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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 -
Optometry Clinics : the Official... 1993The optometrist is often the first practitioner to see patients with ocular trauma and associated orbital fractures. Trauma is now the second leading cause of blindness... (Review)
Review
The optometrist is often the first practitioner to see patients with ocular trauma and associated orbital fractures. Trauma is now the second leading cause of blindness in the United States. Early and accurate diagnosis of orbital fractures is required to avoid compromising the binocular vision and cosmetic appearance of the patient. With an understanding of the characteristic clinical presentations of fractures and a knowledge of current imaging techniques, these disorders can be accurately diagnosed, managed, or referred by the optometrist.
Topics: Eye Injuries; Humans; Orbital Fractures; Tomography, X-Ray Computed
PubMed: 8268697
DOI: No ID Found -
Atlas of the Oral and Maxillofacial... Mar 2021
Review
Topics: Humans; Orbital Fractures; Orthoptics
PubMed: 33516539
DOI: 10.1016/j.cxom.2020.10.002 -
Journal of AAPOS : the Official... Apr 2011To summarize the unique aspects of orbital floor fractures in children with regard to clinical presentation, management, and outcomes. (Review)
Review
PURPOSE
To summarize the unique aspects of orbital floor fractures in children with regard to clinical presentation, management, and outcomes.
METHODS
MEDLINE was searched using PubMed for English-language articles on orbital floor fractures in children. All 154 indexed articles pertaining to floor fractures in patients under 18 years of age in PubMed were reviewed. Studies looking at primarily complex fractures and case reports and studies that included pediatric patients but did not analyze them separately were excluded. Overall, 25 studies were included for the review.
RESULTS
Inferior trapdoor fractures with muscle and soft tissue incarceration are the most common type of orbital fracture in children (27.8%-93%). They often present uniquely with severely restricted extraocular motility and diplopia (44%-100%), nausea and vomiting (14.7-55.6%), and minimal signs of external trauma. The majority of studies (83%) that analyzed time to surgery in relation to outcomes found that children who present early after initial injury and undergo prompt surgical repair appear to recover faster and have better postoperative motility than those receiving delayed treatment.
CONCLUSIONS
Our understanding of pediatric orbital floor fractures continues to evolve. For young patients with symptomatic diplopia with positive forced ductions, soft tissue entrapment confirmed by computed axial tomography, and/or trapdoor fracture plus restricted ocular movement, having surgery within 2-5 days has been shown to result in better postoperative outcomes. It is recommended that surgery be considered within 48 hours of diagnosis. Long-term prospective studies are still needed to further characterize orbital floor fractures in children.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Male; Orbital Fractures; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 21596296
DOI: 10.1016/j.jaapos.2011.02.005 -
Arquivos Brasileiros de Oftalmologia 2022This study aimed to evaluate the mechanisms of injury and types of orbital fractures and their relation to concurrent commotio retinae.
PURPOSE
This study aimed to evaluate the mechanisms of injury and types of orbital fractures and their relation to concurrent commotio retinae.
METHODS
This retrospective study evaluated the records of patients with orbital fractures whose diagnoses had been confirmed by computer tomography between July 2017 and September 2019. Patient demographics, the circumstances of injury, ophthalmic examination results, and radiological findings were tabulated. Statistical analysis of the data used two-tailed student's t-tests, chi-squared tests, and odds ratio calculations. Statistical significance was set at p<0.05.
RESULTS
Of the 204 patients with orbital fractures included in this study, 154 (75.5%) were male. The mean age was 42.1 years. Orbital fractures involving one orbital wall (58.8%) were more common than those affecting multiple walls (41.2%). The majority of fractures affected the inferior wall (60.3%), with the medial walls being the next most frequently affected (19.6%). The most common cause of injury was assault (59.3%), and the second most common was falls (24%). Commotio retinae was observed in 20.1% of orbital fracture cases and was most associated with injuries caused by assault (OR=5.22, p<0.001) and least associated with those caused by falls (OR=0.06, p<0.001). Eye movement restrictions were more common in central than peripheral commotio (OR=3.79, p=0.015) and with medial wall fractures than fractures to other orbital walls (OR=7.16, p<0.001). The odds of commotio were not found to be higher in patients with multi-walled orbital fractures than in those with single-walled fractures (p=0.967).
CONCLUSIONS
In the study population, assault was the most common cause of orbital fractures and resulted in commotio retinae than other causes. Ophthalmologists should be aware of the likelihood of commotio retinae in patients with orbital fractures resulting from assault, regardless of the extent of the patient's injuries.
Topics: Humans; Male; Adult; Female; Orbital Fractures; Retrospective Studies; Eye Injuries
PubMed: 36350902
DOI: 10.5935/0004-2749.2021-0456 -
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 -
Sports Medicine (Auckland, N.Z.) 2003Orbital fractures represent a small proportion of sports-related injuries in the US and abroad. However, the significant functional and cosmetic sequelae of such... (Review)
Review
Orbital fractures represent a small proportion of sports-related injuries in the US and abroad. However, the significant functional and cosmetic sequelae of such fractures warrant a comprehensive evaluation of any athlete sustaining facial trauma. Initial evaluation is directed at excluding neurological impairment or the presence of vision-threatening injury. Subsequent examination should ascertain the presence of signs and symptoms consistent with orbital fracture. These include gross bony deformity, limitation of gaze, diplopia and malposition of the globe. The presence of any of the aforementioned symptoms should prompt further investigation using computed tomography to corroborate or refute clinical suspicion. Orbital fracture mandates referral to an ophthalmologist or oculoplastic surgeon; initial management is dictated by the severity of functional symptoms, and may necessitate early surgical intervention. Those patients who are managed conservatively should return for frequent follow-up, as progressive diplopia, enophthalmos, or gaze limitation are indications for late operative repair. The majority of patients who sustain orbital fractures are able to return to sport, however, persistent diplopia is not uncommon, and may persist despite optimal treatment.
Topics: Athletic Injuries; Diplopia; Humans; Orbital Fractures; Tomography, X-Ray Computed
PubMed: 12688829
DOI: 10.2165/00007256-200333040-00005 -
Acta Chirurgiae Orthopaedicae Et... 2021PURPOSE OF THE STUDY Diagnosis and treatment of fractures of the facial skeleton in children can be difficult due to the skeletal growth. MATERIAL AND METHODS The 9-year...
PURPOSE OF THE STUDY Diagnosis and treatment of fractures of the facial skeleton in children can be difficult due to the skeletal growth. MATERIAL AND METHODS The 9-year retrospective study included patients admitted with the orbital fracture diagnosis to the University Hospital Brno, Children s Hospital, Department of Paediatric ENT, Department of Paediatric Anaesthesiology and Resuscitation, and Department of Paediatric Surgery, Orthopaedics and Traumatology. We looked into the number of patients admitted to the hospital with the orbital fracture diagnosis and the cause of the injury, the age of patients, and the used treatment method - surgical or non-operative treatment were analysed. The following assumptions were applied: 1. Incidence of the injury (orbital fracture) increases with the age of the patient, 2. Incidence of the injury in individual years is constant. RESULTS In the followed-up period, between 2010 and 2018, a total of 47 patients, of whom 8 girls and 39 boys, with the orbital fracture diagnosis were treated. 12 patients underwent surgery, 35 patients were treated non-operatively. The study group included 47 patients with the age range of 1 to 18 years, with the median age 12 years. When the results were processed, a trend was revealed showing an increase in the number of injuries as well as an in the age of patients at the time of injury. The number of injuries increases with age and year. Both the correlations, however, are statistically insignificant and the trend can be considered statistically insignificant. DISCUSSION Both the non-operative and surgical treatment of patients lead to excellent results, even in the long-term follow-up. In paediatric patients, the surgical approach should be opted for only in cases when the non-operative approach is impossible due to the extent and characteristics of fracture and damage to soft tissues. CONCLUSIONS The surgical treatment aims at the best possible anatomical reconstruction of the orbit with no subsequent functional or cosmetic defects. If surgical treatment is necessary, then the transconjunctival approach is most appropriate in children, namely because of the good overview over the operating field, simple procedure as well as the cosmetic outcome. In most cases it is enough to reposition the orbital soft tissues. In complicated cases, with an orbital floor defect, it needs to be covered with a suitable material. Also, the non-operative approach has its place in therapy and the case-by-case approach must be applied. Orbital fractures should always be treated by experienced specialists (ENT, dental surgeon, traumatologist) specialising in paediatric patients. Key words: fracture, orbit, childhood, surgical, non-operative treatment.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Male; Orbital Fractures; Orthopedic Procedures; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 33960922
DOI: No ID Found -
Journal de Radiologie Jun 2006Blow-out fractures, lateral fractures of the face, involve only the inferior and sometimes the medial wall of the orbit. Clinical diagnosis is not always obvious, and CT... (Review)
Review
Blow-out fractures, lateral fractures of the face, involve only the inferior and sometimes the medial wall of the orbit. Clinical diagnosis is not always obvious, and CT is helpful to confirm diagnosis and also detect some failures of surgical treatment: improper position or size of the graft. MRI is valuable to evaluate post-surgical infections.
Topics: Humans; Magnetic Resonance Imaging; Orbital Fractures; Tomography, X-Ray Computed
PubMed: 16788534
DOI: 10.1016/s0221-0363(06)74053-7 -
Plastic and Reconstructive Surgery Dec 2014After studying this article, the participant should be able to: 1. Explain the epidemiology, anatomy, and pathophysiology of orbital floor fractures. 2. Select the... (Review)
Review
LEARNING OBJECTIVES
After studying this article, the participant should be able to: 1. Explain the epidemiology, anatomy, and pathophysiology of orbital floor fractures. 2. Select the optimal timing of--and understand the indications for-operative repair of orbital floor fractures. 3. List advantages and disadvantages of the surgical approaches and materials available for orbital floor reconstruction. 4. Identify special considerations in treating pediatric patients presenting with orbital floor fractures.
SUMMARY
This maintenance of certification module reviews the anatomy, pathophysiology, diagnosis, and management of orbital floor fractures in addition to special considerations for pediatric patients. The shows the evidence rating scale used for the literature review in creating this maintenance of certification article.
Topics: Evidence-Based Medicine; Fracture Fixation; Humans; Medical History Taking; Orbit; Orbital Fractures; Physical Examination
PubMed: 25415098
DOI: 10.1097/PRS.0000000000000719