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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 -
The Journal of Craniofacial Surgery Mar 2024Fracture characteristics and postoperative outcomes of patients presenting with orbital fractures in Baltimore remain poorly investigated. The purpose of our study was...
Fracture characteristics and postoperative outcomes of patients presenting with orbital fractures in Baltimore remain poorly investigated. The purpose of our study was to determine the fracture patterns, etiologies, and postoperative outcomes of patients treated for orbital fractures at 2 level I trauma centers in Baltimore. A retrospective cohort study was conducted on patients who underwent orbital fracture repair at the R Adams Cowley Shock Trauma Center and the Johns Hopkins Hospital from January 2015 to December 2019. Of 374 patients, 179 (47.9%) had orbital fractures due to violent trauma, 252 (67.4%) had moderate to near-total orbital fractures, 345 (92.2%) had orbital floor involvement, and 338 (90.4%) had concomitant neurological symptoms/signs. Almost half of the patients had at least one postoperative ocular symptom/sign [n = 163/333 (48.9%)]. Patients who had orbital fractures due to violent trauma were more likely to develop postoperative ocular symptoms/signs compared with those who had orbital fractures due to nonviolent trauma [n = 88/154 (57.1%), n = 75/179 (41.9%); P = 0.006]. After controlling for factors pertaining to injury severity, there was no significant difference in patient throughput or incidence of any postoperative ocular symptom/sign after repair between the two centers. Timely management of patients with orbital fractures due to violent trauma is crucial to mitigate the risk of postoperative ocular symptoms/signs.
PubMed: 38534184
DOI: 10.1097/SCS.0000000000010090 -
The Journal of Craniofacial Surgery Mar 2024Traumatic optic neuropathy (TON) is a rare but potentially devastating complication of craniofacial trauma. Approximately half of patients with TON sustain permanent...
Traumatic optic neuropathy (TON) is a rare but potentially devastating complication of craniofacial trauma. Approximately half of patients with TON sustain permanent vision loss. In this study, we sought to identify the most common fracture patterns associated with TON. We performed a retrospective review of craniomaxillofacial CT scans of trauma patients who presented to the R Adams Cowley Shock Trauma Center from 2015 to 2017. Included were adult patients who had orbital fractures with or without other facial fractures. Patients diagnosed with TON by a formal ophthalmologic examination were analyzed. Craniofacial fracture patterns were identified. Bivariate analysis and multivariate logistic regression were performed to identify craniofacial fracture patterns most commonly associated with TON. A total of 574 patients with orbital fractures who met inclusion criteria [15 (2.6%)] were diagnosed with TON. The median [interquartile range (IQR)] age was 44 (28-59) years. Patients with optic canal fractures and sphenoid sinus fractures had greater odds of TON compared with patients who did not have these fracture types [adjusted odds ratio (aOR) 95% confidence interval (CI) 31.8 (2.6->100), 8.1 (2.7-24.4), respectively]. Patients who sustain optic canal and sphenoid sinus fractures in the setting of blunt facial trauma are at increased odds of having a TON. Surgeons and other physicians involved in the care of these patients should be aware of this association.
PubMed: 38534175
DOI: 10.1097/SCS.0000000000010081 -
Journal of Oral and Maxillofacial... Jun 2024Though the epidemiology of craniomaxillofacial (CMF) fractures has been well documented at urban hospitals, the characteristics of these fractures in rural hospitals...
BACKGROUND
Though the epidemiology of craniomaxillofacial (CMF) fractures has been well documented at urban hospitals, the characteristics of these fractures in rural hospitals have not been well studied.
PURPOSE
The purpose of this study is to report on the epidemiology of CMF fractures at a regional Level 1 trauma center serving a large rural population in central Illinois.
STUDY DESIGN, SETTING, SAMPLE
This is a retrospective cohort study at a community-based regional tertiary referral center that serves a predominantly rural population. Inclusion criteria comprised patients with radiologically confirmed CMF fractures between 2015 and 2019. Patients with incomplete medical records were excluded.
PREDICTOR VARIABLE
Predictor variables included demographics (age, admission source, race, and sex) and etiology of CMF fracture (assault/domestic violence, all-terrain vehicle/off-road, falls, farm-related, motor vehicle collisions, gunshot wound, and others).
MAIN OUTCOME VARIABLE
The primary outcome variable was the CMF anatomic location including nasal bone, orbit, mandible, malar/maxillary, and other CMF fractures.
COVARIATES
The covariates are not applicable.
ANALYSES
Descriptive statistics were used to summarize a sample of the population characteristics. Wilcoxon ranked sign tests and χ tests of independence were used to assess for statistically significant associations between select variables of interest. Statistical significance was defined as P < .05.
RESULTS
Between 2015 and 2019, a total of 2,334 patients presented to the emergency department with a CMF fracture. After applying the inclusion/exclusion criteria, the final sample was composed of 1,844 patients for the management of 2,405 CMF fractures. The majority of patients were male(62.0%) and young adults (aged 18-39) had the highest number of CMF fractures (819) relative to all other age groups. The most common fracture etiology was fall(37.3%), and nasal bone fractures represented the most common fracture location(41.6%). χ analyses revealed statistically significant associations between the anatomic location of CMF fracture incurred, and differing categories of age, admission source, race, sex, and etiology.
CONCLUSION AND RELEVANCE
Our study shows that patients seen at our Midwestern Level 1 trauma center are more likely to present with nasal bone and malar/maxillary fractures due to falls. In studies based in urban centers, patients are likely to present with orbital and mandibular fractures due to falls and assault.
Topics: Humans; Male; Female; Retrospective Studies; Adult; Trauma Centers; Skull Fractures; Adolescent; Middle Aged; Rural Population; Young Adult; Illinois; Aged; Child; Aged, 80 and over; Child, Preschool; Maxillofacial Injuries; Facial Bones
PubMed: 38527728
DOI: 10.1016/j.joms.2024.03.002 -
Clinical Ophthalmology (Auckland, N.Z.) 2024To evaluate eye and orbital injuries in non-powered scooter, electric-scooter (e-scooter), and hoverboard riders in the United States (US) between 2014 and 2019.
INTRODUCTION
To evaluate eye and orbital injuries in non-powered scooter, electric-scooter (e-scooter), and hoverboard riders in the United States (US) between 2014 and 2019.
METHODS
The National Electronic Injury Surveillance System (NEISS) was queried for head and neck injuries by body part codes related to non-powered scooters and powered scooters/hoverboards from 2014 to 2019. The NEISS complex sampling design was used to obtain US population projections of injuries and hospital admissions. Keywords were queried in case narratives to analyze trends in location, type, and mechanism of eye and orbit injuries.
RESULTS
Since their introduction, a 586% (p=0.01) increase in e-scooter injuries and 866% (p<0.001) increase in hoverboard injuries were observed with an increase in hospital admissions seen in young adults (18-34) in urban areas (e-scooter: 5980% and hoverboard: 479%). Descriptive narratives of the trauma noted eye injuries in 242 unweighted NEISS cases with only 30 cases appropriately documented under body part code 77: eyeball. Eye injuries increased 96.9% during the study period (p=0.23). Specifically, the most common ophthalmic injuries reported included eyebrow (40.9%) and eyelid (11.3%) lacerations, periorbital contusions (18.7%), orbit fractures (6.6%), and corneal abrasions (5.1%).
CONCLUSION
There was a significant increase in both head and neck injury cases and hospital admissions related to e-scooters. Eye and orbit injuries similarly increased but were underreported by body part code compared to injury narratives. Orbital fractures were reported more frequently in injuries from e-scooters than non-powered scooters.
PubMed: 38504934
DOI: 10.2147/OPTH.S452750 -
Cureus Feb 2024The aim of this study is to compare data on the incidence of pediatric orbital fractures before the onset of the coronavirus disease 2019 (COVID-19) pandemic and...
INTRODUCTION
The aim of this study is to compare data on the incidence of pediatric orbital fractures before the onset of the coronavirus disease 2019 (COVID-19) pandemic and during the period of the pandemic in the Japanese population.
METHODS
This retrospective, single-center, observational study including 225 patients (226 sides) aged ≤ 18 years old diagnosed with orbital fracture was conducted in our institution from March 2017 to April 2023. The study compared the incidence of pediatric orbital fractures in the pre-pandemic period from March 2017 to March 2020 and during the pandemic from April 2020 to April 2023.
RESULTS
The most common cause of injury was sports in both groups (137 sides, 60.6%), and the ratio of causes of injury (P = 0.610) or between outdoor and indoor sports (P = 1.000) was not statistically different between the groups. Although the daily rate of patient consults was lowest during the country's state of emergency with priority preventative measures, the difference between pre-pandemic and pandemic was not statistically significant (P = 0.911).
CONCLUSION
Despite the restrictions mandated by the Japanese government during the COVID-19 pandemic, the physical activities of children did not significantly decline. Hence, the risk of pediatric orbital fractures remained the same.
PubMed: 38496177
DOI: 10.7759/cureus.54166 -
Trauma Surgery & Acute Care Open 2024Concomitant traumatic brain injury (TBI) and ocular trauma (OT) are caused by the same physical mechanisms, which may complicate therapeutic intervention if screening...
BACKGROUND
Concomitant traumatic brain injury (TBI) and ocular trauma (OT) are caused by the same physical mechanisms, which may complicate therapeutic intervention if screening and evaluation of each condition are not promptly initiated. The aim of this study is to identify concomitant TBI in OT patients and characterize the pattern of those injured service members (SMs) in non-combat environments to assist in the early detection and treatment of both TBI and OT.
METHODS
Encounters matching the case definitions of TBI and OT for injured SMs were extracted from the Military Health System. Concomitant TBI and OT was identified as patients who were diagnosed with both medical conditions within 30 days. Incidence rates of concomitance were analyzed using a Poisson regression model. The odds of mechanisms and types of OT with concomitant TBI were analyzed using logistic regression models.
RESULTS
From 2017 to 2021, there were 71 689 SMs diagnosed with TBI, and 69 358 patients diagnosed with OT. There were 3251 concomitant cases identified. The overall concomitance rate in OT patients was 4.7%. Clinical presentations of concomitant OT had a higher rate of complications. Blast, transport accidents, assaults, alcohol, falls, and sports-related injuries (in decreasing order) were significantly associated with concomitance rates. Compared with closed globe injuries, OT with orbital fractures, rupture, laceration, adnexal periocular injury, and penetrating injury had higher risks of concomitant TBI. For patients with orbital fractures, nearly half (44.1%) sustained a concomitant TBI.
CONCLUSIONS
A practical approach using temporal proximity of diagnostic data was developed to identify concomitant cases of TBI and OT which presented with more severe injury types than non-concomitant cases. These results indicate OT patients with orbital or open globe injuries sustained from high-impact mechanisms warrant further TBI screening to prompt early detection and treatment.
LEVEL OF EVIDENCE
IV.
PubMed: 38481484
DOI: 10.1136/tsaco-2023-001313 -
Acta Neurochirurgica Mar 2024To compare the types of facial fractures and their treatment in bicyclists admitted to a level 1 trauma centre with major and minor-moderate head injury. (Observational Study)
Observational Study
PURPOSE
To compare the types of facial fractures and their treatment in bicyclists admitted to a level 1 trauma centre with major and minor-moderate head injury.
METHODS
Retrospective analysis of data from bicycle-related injuries in the period 2005-2016 extracted from the Oslo University Hospital trauma registry.
RESULTS
A total of 967 bicyclists with head injuries classified according to the Abbreviated Injury Scale (AIS) were included. The group suffering minor-moderate head injury (AIS Head 1-2) included 518 bicyclists, while 449 bicyclists had major head injury (AIS Head 3-6). The mean patient age was 40.2 years (range 3-91 years) and 701 patients (72%) were men. A total of 521 facial fractures were registered in 262 patients (on average 2 facial fractures per bicyclist). Bicyclists with major head injury exhibited increased odds for facial fractures compared to bicyclists with minor-moderate head injury (sex and age adjusted odds ratio (OR) 2.75, 95% confidence interval (CI) 2.03-3.72, p < 0.001. More specifically, there was increased odds for all midface fractures, but no difference for mandible fractures. There was also increased odds for orbital reconstruction in cyclist with major head injury compared to bicyclist with minor-moderate head injury (adjusted OR 3.34, 95% CI 1.30-8.60, p = 0.012).
CONCLUSION
Bicyclists with more severe head injuries had increased odds for midface fractures and surgical correction of orbital fractures. During trauma triage, the head and the face should be considered as one unit.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Young Adult; Accidents, Traffic; Bicycling; Craniocerebral Trauma; Retrospective Studies; Skull Fractures; Trauma Centers
PubMed: 38472419
DOI: 10.1007/s00701-024-06019-9 -
Cardiovascular Revascularization... Mar 2024Coronary artery calcification (CAC) severity is associated with increased vessel inflammation, atherosclerosis, stent failure, and risk of percutaneous coronary... (Review)
Review
Coronary artery calcification (CAC) severity is associated with increased vessel inflammation, atherosclerosis, stent failure, and risk of percutaneous coronary intervention-related complications. Current modalities for CAC modification include atherectomy techniques (rotational, orbital, and laser) and balloon modification (cutting and scoring). However, these methods are limited by their risk of slow flow/no reflow, coronary dissection, perforation, and myocardial infarction. Intravascular lithotripsy (IVL) emits high-energy sonic waves that induce calcium fractures within a target lesion to improve vessel compliance for stent placement. Low rates of major cardiac adverse events (MACE) and high rates of procedural and angiographic success were observed with IVL in the Disrupt CAD I-IV trials. Optical coherence tomography sub-studies identified calcium fracture as the likely etiology of improved vessel compliance and increased luminal diameter post-IVL. Rates of MACE, procedural, and angiographic success were consistent across the Disrupt CAD trials, suggesting IVL is less operator-dependent compared to other calcium-modifying techniques. Coronary IVL offers interventional cardiologists a safe and effective method of severe CAC modification, while providing reproducible outcomes.
PubMed: 38472025
DOI: 10.1016/j.carrev.2024.03.001