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Emergency Medicine Clinics of North... Feb 2019Appropriate medical care for a patient with a facial fracture can not only optimize aesthetic outcomes but also prevent the potential morbidity and mortality of delayed... (Review)
Review
Appropriate medical care for a patient with a facial fracture can not only optimize aesthetic outcomes but also prevent the potential morbidity and mortality of delayed treatment. In this article, we focus on the clinical presentations, physical examination findings, diagnostic imaging, consultations, and follow-up that patients with facial fractures need related to their emergency department management. Specifically, we address the nuances of evaluating frontal, orbital, nasal, maxillofacial, and mandibular fractures.
Topics: Emergencies; Facial Bones; Fractures, Bone; Frontal Bone; Humans; Mandibular Fractures; Maxillofacial Injuries; Nasal Bone; Orbital Fractures
PubMed: 30454777
DOI: 10.1016/j.emc.2018.09.012 -
Tidsskrift For Den Norske Laegeforening... Apr 2022
Topics: Humans; Orbital Fractures; Tomography, X-Ray Computed
PubMed: 35383443
DOI: 10.4045/tidsskr.21.0586 -
Facial Plastic Surgery Clinics of North... May 2018Anatomic, rather than volumetric, reconstruction leads to improved outcomes in orbital reconstruction. Endoscopic visualization improves lighting and magnification of... (Review)
Review
Anatomic, rather than volumetric, reconstruction leads to improved outcomes in orbital reconstruction. Endoscopic visualization improves lighting and magnification of the surgical site and allows the entire operative team to understand and participate in the procedure. Mirror-image overlay display with navigation-guided surgery allows in situ fine adjustment of the implant contours to match the contralateral uninjured orbit. Precise exophthalmometry is important before, during, and after surgery to provide optimal surgical results.
Topics: Endoscopy; Humans; Orbit; Orbital Fractures; Plastic Surgery Procedures; Surgery, Computer-Assisted
PubMed: 29636153
DOI: 10.1016/j.fsc.2017.12.007 -
Oral and Maxillofacial Surgery Clinics... Nov 2023The unique anatomy and physiology of the growing craniofacial skeleton predispose children to different fracture patterns as compared to adults. Diagnosis and treatment... (Review)
Review
The unique anatomy and physiology of the growing craniofacial skeleton predispose children to different fracture patterns as compared to adults. Diagnosis and treatment of pediatric orbital fractures can be challenging. A thorough history and physical examination are essential for the diagnosis of pediatric orbital fractures. Physicians should be aware of symptoms and signs suggestive of trapdoor fractures with soft tissue entrapment including symptomatic diplopia with positive forced ductions, restricted ocular motility (regardless of conjunctival abnormalities), nausea/vomiting, bradycardia, vertical orbital dystopia, enophthalmos, and hypoglobus. Equivocal radiologic evidence of soft tissue entrapment should not withhold surgery. A multidisciplinary approach is recommended for the accurate diagnosis and proper management of pediatric orbital fractures.
Topics: Adult; Child; Humans; Orbital Fractures; Tomography, X-Ray Computed; Nausea; Vomiting; Physical Examination; Enophthalmos
PubMed: 37302946
DOI: 10.1016/j.coms.2023.05.002 -
Current Opinion in Otolaryngology &... Aug 2023The aim of this study was to summarize current evidence on the clinical presentation, evaluation, and management of pediatric orbital fractures. Recent trends in... (Review)
Review
PURPOSE OF REVIEW
The aim of this study was to summarize current evidence on the clinical presentation, evaluation, and management of pediatric orbital fractures. Recent trends in management strategies as well as emerging surgical techniques for pediatric orbital fracture repair are presented.
RECENT FINDINGS
Although somewhat limited, growing bodies of evidence support a conservative approach with close follow up in pediatric orbital fractures. For those patients necessitating surgical repair, resorbable implants are increasingly preferred given their lack of donor site morbidity and a minimal impact on the developing craniofacial skeleton. There are emerging data reporting the use of three-dimensional (3D) printing-assisted approaches and intraoperative navigation; however, more research is needed to assess their applicability in the pediatric population.
SUMMARY
There are few studies with large patient cohorts and long-term follow up given the rare incidence of pediatric orbital fractures, which restricts the generalizability of research on the topic. The studies available increasingly suggest that fractures without clinical evidence of entrapment can be managed conservatively with close follow up. A variety of reconstructive implants are available for those fractures necessitating repair. Donor site morbidity, availability, and need for additional procedures should all be factored into the reconstructive decision-making process.
Topics: Child; Humans; Orbital Fractures; Plastic Surgery Procedures; Incidence; Printing, Three-Dimensional
PubMed: 36976962
DOI: 10.1097/MOO.0000000000000887 -
The Medical Clinics of North America May 2021The eyelids and orbit encompass intricate bony and soft tissue structures that work harmoniously in concert to protect, support, and nourish the eye in order to... (Review)
Review
The eyelids and orbit encompass intricate bony and soft tissue structures that work harmoniously in concert to protect, support, and nourish the eye in order to facilitate and maintain its function. Insult to periorbital and orbital anatomy can compromise orbital and ocular homeostasis. This article provides a foundational overview of eyelid and orbital anatomy, as well as common and key disorders that may confront internists and medical subspecialists.
Topics: Eye Injuries; Eyelid Diseases; Eyelids; Humans; Orbit; Orbital Diseases; Orbital Fractures
PubMed: 33926646
DOI: 10.1016/j.mcna.2021.02.007 -
Radiologie (Heidelberg, Germany) Mar 2024Orbital trauma can occur independently or in conjunction with other craniofacial trauma and can cause damage to bony and neurovascular structures as well as soft... (Review)
Review
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.
Topics: Humans; Orbital Fractures; Eye Injuries; Tomography, X-Ray Computed
PubMed: 38345620
DOI: 10.1007/s00117-024-01272-6 -
Current Opinion in Otolaryngology &... Aug 2022Advances in the use of patient-specific implants (PSIs) and virtual surgical planning (VSP) for reconstruction of primary and secondary traumatic orbital defects are... (Review)
Review
PURPOSE OF REVIEW
Advances in the use of patient-specific implants (PSIs) and virtual surgical planning (VSP) for reconstruction of primary and secondary traumatic orbital defects are explored.
RECENT FINDINGS
PSIs and VSP are emerging technologies that promise to make complex orbital reconstructions safer and more predictable for patients. Recent studies highlight principles of implant design, the novel use of multiunit implant constructs, and utility of intraoperative imaging adjuncts to achieve favorable outcomes.
SUMMARY
This article summarizes recent developments in PSIs for orbital reconstruction. A complete workflow including presurgical planning, execution in the operating room, postoperative analysis, and avoidance of common pitfalls and implant design errors are reviewed.
Topics: Humans; Orbit; Orbital Fractures; Orbital Implants; Plastic Surgery Procedures; Surgery, Computer-Assisted
PubMed: 35906974
DOI: 10.1097/MOO.0000000000000808 -
Current Opinion in Ophthalmology Sep 2017The current study reviews the recent literature on pediatric orbital blowout fractures and provides guidelines on their management. (Review)
Review
PURPOSE OF REVIEW
The current study reviews the recent literature on pediatric orbital blowout fractures and provides guidelines on their management.
RECENT FINDINGS
The most common problem among patients requiring surgical revision of a previously repaired orbital floor fracture is an improperly placed orbital floor implant, usually erroneously placed under the posterior bony ledge. Although the transconjunctival incision can be combined with a lateral canthotomy and cantholysis, excellent surgical exposure can be obtained without the need for these latter relaxing maneuvers. In surgically repaired pediatric orbital blowout fractures with preoperative diplopia (both trapdoor and nontrapdoor), approximately 85% of patients recover completely over time. Delayed orbital tissue atrophy may play a role in the development of late enophthalmos.
SUMMARY
Most cases of pediatric orbital fracture can initially be followed conservatively to determine if disabling diplopia, when present, resolves without surgery. A notable exception is the trapdoor fracture, in which herniated tissue becomes entrapped by a recoiled bone fragment, causing marked or complete reduction in motility and/or an oculocardiac reflex; we recommend that these fractures be repaired within 24 h from the time of diagnosis. Enophthalmos resulting from an orbital floor fracture does not need to be prevented with early surgery. Enophthalmos can be allowed to develop over time to determine if it is noticeable, and then repair undertaken, if necessary, at that time. When surgery is indicated, a simple transconjunctival incision is preferred over a cutaneous incision, and care should be taken to insure that the implant is placed on the bony ledge at the posterior edge of the defect. Many children with blowout fractures will not require surgery, and those that do usually have excellent outcomes provided the recommendations are closely followed.
Topics: Child; Fracture Fixation; Global Health; Humans; Incidence; Orbital Fractures; Orbital Implants; Tomography, X-Ray Computed; Trauma Severity Indices
PubMed: 28797015
DOI: 10.1097/ICU.0000000000000407 -
Ophthalmic Plastic and Reconstructive...To explore the anatomy, etiopathogenesis, diagnosis and classification, current evidence on intervention and the surgical management of orbital roof fractures and... (Review)
Review
PURPOSE
To explore the anatomy, etiopathogenesis, diagnosis and classification, current evidence on intervention and the surgical management of orbital roof fractures and defects (ORFD) for oculoplastic surgeons presented with such cases.
METHODS
A review of the current literature through the MEDLINE database using the following search terms: "orbital roof fracture (+treatment/management)," "orbital roof defect (+treatment/management)," "orbital roof erosion (+treatment/management)," "orbital roof repair," "orbital roof," "orbital fracture," "pediatric orbital roof (defect/fracture/erosion)," "orbital anatomy," and "orbital roof anatomy" was conducted. As relatively little has been published on this topic, inclusion criteria were broad and peer-reviewed articles judged to be of clinical importance, relevant to the aims of this review, were included. Non-English abstracts were also included if relevant. Year of publication was not a strict exclusion criterion, and older articles were judged for their suitability based on clinical importance and relevance to current practice. Additional references were obtained from citations in key articles and recommendations from the coauthors based on their areas of expertise.
RESULTS
The etiopathogenesis of ORFD varies. Classification systems have been formulated to guide management decisions and can range from conservative management to complex neurosurgery. Eyelid approaches have also been described. This review provides a summary of the evidence for each and a management framework oculoplastic surgeons can use when presented with ORFD.
CONCLUSION
Oculoplastic surgeons can be involved, either alone or as part of a multidisciplinary team, in the management of ORFD, and for some, conduct orbital approach reconstructive surgery.
Topics: Child; Humans; Orbit; Orbital Fractures; Plastic Surgery Procedures
PubMed: 34293784
DOI: 10.1097/IOP.0000000000002025