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Neuroimaging Clinics of North America Feb 2022In order for a radiologist to create reports that are meaningful to facial reconstructive surgeons, an understanding of the principles that guide surgical management and... (Review)
Review
In order for a radiologist to create reports that are meaningful to facial reconstructive surgeons, an understanding of the principles that guide surgical management and the hardware employed is imperative. This article is intended to promote efficient and salient reporting by illustrating surgical approaches and rationale. Hardware selection can be inferred and a defined set of potential complications anticipated when assessing the adequacy of surgical reconstruction on postoperative computed tomography for midface, internal orbital, and mandible fractures.
Topics: Facial Bones; Humans; Orbital Fractures; Postoperative Complications; Plastic Surgery Procedures; Tomography, X-Ray Computed
PubMed: 34809841
DOI: 10.1016/j.nic.2021.08.004 -
Facial Plastic Surgery Clinics of North... Feb 2022The bony orbit is commonly involved in athletic injuries. Evaluation should include a comprehensive history and ocular examination. Computed tomography imaging is the... (Review)
Review
The bony orbit is commonly involved in athletic injuries. Evaluation should include a comprehensive history and ocular examination. Computed tomography imaging is the gold standard for diagnostic testing. Urgent surgical intervention for orbital floor fractures should occur after "white eye" trapdoor fractures or if oculocardiac response occurs. Most orbital fractures do not require urgent intervention and repair can be completed within 2 weeks of injury. There are many approaches to repair orbital fractures, and consideration of techniques depends on the unique fracture pattern. Intraoperative computed tomography has become frequently used and can lead to increased identification of plate malpositioning intraoperatively.
Topics: Athletic Injuries; Facial Bones; Humans; Orbit; Orbital Fractures; Tomography, X-Ray Computed
PubMed: 34809885
DOI: 10.1016/j.fsc.2021.08.003 -
Journal of Oral and Maxillofacial... Jun 2022Fractures of the infraorbital rim (IOR) are often undertreated with a resultant compromise of facial esthetics and function. The purpose of this research was to identify...
PURPOSE
Fractures of the infraorbital rim (IOR) are often undertreated with a resultant compromise of facial esthetics and function. The purpose of this research was to identify types of IOR fractures related clinical findings and assess post-treatment outcomes.
METHODS
A retrospective cohort study was implemented involving all patients treated for IOR fractures during an 18-month period. Data consisted of treatment records, pretreatment and post-treatment photographs, and computed tomographic (CT) scans. The types of fractures were matched to the treatment instituted. The type of fracture was the independent variable, while the dependent variables were (i) clinical findings such as lid and globe malposition, tethering of facial skin, diplopia, and infraorbital nerve paresthesia, and (ii) treatment outcome assessed by surgeon and patient. Data were analyzed statistically to study frequencies, proportions, and associations using SPSS (v26, IBM, Armonk, NY).
RESULTS
Forty-three patients (41 males and 2 females) with IOR fractures were treated between July 2019 and January 2021. The age range was 18 to 50 years. The etiology for trauma in all patients was a motor vehicle accident. Fifty-one fractures were classified into 6 types based on CT presentation. The single line fracture (concomitant with other bones) was the most prevalent (58.8%), while globe malposition was the most common clinical finding (35.8%). Lid malposition, globe malposition, and tethering of facial skin were associated with the type of IOR fracture (P = .04, P = .02, and P = .01, respectively). Excellent outcomes were scored in 32 and 25 fractures by the surgeon and patients, respectively, (P = .015 and P = .003). The inter-rater agreement between the surgeon and patient was significant (Kappa = 0.680; P < .001).
CONCLUSIONS
Clinical findings in IOR fractures are dependent on the fracture type. Treatment of fractures based on their CT presentation produces effective management of signs/symptoms and improved treatment outcomes.
Topics: Adolescent; Adult; Diplopia; Female; Humans; Male; Middle Aged; Orbital Fractures; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 35123938
DOI: 10.1016/j.joms.2022.01.002 -
Indian Journal of Ophthalmology Jul 2019The purpose of this systematic review is to investigate the most common indications, treatment, and outcomes of computer-assisted surgery (CAS) in ophthalmological... (Review)
Review
The purpose of this systematic review is to investigate the most common indications, treatment, and outcomes of computer-assisted surgery (CAS) in ophthalmological practice. CAS has evolved over the years from a neurosurgical tool to maxillofacial as well as an instrument to orbitofacial surgeries. A detailed and organized scrutiny in relevant electronic databases, journals, and bibliographies of the cited articles was carried out. Clinical studies with a minimum of two study cases were included. Navigation surgery, posttraumatic orbital reconstruction, computer-assisted orbital surgery, image-guided orbital decompression, and optic canal decompression (OCD) were the areas of interest. The search generated 42 articles describing the use of navigation in facial surgery: 22 on orbital reconstructions, 5 related to lacrimal sac surgery, 4 on orbital decompression, 2 articles each on intraorbital foreign body and intraorbital tumors, 2 on faciomaxillary surgeries, 3 on cranial surgery, and 2 articles on navigation-guided OCD in traumatic optic neuropathy. In general, CAS is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were related to trauma. Treatment of complex orbital fractures was greatly improved by the use of CAS compared with empirically treated control groups. CAS seems to add a favourable potential to the surgical armamentarium. Planning details of the surgical approach in a three-dimensional virtual environment and execution with real-time guidance can help in considerable enhancement of precision. Financial investments and steep learning curve are the main hindrances to its popularity.
Topics: Decompression, Surgical; Humans; Imaging, Three-Dimensional; Orbital Fractures; Plastic Surgery Procedures; Surgery, Computer-Assisted; Tomography, X-Ray Computed
PubMed: 31238394
DOI: 10.4103/ijo.IJO_807_18 -
Current Opinion in Otolaryngology &... Aug 2019Orbital floor blowout fractures may lead to significant morbidity, including debilitating double vision and globe malposition. Thorough evaluation and timely surgical... (Review)
Review
PURPOSE OF REVIEW
Orbital floor blowout fractures may lead to significant morbidity, including debilitating double vision and globe malposition. Thorough evaluation and timely surgical intervention may prevent long-term sequelae.
RECENT FINDINGS
New studies have demonstrated certain patients with orbital floor fractures to do well when managed conservatively. In those necessitating operative repair, precise surgical dissection and adequate fracture reduction are essential to restoring orbital anatomy and function. Novel surgical techniques and orbital floor reconstruction materials, described in this review, will further optimize patient outcomes.
SUMMARY
A knowledgeable evaluation, thoughtful management strategy and modernized surgical technique can prevent long-term disability in patients with orbital floor blowout fractures.
Topics: Conservative Treatment; Fracture Fixation; Humans; Orbital Fractures; Plastic Surgery Procedures
PubMed: 31219830
DOI: 10.1097/MOO.0000000000000550 -
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 -
Atlas of the Oral and Maxillofacial... Mar 2021
Review
Topics: Humans; Orbital Fractures; Orthoptics
PubMed: 33516539
DOI: 10.1016/j.cxom.2020.10.002 -
The British Journal of Oral &... Nov 2020We aimed to study the prevalence of orbital blowout fractures and evaluate the causes and the location of orbital cavity fractures. In this cross-sectional study, the...
We aimed to study the prevalence of orbital blowout fractures and evaluate the causes and the location of orbital cavity fractures. In this cross-sectional study, the medical records of all patients admitted with facial trauma were assessed, sociodemographic information as well as the aetiology of trauma extracted, and the computed tomographic images of the patients were reassessed. Location of orbital blowout fractures and the severity of orbital fractures were evaluated. A total of 203 cases had blowout fractures (175 male and 28 female patients with a mean (SD) age of 36 (16) years. Road traffic accidents (n=139, 69%) were the most common cause of orbital blowout fractures. Falls (n=29, 14%) and assault (n=20, 10%) were the other causes of trauma to the orbital structure, which resulted in blowout fractures. The medial wall was the most commonly involved location (n=81, 40%) followed by orbital floor (n=64, 32%), the combination of medial wall and floor (n=36, 18%), medial wall and maxilloethmoidal strut combination (n=13, 6%), and all the three locations altogether (n=9, 4%). Most of the blow-out fractures had mild severity (n=107, 53%). There was a significant relation between the severity and location of the blowout fractures (p<0.001).
Topics: Cross-Sectional Studies; Female; Humans; Male; Orbit; Orbital Fractures; Prevalence; Retrospective Studies
PubMed: 32680725
DOI: 10.1016/j.bjoms.2020.07.001 -
European Journal of Trauma and... Apr 2022The aim of this study was to retrospectively review the midface and orbital floor fractures treated at our institution with regard to epidemiological aspects, surgical...
OBJECTIVE
The aim of this study was to retrospectively review the midface and orbital floor fractures treated at our institution with regard to epidemiological aspects, surgical treatment options and postoperative complications and discuss this data with the current literature.
STUDY DESIGN
One thousand five hundred and ninety-four patients with midface and orbital fractures treated at the Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery of the Goethe University Hospital in Frankfurt (Germany) between 2007 and 2017 were retrospectively reviewed. The patients were evaluated by age, gender, etiology, fracture pattern, defect size, surgical treatment and complications.
RESULTS
The average patient age was 46.2 (± 20.8). Most fractures (37.5%) occurred in the age between 16 and 35. Seventy-two percent of patients were male while 28% were female. The most common cause of injury was physical assault (32.0%) followed by falls (30.8%) and traffic accidents (17.0%). The average orbital wall defect size was 297.9 mm (± 190.8 mm2). For orbital floor reconstruction polydioxanone sheets (0.15 mm 38.3%, 0.25 mm 36.2%, 0.5 mm 2.8%) were mainly used, followed by titanium meshes (11.5%). Reconstructions with the 0.15 mm polydioxanone sheets showed the least complications (p < 0.01, r = 0.15). Eighteen percent of patients who showed persistent symptoms and post-operative complications: 12.9% suffered from persistent hypoesthesia, 4.4% suffered from post-operative diplopia and 3.9% showed intra-orbital hematoma.
CONCLUSION
Results of the clinical outcome in our patients show that 0.15 mm resorbable polydioxanone sheets leads to significantly less post-operative complications for orbital floor defects even for defects beyond the recommended 200 mm.
Topics: Adolescent; Adult; Diplopia; Female; Fractures, Multiple; Humans; Male; Orbital Fractures; Polydioxanone; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 34128084
DOI: 10.1007/s00068-021-01716-x -
Facial Plastic Surgery : FPS Oct 2014Among midfacial fractures, the frequency of orbital injuries is surpassed only by nasal fractures. A clear understanding of orbital anatomy and the pathophysiology of... (Review)
Review
Among midfacial fractures, the frequency of orbital injuries is surpassed only by nasal fractures. A clear understanding of orbital anatomy and the pathophysiology of these injuries is critical to accurate diagnosis, precise surgical reconstruction, and successful clinical outcomes. This chapter reviews the mechanism of injury and pathophysiology of orbital fractures as well as the implant materials that are currently used for surgical reconstruction.
Topics: Anatomic Landmarks; Humans; Orbit; Orbital Fractures; Orbital Implants; Plastic Surgery Procedures; Tomography, X-Ray Computed
PubMed: 25397706
DOI: 10.1055/s-0034-1394099