risk of 9,836,431 person-years (average incidence: 6.78 persons/100,000/year) with overall increasing incidence. Surgical treatments were performed in 213 (32%) patients. Patients who received surgical treatment were younger than those who did not (mean age 25.3 ± 13.6 years vs. 34.2 ± 18.6 years, P < 0.001). The diagnosis with diplopia was a significantly associated factor for surgical treatment (2.2% in nonsurgery group vs. 6.6% in surgery group, P = 0.007). Male gender (adjusted hazard ratios [aHR] = 2.1, 95% confidence interval [CI]: 1.79-2.49) and low monthly income (aHR = 1.76, 95% CI: 1.16-2.67) were the risk factors for orbital floor fracture. CONCLUSION The incidence of orbital floor fractures increased in the Taiwanese population between 2001 and 2011. Men and low income patients were at increased risk of orbital floor fracture. More research is necessary to clarify what factors are driving the escalating incidence of orbital fractures in this national population.
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Affiliation(s)
- Yu-Ching Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cindi K. Yim
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, Eye and Ear Infirmary, Eye and Vision Research Institute, New York, USA
| | - Albert Y. Wu
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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14
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Taxis J, Ungerboeck L, Gehrking MR, Motel C, Wurm M, Eckert AW, Spanier G, Nieberle F, Platz Batista da Silva N, Ludwig N, Meier JK, Ettl T, Reichert TE, Spoerl S. Two-Dimensional Post-Traumatic Measurements of Orbital Floor Blowout Fractures Underestimate Defect Sizes Compared to Three-Dimensional Approaches. Tomography 2023; 9:579-588. [PMID: 36961006 PMCID: PMC10037578 DOI: 10.3390/tomography9020047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Orbital floor fractures represent a common fracture type of the midface and are standardly diagnosed clinically as well as radiologically using linear measurement methods. The aim of this study was to evaluate the accuracy of diagnostic measurements of isolated orbital floor fractures based on two-dimensional (2D) and three-dimensional (3D) measurement techniques. A cohort of 177 patients was retrospectively and multi-centrically evaluated after surgical treatment of an orbital floor fracture between 2010 and 2020. In addition to 2D and 3D measurements of the fracture area, further fracture-related parameters were investigated. Calculated fracture areas using the 2D measurement technique revealed an average area of 287.59 mm2, whereas the 3D measurement showed fracture areas with a significantly larger average value of 374.16 mm2 (p < 0.001). On average, the 3D measurements were 1.53-fold larger compared to the 2D measurements. This was observed in 145 patients, whereas only 32 patients showed smaller values in the 3D-based approach. However, the process duration of the 3D measurement took approximately twice as long as the 2D-based procedure. Nonetheless, 3D-based measurement of orbital floor defects provides a more accurate estimation of the fracture area than the 2D-based procedure and can be helpful in determining the indication and planning the surgical procedure.
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Affiliation(s)
- Juergen Taxis
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Lena Ungerboeck
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Mika R Gehrking
- Department of Cranio- and Maxillofacial Surgery, Paracelsus Medical University Nuremberg, Breslauer Straße 201, 90471 Nuremberg, Germany
| | - Constantin Motel
- Department of Cranio- and Maxillofacial Surgery, Paracelsus Medical University Nuremberg, Breslauer Straße 201, 90471 Nuremberg, Germany
| | - Matthias Wurm
- Department of Cranio- and Maxillofacial Surgery, Paracelsus Medical University Nuremberg, Breslauer Straße 201, 90471 Nuremberg, Germany
| | - Alexander W Eckert
- Department of Cranio- and Maxillofacial Surgery, Paracelsus Medical University Nuremberg, Breslauer Straße 201, 90471 Nuremberg, Germany
| | - Gerrit Spanier
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Felix Nieberle
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | | | - Nils Ludwig
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Johannes K Meier
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Tobias Ettl
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Torsten E Reichert
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Steffen Spoerl
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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15
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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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16
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Committeri U, Arena A, Carraturo E, Austoni M, Germano C, Salzano G, De Riu G, Giovacchini F, Maglitto F, Abbate V, Bonavolontà P, Califano L, Piombino P. 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; 12:845. [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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Affiliation(s)
- Umberto Committeri
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Antonio Arena
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Emanuele Carraturo
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Martina Austoni
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Cristiana Germano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Giovanni Salzano
- Otolaryngology and Maxillo-Facial Surgery Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, 07100 Sassari, Italy
| | - Francesco Giovacchini
- Maxillofacial Surgery Unit, Santa Maria Della Misericordia Hospital, San Sisto, 06121 Perugia, Italy
| | - Fabio Maglitto
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Paola Bonavolontà
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Pasquale Piombino
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
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17
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Decline in Maxillofacial Injuries during the Pandemic: The Hidden Face of COVID-19. J Clin Med 2022; 12:jcm12010128. [PMID: 36614929 PMCID: PMC9821158 DOI: 10.3390/jcm12010128] [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: 11/08/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Maxillofacial injuries result from a variety of daily activities. Traffic accidents, interpersonal violence, and falls represent some of the most common etiological factors behind maxillofacial fractures. During the COVID-19 outbreak, the social distancing measures imposed by healthcare authorities aimed at abolishing the spread of the viral infection. This study aimed to evaluate the effect of social distancing measures on the incidence of maxillofacial injuries. METHODS Data were retrieved from the medical file registry at the Galilee Medical Center, Nahariya, Israel. Incidence, gender, age, etiology, and cost of hospitalization during the COVID-19 lockdown and the previous periods were retrieved. RESULTS A decrease in maxillofacial fractures was registered during the 2020 lockdown; younger patients had the largest share of maxillofacial traumas during this period. The midface was the most involved facial region in both periods, and a reduction of 62.3% in the cost of OMF fracture treatment was observed during the COVID-19 era. CONCLUSIONS The occurrence, etiology, and cost of treatment of maxillofacial injuries during the COVID-19 period were different from those in the corresponding period in the pre-COVID-19 era. These results can provide a guide to help design programs for the prevention of OMF trauma.
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18
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Piombino P, Troise S, Maglitto F, Barone S, Sani L, Committeri U, Norino G, Bonavolontà P, Salzano G, Vaira LA, De Riu G, Califano L. Management of Orbital Floor Fractures: Our Experience in 10 Years. Indian J Otolaryngol Head Neck Surg 2022; 74:547-554. [PMID: 36514430 PMCID: PMC9741679 DOI: 10.1007/s12070-022-03127-9] [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: 12/26/2021] [Accepted: 07/10/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Orbital floor Fractures are the most common fractures involving the facial skeleton and usually occurs after traumatic events. The reconstruction of the orbital floor can be performed with different biocompatible materials. The aim of our retrospective study is to analyze the short- and long-term outcomes of surgically treated patients based on the material used to repair the orbital floor. Methods We enrolled 146 patients hospitalized for orbital floor fractures in the Maxillofacial Surgery Unit of the Federico II University of Naples from 1 to 2010 to July 2020. All the fractured orbital floors were reconstructed with non-resorbable (Titanium Mesh, SynPor, SuPor and MedPor implants) or resorbable (collagen membrane, bovinum pericardium membrane, autologous bone graft) materials. Results We utilized non-resorbable materials in 56% (82 cases) and resorbable implants in 44% (64 cases). An improvement of the preoperative symptomatology and an aesthetical good outcome was achieved in most cases. Conclusions Data obtained supports that both resorbable and non-resorbable materials for orbital floor reconstruction are a safe and effective alternatives and offer satisfactory results in functional and aesthetic evaluations.
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Affiliation(s)
- Pasquale Piombino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Stefania Troise
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Fabio Maglitto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Simona Barone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Lorenzo Sani
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Umberto Committeri
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Giovanna Norino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Paola Bonavolontà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Giovanni Salzano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Sassari, Italy
| | - Luigi Califano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
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19
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Eng JF, Younes S, Crovetti BR, Williams KJ, Haskins AD, Hernandez DJ, Yen MT, Olson KL, Allen RC, Sivam SK. Characteristics of Orbital Injuries Associated with Maxillofacial Trauma. Laryngoscope 2022. [DOI: 10.1002/lary.30477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Affiliation(s)
- James F. Eng
- Department of Otolaryngology—Head and Neck Surgery Baylor College of Medicine Houston Texas USA
| | - Sami Younes
- School of Medicine Baylor College of Medicine Houston Texas USA
| | | | - Katherine J. Williams
- Department of Ophthalmology Cullen Eye Institute, Baylor College of Medicine Houston Texas USA
| | - Angela D. Haskins
- Department of Otolaryngology—Head and Neck Surgery Baylor College of Medicine Houston Texas USA
| | - David J. Hernandez
- Department of Otolaryngology—Head and Neck Surgery Baylor College of Medicine Houston Texas USA
| | - Michael T. Yen
- Department of Ophthalmology Cullen Eye Institute, Baylor College of Medicine Houston Texas USA
| | - Krista L. Olson
- Department of Otolaryngology—Head and Neck Surgery Baylor College of Medicine Houston Texas USA
| | - Richard C. Allen
- Department of Ophthalmology Cullen Eye Institute, Baylor College of Medicine Houston Texas USA
| | - Sunthosh K. Sivam
- Department of Otolaryngology—Head and Neck Surgery Baylor College of Medicine Houston Texas USA
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20
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Kim EJ, Ganga A, Kang C, Elnemer W, Lee JY, Ronquillo YC, Hoopes PC, Moshirfar M. Motorcycle-Associated Ocular Injuries: A Narrative Review. Clin Ophthalmol 2022; 16:3457-3479. [PMID: 36267681 PMCID: PMC9576601 DOI: 10.2147/opth.s387034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Motorcycle-related injuries involving the eye and orbit are not well characterized, with a paucity of prospective studies focusing specifically on motorcycle-associated eye injuries nor literature reviews having been conducted on the subject. To better understand the injury types and descriptive characteristics of patients experiencing motorcycle-associated eye injuries, we sought to conduct a narrative review. Methods The research team utilized the following databases: PubMed, EMBASE, and Web of Science to query for English articles from peer-reviewed journals that provided some patient data regarding eye injury due to motorcycle or moped accidents or usage. Results A total of 65 studies were included in our qualitative synthesis. Of these studies, 40 (61.5%) were case reports, 20 retrospective case series (30.8%), and five (7.69%) were observational prospective studies. Among the 25 retrospective and prospective studies, 12 (48.0%) of these studies primarily focused on motorcycle-associated injuries. These 65 studies described a wide variety of motorcycle-associated eye injuries, including but not limited to orbital fractures and associated sequelae, foreign bodies, vitreoretinal trauma, neuro-ophthalmic trauma, corneal injuries, open globe injuries, lacerations, and globe avulsions. Conclusion The current state of the literature indicates that knowledge regarding the ocular manifestations of motorcycle accidents is limited to mostly case reports and few retrospective cohort studies focused specifically on motorcycle-associated eye injuries. However, it is evident that the types of motorcycle-associated eye injuries are legion and predominantly seen in adult males, potentially leading to severe injuries and loss of vision and blindness.
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Affiliation(s)
- Eric J Kim
- Division of Ophthalmology, Warren Alpert Medical School at Brown University, Providence, RI, USA,Correspondence: Eric J Kim, Division of Ophthalmology, Warren Alpert Medical School at Brown University, Providence, RI, USA, Tel +1 978-289-0659, Email
| | - Arjun Ganga
- Division of Ophthalmology, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Chaerim Kang
- Program in Liberal Medical Education, Brown University, Providence, RI, USA
| | | | | | | | | | - Majid Moshirfar
- Hoopes Vision Research Center, Draper, UT, USA,John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA,Utah Lions Eye Bank, Murray, UT, USA
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21
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Wang H, Chi Y, Huang H, Su S, Xue H, Hou J. Combined use of 3D printing and computer-assisted navigation in the clinical treatment of multiple maxillofacial fractures. Asian J Surg 2022:S1015-9584(22)01374-4. [DOI: 10.1016/j.asjsur.2022.09.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022] Open
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22
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Spalthoff S, Oetzel F, Dupke C, Zeller AN, Jehn P, Gellrich NC, Korn P. Quantitative analysis of soft tissue sagging after lateral midface fractures: A 10-year retrospective study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e619-e625. [PMID: 35202862 DOI: 10.1016/j.jormas.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lateral midface fractures occasionally require open reduction and internal fixation to restore function and facial symmetry. However, some patients retain facial asymmetry despite undergoing surgery due to hard tissue displacement or soft tissue sagging. This study aimed to determine the influence of soft tissue sagging on the postoperative facial symmetry. METHODS We examined the medical records of 590 patients who underwent planned plate removal after lateral midface or zygomatic bone fractures. After applying the inclusion and exclusion criteria, we analyzed 106 cases of lateral midface fractures for hard tissue displacement and soft tissue sagging using pre- and postoperative radiological imaging and postoperative face scanning. RESULTS We observed significantly larger soft tissue sagging (p < 0.001) and hard tissue displacement (p = 0.006) on the fractured side than on the non-fractured side. There was no correlation between differences in the soft tissue sagging and those in the hard tissue displacement (|rho|=0). Linear regression analysis showed no statistical influence of sex or age group on the soft tissue sagging and hard tissue displacement. CONCLUSION Therefore, we recommend treating soft tissue sagging as a discrete aspect of midfacial fracture treatment to achieve optimal postoperative facial symmetry. From a clinical perspective, we recommend better soft tissue management during open fracture treatment than focusing mainly on the reduction of bony hard tissues.
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Affiliation(s)
- S Spalthoff
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany.
| | - F Oetzel
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | - C Dupke
- Department of Biometry and Environmental System Analysis, University of Freiburg, Tennenbacher Straße 4, 79106 Freiburg, Germany
| | - A-N Zeller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | - P Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | - N-C Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | - P Korn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
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Personalized Medicine Workflow in Post-Traumatic Orbital Reconstruction. J Pers Med 2022; 12:jpm12091366. [PMID: 36143151 PMCID: PMC9500769 DOI: 10.3390/jpm12091366] [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: 07/04/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Restoration of the orbit is the first and most predictable step in the surgical treatment of orbital fractures. Orbital reconstruction is keyhole surgery performed in a confined space. A technology-supported workflow called computer-assisted surgery (CAS) has become the standard for complex orbital traumatology in many hospitals. CAS technology has catalyzed the incorporation of personalized medicine in orbital reconstruction. The complete workflow consists of diagnostics, planning, surgery and evaluation. Advanced diagnostics and virtual surgical planning are techniques utilized in the preoperative phase to optimally prepare for surgery and adapt the treatment to the patient. Further personalization of the treatment is possible if reconstruction is performed with a patient-specific implant and several design options are available to tailor the implant to individual needs. Intraoperatively, visual appraisal is used to assess the obtained implant position. Surgical navigation, intraoperative imaging, and specific PSI design options are able to enhance feedback in the CAS workflow. Evaluation of the surgical result can be performed both qualitatively and quantitatively. Throughout the entire workflow, the concepts of CAS and personalized medicine are intertwined. A combination of the techniques may be applied in order to achieve the most optimal clinical outcome. The goal of this article is to provide a complete overview of the workflow for post-traumatic orbital reconstruction, with an in-depth description of the available personalization and CAS options.
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Lakshmi R, Chitra A, Singh A, Pentapati KC, Gadicherla S. Neurosensory Assessment of Infraorbital Nerve Injury Following Unilateral Zygomaticomaxillary Complex Fracture – A Prospective Study. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2206140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
This study aimed to assess the difference in the recovery pattern of branches of infraorbital nerve paraesthesia after zygomaticomaxillary complex (ZMC) fracture in both surgically and non-surgically managed patients.
Materials & Methods:
A prospective, observational study involving 31 patients with unilateral ZMC fracture - 15 in the surgical group (Group A) and 16 in the non-surgical group (Group B) was evaluated. These patients were assessed at the time of injury, 3-months follow-up, and 6-months follow-up for the sensory function of the infraorbital nerve. The assessment of paraesthesia by cotton wisp test, light touch monofilament test, and the cold thermal test was subjected to intra-group and inter-group correlation by McNemar test and Fischer's exact test. Repeated Measures ANOVA with post-hoc Bonferroni test for intra-group correlation and independent sample t-test for inter-group correlation were used for two-point discrimination.
Results:
A statistically significant improvement was noted on both 3 and 6 months follow-up in the malar region in group A. Other statistically significant improvements were noted only on 6 months follow-up in the infraorbital region in group A. On the 2-point discrimination test, all the facial regions showed significant improvement in both the groups over 3 months and 6 months of follow-up.
Conclusion:
There was a significant improvement in the infraorbital nerve sensory function following ZMC fracture over 6 months; however, the surgical intervention showed no statistical significance. Further, it can also be concluded that the inferior palpebral branch of the infraorbital nerve shows maximum functional disruption resulting in a higher incidence of paraesthesia in the infraorbital and malar region.
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Chu YY, Yang JR, Lai BR, Liao HT. Preliminary outcomes of the surgical navigation system combined with intraoperative three-dimensional C-arm computed tomography for zygomatico-orbital fracture reconstruction. Sci Rep 2022; 12:7893. [PMID: 35550552 PMCID: PMC9098405 DOI: 10.1038/s41598-022-11659-x] [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: 08/10/2021] [Accepted: 04/27/2022] [Indexed: 11/09/2022] Open
Abstract
This study analyzed the outcomes of zygomatico-orbital fracture reconstruction using the real-time navigation system with intraoperative three-dimensional (3D) C-arm computed tomography (CT). Fifteen patients with zygomatico-orbital or isolated orbital/zygoma fractures were enrolled in this prospective cohort. For zygoma reduction, the displacement at five key sutures and the differences between preoperative and intraoperative CT images were compared. For orbital reconstruction, the bilateral orbital volume differences in the anterior, middle, and posterior angles over the medial transitional buttress were measured. Two patients required implant adjustment once after the intraoperative 3D C-arm assessment. On comparing the preoperative and postoperative findings for the zygoma, the average sum of displacement was 19.48 (range, 5.1–34.65) vs. 1.96 (0–3.95) mm (P < 0.001) and the deviation index was 13.56 (10–24.35) vs. 2.44 (0.6–4.85) (P < 0.001). For the orbit, the mean preoperative to postoperative bilateral orbital volume difference was 3.93 (0.35–10.95) vs. 1.05 (0.12–3.61) mm3 (P < 0.001). The mean difference in the bilateral angles at the transition buttress was significantly decreased postoperatively at the middle and posterior one-third. There was no significant difference in orbital volume, angle of the transition zone, and the sum of five zygoma distances between post operative results and preoperative virtual planning. The surgical navigation system with the intraoperative 3D C-arm can effectively improve the accuracy of zygomatico-orbital fracture reconstruction and decrease implant adjustment times.
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Affiliation(s)
- Yu-Ying Chu
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fuxing Street, Taoyuan, 333, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Jia-Ruei Yang
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fuxing Street, Taoyuan, 333, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Bo-Ru Lai
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fuxing Street, Taoyuan, 333, Taiwan.,Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Han-Tsung Liao
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fuxing Street, Taoyuan, 333, Taiwan. .,Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan. .,Department of Plastic Surgery, Xiamen Chang Gung Hospital, Xiamen, 361000, China.
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Does Early Treatment of Paediatric Orbital Fracture Offer Any Advantage in Terms of Post-Operative Clinical Outcomes. J Maxillofac Oral Surg 2022; 21:25-33. [PMID: 35400913 PMCID: PMC8934817 DOI: 10.1007/s12663-021-01543-y] [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: 11/10/2020] [Accepted: 02/24/2021] [Indexed: 10/21/2022] Open
Abstract
Background Trapdoor fractures commonly occur in children below 6 years of age. The high resiliency of bone, pneumatisation of sinuses and other factors lead to entrapment of muscle and/or soft tissue which undergoes ischaemic changes leading to residual diplopia. The timing of intervention in children ranges from 24 h to greater than 2 weeks. Early surgical intervention is particularly indicated in cases of Oculocardiac reflex. Methods A Prisma guided systematic review of literature was conducted with no filters on language till September 2020. Studies on paediatric orbital fractures with data on timing of intervention and clinical outcomes were considered eligible for the review. The Oxford Level Of Evidence was used to assess the strength of individual studies. Results A total of 19 studies (18 English, 1 French) were selected; except for one study all were retrospective series. The timing of intervention ranged from 24 h to more than 1 month. Most of the studies agreed that orbital fractures in children should receive early intervention preferably within 2 weeks. In case of white-eyed blowout fracture, oculocardiac reflex and trapdoor fractures with muscle entrapment surgical intervention should be carried out within 24-48 h. Discussion Children presenting with facial injuries should be thoroughly examined for signs of muscle entrapment, diplopia, nausea, vomiting and bradycardia. If present these should receive early intervention. In cases with no signs of oculocardiac reflex and muscle entrapment a treatment within 2 weeks is recommended. If diplopia is mild or resolving with minimal hypoglobus and enophthalmos a wait and watch policy should be carried out.
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Canzi G, Corradi F, Novelli G, Bozzetti A, Sozzi D. "6 Anatomical Landmarks" Technique for Satisfactory Free-Hand Orbital Reconstruction With Standard Preformed Titanium Mesh. Craniomaxillofac Trauma Reconstr 2022; 15:51-57. [PMID: 35265278 PMCID: PMC8899354 DOI: 10.1177/19433875211007614] [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: 11/15/2022] Open
Abstract
Study Design Retrospective study. Objective Resolution of clinical signs and symptoms following orbital fractures depends on the accurate restoration of the orbital volume. Computer-Assisted procedures and Patient Specific Implants represent modern solutions, but they require additional resources. A more reproducible option is the use of standard preformed titanium meshes, widely available and cheaper; with their use quality of results is proportional to the accuracy with which they are positioned. This work identifies 6 reproducible and constant anatomical landmarks, as an intraoperative guide for the precise positioning of titanium preformed meshes. Methods 90 patients treated at the Maxillofacial Surgery Department, Niguarda Trauma Center, Milan, for unilateral orbital reconstruction (January 2012 to December 2018), were studied. In all cases reconstruction was performed respecting the 6 proposed anatomical landmarks. The outcomes analyzed are: post-operative CT adherence to the 6 anatomical markers and symmetry achieved respect to controlateral orbit; number/year of re-interventions and duration of surgery; resolution of clinical defects (at least 12-months follow-up); incidence of complications. Results Satisfactory results were obtained in terms of restoration of orbital size, shape and volume. Clinical defects early recovered with a low incidence of complications and re-interventions. Operating times and radiological accuracy have shown a progressive improvement during years of application of this technique. Conclusions The proposed "6 anatomical landmarks" is an easy free-hand technique that allows everyone to obtain high levels of reconstructive accuracy and it should be a skill of all surgeons who deal with orbital reconstruction in daily clinical activity.
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Affiliation(s)
- Gabriele Canzi
- Maxillofacial Surgery Unit, Emergency Department, ASST-GOM Niguarda, Niguarda Hospital, Milan, Italy,Gabriele Canzi, MD, Maxillofacial Surgery Unit, Emergency Department, ASST-GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
| | - Federica Corradi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giorgio Novelli
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Alberto Bozzetti
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Davide Sozzi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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Automated 3D Analysis of Zygomaticomaxillary Fracture Rotation and Displacement. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3888. [PMID: 34712545 PMCID: PMC8547911 DOI: 10.1097/gox.0000000000003888] [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: 07/12/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
Background The zygomaticomaxillary complex (ZMC) can experience a multitude of deforming forces. There is limited understanding on which deformities alter patient outcomes. This study utilized an automated, three-dimensional analysis to elucidate which fracture patterns and rotational deformities are most prevalent and associated with postoperative complications. Methods This study was a 7-year retrospective review of patients with unilateral ZMC fractures who underwent surgical intervention. Patient demographics, injury mechanisms, presenting symptoms, and postoperative outcomes were collected. Segmentation was completed using Mimics software. The lateral-medial, superior-inferior, and anterior-posterior axes were manually identified on the zygoma and then displacement, rotational direction, and rotational degrees were automatically calculated using Geomagic software. Total displacement score was generated by summation of individual displacement scores at each of the five sutures. Results Eighty-one patients satisfied inclusion criteria. The most prevalent rotational pattern of the zygoma was medially-superiorly-posteriorly (P < 0.001). When comparing rotation along the three axes, the zygoma had the greatest rotation along the lateral-medial axis compared with the superior-inferior (P = 0.003) and anterior-posterior (P < 0.001) axes. Within each axis, the zygoma was more likely to rotate medially than laterally (P = 0.003) and posteriorly than anteriorly (P = 0.01). Multivariate analysis identified total displacement scores and degrees rotated along the lateral-medial axis as significant predictors of facial complications and reoperation. Conclusions This study suggests that patients with unilateral ZMC fractures who undergo surgical intervention are at an increased risk for adverse outcomes with greater rotation along the lateral-medial axis and higher total displacement scores. Additionally, the automated analysis method described can provide objective data to better characterize ZMC fractures.
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Longeac M, Depeyre A, Pereira B, Barthelemy I, Pham Dang N. Virtual surgical planning and three-dimensional printing for the treatment of comminuted zygomaticomaxillary complex fracture. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:386-390. [DOI: 10.1016/j.jormas.2020.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
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Kooger TJA, Joosse MV, van Minderhout EM, Hergaarden K, Khouw YL. Epidemiology of Orbital Fractures in a Large Hospital in the Netherlands: Results of Implementation of a Multidisciplinary Orbital Trauma Team. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
This study aims to describe the epidemiology, aetiology and therapy of orbital fractures in a large municipal hospital in The Hague, the Netherlands, and to demonstrate the effectiveness of an integrated approach of orbital trauma care with a team consisting of an ophthalmologist, an orthoptist and an oral and maxillofacial (OMF) surgeon.
Methods:
We obtained data from patients with an orbital fracture between June 2015 until July 2018. Primary outcomes were the classification of orbital fractures and treatment (conservative or surgical).
Results:
182 patients were included in this study. The most common type of orbital fracture was an isolated orbital floor fracture (n=56, 30.8%). In most cases, therapy was conservative (69.2%). When surgical repair was indicated, a polydioxanone (PDS) plate was most commonly used (11.5%). The main cause of an orbital fracture was a fall accident (38.5%), followed by assault (32.4%). 32.4% of the patients were intoxicated with alcohol.
Conclusion:
In our study population, almost 70% (69.2%) of the patients were treated conservatively in our study. Compared to the international literature, this percentage is considerably higher than in other studies. In our opinion, our integrated approach to orbital trauma has led to a justifiable reduction of the proportion of cases receiving surgical intervention in orbital fractures. We would like to advocate the implementation of a similar team in other hospitals to improve the quality and cost-effectiveness of treatment in patients with orbital fractures.
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Sigron GR, Barba M, Chammartin F, Msallem B, Berg BI, Thieringer FM. Functional and Cosmetic Outcome after Reconstruction of Isolated, Unilateral Orbital Floor Fractures (Blow-Out Fractures) with and without the Support of 3D-Printed Orbital Anatomical Models. J Clin Med 2021; 10:jcm10163509. [PMID: 34441806 PMCID: PMC8397200 DOI: 10.3390/jcm10163509] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 01/16/2023] Open
Abstract
The present study aimed to analyze if a preformed "hybrid" patient-specific orbital mesh provides a more accurate reconstruction of the orbital floor and a better functional outcome than a standardized, intraoperatively adapted titanium implant. Thirty patients who had undergone surgical reconstruction for isolated, unilateral orbital floor fractures between May 2016 and November 2018 were included in this study. Of these patients, 13 were treated conventionally by intraoperative adjustment of a standardized titanium mesh based on assessing the fracture's shape and extent. For the other 17 patients, an individual three-dimensional (3D) anatomical model of the orbit was fabricated with an in-house 3D-printer. This model was used as a template to create a so-called "hybrid" patient-specific titanium implant by preforming the titanium mesh before surgery. The functional and cosmetic outcome in terms of diplopia, enophthalmos, ocular motility, and sensory disturbance trended better when "hybrid" patient-specific titanium meshes were used but with statistically non-significant differences. The 3D-printed anatomical models mirroring the unaffected orbit did not delay the surgery's timepoint. Nonetheless, it significantly reduced the surgery duration compared to the traditional method (58.9 (SD: 20.1) min versus 94.8 (SD: 33.0) min, p-value = 0.003). This study shows that using 3D-printed anatomical models as a supporting tool allows precise and less time-consuming orbital reconstructions with clinical benefits.
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Affiliation(s)
- Guido R. Sigron
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (M.B.); (B.M.); (B.-I.B.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
- Correspondence: ; Tel.: +41-(0)61-265-73-44
| | - Marina Barba
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (M.B.); (B.M.); (B.-I.B.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
| | - Frédérique Chammartin
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland;
| | - Bilal Msallem
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (M.B.); (B.M.); (B.-I.B.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
| | - Britt-Isabelle Berg
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (M.B.); (B.M.); (B.-I.B.); (F.M.T.)
| | - Florian M. Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (M.B.); (B.M.); (B.-I.B.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
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Baviskar PS, Natarajan S. Use of custom fabricated surgical jig to improve surgical outcomes in open reduction internal fixation of unilateral orbital fractures: A prospective clinical study. Saudi J Ophthalmol 2021; 35:244-250. [PMID: 35601861 PMCID: PMC9116094 DOI: 10.4103/sjopt.sjopt_49_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 06/28/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of the study was to assess the efficacy of virtual planning and surgical guide jig to improve surgical outcomes of open reduction and internal fixation with restoration and correction of orbital volume (OV) in unilateral orbital wall fractures. METHODS Fifteen patients with unilateral orbital fractures were assessed with ophthalmologic and radiographic parameters. The orbit was divided into three zones on computed tomography to localize defects. Fractures were coded into Fx Mx Rx Lx (F = Orbital Floor, M = Medial Wall, L = Lateral wall, R = Orbital Roof) based on pattern and specific wall involved. 1-mm sections were used to make stereolithographic models, design the custom fabricated surgical jig for intraoperative use as a guide. RESULTS Pre- and postoperative ophthalmological parameters, OV, were compared with the contralateral normal orbit serving as the reference. Postoperative ophthalmological parameters showed significant improvement in terms of visual acuity, enophthalmos, dystopia, and traumatic optic neuropathy. OV changes were concentrated in Zones 2 and 3. OV showed adequate restoration postoperatively. CONCLUSION The surgical jig served as an efficient guide to improve surgical outcomes of open reduction internal fixation. Preplanned intraoperative positioning helped achieve adequate anatomical reduction and fixation with an adequate reconstruction of OV aiding the effective transfer of virtual surgical plan on the table with improved surgical outcomes in clinical performance and functional restitution.Clinical trial registration: The Clinical Trials Registry of India (CTRI) Registration No.: CTRI/2019/11/021929.
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Affiliation(s)
- Padmakar S. Baviskar
- Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Kamothe, Sector 01, Navi Mumbai, Maharashtra, India
| | - Srivalli Natarajan
- Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Kamothe, Sector 01, Navi Mumbai, Maharashtra, India
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Unilateral Zygomatic Complex Fracture - A Comparison Between non Surgical Treatment and Surgical Treatment. J Craniofac Surg 2021; 32:e627-e630. [PMID: 33654041 DOI: 10.1097/scs.0000000000007603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Medical advances have enabled zygomatic complex (ZMC) fractures to be treated by various approaches. This study aim to analyse the demographics and treatment outcomes of unilateral ZMC fractures, treated non-surgically or surgically. METHODS This 5 year non-randomized prospective study had included 65 cases of unilateral ZMC fractures from October 2014 until December 2019. Patients were treated and divided into non-surgical and surgically treated group. Treatment outcomes in terms of step deformities, malar depression, diplopia, infraorbital hypoaesthesia and mouth opening were evaluated up to 6 months post trauma/intervention. RESULTS Road traffic accident (96.9%) was the main cause, with predominant male involvement (80%) and median age of 28 years. Significant improvements (p<0.05) were observed for step deformities and malar depression among the surgically treated group at postoperative day 1 and week 1. Throughout the 6 months review, infraorbital hypoesthesia and diplopia showed no significant differences between both groups, (p>0.05). Besides, all patients showed significant mouth opening improvement (p < 0.05) over 6 months period. CONCLUSION We found that infraorbital hypoaesthesia and limited of mouth opening should not be the absolute indications for surgical treatment of ZMC fractures. Non-surgical treatment that included early jaw exercise and symptomatic treatment had potential value for satisfactory functional gain.
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Su P, Paquet C, O'Dell K, Reinstadler D, Kokot N, Granzow J, Chambers TN, Kochhar A. Trends in Operative Complex Middle and Upper Maxillofacial Trauma: A 17-Year Study. Laryngoscope 2021; 131:1985-1989. [PMID: 33571397 DOI: 10.1002/lary.29442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 12/11/2020] [Accepted: 01/28/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Over 3 million incidents of facial trauma occur each year in the United States. This study aims to determine trends in operative middle and upper maxillofacial trauma in one of the largest US cities. STUDY DESIGN Retrospective case-control study. METHODS Retrospective chart review of all operative middle and upper maxillofacial trauma from July 1993 to July 2010 presenting to Los Angeles County Hospital, a Level I Trauma Center. Data included demographics, mechanism of injury, and fracture characteristics. RESULTS Analysis was performed for a total of 4,299 patients and 5,549 facial fractures. Mean patient age was 34.6, and most patients were male (88%). Between the two time periods (1993-2001 and 2002-2010), there was a 42% reduction in operative maxillofacial trauma (3,510 to 2,039). Orbital floor and zygomaticomaxillary complex fractures were the most prevalent types of fractures. Panfacial fractures demonstrated the largest reduction in number of fractures (325 to 5, P<0.01). Assault and motor vehicle accidents (MVA) were the two most common mechanisms of injury. Operative fractures due to MVAs decreased (390 to 214, P = .74), whereas fractures due to assault increased (749 to 800, P<0.01). Compared to adults, pediatric facial trauma (age < 18) were caused by a higher percentage of MVAs (27% vs. 13%), auto versus pedestrian (9% vs. 5%), and gunshot wounds (8% vs. 4%) (P<0.01). CONCLUSIONS Operative middle and upper maxillofacial trauma decreased over a 17-year period. Assault was the most significant mechanism of trauma overall. These trends suggest that focusing future prevention strategies on curtailing interpersonal violence may more effectively address the burden of facial trauma. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1985-1989, 2021.
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Affiliation(s)
- Peiyi Su
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Los Angeles County Medical Center, Los Angeles, California, U.S.A
| | - Christian Paquet
- Facial Plastic and Reconstructive Surgery, Biltmore ENT, Facial Plastics & Allergy, Phoenix, Arizona, U.S.A
| | - Karla O'Dell
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Los Angeles County Medical Center, Los Angeles, California, U.S.A
| | - David Reinstadler
- Facial Plastic and Reconstructive Surger, The Ocean Clinic, Newport Beach, California, U.S.A
| | - Niels Kokot
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Los Angeles County Medical Center, Los Angeles, California, U.S.A
| | - Jay Granzow
- Department of Plastic Surgery, Harbor-UCLA Medical Center and the UCLA David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Tamara N Chambers
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Los Angeles County Medical Center, Los Angeles, California, U.S.A
| | - Amit Kochhar
- Department of Otolaryngology-Head and Neck Surgery, Pacific Neuroscience Institute of Providence Saint John's Health, Santa Monica, California, U.S.A
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Rathod PK, Yadav R, Bhutia O, Roychoudhury A, Bhatt K, Kaur K. Is Zygomatic Osteotomy a Viable Option to Achieve Symmetry and Stability in Post-traumatic Residual Deformity of the Zygomaticomaxillary Complex? J Oral Maxillofac Surg 2021; 79:1328.e1-1328.e13. [PMID: 33610490 DOI: 10.1016/j.joms.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE In residual deformity cases, it is difficult to reposition the zygomaticomaxillary-complex (ZMC) intraoperatively, due to resorbed fracture edges, and lack of zygoma analysis to 3-dimensionally quantify the deformity. Instability after zygomatic osteotomy and miniplate fixation (ZOMF) due to the gap between osteotomized segments, scar tissue, muscle pull, and other factors is also unknown. The study aims to evaluate symmetry and stability after ZOMF. MATERIALS AND METHODS In this prospective study, a ZMC analysis was designed and patients with unilateral post-traumatic residual deformity (>10 weeks) of ZMC were treated with ZOMF. Measurements were evaluated on affected and unaffected sides at preoperatively, immediately, and 6 months postoperatively using MIMICS software. The primary outcome variable was the symmetry and stability of ZMC. Secondary parameters were changes in orbital volume, diplopia, ocular motility, mouth opening, and patient satisfaction. P < .05 was considered statistically significant. The continuous variables were compared by paired t-test. The change within the continuous variable with time was assessed by repeated measure ANOVA, followed by multiple comparisons using the Bonferroni test. The changes within the categorical variable were assessed by the McNemar test. RESULTS Ten patients were enrolled (mean age = 29.2 ± 9.97 years; male:female = 9:1; right:left = 4:6). The mean duration from trauma to surgery was 34.84 ± 31.35 weeks. There was an improvement in the symmetry in anteroposteriorly (P = .005), mediolaterally (P = .001), and at the arch (P = .011) postoperatively. All parameters remained stable at 6 months postoperatively (difference not significant, P > .05); with the median satisfaction score of 4 of 5. Significant improvement in mouth opening (P = .014) and orbital volume (P = .001) was noted. CONCLUSIONS Virtual measurements as per the proposed protocol helped in communication and quantifying ZMC. Four-point fixation with miniplates provided enough stability over the 6-month follow-up period.
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Affiliation(s)
- Prem Kumar Rathod
- Junior Resident, Division of Oral and Maxillofacial Surgery, CDER, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Yadav
- Associate Professor, Division of Oral and Maxillofacial Surgery, CDER, All India Institute of Medical Sciences, New Delhi, India.
| | - Ongkila Bhutia
- Professor, Division of Oral and Maxillofacial Surgery, CDER, All India Institute of Medical Sciences, New Delhi, India
| | - Ajoy Roychoudhury
- Professor and Head, Division of Oral and Maxillofacial Surgery, CDER, All India Institute of Medical Sciences, New Delhi, India
| | - Krushna Bhatt
- Assistant Professor, Division of Oral and Maxillofacial Surgery, CDER, All India Institute of Medical Sciences, New Delhi, India
| | - Kamalpreet Kaur
- Senior Resident, Division of Oral and Maxillofacial Surgery, CDER, All India Institute of Medical Sciences, New Delhi, India
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Supra-Temporalis Approach for Treating Zygomaticomaxillary Complex Fracture. J Craniofac Surg 2021; 32:1087-1089. [PMID: 33481467 DOI: 10.1097/scs.0000000000007463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE There are multiple approaches described to access the zygomaticomaxillary complex (ZMC) fractures: lateral eyebrow, upper blepharoplasty, coronal, subciliary, subtarsal, infraorbital, transconjunctival, and transoral. All these approaches have their advantages, disadvantages, and indications according to location of fracture, degree of displacement, and surgeon's experience with a specific technique. However, there is not a good approach for treating the zygomatic arch or body fracture. In this paper, the authors described a supra-temporalis approach to treat the zygomatic arch or body fracture. PATIENTS AND METHODS Eight patients with traumatically ZMC fractures who received open reduction and internal stable fixation with supra-temporalis approach were retrospectively reviewed. A minimized supra-temporalis incision and trans-temporalis fascia access was used. Blunt dissection was performed perpendicularly to the fractured zygomatic arch and body. The open reduction and internal fixation of ZMC fractures were performed. After confirming that the fracture was fixed rigidly, the incision was closed layer by layer. RESULTS Using this approach, the zygomatic arch, body, frontozygomatic suture, and fracture stumps were exposed perpendicularly. No extensive incision was needed and minimal invasion was realized. Postoperative CT scan showed that the fractures been repositioned and fixed in the normal position. Facial asymmetry was reconstructed and keep in the follow-up. CONCLUSIONS Supra-temporalis approach gave an optimal view of the bony field, which allowed surgeons to work perpendicularly to the fracture, and facilitated the reduction of the displaced fractured stumps. It was regarded as an ideal and valuable alternative in this potentially complicated procedure.
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Finite Element Analysis of 2- and 3-Point Internal Fixation Methods for the Treatment of Zygomaticomaxillary Complex Fracture. J Craniofac Surg 2020; 31:2208-2212. [PMID: 33136856 DOI: 10.1097/scs.0000000000006811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Open reduction followed by internal fixation (ORIF) has been regarded as the most effective technique for surgical repair of zygomaticomaxillary complex (ZMC) fractures. However, the ideal internal fixation method to achieve stable reduction remains controversial. This research aims to assess and compare the stability of the 2- and 3-point screw-plate fixation methods using finite element method (FEM). Based on computed tomography (CT), the finite element models of 2-point (ZFS + IOR) and 3-point (ZFS + IOR + ZMB) fixation for isolated displaced ZMC fracture were reconstructed. The force of 120 N was applied to the models to simulate the masseter muscle strength. The maximum stress and displacement of the 2 models were measured to compare the stability. Two geometrically accurate and finite element models were reconstructed successfully. In both the 2- and 3-point fixation models, the maximum stress was significantly lower than the mechanical properties of pure titanium and titanium alloys and the maximum displacement was ≤0.1 mm. The results of this study suggested that both 2- and 3-point fixation of isolated displaced ZMC fractures provide good stability. The FEM innovatively applied in this study can not only show the biomechanical properties of the orbital skeleton and masseter muscle but also assess the stability of the two fixation methods and provide a theoretical reference. This study verifies the effectiveness of 2-point fixation and combined with the clinical benefits of reduced incisions, shorter operative time and lower cost, make this an attractive method.
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ÖZKAYA NK, ERÇÖÇEN A. Reconstruction of orbital floor fractures using a porous polyethylene implant: outcomes in the early, intermediate and late postoperative periods. ENT UPDATES 2020. [DOI: 10.32448/entupdates.718393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Retrospective Analysis of Subtarsal Incision in Maxillofacial Trauma. J Maxillofac Oral Surg 2020; 19:443-446. [PMID: 32801542 DOI: 10.1007/s12663-019-01302-0] [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: 08/25/2018] [Accepted: 10/24/2019] [Indexed: 10/25/2022] Open
Abstract
Introduction Subciliary, subtarsal and infraorbital incisions are the conventional cutaneous approaches to infraorbital rim and floor. Materials and Methods A retrospective study was developed with 30 patients reviewed over a period of 12 months. Result No cases showed ectropion in minimum 12-month follow-up. Mild scleral show was present in 3 cases. At the end of 12 months, scar was invisible in 25 patients, mild in 4 patients and moderate in 1 patient who developed wound infection. Conclusion Subtarsal incision shows good result with very minimal post-operative complications.
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Sharma P, Rattan V, Rai S, Chhabbra R. Does Intraoperative Computed Tomography Improve the Outcome in Zygomatico-Orbital Complex Fracture Reduction? J Maxillofac Oral Surg 2020; 20:189-200. [PMID: 33927486 DOI: 10.1007/s12663-020-01420-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/10/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose Zygomatico-orbital (ZMO) fractures pose considerable difficulty in intraoperative assessment during open reduction and internal fixation (ORIF), and this can be attributed to its three-dimensional complex anatomy and articulations. Recent advancements in the form of intraoperative imaging and navigation have led to an adequate assessment and correct reduction of these fractures minimizing chances of any revision surgery. The purpose of this study was to evaluate the advantage of intraoperative computerized tomography (CT) scan in the management of ZMO/isolated orbital complex fracture and further to develop a protocol for managing such fractures. Methods Twenty-three cases of ZMO/isolated orbital fractures were managed with ORIF, followed by an intraoperative CT scan. The evaluation was focused on the articulations of the zygoma and orbital wall reconstruction. The score of 0 and 1 was given for inadequate and adequate reduction, respectively. Necessary corrections were performed in case of improper reduction followed by a repeat CT scan if required. The reduction score was statistically correlated with number of incisions. Results In 8 (35%) out of 23 patients, clinical judgment was inaccurate when radiologically assessed with an intraoperative CT scan. In 6 out of 8 cases, a repeat CT scan was done after revision of reduction. The reduction score improved with additional incision and revision in the second CT scan. Conclusion Intraoperative CT has an important role in assessing the accuracy of reduction and confirming implant position in ZMO/isolated orbital fractures. This can avoid the need for secondary corrective surgery and postoperative imaging. Intraoperative CT is an important tool to improve surgical outcomes in the management of ZMO orbital fractures.
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Affiliation(s)
- Preeti Sharma
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vidya Rattan
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Sachin Rai
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Rajesh Chhabbra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
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Tabrizi R, Neamati M, Rajabloo S, Latifi F. Does the Lag Time Between Injury and Treatment Affect Recovery of Infraorbital Nerve Disturbances in Zygomaticomaxillary Complex Fractures? Craniomaxillofac Trauma Reconstr 2020; 13:105-108. [PMID: 32642040 DOI: 10.1177/1943387520902896] [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] [Indexed: 11/17/2022] Open
Abstract
Study Design A cross-sectional study. Objective Neurosensory disturbances (NSDs) of the infraorbital nerve (ION) are common following orbito-zygomaticomaxillary complex (ZMC) fractures. This study aimed to evaluate the effect of lag time between injury and treatment on recovery of NSDs of the ION following open reduction internal fixation. Methods Subjects who had ZMC fracture and paresthesia were studied. The lag time between injury and treatment was considered as the predictive factor. The level of NSDs according to the brush test and two-point discrimination (TPD) test and self-reported NSD were the outcomes of this study. Self-reported NSD was quantified using a visual analog scale. Results Forty patients were studied. The lag time between injury and treatment had a significant correlation with the result of the TPD test and the self-reported level of NSD. In 73.6% of patients who had NSD following ZMC fracture, every 1-day delay in treatment increased the incidence of self-reported paresthesia by 0.44. Conclusions It seems, a delay in treatment of ZMC fractures increased the risk of NSD.
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Affiliation(s)
- Reza Tabrizi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Neamati
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Rajabloo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Latifi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Three-Dimensional Analysis of Isolated Orbital Floor Fractures Pre- and Post-Reconstruction with Standard Titanium Meshes and "Hybrid" Patient-Specific Implants. J Clin Med 2020; 9:jcm9051579. [PMID: 32455967 PMCID: PMC7291031 DOI: 10.3390/jcm9051579] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to compare the efficacy of the intraoperative bending of titanium mesh with the efficacy of pre-contoured “hybrid” patient-specific titanium mesh for the surgical repair of isolated orbital floor fractures. In-house 3D-printed anatomical models were used as bending guides. The main outcome measures were preoperative and postoperative orbital volume and surgery time. We performed a retrospective cohort study including 22 patients who had undergone surgery between May 2016 and November 2018. The first twelve patients underwent conventional reconstruction with intraoperative free-hand bending of an orbital floor mesh plate. The subsequent ten patients received pre-contoured plates based on 3D-printed orbital models that were produced by mirroring the non-fractured orbit of the patient using a medical imaging software. We compared the preoperative and postoperative absolute volume difference (unfractured orbit, fractured orbit), the fracture area, the fracture collapse, and the effective surgery time between the two groups. In comparison to the intraoperative bending of titanium mesh, the application of preformed plates based on a 3D-printed orbital model resulted in a non-significant absolute volume difference in the intervention group (p = 0.276) and statistically significant volume difference in the conventional group (p = 0.002). Further, there was a significant reduction of the surgery time (57.3 ± 23.4 min versus 99.8 ± 28.9 min, p = 0.001). The results of this study suggest that the use of 3D-printed orbital models leads to a more accurate reconstruction and a time reduction during surgery.
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Hashemi HM, Avval SK. Prevalence of Ocular Complications in Patients with Zygomatic Bone Fractures in an Iranian Population. Front Dent 2020; 17:1-4. [PMID: 33615306 PMCID: PMC7882201 DOI: 10.18502/fid.v17i9.4127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/28/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives: Damages to the middle third of the facial bone generally involve the orbital skeleton and can lead to eye impairment. In this study, it is attempted to determine the incidence of ophthalmic injuries in maxillofacial trauma with zygomatic bone fractures. Materials and Methods: One hundred and fifteen cases with ophthalmic (ocular) involvement after maxillofacial trauma were referred to the Shariati Hospital, Tehran, Iran, and were visited at the Ophthalmology Department between 2016 and 2018. Zygomatic fractures and resulting ocular complications were evaluated in 87 males and 28 females with the mean ages of 26 and 32 years, respectively. Results: Subconjunctival ecchymosis was detected in 23.07% of men and 21.05% of women. Displacement of the palpebral fissure was detected in 26.5% of men and 27.6% of women. Furthermore, the unequal pupillary level was observed in 18.37% of men and 15.78% of women. Diplopia was detected in 8.9% of men and 10.5% of women. Additionally, enophthalmos was observed in 23.1% of men and 25% of women. Conclusion: The most common ocular presentations in midfacial trauma are diplopia and reduced visual acuity. Even after the operation, a significant number of patients experience poor vision and diplopia. Ophthalmology consultation is essential for these patients.
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Affiliation(s)
- Hamid Mahmood Hashemi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.,Craniomaxillofcial Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarvenaz Karimi Avval
- Craniomaxillofcial Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Amin D, Al-Mulki K, Henriquez OA, Cheng A, Roser S, Abramowicz S. Review of Orbital Fractures in an Urban Level I Trauma Center. Craniomaxillofac Trauma Reconstr 2020; 13:174-179. [PMID: 33456683 DOI: 10.1177/1943387520924515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To perform a comprehensive review and analysis of surgically treated orbital fractures. Study Design Retrospective cohort chart review study for surgically treated orbital fractures during 5 years. Results A total of 173 patients (average age 41.6 years) were diagnosed with orbital fractures. Most were male with a ratio of 3.3:1. Most fractures were caused by assault (39.3%); 22.5% of the cases were bilateral. The left orbit (40.5%) was fractured more than the right. The orbital floor (97.1%) was the most common anatomic location and the maxilla (65.3%) was the most commonly involved bone. The average time from trauma to surgical intervention was 8.7 ± 14.6 days and the average time from surgical intervention to discharge was 5.1 ± 9.0 days. The transconjunctival incision (63%) was the most commonly used incision, and nonresorbable implant (92.7%) was the most commonly used implant. Finally, the length of stay for the repair of a simple orbital fracture was less than for complex orbital fracture (1.5 days and 5.9 days, respectively). Conclusion Understanding the patterns and mechanisms of injury associated with orbital fractures can assist in developing standardized treatment protocols across all surgical specialties. This would ultimately allow for a uniform high quality of surgical care for patients with maxillofacial fractures.
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Affiliation(s)
- Dina Amin
- Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Kareem Al-Mulki
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Oswaldo A Henriquez
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Angela Cheng
- Division of Plastic Surgery, Department of General Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven Roser
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Lehtinen V, Pyötsiä K, Snäll J, Toivari M. Zygomatico-Orbital Fracture-Dislocation in Surgical Treatment: Novel 3-Dimensional Software Automated Analysis. J Oral Maxillofac Surg 2020; 78:1372-1381. [PMID: 32304659 DOI: 10.1016/j.joms.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The human capability to detect the degree of zygomatico-orbital (ZMO) fracture-dislocation in surgical treatment is unknown. The aim of this study was to examine the association between ZMO fracture-dislocation and injury etiology and treatment. MATERIALS AND METHODS We implemented a retrospective cross-sectional study, enrolled a sample composed of patients with an isolated unilateral ZMO fracture, and analyzed fracture-dislocation from computed tomography images with an automatic algorithm. The primary predictor variable was mean surface point-to-point dislocation (the mean distance of dislocation for all surface points in isolated ZMO fracture segments between the original position and after virtual repositioning). The primary outcome was the treatment choice (operative vs nonoperative). Other studied variables were gender, age group, injury mechanism, clinical asymmetry, and human-evaluated dislocation on computed tomography images. Descriptive and bivariate statistics were computed, and the threshold for statistical significance was set at P < .05. RESULTS The sample consisted of 115 patients with a mean age of 66.3 years, 66.1% of whom were male patients, and the most common cause of injury was falling on the ground (49.6%). Operative treatment was required in 58 patients (50.4%). A significant association was found between mean dislocation and operative treatment. Mean dislocation of operatively versus nonoperatively treated fractures was 2.39 mm versus 1.05 mm (P < .001). Mean fracture-dislocation was greatest in injuries caused by assault (2.41 mm) and smallest in motor vehicle accidents (1.08 mm) and ground-level falls (1.25 mm). The threshold of human-eye detection for ZMO fracture-dislocation was 1.97 mm. CONCLUSIONS The results of this study demonstrate that the threshold for operative treatment of ZMO fracture-dislocation is over 2 mm, which the human eye is able to detect. True dislocation is greater in younger patients than elderly patients and in injuries caused by assault compared with falling.
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Affiliation(s)
- Valtteri Lehtinen
- Dental Student and Researcher, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Krista Pyötsiä
- Researcher, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Snäll
- Head of Department, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miika Toivari
- Resident, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Abstract
OBJECTIVES This study aimed to determine the pattern of fractured zygoma, different treatment modalities, and complications of the treatment in our center. It also aimed to determine the association between the treatment modalities and complication of treatment, and association between number of fixation and complication. METHODOLOGY A retrospective review was conducted from January 2008 until December 2011. All patients diagnosed with zygomatic complex fractured that met the inclusion and exclusion criteria were included in the study. Zingg's Classification was used in the study. RESULTS The median age was 23.5. Type A was the most common fracture type made up 26.6%. About 90.8% of the injury was caused by road traffic accident. Forty-four patients were treated with open reduction and internal fixation and 4 patients were treated with close reduction only. Fifty patients were treated conservatively. Gillies approach in combination with fixation is the most common procedure accounted for 50%. Three-point fixation at infraorbital, maxillary buttress, frontozygomatic suture, and zygomatic arch was the most common site. However, there were no significant associations between the number of fixation and the occurrence of the complication (P = 0.307). About 29.2% in the treatment group and 66% in the conservative group had complications. About 35.7% of patients in treatment group had complications, while 66% had trismus in conservative group. CONCLUSION There was a significant association between types of treatment and the occurrence of complication (P = 0.001). However, there were no significant association between number of fixation and the occurrence of complications (P = 0.307).
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Shokri T, Sokoya M, Cohn JE, Bahrami A, Inman J, Ducic Y. Single-Point Fixation for Noncomminuted Zygomaticomaxillary Complex Fractures-A 20-Year Experience. J Oral Maxillofac Surg 2020; 78:778-781. [PMID: 32006491 DOI: 10.1016/j.joms.2019.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/18/2019] [Accepted: 12/21/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE Zygomaticomaxillary complex (ZMC) fractures occur often. However, no clinical consensus has been reached regarding the number of fixation points required when performing open reduction and internal fixation (ORIF). The objective of the present study was to explore the utility of single-point fixation in the management of noncomminuted ZMC fractures. PATIENTS AND METHODS We analyzed the data from a retrospective case series of 211 patients treated during a 20-year period. RESULTS The mean length of follow-up was 3.4 months. Of the 211 patients, 162 with noncomminuted ZMC fractures had been treated with single-point fixation of the zygomaticomaxillary buttress. During the follow-up period, 1 patient experienced tooth loss because of a root present in the fracture line, 7 experienced intraoral plate exposure, with 2 subsequently undergoing plate exchange, and 8 developed a wound infection. No patients required orthognathic surgery or cheek implants for malar asymmetry. No patient developed hypoglobus or enophthalmos, and none required revision ORIF of their ZMC fracture. CONCLUSIONS To the best of our knowledge, the present study represents the largest series in the literature reporting the surgical results and outcomes of patients with noncomminuted ZMC fractures treated with single-point fixation. In experienced hands, we believe this is a viable surgical option if appropriate surgical considerations are made.
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Affiliation(s)
- Tom Shokri
- Resident, Department of Otolaryngology - Head and Neck Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA.
| | - Mofiyinfolu Sokoya
- Assistant Professor, Department of Otolaryngology - Head and Neck Surgery, University of Arizona School of Medicine, Tucson, AZ
| | - Jason E Cohn
- Resident, Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Arash Bahrami
- Resident, Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Jared Inman
- Associate Professor, Department of Otolaryngology Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA
| | - Yadranko Ducic
- Attending Physician, Department of Facial Plastic and Reconstructive Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX
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Anatomic Factors Predicting Postoperative Strabismus in Orbital Wall Fracture Repair. Sci Rep 2019; 9:14785. [PMID: 31616002 PMCID: PMC6794272 DOI: 10.1038/s41598-019-51127-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 09/25/2019] [Indexed: 11/25/2022] Open
Abstract
This study is aimed to determine the relationship between orbital fracture sites in each CT scan view and postoperative diplopia. Data for 141 patients of orbital wall fracture were analyzed retrospectively. One group of examiners reviewed sagittal, coronal and axial CT scans. Descriptive statistical analysis was used to assess each fracture area and its potential relationship with the occurrence of postoperative diplopia. Among the three anatomical views, sagittal sections were significantly associated with post-operative diplopia (PD) (p = 0.044). For orbital wall fractures in a single location, C1 (p = 0.015), A1 (p = 0.004) and S3 (p = 0.006) fractures were significantly related to PD. Orbital wall fractures found in more than one location resulted in a higher probability of PD in all sections:, C1 + C2 group (p = 0.010), C1 + C2 + C3 group (p = 0.005), A1 + A2 group (p = 0.034), A3 + A1 group (p = 0.005), S1 + S2 group (p < 0.001), S2 + S3 group (p = 0.006) and S1 + S2 + S3 group (p < 0.001). For combinations of two or three sections, we found that only fractures involving both coronal and sagittal sections led to a significantly increased risk of PD (p = 0.031). PD is the main posttreatment complication of orbital bone fracture reduction. In addition to the known myogenic cause (failure to relieve entrapment) of diplopia, both trauma and surgical manipulation can compromise ocular motor nerve function and possibly result in the development of neurogenic causes of diplopia. Careful assessment of patient symptoms (whether preoperative diplopia is present), and the location of orbital fractures (and the influence of related musculature, fat, and nerves) on CT scans are strongly related to surgical success.
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Dikhit PS, Mohapatra M, Jena AK, Srivastava A. Emerging Trends of Zygomaticomaxillary Complex Fractures and Their Etiological Analysis in a Tertiary Health Centre from Eastern India: A Retrospective Study. J Maxillofac Oral Surg 2019; 20:70-75. [PMID: 33584045 DOI: 10.1007/s12663-019-01295-w] [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: 09/25/2018] [Accepted: 09/25/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Maxillofacial region is one of the most complicated arrangements of bony and soft tissues in human body, superiorly bounded by cranial bones and inferiorly by the mandible with interposed dentition. This is one of the reasons which make injuries to this region difficult to manage and often controversial. The severity and patterns of these injuries have changed considerably due to the increasing reliance on fast road transportation facilities and interpersonal violence. Materials and methods The aim of the present study is to analyze retrospectively the changing patterns of mid-face fractures in a sample of patients reporting to Department of Oral and Maxillofacial Surgery in AIIMS Bhubaneswar, India, from April 2017 to April 2018. A performa was prepared which included age, sex, etiology of injury, alcohol influence, and treatment given during hospital stay. Results Road traffic accidents contributed 68.11% of zygomaticomaxillary complex (ZMC) fractures, followed by assault (18.11%) and fall from height (13.76%). RTA was the major cause of atypical ZMC fractures as compared to conventional ZMC fractures (P < 0.001). Discussion Due to modern lifestyle and changes in fast transportation, recent fracture patterns do not follow the tell-tale signs or patterns and often need unique and patient-specific treatment plan, making the skills of maxillofacial surgeons the pivotal factor in better prognosis.
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Affiliation(s)
- Punit S Dikhit
- Department of Dentistry, AIIMS, Bhubaneswar, Bhubaneshwar, India.,Kidwai Memorial Institute of Oncology, Bangalore, India
| | | | - Ashok Kumar Jena
- Department of Dentistry, AIIMS, Bhubaneswar, Bhubaneshwar, India
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Gadkari N, Bawane S, Chopra R, Bhate K, Kulkarni D. Comparative evaluation of 2-point vs 3-point fixation in the treatment of zygomaticomaxillary complex fractures – A systematic review. J Craniomaxillofac Surg 2019; 47:1542-1550. [DOI: 10.1016/j.jcms.2019.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/07/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022] Open
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