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Journal of Clinical Medicine Mar 2024Orbital wall fractures are common in maxillofacial trauma, and artificial implants are often used for reconstruction. However, there has always been concern about...
Orbital wall fractures are common in maxillofacial trauma, and artificial implants are often used for reconstruction. However, there has always been concern about infection because implants are directly exposed to the airway. This study was conducted to determine the effectiveness of a combination of resorbable plates and antibiotic-impregnated collagen sheets in reconstructions of orbital fractures and to determine whether it had an effect in reducing postoperative antibiotic use. The retrospective study was conducted on 195 patients who underwent orbital wall reconstruction from March 2019 to August 2022. The 176 patients in the control group underwent reconstruction using only resorbable plates and were administered postoperative antibiotics for 5 to 7 days. On the other hand, the 19 patients in the experimental group underwent reconstruction using a combination of resorbable plates and antibiotic-impregnated collagen sheets and only received antibiotics once before surgery. The occurrence of ocular complications, the length of hospitalization, the infection incidence rate, and the adverse effects of antibiotics were investigated. significant ocular complications were observed in the experimental group during a follow-up period of more than 1 year. Regarding postoperative infections, there were two cases of infection in the control group (infection rate: 1.14%), while no infection was found in the experimental group. The hospitalization period of the experimental group was significantly shorter than that of the control group ( < 0.01), and the incidence of total adverse effects of antibiotics, especially nausea, was lower in the experimental group ( = 0.02). The combined use of resorbable plates and antibiotic-impregnated collagen sheets allows effective orbital wall reconstruction without infection, with a shorter hospital stay, and with fewer antibiotic adverse effects.
PubMed: 38610668
DOI: 10.3390/jcm13071900 -
The Journal of Craniofacial Surgery Apr 2024Orbital fractures frequently require operative management by a plastic and reconstructive surgeon. Due to the proximity to the globe and complexity of the...
BACKGROUND
Orbital fractures frequently require operative management by a plastic and reconstructive surgeon. Due to the proximity to the globe and complexity of the reconstruction, orbital fractures, and related procedures have the potential to be a source of medical litigation. The aim of the present study was to review orbital fracture malpractice litigation, including case outcomes and compensatory damages.
METHODS
The Westlaw and Lexis Nexis databases were queried for jury verdicts and settlements related to orbital fracture malpractice lawsuits. The Boolean terms included "orbit! /10 fracture," "orbit! & fracture," and "ocular & fracture" for both databases. Cases were included if they were state or federal cases related to both orbital fracture and medical malpractice involving surgical or medical mismanagement or misdiagnosis of orbital fracture.
RESULTS
A total of 49 cases from 1994 to 2018 met inclusion criteria between the databases. The most common legal complaint was the defendant's failure to make a diagnosis either by not ordering the proper radiological tests or by not interpreting radiological tests correctly, seen in 35% of cases. In 57% of the cases, the defendant was a surgeon, 46% of which involved a plastic surgeon specifically. Cases were resolved in favor of the defendant 49% of the time. Most cases (57%) resulted in a monetary outcome of $0. However, cases that were decided in favor of the plaintiff had significant compensatory damages with the majority being over $100,000, and 1 case as high as $8 million.
CONCLUSION
Although almost half of the orbital fracture malpractice cases resulted in an outcome favoring the defendant, significant monetary consequences against the defendant were possible in cases when the plaintiff prevailed.
PubMed: 38597600
DOI: 10.1097/SCS.0000000000010052 -
Journal of Pharmacy & Bioallied Sciences Feb 2024The aim of this study was to evaluate the accuracy of the degree of fracture reduction after open reduction and internal fixation of Zygomaticomaxillary Complex (ZMC)...
BACKGROUND
The aim of this study was to evaluate the accuracy of the degree of fracture reduction after open reduction and internal fixation of Zygomaticomaxillary Complex (ZMC) fractures in the Saudi population of the Al-Baha region, using Gillies approach. Further comparison with preoperative and postoperative standardized computed tomography (CT) views with the calculation of residual deformity percentage, which remained after the ZMC rehabilitation.
METHODS
A 5-year retrospective CT-based study on preoperative and postoperative axial CT scans of 46 male patients with ZMC fractures. The CT measurements were made (in millimeters) at the fracture site of maximum displacement through the anterior orbital rim and orbital floor, posterolateral wall of the maxillary sinus, zygomatic arch, and zygomaticofrontal suture. For the zygomatic arch, measurements were made (in mm) by drawing a tangent to the fractured arch segments and dropping a perpendicular to the inward displaced fractured arch. The total difference in all measured parts between preoperative and postoperative displacement was calculated in percentages.
RESULTS
Upon comparison of preoperative and postoperative zygomaticomaxillary complex CTs, three-point fixation at the regions of infraorbital rim, frontozygomatic suture, and posterolateral wall of the maxilla results in a reduction of the fracture sites in the range of 72.85% to 85%. Maximum reduction was noted at the zygomatic arch, that is, 85%, and minimum at the infraorbital rim, that is, 72.85%. The reduction obtained at all four sites was statistically significant, with values ranging from .011 to .039.
CONCLUSION
Gillies temporal approach and three-point fixation at the regions of the infraorbital rim, frontozygomatic suture, and posterolateral wall of the maxilla results in satisfactory treatment of ZMC fractures and improves patients oral health and quality of life.
PubMed: 38595412
DOI: 10.4103/jpbs.jpbs_975_23 -
Journal of Rehabilitation Medicine.... 2024On 6 February 2023, 2 earthquakes with magnitudes of 7.7 and 7.6 mW occurred in Pazarcık and Elbistan districts of Kahramanmaraş province (Turkey) and affected 11...
OBJECTIVE
On 6 February 2023, 2 earthquakes with magnitudes of 7.7 and 7.6 mW occurred in Pazarcık and Elbistan districts of Kahramanmaraş province (Turkey) and affected 11 provinces in total, especially Hatay, Malatya, and Adıyaman. Here, we report 3 earthquake victims in order to define patients profiles.
CASE REPORTS
Three patients who were taken to the orthopedic and neurological rehabilitation program in our inpatient Physical Medicine and Rehabilitation unit after the earthquake are presented. Our first case, a 46-year-old man, remain-ed in the debris for 8.5 h. His left leg was left in the wreckage, and he later developed a drop foot on the left due to compartment syndrome, which developed with pain and swelling in the left calf. There is no fasciotomy procedure. Venous Doppler was reported to be within normal limits. Our second case is a 52-year-old man who was in the debris for 36 h and has a left braxial plexus injury and a left drop foot. He has Buerger's disease in his medical history. The third case is an 8-year-old girl trapped in rubble during the earthquake with a right orbital fracture and a left foot transmetarsal amputation. She has no neurological signs.
DISCUSSION
The patients that apply to our Physical Medicine and Rehabilitation clinic are especially amputees, patients with traumatic brain injury, spinal cord injury, peripheral nerve damage, plexus damage, multiple fractures, joint limitations and soft tissue loss in the musculoskeletal system. After the earthquake, we encountered patients from a wide variety of spectrums in our clinic. In addition to primary musculoskeletal injuries, they also experience systemic problems affecting the musculoskeletal system. Additionally, thrombosis, infection, renal failure, and multiple organ failures may also occur.
CONCLUSION
Countries should develop guidelines for disaster preparedness and establish coordination units that can take quick action, make decisions, and communicate in times of disaster. A good definition of patient clinical profiles after the earthquake will ensure early intervention and prevent permanent disability and functional losses.
PubMed: 38590453
DOI: 10.2340/jrmcc.v7.40039 -
Oral Surgery, Oral Medicine, Oral... Jul 2024This article outlines the management of a rare and severe nasoorbital injury resulting from a chainsaw kickback accident in a 60-year-old male. A meta-narrative review... (Review)
Review
PURPOSE
This article outlines the management of a rare and severe nasoorbital injury resulting from a chainsaw kickback accident in a 60-year-old male. A meta-narrative review of English, French, and German literature indexed in PubMed, Embase, and the Cochrane Library up to January 8, 2024, accompanies the case report.
METHODS
This was a case report combined with a comprehensive review based on the 2011 Oxford Centre for Evidence-Based Medicine's highest and most recent level of evidence (LoE) and highest recommendation grade (RG). Rigorous selection criteria were applied.
RESULTS
The patient had an open nasal fracture, complex lacerations, and avulsion of the left eyelid, lateral orbital wall and lateral rectus muscle. Staged surgical interventions comprised repositioning and fixation of the fractured nose, buccal mucosal grafting for nasal mucosa and conjunctiva repair, titanium mesh and polydioxanone sheet for lateral orbital wall reconstruction, and subsequent muscle and eyelid repair. The second intervention 3 months postsurgery addressed lateral ectropion, nasal dorsal hump, and nasolacrimal system issues. Despite the rarity of such injuries, evidence-based discussions were conducted.
CONCLUSIONS
Complex nasoorbital trauma resulting from chainsaw kickback necessitates a meticulous, staged surgical approach. The inside-out technique proved effective in addressing various challenges. This article concludes with evidence-based recommendations, highlighting the importance of adapting established principles to unique nature of these injuries.
Topics: Humans; Male; Middle Aged; Plastic Surgery Procedures; Eyelids; Orbital Fractures
PubMed: 38582707
DOI: 10.1016/j.oooo.2024.02.004 -
The Journal of Craniofacial Surgery Apr 2024The objective of this study is to validate the possibility of setting volumetric surgical indications by predicting permanent enophthalmos using a simplified formula.
BACKGROUND
The objective of this study is to validate the possibility of setting volumetric surgical indications by predicting permanent enophthalmos using a simplified formula.
METHODS
The volume difference of bilateral orbits in a CT scan was automatically measured, and permanent enophthalmos was predicted by substituting the volume difference into a formula made using the 3-dimensional (3D) integral model.
RESULTS
The predicted enophthalmos showed a strong positive correlation with the permanent enophthalmos of 52 blowout fracture patients. Analyzing CT of 768 pure blowout fracture patients, the mean predicted enophthalmos was 1.84 mm, and both the size of the fracture area and the degree of EOM herniation showed the absence of correlations.
CONCLUSIONS
Through the digitized orbital volume analysis and formula using the 3D integral model, blowout fracture patients who require surgery in the early post-traumatic period can be identified with convenience and reproducibility.
PubMed: 38578106
DOI: 10.1097/SCS.0000000000010092 -
BMC Ophthalmology Apr 2024Trauma-induced orbital blowout fracture (OBF) with eyeball displacement into the maxillary sinus is rare.
BACKGROUND
Trauma-induced orbital blowout fracture (OBF) with eyeball displacement into the maxillary sinus is rare.
CASE PRESENTATION
We present the case of a 14-year-old with a closed head injury, OBF, and displacement of the eyeball into the maxillary sinus following a car accident. A prompt transconjunctival access surgery was performed for eyeball repositioning and orbital reconstruction in a single session, mitigating anaesthesia-related risks associated with multiple surgeries. At the 12-month follow-up, his visual acuity was 20/200. Despite limited eye movement and optic nerve atrophy, overall satisfaction with the ocular appearance was achieved.
CONCLUSIONS
This report offers novel insights into the mechanisms of OBF occurrence and the development of postoperative complications.
Topics: Male; Humans; Adolescent; Maxillary Sinus; Eye; Orbital Fractures; Ocular Motility Disorders; Head Injuries, Closed
PubMed: 38566099
DOI: 10.1186/s12886-024-03421-w -
Oral and Maxillofacial Surgery Apr 2024Orbital fractures are common injuries and represent an interesting chapter in maxillofacial surgery. This retrospective study analyses data collected from 528 patients...
PURPOSE
Orbital fractures are common injuries and represent an interesting chapter in maxillofacial surgery. This retrospective study analyses data collected from 528 patients surgically treated at the University Hospital "Magna Graecia", Catanzaro, Italy, from 1st January 2007 to 31st January 2021.
METHODS
The inclusion criteria were a diagnosis of orbital bone fracture, complete clinical and radiological records, and a minimum follow-up of 12 months. We analyzed gender, age, etiology, fracture type, treatment, timing of repair, and associated complications.
RESULTS
The most frequent cause of trauma was road accidents (37.88%), followed by domestic accidents (25.95%). The manifestation of diplopia (72.35%), infraorbital nerve hypoesthesia (53.41%), extrinsic eye movement limitation (51.70%), and enophthalmos (41.29%), determined the indication for surgery. Our trauma team preferred the sub-eyelid approach (79.36%). The study shows a statistical significance in the correlation between the severity of the herniation of the lower rectus muscle and the presence of preoperative diplopia (p-value = 0.00416); We found the same statistical significance for the post-postoperative diplopia (p-value = 0.00385). Patients treated two weeks after the trauma show a higher rate of diplopia and a greater limitation of long-term post-operative eye movements than those treated within two weeks (diplopia 23.08% vs. 15.56%; eye movements limitation 13.33% vs. 7.69%). Early surgical treatment (> 14 days) reduces the likelihood of functional and structural damage to the lower rectus muscle.
CONCLUSION
Our data will support future maxillofacial traumatology studies, and the education and prevention measures taken will reduce the incidence of orbital trauma.
PubMed: 38556588
DOI: 10.1007/s10006-024-01236-z -
Plastic and Reconstructive Surgery Mar 2024For decades, there has been an ongoing debate about the ideal timing of orbital fracture repair (OFR) in adults.
PURPOSE
For decades, there has been an ongoing debate about the ideal timing of orbital fracture repair (OFR) in adults.
METHODS
We conducted a retrospective review of patients who underwent OFR at two centers (2015-2019). Excluded were patients <18 years old and those with follow-up <2 weeks. Our primary outcome was the incidence/persistence of postoperative enophthalmos/diplopia at least 2 weeks following OFR. The association between surgical timing and postoperative ocular complications was assessed in patients with extraocular muscle (EOM) entrapment, enophthalmos and/or diplopia, and different fracture sizes.
RESULTS
Of n=253 patients, n=13 (5.1%) had preoperative EOM entrapment. Of these, patients who had OFR within 2 days of injury were less likely to develop postoperative diplopia compared with patients who had OFR within 8-14 days (n=1/8 [12.5%], n=3/3 [100%]; P=0.018). Patients who had OFR for near-total defects within 1 week of injury were significantly less likely to have postoperative enophthalmos (n=0 [0.0%]) compared with those who had surgery after 2 weeks (n=2 [33.3%] after 15 to 28 days, n=8 [34.8%] after 28 days from injury, P<0.001). Patients who had delayed OFR for large fractures smaller than near-total defects, preoperative persistent diplopia, or enophthalmos were not at significantly greater likelihood of postoperative ocular complications compared with those who had early OFR.
CONCLUSION
We recommend OFR within 2 days of injury for EOM entrapment and 1 week for near-total defects. Surgical delay up to at least 4 weeks is possible in case of less severe fractures, preoperative persistent diplopia, or enophthalmos.
PubMed: 38546673
DOI: 10.1097/PRS.0000000000011420 -
Life (Basel, Switzerland) Feb 2024Subciliary incision is a common approach for facial fracture surgery; however, it has a higher incidence of lower lid ectropion, which can be particularly challenging...
Lateral Tarsoplasty Combined with a Full-Thickness Skin Graft for Managing Severe Lower Eyelid Ectropion Following the Subciliary Approach for Infra-Orbital Rim Fracture: A Retrospective Observational Study.
Subciliary incision is a common approach for facial fracture surgery; however, it has a higher incidence of lower lid ectropion, which can be particularly challenging for beginning surgeons to manage. This study reports the usage of lateral tarsoplasty combined with a full-thickness skin graft (FTSG) to correct severe ectropion following the subciliary approach for infra-orbital rim fractures. We retrospectively reviewed all facial fracture cases involving infra-orbital rim fractures through a subciliary approach treated in our department between March 2021 and May 2023. Electronic medical records and clinical digital photographs of patients who met the inclusion criteria were reviewed. After reviewing 196 cases that used the subciliary approach, we found 6 patients (3.06%; 4 males and 2 females; mean age, 68.5 ± 4.89 years) with postoperative severe ectropion managed using lateral tarsoplasty and FTSG. The mean ectropion development and correction times after facial fracture surgery were 0.78 ± 0.24 and 0.91 ± 0.37 months, respectively. At the 12-month follow-up, all patients showed favorable outcomes, and the position of their lower eyelids was well maintained without ectropion recurrence. Based on these successful outcomes, lateral tarsoplasty combined with FTSG is proposed to be an effective and straightforward method for managing lower eyelid ectropion caused by facial fracture surgery.
PubMed: 38541640
DOI: 10.3390/life14030314