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Park RB, North VS, Rebhun CL, Belinsky I, Godfrey KJ, Tran AQ. Globe Compression by Bone Fragments in Orbital Blow-in Fractures: A Case Series and Systematic Review. Ophthalmic Plast Reconstr Surg 2023; 39:162-169. [PMID: 36190787 DOI: 10.1097/iop.0000000000002272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
PURPOSE The purpose of this study was to describe the clinical characteristics, management, and outcomes of orbital blow-in fractures involving compression of the globe by bone fragments. METHODS A retrospective case series and systematic literature review were performed. RESULTS Three male patients (mean age 29 years) with orbital blow-in fractures causing globe indentation presented with extraocular movement restriction, choroidal folds, and B-scan ultrasonography demonstrating deformation of the globe contour by a hyperechoic bone fragment. All underwent surgical repair within 1 day of presentation resulting in improved visual outcomes. An additional 10 cases were identified in the literature review. The majority of patients were male (80%) with a mean age of 29 years. Fractures originated primarily from the lateral orbital wall (50%) or the orbital roof (40%). Globe compression was evident on CT of the orbit (100%) and ultrasonography (30%). Common presenting signs included decreased visual acuity (70%), restriction of supraduction (40%) or abduction (40%), choroidal folds (30%), brow laceration (40%), periorbital edema (40%), and hypoglobus (40%). Most patients underwent surgical intervention (80%) involving fracture reduction (50%) or fragment removal (38%). Reported postsurgical outcomes were excellent with resolution of diplopia, motility, and visual acuity. CONCLUSION Globe indentation from blow-in fractures are rare. Clinicians should be suspicious in cases of high-velocity trauma to the superolateral orbit with hypoglobus, motility limitation, and indentation of the globe upon dilated exam. Prompt diagnosis and early surgical removal of the compressive orbital bone fragments in a multidisciplinary fashion can lead to good visual, functional, and cosmetic outcomes.
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Affiliation(s)
- Royce B Park
- Department of Ophthalmology, University of Illinois Eye and Ear Infirmary, Chicago, Illinois, U.S.A
| | - Victoria S North
- Department of Ophthalmology, New York University Langone Health, New York, New York, U.S.A
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, U.S.A
| | - Carl L Rebhun
- Department of Ophthalmology, New York University Langone Health, New York, New York, U.S.A
| | - Irina Belinsky
- Department of Ophthalmology, New York University Langone Health, New York, New York, U.S.A
| | - Kyle J Godfrey
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, U.S.A
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Ann Q Tran
- Department of Ophthalmology, University of Illinois Eye and Ear Infirmary, Chicago, Illinois, U.S.A
- Department of Ophthalmology, New York University Langone Health, New York, New York, U.S.A
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, U.S.A
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Pati D, Mishra N, Kar I, Meher B, Samal D, Rath KC. Nasoorbitoethmoid fractures in a tertiary care hospital of eastern India: A prospective study. Natl J Maxillofac Surg 2021; 12:42-49. [PMID: 34188399 PMCID: PMC8191546 DOI: 10.4103/njms.njms_151_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/17/2020] [Accepted: 12/02/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The purpose of this study was to report on the pattern of occurrence of nasoorbitoethmoid (NOE) fractures in Odisha and the various factors that influence their distribution. METHODS The study period was from January 1, 2016 to December 15, 2017. After approval from the Institutional Ethics Committee, all patients diagnosed with naso-orbito-ethmoid fractures reporting to the department of OMFS and Level-1 trauma centers were included in the study. Sociodemographic data along with the etiology and type of fracture were mentioned. Associated injuries to other body parts were noted. Open reduction was possible only in five cases of NOE fractures. The treatment plan including the operative approach and postoperative results was evaluated. RESULTS A total of 1192 patients with facial fracture were seen, of which 52 (4.36%) patients had NOE fractures. Males far outnumbered females in a ratio of 9:1. Thirty-three patients (63.46%) had unilateral NOE fracture, while the rest 19 (36.54%) had bilateral NOE fracture. Sixteen (30.76%) cases were classified as Type I, 35 (67.30%) as Type II, and 1 (1.92%) as Type III. Road traffic accidents were the most common cause of NOE fractures (69%), followed by fall (17%) and assault (10%). The most common neurological injury to be associated with NOE fractures was pneumocephalus (29%), followed by diffuse axonal injury (8%). Telecanthus (100%) was found to be the primary clinical feature in patients of NOE fracture, followed by a depressed nasal bridge (92%). Fracture of the nasal bone was invariably associated with NOE fracture. Complications observed due to untreated NOE fractures included a shortened and retruded nose, shortened palpebral fissures, telecanthus, and enophthalmos. CONCLUSION Contemporary management of NOE complex fractures demands precise diagnosis and immediate surgical management with anatomic reduction and rigid fixation of the involved bone segments. With an improvement in socioeconomic status and increased awareness among maxillofacial surgeons, hopefully, a greater number of NOE fracture patients will avail the benefits of open reduction in future.
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Affiliation(s)
- Debashish Pati
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Niranjan Mishra
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Indubhusan Kar
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Brundabati Meher
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Dipti Samal
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Krushna Chandra Rath
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
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Meng X, Wen Q, Gu J, Wang Y. Endoscopic endonasal open reduction for fractures of the frontal process of the maxilla. J Int Med Res 2020; 48:300060520920043. [PMID: 32345079 PMCID: PMC7221172 DOI: 10.1177/0300060520920043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/16/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study was performed to evaluate the clinical efficacy of endoscopic endonasal open reduction of fractures of the frontal process of the maxilla (FFPM). METHODS We performed a retrospective study of patients who underwent endoscopic endonasal open reduction of FFPM from December 2013 to October 2018. The preoperative assessment included nasal endoscopy, computed tomography imaging, and three-dimensional craniofacial reconstruction. The clinical results were evaluated with a visual analog scale at 2 days and 1 year postoperatively. RESULTS Thirty-two patients (25 male, 7 female) with an average age of 39 years were included in the study. All patients successfully underwent a surgical operation via the endoscopic endonasal approach with a nasal mucosal incision, and the nasal deformities were corrected. At the 1-year follow-up, six (18.8%) and 26 (81.2%) patients were somewhat satisfied and very satisfied with the aesthetic result, respectively, and five (15.6%) and 27 (84.4%) were somewhat satisfied and very satisfied with the functional result, respectively. CONCLUSION Endoscopic endonasal open reduction can be considered a reliable method for anatomical reduction of FFPM. This technology provides a viable choice for the treatment of FFPM.
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Affiliation(s)
- Xiangming Meng
- Department of Otorhinolaryngology, Wuxi Huishan
District People’s Hospital, Wuxi, P.R. China
| | - Qingbo Wen
- Department of Otorhinolaryngology, Wuxi Huishan
District People’s Hospital, Wuxi, P.R. China
| | - Jianhong Gu
- Department of Otorhinolaryngology, Wuxi Huishan
District People’s Hospital, Wuxi, P.R. China
| | - Yangyang Wang
- Department of Otorhinolaryngology, Wuxi Huishan
District People’s Hospital, Wuxi, P.R. China
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Etemadi Sh M, Shahnaseri S, Soltani P, Kalantar Motamedi MR. Management of Naso-Orbito-Ethmoid Fractures: A 10-Year Review. Trauma Mon 2016; In press. [DOI: 10.5812/traumamon.29230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Atighechi S, Baradaranfar MH, Karimi G, Dadgarnia MH, Mansoorian HR, Barkhordari N, Sajadinejad BS, Behniafard N. Diagnostic value of ultrasonography in the diagnosis of nasal fractures. J Craniofac Surg. 2014;25:e51-e53. [PMID: 24406602 DOI: 10.1097/scs.0b013e3182a2eeda] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION This study examined the diagnostic value of ultrasound and radiography compared with clinical examinations as the gold standard method to determine whether ultrasound can be used for early diagnosis of nasal fracture. METHODS This prospective study was conducted on 128 patients with clinical signs of nasal fracture. Radiography in all patients was performed by 2 different radiologists on Waters and lateral view with a 10-MHz ultrasound probe, and clinical examinations were done by an ENT specialist. Radiography and ultrasound findings were recorded and compared with the final diagnosis which was based on clinical examinations. Results were analyzed with different statistical methods to determine sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. RESULTS In the assessment of fracture with ultrasound, sensitivity was 84%, specificity 75%, accuracy 82%, positive predictive value 91%, and negative predictive value 61%. In the assessment of fracture on lateral view radiography, sensitivity was 50%, specificity 72%, accuracy 55%, positive predictive value 84%, and negative predictive value 32%. On Waters view radiography, sensitivity was 53%, specificity 65%, accuracy 56%, positive predictive value 82%, and negative predictive value 31%. On lateral-waters view radiography, sensitivity was 64%, specificity 58%, accuracy 62%, positive predictive value 82%, and negative predictive value 34%. Fracture diagnosis by ultrasound was significantly better as compared with radiography (P = 0.04). CONCLUSION The nasal bone ultrasound study is a useful method in determining the nasal fracture and radiography can be replaced with ultrasound in early diagnosis of fracture.
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Lee IS, Lee JH, Woo CK, Kim HJ, Sol YL, Song JW, Cho KS. Ultrasonography in the diagnosis of nasal bone fractures: a comparison with conventional radiography and computed tomography. Eur Arch Otorhinolaryngol 2016; 273:413-8. [PMID: 25749616 DOI: 10.1007/s00405-015-3595-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to evaluate and compare the diagnostic efficacy of ultrasonography (US) with radiography and multi-detector computed tomography (CT) for the detection of nasal bone fractures. Forty-one patients with a nasal bone fracture who underwent prospective US examinations were included. Plain radiographs and CT images were obtained on the day of trauma. For US examinations, radiologist used a linear array transducer (L17-5 MHz) in 24 patients and hockey-stick probe (L15-7 MHz) in 17. The bony component of the nose was divided into three parts (right and left lateral nasal walls, and midline of nasal bone). Fracture detection by three modalities was subjected to analysis. Furthermore, findings made by each modality were compared with intraoperative findings. Nasal bone fractures were located in the right lateral wall (n = 28), midline of nasal bone (n = 31), or left lateral wall (n = 31). For right and left lateral nasal walls, CT had greater sensitivity and specificity than US or radiography, and better agreed with intraoperative findings. However, for midline fractures of nasal bone, US had higher specificity, positive predictive value, and negative predictive value than CT. Although two US evaluations showed good agreements at all three sites, US findings obtained by the hockey-stick probe showed closer agreement with intraoperative findings for both lateral nasal wall and midline of nasal bone. Although CT showed higher sensitivity and specificity than US or radiography, US found to be helpful for evaluating the midline of nasal bone. Furthermore, for US examinations of the nasal bone, a smaller probe and higher frequency may be required.
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Chou C, Chen CW, Wu YC, Chen KK, Lee SS. Refinement treatment of nasal bone fracture: A 6-year study of 329 patients. Asian J Surg 2015; 38:191-8. [PMID: 25451630 DOI: 10.1016/j.asjsur.2014.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 09/11/2014] [Accepted: 09/19/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The reliability of X-ray radiography for diagnosing nasal bone fractures (NBFs) remains controversial. Recent studies show that, for determining the orientation and location of the displaced/depressed fracture, nasal sonography is as accurate as facial computed tomography. This retrospective study compared conductor-assisted nasal sonography (CANS) to conventional diagnostic tools and reported subjective patient satisfaction and discomfort after closed reduction combined with tube technique. METHODS This retrospective study reports the results of 329 refinement treatments for nasal bone fracture (including 199 men and 130 women) performed from 2005 to 2011. All patients were assessed with CANS and completed a survey immediately prior to removing the packing. Questionnaires were adapted from the nasal obstruction symptom evaluation (NOSE) scale. RESULTS The study found that CANS has a 97.2% rate of accuracy in diagnosing NBF. The visual analog scale scores of nasal obstruction, nasal congestion, sleep disturbance, trouble breathing, and inability to move air through the nose were analyzed. The experimental group scores were significantly different from the control group for all scores (p < 0.001). CONCLUSION Compared to conventional methods, CANS is more accurate for detecting NBF. We recommend its use as an alternative tool for diagnosing a nasal fracture. Because the tube technique balances pressure between the nasopharynx and middle ear during swallowing, patient comfort is enhanced. Application of these modifications can improve accuracy in diagnosing NBF and can improve the quality of NBF treatment.
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Lee MH, Cha JG, Hong HS, Lee JS, Park SJ, Paik SH, Lee HK. Comparison of high-resolution ultrasonography and computed tomography in the diagnosis of nasal fractures. J Ultrasound Med 2009; 28:717-723. [PMID: 19470811 DOI: 10.7863/jum.2009.28.6.717] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the value of high-resolution ultrasonography (HRUS) and computed tomography (CT) in the diagnosis of nasal fractures. METHODS Facial CT and HRUS examinations performed on 140 consecutive patients (103 male and 37 female; age range, 2-74 years; mean, 26 years) with nasal trauma between October 2004 and April 2007 were retrospectively evaluated. Sonograms were obtained with a hockey stick probe (15-7 MHz linear array transducer). All patients also underwent facial CT and conventional radiography. The nasal fracture detection rates for HRUS, CT, and conventional radiography were compared with the clinical and surgical diagnosis. Nasal fractures were classified into high- and low-grade groups according to severity. They were also compared with the CT findings of all 280 lateral nasal bones and with HRUS findings as the reference standard. RESULTS The accuracy rates for HRUS, CT, and conventional radiography in detecting nasal fractures were 100%, 92.1%, and 78.6%, respectively. Compared with HRUS, CT revealed only 196 of 233 lateral nasal bone fractures; its accuracy was 80%. In high-grade fractures, the accuracy of CT was 87%, but it decreased to 68% in low-grade fractures. CONCLUSIONS Compared with HRUS, CT had lower accuracy, especially in low-grade nasal fractures. Thus, HRUS is a reliable diagnostic tool for the evaluation of nasal fractures.
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Affiliation(s)
- Min Hee Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, 1174 Jungdong, Wonmi-gu, Gyeonggi-do 420-021, Korea
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Abstract
OBJECTIVE We describe the sonographic findings of nasal fracture in children, and we evaluate the diagnostic value of sonography as compared with conventional radiography and clinical findings to determine whether sonography can be a primary technique for evaluating nasal fracture in children. MATERIALS AND METHODS Conventional radiographs and sonographic scans were obtained in 26 consecutive children with nasal trauma who were seen at our hospital from March 2003 to March 2005. There were five girls and 21 boys, and their ages ranged from 1 year 9 months to 15 years 11 months (mean age, 9.9 years). The following sonographic scans (HDI-5000 unit with a 7-15-MHz linear array transducer) were used to evaluate the nasal bone at different levels: a midline longitudinal image; axial scans of the nasal bones at the upper, middle, and lower levels; images of the nasal septum; and transverse and longitudinal scans of both lateral walls. Ten children also underwent CT. RESULTS Conventional radiographs depicted 14 (54%) of 26 fractures. Sonographic scans were able to show all the fracture lines. One case was diagnosed as an old nasal fracture on the basis of a physical examination, even though a visible fracture line was seen on sonography. The sonographic findings of nasal fracture were disruption of the bone continuity with or without separation of the fractured segment (7/26), displacement of the bone segment as being depressed or overriding (20/26), associated septal deviation (7/26), and separation of the pyriform aperture of the maxilla and nasal bone (2/26). The associated findings were soft-tissue edema and hypoechoic hematoma near the fracture lines in 25 cases. The fractures involved both sides of the nasal bones in 11 of 26 cases, the midline part of the bones in six of 26 cases, and the unilateral paramedian or lateral part of the bones in 12 of 26 cases. Among the 10 CT scans, one CT scan did not depict the fracture, showing only soft-tissue swelling, and one scan showed fractures of the orbital floor and maxilla. CONCLUSION Sonography can be a primary diagnostic technique for evaluating nasal fracture in children. It inflicts no radiation, provides various imaging planes without positional change, and can be used to evaluate the cartilaginous septum. Potential pitfalls are the nasofrontal suture, the junction between the nasal bone and the pyriform aperture of the maxilla, the vascular groove, and the presence of an old fracture. CT can be used in addition to sonography in cases of suspected complex facial bone trauma.
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Affiliation(s)
- Hyun Sook Hong
- Department of Radiology, Soonchunhyang University Hospital, 1174 Jung-Dong, Wonmi-Gu, Bucheon-Si, Gyeonggi-Do 420-021, South Korea
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Jank S, Deibl M, Strobl H, Oberrauch A, Nicasi A, Missmann M, Bodner G. Intrarater reliability in the ultrasound diagnosis of medial and lateral orbital wall fractures with a curved array transducer. J Oral Maxillofac Surg 2006; 64:68-73. [PMID: 16360859 DOI: 10.1016/j.joms.2005.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Indexed: 11/29/2022]
Abstract
PURPOSE The aims of the study were to document the effectiveness of ultrasound (US) in diagnosing orbital wall fractures when compared with computed tomography (CT) and to measure the intraobserver reliability of US using a curved array transducer. MATERIALS AND METHODS From December 2003 to March 2004, 13 patients with the clinical diagnosis of an orbital trauma were investigated prospectively by CT (reference) and 2 US investigators. Both orbits were investigated. Sensitivity, specificity, accuracy, and positive and negative predictive value were calculated. The statistical difference between the 2 US investigators was calculated by a chi-square test. The interrater reliability was calculated using the lambda coefficient. Values below 0.4 represent poor reliability, between 0.4 and 0.75 represent fair to good reliability, and a score > 0.75 is graded as excellent reliability. RESULTS The comparison of the results of the 2 US investigators by the chi-square test showed P values of .385 for the medial orbital wall and .638 for the lateral orbital wall, which shows no significant difference. The lambda-value for the investigation of the medial orbital wall reached 0.429, 0.714, and 0.750. The lambda-value for the investigation of the lateral orbital wall yielded 0.647, 0.750, and 0.882. These values show a good and excellent inter-rater reliability. CONCLUSION The US investigation does not yet reach the diagnostic quality of CT. US could be a helpful diagnostic imaging tool in cases with clear clinical symptoms. The results of the current study and the previously published results imply that US has the potential to reach the same diagnostic quality as CT in the future, but further studies must be performed to improve the diagnostic quality of the method.
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Affiliation(s)
- Siegfried Jank
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Germany.
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Abstract
The aim of diagnostic imaging for maxillofacial trauma is to provide additional information that can positively influence medical or surgical patient management. Current advances in diagnostic imaging have come from the confluence of 3 driving forces: (1) the demand from clinicians to enhance and expand their diagnostic abilities; (2) the development of new theoretical concepts by basic scientists; and (3) the application of concepts by engineers and manufacturers to provide increasingly sophisticated imaging capabilities. The role of imaging within the health care environment is, however, also buffeted by the complex, sometimes competing, interactions of external social, political, economic, and technological pressures at the national, regional, and local levels. The purposes of this review are to provide a perspective on current imaging modalities used for maxillofacial trauma and to provide an insight into the influences, both technologic and external, on future developments and applications.
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Affiliation(s)
- William Charles Scarfe
- University of Louisville School of Dentistry, Department of Surgical/Hospital Dentistry, Louisville, KY 40292, USA.
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Jank S, Siegfried J, Deibl M, Martina D, Strobl H, Heinrich S, Oberrauch A, Andreas O, Nicasi A, Alessandro N, Missmann M, Martin M, Bodner G, Gerd B. Interrater reliability of sonographic examinations of orbital fractures. Eur J Radiol 2005; 54:344-51. [PMID: 15899334 DOI: 10.1016/j.ejrad.2004.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Revised: 06/12/2004] [Accepted: 07/14/2004] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study is to determine whether there are statistically significant variations among different observers when examining fractures of the orbital walls. MATERIAL AND METHODS From December 2003 to April 2004, 28 patients with clinically suspected orbital fractures were examined by ultrasound prospectively. The US images of the infra-orbital margins, the orbital floors, the medial and lateral orbital walls of each patient were reexamined by two independent investigators. RESULTS Computed tomography revealed fractures of the orbital floor in 28 out of 31 patients (90.3%). The infra-orbital margins showed fractures of 14 of 31 patients (45.2%). The ultrasound examinations of the orbits by the three examiners presented satisfactory correlation regarding sensitivity and specificity. There were no significant differences between investigators. There was good agreement among the ultrasound examiners regarding the infra-orbital margins. This was not the case for the orbital floors. CONCLUSIONS If there are clear cut clinical findings ultrasound examination could represent an alternative to computed tomography. If the clinical findings were indeterminate, computed tomography was essential as implicated by this study. Accordingly, further evaluation of ultrasound examinations of fractures of the orbital margins and floors are necessary.
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Affiliation(s)
- Siegfried Jank
- Department of Oral and Maxillofacial Surgery, University of Innsbruck, Maximilianstr. 10, A-6020 Innsbruck, Australia.
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Jank S, Deibl M, Strobl H, Oberrauch A, Nicasi A, Missmann M, Bodner G. Reliabilit�t der sonographischen Diagnostik von Orbitabodenfrakturen und Frakturen des Infraorbitalrandes. ACTA ACUST UNITED AC 2004; 8:337-43. [PMID: 15503239 DOI: 10.1007/s10006-004-0571-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the study was to evaluate the interobserver variation of the ultrasound diagnosis of orbital floor fractures and fractures of the infraorbital rim. MATERIAL AND METHODS A total of 25 patients with a clinical diagnosis of an orbital trauma were investigated prospectively by computed tomography (CT) and ultrasonography (US). Inter-observer variation was calculated using the lambda coefficient (lambda). The US images were reassessed by two inexperienced investigators. RESULTS The lambda value for the US investigation of the orbital floor showed poor reliability comparing the US findings with the results of the re-investigators. The comparison between the two re-investigators showed a good reliability for the US evaluation of the orbital floor. The lambda for the US investigation of the infraorbital margin showed a good reliability comparing the US findings with the results of the both re-investigators. The comparison of the two re-investigators showed a good reliability as well. CONCLUSION Ultrasound is not yet an alternative method for the evaluation of orbital floor fractures and fractures of the infraorbital margin. To replace CT which is accepted as the current gold standard, further studies have to be done to reach a better diagnostic quality of the method and to achieve a better calibration of the investigations.
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Affiliation(s)
- S Jank
- Abteilung für Mund-, Kiefer und Gesichtschirurgie, Universität Innsbruck.
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Jank S, Emshoff R, Strobl H, Etzelsdorfer M, Nicasi A, Norer B. Effectiveness of ultrasonography in determining medial and lateral orbital wall fractures with a curved-array scanner. J Oral Maxillofac Surg 2004; 62:451-5. [PMID: 15085512 DOI: 10.1016/j.joms.2003.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the diagnostic value of ultrasonography to determine medial and lateral orbital wall fractures. MATERIALS AND METHODS Sixty-two patients with the clinical diagnosis of an orbital trauma underwent coronal computed tomography (CCT) and ultrasonographic investigation (US). Inclusion criteria were clinically suspected orbital injuries defined by reduced bulbus motility, diplopia, or additional traumatic injuries of the orbit or the globe. US and CCT were used as imaging diagnostic methods. RESULTS Ultrasonography showed a sensitivity of 56%, a specificity of 95%, and an accuracy of 88% at the medial orbital rim. Regarding the lateral orbital rim, ultrasonography showed a sensitivity of 92%, a specificity of 88%, and an accuracy of 90% using CCT as a reference method. CONCLUSION Ultrasonography with a curved-array scanner seems to be a valuable method in the detection of lateral orbital wall fractures. Further studies have to be done to improve sensitivity in the interpretation of medial orbital wall fractures.
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Affiliation(s)
- Siegfried Jank
- Department of Oral and Maxillofacial Surgery, University of Innsbruck, Innsbruck, Austria.
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Rake PA, Rake SA, Swift JQ, Schubert W. A single reformatted oblique sagittal view as an adjunct to coronal computed tomography for the evaluation of orbital floor fractures. J Oral Maxillofac Surg 2004; 62:456-9. [PMID: 15085513 DOI: 10.1016/j.joms.2003.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE We sought to determine whether it is beneficial to routinely include a single reformatted oblique sagittal view as an adjunct to coronal computed tomography (CT) for the evaluation and treatment of orbital floor fractures, when imaging is obtained on patients with orbital trauma. MATERIALS AND METHODS A retrospective analysis of 12 midface CT scans was performed. All of the patients included in the study had been determined by a staff radiologist to have radiographic evidence of orbital fractures. Five surgeons who treat orbital floor fractures, but do not routinely order oblique sagittal views, were asked to evaluate the selected CT scans without being given a clinical history. The surgeons were allowed to evaluate the reformatted coronal CT and were asked to rate their ability to determine the location and the size of the fracture in a medial-lateral dimension and an anterior-posterior dimension, volume of orbital contents herniated into the maxillary sinus, and radiographic evidence of inferior rectus entrapment. The surgeons were then allowed to evaluate a single reformatted oblique sagittal view through each orbit. They were asked the same questions and these 2 additional questions, "Do you think the oblique view gave you additional information, and would it change your treatment plan?" RESULTS Confidence in determining the size and location of the fracture in a medial-lateral dimension was not improved with the addition of the reformatted oblique sagittal view; however, location and size of the fracture in an anterior-posterior dimension and volume displaced from the orbit into the maxillary sinus and evidence of inferior rectus entrapment were improved with the addition to the oblique sagittal view. Seventy-eight percent of responders said that the oblique sagittal view provided additional information, and 18% of the responders said that the additional information changed the treatment plan. CONCLUSION Routinely obtaining a single reformatted oblique sagittal view as an adjunct to coronal CT provides additional valuable information to the surgeon in treating orbital floor fractures. Reformatted views do not subject patients to additional radiation and the time to obtain these views is minimal.
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Affiliation(s)
- P Angela Rake
- Division of Oral and Maxillofacial Surgery, University of Minnesota, Minneapolis, MN, USA
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Jank S, Schuchter B, Emshoff R, Strobl H, Koehler J, Nicasi A, Norer B, Baldissera I. Clinical signs of orbital wall fractures as a function of anatomic location. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96:149-53. [PMID: 12931086 DOI: 10.1016/s1079-2104(03)00317-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this study was to see whether clinical signs of medial orbital wall fractures distinguished these fractures from fractures of the lateral orbital wall and the orbital floor. STUDY DESIGN The orbital fractures of 424 patients were analyzed. The patients were divided into 2 groups: (1) patients with orbital fractures with a medial orbital wall component and (2) patients with orbital fractures without a medial orbital wall component. RESULTS Orbital fractures with involvement of the medial orbital wall showed a significantly higher incidence (P =.001) of diplopia and exophthalmos (P =.039) than fractures without involvement of the medial wall. CONCLUSION Posttraumatic orbital clinical signs are associated with a higher incidence of medial orbital wall component fracture. Apparent lack of involvement of the medial orbital wall should not be an exclusion criterion for a surgical intervention when clinical orbital signs exist.
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Affiliation(s)
- Siegfried Jank
- Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria.
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17
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Jank S, Strobl H, Emshoff R, Etzelsdorfer M, Nicasi A, Missmann M, Norer B. [Imaging diagnosis of medial and lateral orbital wall fractures. Sonography versus computed tomography]. Mund Kiefer Gesichtschir 2003; 7:208-13. [PMID: 12961070 DOI: 10.1007/s10006-003-0477-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the diagnostic value of a curved array scanner in the diagnosis of medial and lateral orbital wall fractures. MATERIAL AND METHODS Fifty-three patients with the clinical diagnosis of an orbital trauma were investigated prospectively within a period of 16 months by CT and ultrasonography. The intraoperative findings were used as a reference. RESULTS CT reached a sensitivity of 100% and a specificity of 96% in the diagnosis of medial orbital wall fractures, while ultrasound yielded a sensitivity of 80% and a specificity of 96%. There was no significant difference found between CT and ultrasonography ( p=0.402). In the investigation of lateral orbital wall fractures, CT reached a sensitivity of 88% and a specificity of 87%, while ultrasonography yielded a sensitivity of 97% and a specificity of 95%. Ultrasonography achieved significantly better results than CT ( p=0.008). CONCLUSION The ultrasound investigation with a curved array scanner could be used as an additional method in the diagnosis of medial and lateral orbital wall fractures. Further technical improvements of the transducers need to be developed to increase the sensitivity of ultrasound in the diagnosis of medial orbital wall fractures.
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Affiliation(s)
- S Jank
- Abteilung für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinik für Mund-, Kiefer- und Gesichtschirurgie, Universität Innsbruck.
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Abstract
This article presents a strategy for treating naso-orbito-ethmoid fractures. Eight steps for the management of such injuries are presented: surgical exposure, identification of the medial canthal tendon/tendon-bearing bone fragment, reduction/reconstruction of medial orbital rim, reconstruction of the medial orbital wall, transnasal canthopexy, reduction of septal fractures, nasal dorsum reconstruction/augmentation, and soft tissue adaptation. Following these steps can make treatment outcomes more predictable.
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Affiliation(s)
- E Ellis
- Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9031
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Ilankovan V, Hadley D, Moos K, el Attar A. A comparison of imaging techniques with surgical experience in orbital injuries. A prospective study. J Craniomaxillofac Surg 1991; 19:348-52. [PMID: 1795048 DOI: 10.1016/s1010-5182(05)80277-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The aim of the study is to compare the effectiveness of computerised tomography (CT) and magnetic resonance (MR) imaging in diagnosing herniation and entrapment of orbital soft tissues in orbital fractures. 15 consecutive patients with clinical signs and symptoms of medial orbital wall injury were examined with CT and MR. The data were subsequently compared with the findings of the surgical exploration with regard to the extent of the wall fractures, the presence of soft tissue herniation and its entrapment. CT and MR were equally accurate in demonstrating or excluding orbital wall fractures but both modalities slightly underestimated their incidence. CT and MR underestimated the actual incidence of soft tissue herniation and entrapment when compared with the surgical findings but the extent of soft tissue herniation and entrapment were demonstrated more clearly by MR than by CT scanning. MR imaging when available should therefore be used as the initial imaging modality and CT held in reserve for confirmation as positioning in the MR unit is easier and more comfortable for recently injured patients who may well have other injuries.
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Affiliation(s)
- V Ilankovan
- Dept. of Oral and Maxillofacial Surgery, Canniesburn Hospital, Glasgow
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