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Polat S, Aksay UC, Tunç M, Özşahin E, Yar K, Göker P. Bibliometric Analysis of Orbital Surgery Using Web of Science Database. J Craniofac Surg 2025:00001665-990000000-02656. [PMID: 40273035 DOI: 10.1097/scs.0000000000011428] [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: 01/02/2025] [Accepted: 03/30/2025] [Indexed: 04/26/2025] Open
Abstract
AIM There are more than 100 different clinical pathologies that affect the orbit, originating from the orbit or surrounding structures. Various surgical approaches have been described to solve this number of lesions. To date, there have been few evaluations of research productivity in the field of orbital surgery. The aim of this study is to analyze the research productivity of articles on orbital surgery. METHODS On October 20, 2024, using the advanced search section in the Web of Science (WoS) Core Collection database, a search was made about orbital surgery. From 1980 to November 20, 2024, research articles in the relevant field were analyzed. Language restrictions are not used. The filter was "Topic=Orbital Surgery OR Orbit Surgery OR Oculoplastic OR Oculoplastics OR Oculoplasty OR Orbitotomy OR Orbital Tumor Surgery OR Optic Nerve Surgery OR Orbital Decompression OR Orbital Reconstruction OR Orbital Exenteration OR Orbital Implant Surgery (Should - Search within topic)." Filters were applied, and as a result, 4590 publications were included in this study. VOSviewer software was used to perform bibliometric analyses. RESULTS The number of publications and citations for each year mostly increases until 2021. Among the countries with the most documents and citations, the United States ranks first in both rankings. Also, the organization with the most publications is the University of California, Los Angeles. Ophthalmic Plastic and Reconstructive Surgery is the journal that publishes the most documents and receives the most citations. The most cited 3 document is about Graves orbitopathy. The most recurring keywords were related to treatment and disease management. CONCLUSIONS This study would provide a novel perspective to the studies about orbital surgery and contribute to the researchers about the limits of the topic, and being aware of the active journals that publish the papers on this issue would facilitate the work of the researchers.
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Affiliation(s)
- Sema Polat
- Department of Anatomy, Faculty of Medicine, Cukurova University
| | - Ufuk Can Aksay
- Department of Anatomy, Faculty of Medicine, Cukurova University
| | - Mahmut Tunç
- Department of Therapy and Rehabilitation, Vocational School of Health Services, Baskent University
| | - Esin Özşahin
- Department of Anatomy, University Faculty of Medicine, Baskent University
| | - Kemal Yar
- Department of Ophthalmology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Pinar Göker
- Department of Anatomy, Faculty of Medicine, Cukurova University
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2
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Mallick AH, Sirang Z. Post-traumatic Isolated Superior Rectus Hematoma Treated With Oral Steroids. Cureus 2025; 17:e81763. [PMID: 40330343 PMCID: PMC12052035 DOI: 10.7759/cureus.81763] [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: 04/05/2025] [Indexed: 05/08/2025] Open
Abstract
We present a rare case of an isolated right superior rectus hematoma in a 14-year-old boy following a road traffic accident (RTA), which was effectively treated with oral corticosteroids alone. This case emphasizes the importance of prompt diagnosis and conservative treatment in isolated extraocular muscle hematomas. It also highlights the role of clinical awareness and imaging in guiding treatment while avoiding unnecessary surgery. Additionally, the case raises awareness about the rare presentations of orbital trauma and the effectiveness of non-invasive treatments.
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Affiliation(s)
- Abdul Hadi Mallick
- Ophthalmology and Visual Sciences, Aga Khan University Hospital, Karachi, PAK
| | - Zubaida Sirang
- Ophthalmology and Visual Sciences, Aga Khan University Hospital, Karachi, PAK
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3
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Owens WR, Skochdopole AJ, Gillipelli SR, Layon SA, Latham KP. The Approach to Cranioorbital Gunshot Wounds. Semin Plast Surg 2025; 39:37-42. [PMID: 40160837 PMCID: PMC11945217 DOI: 10.1055/s-0044-1801737] [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: 04/02/2025]
Abstract
Gunshot wounds to the head result in significant morbidity with a low rate of survival. Current treatment recommendations for penetrating traumatic brain injury (pTBI), established in 2001, are based off techniques used in recent Middle Eastern conflicts. However, many advancements in care have been made and updates in official pTBI treatment guidelines are being formulated. While some penetrating brain injury patients are managed nonoperatively due to poor prognosis, many undergo emergent interventions and delayed reconstruction by various surgical subspecialists. This article explores the management of pTBI and the collaborative roles of neurosurgeons, ophthalmologists, and plastic surgeons.
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Affiliation(s)
- Winston R. Owens
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Anna J. Skochdopole
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Srinithya R. Gillipelli
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Sarah A. Layon
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Kerry P. Latham
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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4
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Albrecht T, Burkhardt V, Offergeld C. [Trauma of the midface : Symptoms, diagnostics and treatment]. RADIOLOGIE (HEIDELBERG, GERMANY) 2025; 65:52-60. [PMID: 39774690 DOI: 10.1007/s00117-024-01408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 01/11/2025]
Abstract
Midface fractures present a clinical challenge in otorhinolaryngology due to their often complex injury pattern and nonspecific symptoms. Precise diagnostics, including differentiated imaging procedures, are required. Interdisciplinary consultation between otorhinolaryngology, maxillofacial surgery, neurosurgery, and ophthalmology is often necessary. When selecting radiographic modalities, radiation hygiene should be taken into account. Sonography provides a radiation-free imaging alternative for fractures of the nasal framework and anterior wall of the frontal sinus. The goal of treatment is to achieve stable and symmetrical reconstruction. Depending on the injury pattern, different osteosynthesis materials, individual access routes, and various surgical procedures can be used. In clinical practice, the management of midface fractures requires a multidisciplinary, flexible, and pragmatic approach based on the fracture pattern and clinical experience.
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Affiliation(s)
- Tobias Albrecht
- Klinik für Hals-,Nasen- und Ohrenheilkunde, Universitätsklinikum Tübingen, Tübingen, Deutschland, Elfriede-Aulhorn-Straße 5, 72076.
| | - Valentin Burkhardt
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Christian Offergeld
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
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5
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Zhao Z, Guo Z, Hu W, Long J. Assessment of the Correlation Between Types of Orbital Fractures and Ocular Symptoms, and the Effect of Manual Preformed and Patient-Specific Mesh Implants: A Retrospective Study. J Craniofac Surg 2025; 36:84-88. [PMID: 39287427 DOI: 10.1097/scs.0000000000010656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 08/13/2024] [Indexed: 09/19/2024] Open
Abstract
OBJECTIVE Although certain orbital fractures are associated with specific clinical symptoms, these relationships should be reviewed comprehensively. The optimal choice between manual preformed mesh implants (MPIs) and patient-specific mesh implants (PSIs) for orbital reconstruction remains undetermined due to inconclusive evidence regarding their effectiveness. METHODS This retrospective study investigated 280 patients with unilateral orbital fractures to explore the correlation between clinical ocular symptoms, including diplopia, enophthalmos, limitation of ocular movement, blindness, and the specific type of orbital fracture. The effects on orbital volume (OV) and orbital volume ratio (OVR) of MPI and PSI with and without the use of navigation were also evaluated in this study. Patients were categorized into 4 groups: MPI, PSI, navigation-assisted MPI, and navigation-assisted PSI. After this categorization, alterations in OV and OVR were analyzed before and after surgical intervention. RESULTS Significant correlations were observed between the orbital fracture type and diplopia, enophthalmos, and limitation of ocular movement ( P < 0.05). Patients in the MPI group exhibited a notable difference in the postoperative OV between the injured and normal sides ( P < 0.05), but no statistically significant difference was found in the postoperative OV between the injured and normal sides among the patients in the other 3 groups ( P > 0.05). Moreover, the MPI group demonstrated significantly higher postoperative OVR than the other groups ( P < 0.05). Notably, PSI remained effective with or without navigation, MPI combined with navigation technology achieved a reconstruction quality similar to that of PSI by rectifying positioning errors during surgery. CONCLUSION The authors found significant correlations ( P < 0.05) between orbital fracture type and diplopia, enophthalmos, and limitations of ocular movement. Patient-specific mesh implant plays an important role in orbital reconstruction. It is also a good method for reconstructing orbital fractures using MPI assisted by navigation technology.
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Affiliation(s)
- Zhihao Zhao
- State Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Bhaskar MN, Shabari UB, Raikar SG, Suresh KK, Bharathi P. Reconstruction of Infraorbital Floor using Marlex Mesh through Intraoral Vestibular Approach using Endoscope for Reduction. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S3784-S3786. [PMID: 39926822 PMCID: PMC11805326 DOI: 10.4103/jpbs.jpbs_1073_24] [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: 08/21/2024] [Revised: 09/12/2024] [Accepted: 09/17/2024] [Indexed: 02/11/2025] Open
Abstract
Infraorbital floor fracture is a common occurrence in cases of road traffic accidents. A variety of approaches and materials are available for the repair of such fractures. In this case series, we have discussed a conservative approach using an endoscope and the use of Marlex mesh for the repair of ZMC fractures. We have briefly discussed the importance of the selected approach and material, as well as the various advantages of using this combination.
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Affiliation(s)
- MN Bhaskar
- Department of Otorhinolaryngology ENT, Kannachur Institute of Medical Sciences, Deralakatte, Mangalore, Karnataka, India
| | - UB Shabari
- Department of OMFS, AJ Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Shruti G Raikar
- Department of Plastic Surgery, Yenapoya Medical College Hospital, Deralakatte Ullal, Mangaluru, Karnataka, India
| | - KK Suresh
- Department of Radiodiagnosis, Kanachur Institite of Medical Sciences, Deralakatte, Mangaluru, Karnataka, India
| | - P Bharathi
- Department of Periodontology, Sharavathi Dental College and Hospital, Shivamogga, Karnataka, India
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7
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Albrecht T, Burkhardt V, Offergeld C. [Trauma of the midface : Symptoms, diagnostics and treatment]. HNO 2024; 72:676-684. [PMID: 38913183 DOI: 10.1007/s00106-024-01492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/25/2024]
Abstract
Midface fractures present a clinical challenge in otorhinolaryngology due to their often complex injury pattern and nonspecific symptoms. Precise diagnostics, including differentiated imaging procedures, are required. Interdisciplinary consultation between otorhinolaryngology, maxillofacial surgery, neurosurgery, and ophthalmology is often necessary. When selecting radiographic modalities, radiation hygiene should be taken into account. Sonography provides a radiation-free imaging alternative for fractures of the nasal framework and anterior wall of the frontal sinus. The goal of treatment is to achieve stable and symmetrical reconstruction. Depending on the injury pattern, different osteosynthesis materials, individual access routes, and various surgical procedures can be used. In clinical practice, the management of midface fractures requires a multidisciplinary, flexible, and pragmatic approach based on the fracture pattern and clinical experience.
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Affiliation(s)
- Tobias Albrecht
- Klinik für Hals-,Nasen- und Ohrenheilkunde, Universitätsklinikum Tübingen, Tübingen, Deutschland, Elfriede-Aulhorn-Straße 5, 72076.
| | - Valentin Burkhardt
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Christian Offergeld
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
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8
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Starck E, Lusila N, Suojanen J, Kormi E. Are Age and Trauma Mechanism Associated with Volume Change in the Fractures of the Bony Orbit? J Clin Med 2024; 13:3618. [PMID: 38930147 PMCID: PMC11204536 DOI: 10.3390/jcm13123618] [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: 05/21/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Blowout fractures are common midfacial fractures in which one or several of the bones of orbital vault break. This is usually caused by a direct trauma to the eye with a blunt object such as a fist. Fracturing of the fragile orbital bones can lead to changes in the orbital volume, which may cause enophthalmos, diplopia, and impaired facial aesthetics. Objectives: The aim of this study is to investigate whether there is an association between volume change of the bony orbit and age, gender, or trauma mechanism. Methods: A retrospective study of patients with unilateral blowout or blow-in fractures treated and examined in Päijät-Häme Central Hospital, Lahti, Finland was conducted. Altogether, 127 patients met the inclusion criteria. Their computed tomographs (CT) were measured with an orbit-specific automated segmentation-based volume measurement tool, and the relative orbital volume change between fractured and intact orbital vault was calculated. Thereafter, a statistical analysis was performed. A p-value less than 0.05 was considered significant. Results: We found that relative increase in orbital volume and age have a statistically significant association (p = 0.022). Trauma mechanism and gender showed no significant role. Conclusions: Patient's age is associated with increased volume change in fractures of the bony orbit.
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Affiliation(s)
- Ella Starck
- Clinicum, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Niilo Lusila
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Radiology, Päijät-Häme Central Hospital, 15850 Lahti, Finland
| | - Juho Suojanen
- Clinicum, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Päijät-Häme Central Hospital, 15850 Lahti, Finland
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Eeva Kormi
- Clinicum, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Päijät-Häme Central Hospital, 15850 Lahti, Finland
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9
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Vasile VA, Pirvulescu RA, Iancu RC, Garhöfer G, Schmetterer L, Ghita AM, Ionescu D, Istrate S, Piticescu RM, Cursaru LM, Popa-Cherecheanu A. Titanium Implants Coated with Hydroxyapatite Used in Orbital Wall Reconstruction-A Literature Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1676. [PMID: 38612189 PMCID: PMC11012370 DOI: 10.3390/ma17071676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
With the increasing incidences of orbital wall injuries, effective reconstruction materials and techniques are imperative for optimal clinical outcomes. In this literature review, we delve into the efficacy and potential advantages of using titanium implants coated with nanostructured hydroxyapatite for the reconstruction of the orbital wall. Titanium implants, recognized for their durability and mechanical strength, when combined with the osteoconductive properties of hydroxyapatite, present a potentially synergistic solution. The purpose of this review was to critically analyze the recent literature and present the state of the art in orbital wall reconstruction using titanium implants coated with nanostructured hydroxyapatite. This review offers clinicians detailed insight into the benefits and potential drawbacks of using titanium implants coated with nanostructured hydroxyapatite for orbital wall reconstruction. The highlighted results advocate for its benefits in terms of osseointegration and provide a novel strategy for orbital reconstruction, though further studies are essential to establish long-term efficacy and address concerns.
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Affiliation(s)
- Victor A. Vasile
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Ruxandra A. Pirvulescu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Raluca C. Iancu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- School of Chemical and Biological Engineering, Nanyang Technological University, Singapore 637459, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, 4056 Basel, Switzerland
| | - Aurelian M. Ghita
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Diana Ionescu
- Department of ENT, Children’s Clinical Hospital “Dr. V. Gomoiu”, 022102 Bucharest, Romania
| | | | - Roxana M. Piticescu
- Nanostructured Materials Laboratory, National R&D Institute for Nonferrous and Rare Metals, 077145 Pantelimon, Romania
| | - Laura M. Cursaru
- Nanostructured Materials Laboratory, National R&D Institute for Nonferrous and Rare Metals, 077145 Pantelimon, Romania
| | - Alina Popa-Cherecheanu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
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Udelhoven A, Kettner M. [Orbital trauma]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:189-195. [PMID: 38345620 DOI: 10.1007/s00117-024-01272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/22/2024]
Abstract
Orbital trauma can occur independently or in conjunction with other craniofacial trauma and can cause damage to bony and neurovascular structures as well as soft tissues. Appropriate interdisciplinary treatment of patients is essential to prevent long-term damage such as blindness or muscle dysfunction. Even complex fractures and soft tissue damage can be visualized using modern thin-layer computed tomography (CT), which is necessary for proper treatment.
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Affiliation(s)
- Anne Udelhoven
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Neurozentrum (Geb. 90), Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66421, Homburg/Saar, Deutschland.
| | - Michael Kettner
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Neurozentrum (Geb. 90), Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66421, Homburg/Saar, Deutschland
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11
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Gokharman FD, Kadirhan O, Celik Aydin O, Yalcin AG, Kosar P, Aydin S. A Comprehensive Look at Maxillofacial Traumas: On the Basis of Orbital Involvement. Diagnostics (Basel) 2023; 13:3429. [PMID: 37998566 PMCID: PMC10670346 DOI: 10.3390/diagnostics13223429] [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: 09/17/2023] [Revised: 10/28/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Orbital wall fractures that may develop in maxillofacial traumas (MFTs) may cause ophthalmic complications (OCs). The aim of this study is to determine the frequency of orbital fractures (OFs) accompanying MFTs and findings suspicious for orbital traumatic involvement. MATERIALS AND METHODS Computed tomography (CT) images of 887 patients who presented to the emergency department within a 1-year period with a history of MFT were retrospectively scanned. During the examination, patients with orbital wall fractures, craniofacial bone fractures, and posttraumatic soft tissue changes were recorded. RESULTS OF was observed in 47 (5.3%) of the patients admitted for MFT. In cases with OFs, accompanying nasal (25.5%), ethmoid (2.1%), frontal (19.1%), maxillary (38%), and zygomatic bone fracture (10.6%), sphenoid (4.3%), and soft tissue damage (55.3%) were observed. It was observed that the pathologies mentioned at these levels were significantly higher than in patients without orbital involvement (p < 0.05). In our study, mild (48.9%) and moderate-severe (2.12-4.25%) OCs accompanying OFs were observed after MFT. CONCLUSIONS The frequency of MFT varies depending on various factors, and such studies are needed to take preventive measures. Knowing the risk and frequency of orbital damage accompanying MFTs may help reduce complications by allowing rapid and accurate diagnosis.
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Affiliation(s)
- Fatma Dilek Gokharman
- Department of Radiology, SBU Ankara Education and Research Hospital, Ankara 06660, Turkey; (A.G.Y.); (P.K.)
| | - Ozlem Kadirhan
- Department of Radiology, Erzincan University, Erzincan 24100, Turkey; (O.K.); (S.A.)
| | - Ozlem Celik Aydin
- Department of Pharmacology, Erzincan University, Erzincan 24100, Turkey;
| | - Arzu Gulsah Yalcin
- Department of Radiology, SBU Ankara Education and Research Hospital, Ankara 06660, Turkey; (A.G.Y.); (P.K.)
| | - Pınar Kosar
- Department of Radiology, SBU Ankara Education and Research Hospital, Ankara 06660, Turkey; (A.G.Y.); (P.K.)
| | - Sonay Aydin
- Department of Radiology, Erzincan University, Erzincan 24100, Turkey; (O.K.); (S.A.)
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Moe MC, Özmert E, Baudouin C, Binadra A, Crafoord S, Jo Y, Kiratli H, Moore M, Pitsiladis YP, Rolle U, Tan B, Yanik Ö, Budgett R, Erdener U, Steffen K, Engbretsen L. International Olympic Committee (IOC) consensus paper on sports-related ophthalmology issues in elite sports. BMJ Open Sport Exerc Med 2023; 9:e001644. [PMID: 37485004 PMCID: PMC10357794 DOI: 10.1136/bmjsem-2023-001644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
Vision plays an important role in an athletes' success. In sports, nearly 80% of perceptual input is visual, and eye health and sports medicine are closely intertwined fields of utmost importance to athletes. The physical nature of sports activities renders individuals more prone to various eye injuries than the general population. Ocular trauma can lead to lifelong sequelae, and impaired vision requires careful follow-up and management. Apart from injuries, athletes may also experience vision problems that can hamper their performance, including blurred vision, double vision, and light sensitivity. The interdisciplinary nature of sports medicine necessitates collaboration between sports medicine professionals and ophthalmologists. Through such collaborations, athletes can receive appropriate eye care, education on proper eye protection and guidance on adopting good eye health practices. If any inconspicuous symptoms are not detected and treated promptly, athletes may acquire systemic injuries because of defective vision, preventing them from achieving high level athletic performance in competitions. The protection of the elite athlete is the responsibility of all of us in sports medicine. To advance a more unified, evidence-informed approach to ophthalmic health assessment and management in athletes and as relevant for sports medicine physicians, the International Olympic Committee Consensus Group aims for a critical evaluation of the current state of the science and practice of ophthalmologic issues and illness in high-level sports, and present recommendations for a unified approach to this important issue.
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Affiliation(s)
- Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Emin Özmert
- Ophthalmology, Ankara University Faculty of Medicine, Ankara, Türkiye
- Department of Ophthalmology, Vehbi Koç Eye Hospital, Ankara, Türkiye
| | - Christophe Baudouin
- Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital & Vision Institute, Paris, France
| | - Abhinav Binadra
- Medical & Scientific, International Olympic Committee, Lausanne, Switzerland
| | - Sven Crafoord
- Faculty of Medicine and Health, Department of Ophthalmology, Örebro University Hospital, Orebro, Sweden
| | - Young Jo
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon, South Korea
| | - Hayyam Kiratli
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Melita Moore
- Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, California, USA
| | - Yannis P Pitsiladis
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Udo Rolle
- Department of Paediatric Surgery and Paediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/M, Germany
| | - Ben Tan
- SingHealth Duke-NUS Sport & Exercise Medicine Centre, Singapore
| | - Özge Yanik
- Ophthalmology, Ankara University Faculty of Medicine, Ankara, Türkiye
- Department of Ophthalmology, Vehbi Koç Eye Hospital, Ankara, Türkiye
| | - Richard Budgett
- Medical & Scientific, International Olympic Committee, Lausanne, Switzerland
| | - Ugur Erdener
- Medical & Scientific, International Olympic Committee, Lausanne, Switzerland
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Türkiye
- World Archery, Lausanne, Switzerland
| | - Kathrin Steffen
- Oslo Sports Trauma Center, Institute of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Lars Engbretsen
- Medical & Scientific, International Olympic Committee, Lausanne, Switzerland
- Oslo Sports Trauma Center, Institute of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Division of Orthopaedic Surgery, University of Oslo Faculty of Medicine, Oslo, Norway
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Alik M, Malik M, Ashrafi R, Wu AY. Epidemiologic Pattern and Injury Mechanism of Intimate Partner Violence-Related Ocular Trauma in the US. JAMA Ophthalmol 2023; 141:431-439. [PMID: 36995733 PMCID: PMC10064286 DOI: 10.1001/jamaophthalmol.2023.0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/04/2023] [Indexed: 03/31/2023]
Abstract
Importance Intimate partner violence (IPV) is an important cause of death and disability worldwide. The literature estimates that 45% of IPV injuries involve the eyes. Many medical fields have increased IPV-related research; however, ophthalmology IPV research remains rare. Objective To evaluate the epidemiologic pattern and injury mechanism of IPV related to ocular trauma. Design, Setting, and Participants This study was a retrospective cross-sectional analysis with deidentified data using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes from the National Trauma Data Bank (NTDB), which is a data set collected by the American College of Surgeons. The NTDB is the largest US hospitalized trauma case database with submissions from more than 900 US facilities. Included in this analysis were the IPV-related ocular injuries of patients hospitalized between 2017 and 2019. Study data were analyzed from April 20 to October 15, 2022. Exposures IPV-related ocular injuries. Main Outcomes and Measures Ocular injuries and adult IPV trauma survivors were identified with the ICD-10-CM codes. The following demographic data were collected: sex, age, race and ethnicity, health insurance plan, substance misuse screening results, trauma level of hospital, the emergency department disposition, the total Glasgow Coma Scale score, the abbreviated injury scale, and caregiver at discharge. Results A total of 2598 of the recorded ocular injuries were associated with IPV. Patients had a mean (SD) age of 45.2 (18.4) years, and 1618 were female (62.3%). Most patients in the population sample (1195 [46.0%]) were aged 18 to 39 years. The race and ethnicity distribution was as follows: 629 Black (24.2%), 296 Hispanic (11.4%), 1358 White (52.3%), 229 other (8.8%), and 86 missing (3.3%). Insurance statuses were Medicaid (847 [32.6%]), Medicare (524 [20.2%]), private insurance (524 [20.2%]), and self-pay (488 [18.8%]). Women had greater odds of testing positive during alcohol screening (odds ratio [OR], 1.42; 95% CI, 1.21-1.67; P < .001). Black patients were most likely to have Medicaid (OR, 1.64; 95% CI, 1.35-1.99; P < .001), Hispanic patients were most likely to self-pay (OR, 1.96, 95% CI, 1.48-2.58; P < .001), and White patients were most likely to use Medicare (OR, 2.94, 95% CI, 2.33-3.73; P < .001). Conclusions and Relevance Social determinants of health were identified as key risk factors for IPV-related ocular injuries. Study findings highlight identifiable risk factors associated with IPV and ocular trauma that can contribute to IPV awareness among ophthalmologists.
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Affiliation(s)
- Maya Alik
- McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Mishaal Malik
- Central Michigan University College of Medicine, Mt Pleasant
| | - Reza Ashrafi
- Cornell University College of Engineering, Ithaca, New York
| | - Albert Y. Wu
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California
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Ray CN, Marsh HD, Gilmore JE, Kirk DW, Larumbe-Zabala E, Freedman KA. Review of 451 Patients Presenting With Orbital Wall Fractures: A Retrospective Analysis. J Craniofac Surg 2023; 34:126-130. [PMID: 35994738 DOI: 10.1097/scs.0000000000008959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/15/2022] [Indexed: 01/11/2023] Open
Abstract
A retrospective review of the electronic medical records of patients presenting to the University Medical Center in Lubbock, Texas with orbital wall fractures. Clinical data such as associated ocular injuries and different management approaches are analyzed and discussed to help clarify the specific indications for, and timing of, a formal ophthalmologic examination. All patients who presented to the emergency department for an orbital fracture after suffering various types of traumas between 2008 and 2017 were included. The study reviewed 451 patients with orbital wall fractures with a wide variety of presentations as well as demographics. There were 411 cases of adults presenting with an average age of 34 years and 40 pediatric presentations with an average age of 14 years. The average age of the combined study population was 30 years. Only 16.9% of patients required surgical correction for their orbital fractures and assault accounted for nearly 50% of all the orbital fractures reviewed in this study. In this large retrospective review, no notable relationship was found between orbital wall fractured and ocular injury. Alarm symptoms for more visual threatening injuries such as retinal tears, detachments, open globe injury, and extraocular muscle entrapment are all reasonable indications to consult ophthalmology emergently. Most orbital fractures are not vision threatening, do not usually require surgical correction, and typically occur in the setting of assault.
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Affiliation(s)
- Coby N Ray
- Department of Ophthalmology, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Harrison D Marsh
- Department of Ophthalmology, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Jane E Gilmore
- Department of Ophthalmology, Texas Tech University Health Sciences Center, Lubbock, TX
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas
| | - Declan W Kirk
- Department of Ophthalmology, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Eneko Larumbe-Zabala
- Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Kenn A Freedman
- Department of Ophthalmology, Texas Tech University Health Sciences Center, Lubbock, TX
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15
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Vasile VA, Istrate S, Iancu RC, Piticescu RM, Cursaru LM, Schmetterer L, Garhöfer G, Cherecheanu AP. Biocompatible Materials for Orbital Wall Reconstruction-An Overview. MATERIALS (BASEL, SWITZERLAND) 2022; 15:2183. [PMID: 35329635 PMCID: PMC8954765 DOI: 10.3390/ma15062183] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/27/2022] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
The reconstruction of an orbit after complex craniofacial fractures can be extremely demanding. For satisfactory functional and aesthetic results, it is necessary to restore the orbital walls and the craniofacial skeleton using various types of materials. The reconstruction materials can be divided into autografts (bone or cartilage tissue) or allografts (metals, ceramics, or plastic materials, and combinations of these materials). Over time, different types of materials have been used, considering characteristics such as their stability, biocompatibility, cost, safety, and intraoperative flexibility. Although the ideal material for orbital reconstruction could not be unanimously identified, much progress has been achieved in recent years. In this article, we summarise the advantages and disadvantages of each category of reconstruction materials. We also provide an update on improvements in material properties through various modern processing techniques. Good results in reconstructive surgery of the orbit require both material and technological innovations.
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Affiliation(s)
- Victor A Vasile
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, District 5, 020021 Bucharest, Romania
| | - Sinziana Istrate
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, District 5, 020021 Bucharest, Romania
- Department of Ophthalmology, University Emergency Hospital, 020021 Bucharest, Romania
| | - Raluca C Iancu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, District 5, 020021 Bucharest, Romania
- Department of Ophthalmology, University Emergency Hospital, 020021 Bucharest, Romania
| | - Roxana M Piticescu
- Nanostructured Materials Laboratory, National R&D Institute for Nonferrous and Rare Metals, 077145 Pantelimon, Romania
| | - Laura M Cursaru
- Nanostructured Materials Laboratory, National R&D Institute for Nonferrous and Rare Metals, 077145 Pantelimon, Romania
| | - Leopold Schmetterer
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- School of Chemical and Biological Engineering, Nanyang Technological University, Singapore 637459, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, 1090 Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, 1090 Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, 4056 Basel, Switzerland
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, 1090 Vienna, Austria
| | - Alina Popa Cherecheanu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, District 5, 020021 Bucharest, Romania
- Department of Ophthalmology, University Emergency Hospital, 020021 Bucharest, Romania
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16
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Parameswaran A, Panneerselvam E, Ramanathan M, Mathew M, Mukherjee B. Classification and management of infra-orbital rim fractures. J Oral Maxillofac Surg 2022; 80:1053-1061. [DOI: 10.1016/j.joms.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 01/02/2022] [Accepted: 01/02/2022] [Indexed: 11/16/2022]
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Pereira RMA, Barbosa OC, Basílio AFP, Santana ACS, Paula DMD, Marangon H. Surgical Decompression of the Orbit due to Frontal Bone and Roof of the Orbit Fractures - A Case Report. Ann Maxillofac Surg 2021; 10:495-500. [PMID: 33708604 PMCID: PMC7944003 DOI: 10.4103/ams.ams_87_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: 03/24/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/24/2022] Open
Abstract
Trauma in the face region has a very varied etiology and can be associated with several important structures. Isolated fractures in the orbit region correspond to about 4 to 16% of all facial fractures and this incidence increases to 30 to 55% if we take into account fractures that expand to extraorbital regions. The present clinical report aims to describe the case of a male patient, 21-years-old, victim of a motorcycle accident with facial trauma and traumatic brain injury due to frontal collision. Clinical and imaging examinations showed multiple fractures in the face with herniation of brain mass to the orbital region and consequent extrusion of the eyeball. Surgical procedures were performed to reduce and fix fractures and multidisciplinary treatment aimed at preserving vision and brain integrity. Thus, the surgical approach and the multidisciplinary treatment led to an excellent prognosis attested by the one-year postoperative period.
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Affiliation(s)
- Rafael M A Pereira
- School of Dentistry, University Center of Patos de Minas, Patos de Minas, Minas Gerais, Brazil
| | - Otávio C Barbosa
- School of Dentistry, University Center of Patos de Minas, Patos de Minas, Minas Gerais, Brazil
| | - Ana Flávia P Basílio
- School of Dentistry, University Center of Patos de Minas, Patos de Minas, Minas Gerais, Brazil
| | - Anna Cecilia S Santana
- School of Dentistry, University Center of Patos de Minas, Patos de Minas, Minas Gerais, Brazil
| | - Douglas M De Paula
- School of Dentistry, University Center of Patos de Minas, Patos de Minas, Minas Gerais, Brazil
| | - Helvécio Marangon
- School of Dentistry, University Center of Patos de Minas, Patos de Minas, Minas Gerais, Brazil
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Bicak A, Hale J, Day KM. Bilateral Orbital Reconstruction With Autologous Bone Graft After Gunshot Wound to Upper Midface. Cureus 2021; 13:e13611. [PMID: 33816010 PMCID: PMC8011473 DOI: 10.7759/cureus.13611] [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] [Indexed: 11/05/2022] Open
Abstract
Ballistic maxillofacial injuries are highly destructive, producing significant morbidity and mortality. Survivors’ defects pose unique reconstructive challenges, such as loss of periorbital bone stock in upper midface injuries. While orbital reconstruction has transitioned from primarily autologous grafts to alloplastic implants, ballistic trauma remains a niche that warrants the use of autologous bone equally with alloplastic materials. We report a case of an upper midface gunshot wound in a 20-year-old male producing bilateral comminuted medial orbital wall fractures. Reconstruction utilized bilateral split-thickness calvarial bone grafts through preseptal transcaruncular transconjunctival incisions. This case illustrates the utility of autologous bone grafts in the setting of lost periorbital bone stock and minimizing foreign body in surgical fields at high risk of infection or complication. Further studies are necessary to refine the indications for autologous bone grafting and its benefit relative to alloplastic implants in ballistic periorbital trauma.
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Affiliation(s)
- Adam Bicak
- Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Jessica Hale
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Kristopher M Day
- Plastic Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA
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Orbital Bone Fractures in a Central London Trauma Center: A Retrospective Study of 582 Patients. J Craniofac Surg 2021; 32:1334-1337. [PMID: 33405442 DOI: 10.1097/scs.0000000000007384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The aim of the present study was to evaluate the injury patterns and etiology of orbital bone fractures treated at a busy level one trauma center.Between 2015 and 2019, patients with orbital bone fractures from the Department of Oral and Maxillofacial Surgery at the Royal London Hospital, were evaluated in a retrospective analysis. A pro-forma was used to collect data from electronic patient records. Parameters included age, gender, maxillofacial fracture, mechanism of injury, and length of hospital admission.Of 582 patients, 82% (n = 476) were male and 18% (n = 106) were female, with those in the age group 20 to 29 years most affected (36%; n = 212). The most common etiology was interpersonal violence (55%; n = 320), followed by falls (20%; n = 118) and road traffic accidents (12%, n = 68). The most common isolated orbital bone fracture site was the orbital floor (40%; n = 234). Of the impure orbital fractures, the zygoma was the most commonly involved structure adjacent to the orbit (19%, n = 110).In our department, the authors see high numbers of complex orbital bone requiring surgical treatment. Interpersonal violence is a significant cause of orbital bone fractures with young males most affected. This study provides an insight into the current trends in etiology, demographics, and clinical findings of orbital fractures that will help guide prevention and treatment strategies.
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20
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Huang CH, Hsieh DJ, Wu YC, Yen KC, Srinivasan P, Lee HC, Chen YC, Lee SS. Reconstruction of the orbital floor using supercritical CO 2 decellularized porcine bone graft. Int J Med Sci 2021; 18:3684-3691. [PMID: 34790040 PMCID: PMC8579291 DOI: 10.7150/ijms.64359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/26/2021] [Indexed: 12/03/2022] Open
Abstract
Orbital floor fractures subsequently lead to consequences such as diplopia and enophthalmos. The graft materials used in orbital floor fractures varied from autografts to alloplastic grafts, which possess certain limitations. In the present study, a novel porcine bone matrix decellularized by supercritical CO2 (scCO2), ABCcolla® Collagen Bone Graft, was used for the reconstruction of the orbital framework. The study was approved by the institutional review board (IRB) of Kaohsiung Medical University Chung-Ho Memorial Hospital (KMUH). Ten cases underwent orbital floor reconstruction in KMUH in 2019. The orbital defects were fixed by the implantation of the ABCcolla® Collagen Bone Graft. Nine out of ten cases used 1 piece of customized ABCcolla® Collagen Bone Graft in each defect. The other case used 2 pieces of customized ABCcolla® Collagen Bone Graft in one defect area due to the curved outline of the defect. In the outpatient clinic, all 10 cases showed improvement of enophthalmos on CT (computerized tomography) at week 8 follow-up. No replacement of implants was needed during follow-ups. To conclude, ABCcolla® Collagen Bone Graft proved to be safe and effective in the reconstruction of the orbital floor with high accessibility, high stability, good biocompatibility, low infection rate and low complication rate.
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Affiliation(s)
- Chao-Hsin Huang
- School of Post Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Dar-Jen Hsieh
- Center of Research and Development, ACRO Biomedical Co., Ltd. Kaohsiung, Taiwan
| | - Yi-Chia Wu
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Regenerative medicine and cell therapy research center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ko-Chung Yen
- Center of Research and Development, ACRO Biomedical Co., Ltd. Kaohsiung, Taiwan
| | | | - Hsiao-Chen Lee
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ying-Che Chen
- Department of Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Su-Shin Lee
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Regenerative medicine and cell therapy research center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
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