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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 -
Chinese Neurosurgical Journal Apr 2024Cranial nerve palsy (CNP) is a common complication of traumatic brain injury (TBI). Despite a high incidence of TBI in Nepal (382 per 100,000), literature on the...
BACKGROUND
Cranial nerve palsy (CNP) is a common complication of traumatic brain injury (TBI). Despite a high incidence of TBI in Nepal (382 per 100,000), literature on the specific management and outcome of CNP is lacking. This study aimed to examine the outcomes of TBI patients involving single versus multiple CNP.
METHODS
A retrospective chart review of 170 consecutive TBI patients admitted to the tertiary neurosurgical center in Nepal between April 2020 and April 2022 was conducted. Demographic, clinical, and etiological characteristics; imaging findings; and management strategies were recorded, compared, and analyzed using descriptive statistics. The Glasgow Outcome Scale Extended (GOSE) was used to measure the outcomes in two groups of patients (single and multiple CNP) at 3 months.
RESULTS
Out of 250 eligible patients, 80 were excluded and CNP was noted in 29 (17.1%) of the remaining 170. The median age was 34.9 years, and falls (60.6%) were the most common cause of trauma. TBI severity was categorized based on GCS: mild (82.4%), moderate (15.9%), and severe (1.8%). Cranial nerve involvement was seen in 29 (17.05%) patients: single cranial nerve involvement in 26 (89.65%) and multiple nerve involvement in 3 (10.34%). The most common isolated cranial nerve involved was the oculomotor nerve (37.9%). CT findings revealed a maximum of skull fractures with no significant association between CNP and CT findings.
CONCLUSIONS
CNP is a common consequence of TBI with the most common etiology being falls followed by RTA. Single CNP was more common than multiple CNP with no significant difference in the outcome in the 3-month GOSE score. Further research is needed to determine the burden of traumatic CNP and establish specific management guidelines for different types of CNP.
PubMed: 38556895
DOI: 10.1186/s41016-024-00361-8 -
Journal of Stomatology, Oral and... Jun 2024This study aims to quantify the facial symmetry of surgically treated zygomaticomaxillary complex (ZMC) fractures through a new reliable three-dimensional evaluation... (Comparative Study)
Comparative Study
OBJECTIVE
This study aims to quantify the facial symmetry of surgically treated zygomaticomaxillary complex (ZMC) fractures through a new reliable three-dimensional evaluation method, which is crucial for improving post-operative aesthetic and functional outcomes.
MATERIAL AND METHODS
Healthy patients and patients with surgically treated ZMC fractures were retrospectively reviewed. Using Brainlab Elements® the zygomatic bone and the orbit of each patient was segmented and mirrored. Subsequently, the mirrored side was matched with the other side via volume-based registration, using the segmented orbit as reference. Volumetric asymmetry was measured using 3-matic software, and a surface-based matching technique was used to calculate the mean absolute differences (MAD) between the surfaces of the two sides of the ZMC. The reliability of this novel method using volume-based registration was tested, and the intra-class correlation coefficient was assessed.
RESULTS
The MAD between the surfaces of the left and right sides in the control group was 0.51 mm (±0.09). As for the ZMC fracture group, MAD was 0.78 mm (±0.20) and 0.72 mm (±0.15) pre- and post-operatively, respectively. The MAD showed statistically significant differences between pre- and post-operative groups (p = 0.005) and between control and post-operative groups (p < 0.001). The intra-class correlation coefficient was high (≥0.99).
CONCLUSIONS
This evaluation method using mirroring and volume-based registration to determine the symmetrical position of the ZMC is reliable. The surface-based measurements revealed an improved symmetry after surgery. However, the symmetry of the treated patients remained lower than the control group.
Topics: Humans; Zygomatic Fractures; Female; Male; Imaging, Three-Dimensional; Retrospective Studies; Adult; Maxillary Fractures; Middle Aged; Facial Asymmetry; Reproducibility of Results; Young Adult
PubMed: 38556166
DOI: 10.1016/j.jormas.2024.101857 -
BMC Psychiatry Mar 2024Neurodevelopmental disorders (NDDs), such as Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Tourette Syndrome (TS), have been...
BACKGROUND
Neurodevelopmental disorders (NDDs), such as Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Tourette Syndrome (TS), have been extensively studied for their multifaceted impacts on social and emotional well-being. Recently, there has been growing interest in their potential relationship with fracture risks in adulthood. This study aims to explore the associations between these disorders and fracture rates, in order to facilitate better prevention and treatment.
METHODS
Employing a novel approach, this study utilized Mendelian randomization (MR) analysis to investigate the complex interplay between ADHD, ASD, TS, and fractures. The MR framework, leveraging extensive genomic datasets, facilitated a systematic examination of potential causal relationships and genetic predispositions.
RESULTS
The findings unveil intriguing bidirectional causal links between ADHD, ASD, and specific types of fractures. Notably, ADHD is identified as a risk factor for fractures, with pronounced associations in various anatomical regions, including the skull, trunk, and lower limbs. Conversely, individuals with specific fractures, notably those affecting the femur and lumbar spine, exhibit an increased genetic predisposition to ADHD and ASD. In this research, no correlation was found between TS and fractures, or osteoporosis.These results provide a genetic perspective on the complex relationships between NDDs and fractures, emphasizing the importance of early diagnosis, intervention, and a holistic approach to healthcare.
CONCLUSION
This research sheds new light on the intricate connections between NDDs and fractures, offering valuable insights into potential risk factors and causal links. The bidirectional causal relationships between ADHD, ASD, and specific fractures highlight the need for comprehensive clinical approaches that consider both NDDs and physical well-being.
Topics: Humans; Autism Spectrum Disorder; Mendelian Randomization Analysis; Neurodevelopmental Disorders; Tourette Syndrome; Attention Deficit Disorder with Hyperactivity; Osteoporosis; Fractures, Bone; Genetic Predisposition to Disease
PubMed: 38539137
DOI: 10.1186/s12888-024-05693-4 -
Emergency Radiology Jun 2024Ultrasonography, a radiation-free and cost-effective modality, stands out as a promising tool for evaluating nasal bone fractures. Despite limited literature on its... (Meta-Analysis)
Meta-Analysis
Ultrasonography, a radiation-free and cost-effective modality, stands out as a promising tool for evaluating nasal bone fractures. Despite limited literature on its pediatric application, there is an increasing recognition of its potential to enhance diagnostic precision. To evaluate the diagnostic efficacy of ultrasound in detecting pediatric nasal bone fractures. Employing established guidelines, a systematic review and meta-analysis were conducted through a comprehensive literature search in PubMed, Scopus, Web of Science, and Embase databases until December 5, 2023. Inclusion criteria encompassed studies reporting diagnostic accuracy measures of ultrasound in pediatric patients with nasal bone fractures. Data extraction and analysis were undertaken for the selected studies. Involving four studies with 277 patients, ultrasound demonstrated a pooled sensitivity of 66.1% (95% CI: 35.1-87.5%) and specificity of 86.8% (95% CI: 80.1-91.4%) in diagnosing pediatric nasal fractures. The area under the receiver operating characteristic curve (AUC) was 0.88 (95% CI: 0.72-0.93). After excluding an outlier study, sensitivity and specificity increased to 78.0% (95% CI: 65.6-86.9%) and 87.8 (95% CI: 78.1-93.6%), respectively, with an AUC of 0.79 (95% CI: 0.75-0.94). Pooled positive and negative likelihood ratios were 5.11 (95% CI: 2.12-9.15) and 0.40 (95% CI: 0.14-0.77) before exclusion and 6.75 (95% CI: 3.47-12.30) and 0.26 (95% CI: 0.15-0.40) after exclusion of an outlier study, respectively. This study highlighted ultrasonography's utility in diagnosing pediatric nasal bone fractures with high accuracy and specificity. However, caution is advised in relying solely on ultrasound due to suboptimal overall diagnostic performance, evident in likelihood ratios.
Topics: Child; Humans; Nasal Bone; Sensitivity and Specificity; Skull Fractures; Ultrasonography
PubMed: 38538882
DOI: 10.1007/s10140-024-02225-1 -
Scientific Reports Mar 2024One factor for the lacking integration of the middle ear stapes footplate prosthesis or the missing healing of stapes footplate fractures could be the known osteogenic...
One factor for the lacking integration of the middle ear stapes footplate prosthesis or the missing healing of stapes footplate fractures could be the known osteogenic inactivity. In contrast, it was recently demonstrated that titanium prostheses with an applied collagen matrix and immobilised growth factors stimulate osteoblastic activation and differentiation on the stapes footplate. Regarding those findings, the aim of this study was to evaluate the potential of bone regeneration including bone remodeling in the middle ear. Ten one-year-old female merino sheep underwent a middle ear surgery without implantation of middle ear prostheses or any other component for activating bone formation. Post-operatively, four fluorochromes (tetracycline, alizarin complexion, calcein green and xylenol orange) were administered by subcutaneous injection at different time points after surgery (1 day: tetracycline, 7 days: alizarin, 14 days: calcein, 28 days: xylenol). After 12 weeks, the temporal bones including the lateral skull base were extracted and histologically analyzed. Fluorescence microscopy analysis of the entire stapes with the oval niche, but in particular stapes footplate and the Crura stapedis revealed evidence of new bone formation. Calcein was detected in all and xylenol in 60% of the animals. In contrast, tetracycline and alizarin could only be verified in two animals. The authors were able to demonstrate the osseoregenerative potential of the middle ear, in particular of the stapes footplate, using fluorescence sequence labelling.
Topics: Sheep; Female; Animals; Fluorescent Dyes; Osteogenesis; Ear, Middle; Tetracyclines; Anthraquinones; Fluoresceins; Xylenes
PubMed: 38528064
DOI: 10.1038/s41598-024-57630-w -
Cureus Feb 2024The pterion and asterion serve as crucial landmarks on the skull, representing the antero-lateral and postero-lateral fontanelles in neonates, respectively. In clinical...
INTRODUCTION
The pterion and asterion serve as crucial landmarks on the skull, representing the antero-lateral and postero-lateral fontanelles in neonates, respectively. In clinical practice, these points play a pivotal role in guiding the understanding of deeper structures and their relationships to the head's surface. The thin calvarium at these junctures is susceptible to fractures, and the underlying vessels are prone to tear, often leading to extradural hematoma formation, necessitating burr hole surgery for evacuation.
MATERIAL AND METHODS
The study involved 40 human dry skulls in Indians (n= 27 male (10.8%), n= 13 female (5.2%)) of unknown age, evaluating morphometric characteristics of 80 pterions and asterions. Measurements were conducted using a digital caliper (SKADIOO±0.2mm/0.01") in millimeters on both sides of each skull. The investigation also included an examination of sutural patterns in Pterion and asterion.
RESULTS
Three types of sutural patterns were identified in the pterion, the most common being the sphenoparietal variety (75% on the right, 70% on the left), followed by the epipteric variety, which was the second most common (11.3% on the right, 12.5% on the left), and then the frontotemporal type (1.3% on the right, 2.5% on the left). Two sutural patterns were observed in the asterion: type 1 (presence of sutural bone) in 17.9% of skulls and type 2 (absence of sutural bone) in 82.1%.
CONCLUSION
The differences in pterion and asterion positions across various populations explored in previous studies motivated us to conduct this research in the Indian population. Our findings revealed that among Indians, the predominant pterion type is predominantly sphenoparietal, whereas type 2 is the most prevalent in asterion. Understanding the clinical significance of the pterion and asterion is crucial for healthcare professionals to ensure precise and safe surgical procedures, particularly for the effective treatment of head trauma patients.
PubMed: 38510880
DOI: 10.7759/cureus.54466 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Mar 2024Traumatic head injuries (THIs) are one of the major causes of death in forensic cases. The aim of this study was to investigate the characteristics of patients with...
BACKGROUND
Traumatic head injuries (THIs) are one of the major causes of death in forensic cases. The aim of this study was to investigate the characteristics of patients with fatal THIs.
METHODS
In this study, a total of 311 patients with fatal THIs, who underwent postmortem examinations and/or autopsies, were retrospectively analyzed. Cases were evaluated based on sex, age group, incident origin, cause of the incident, presence of skull fracture, type of fractured bone (if any), fracture localization and pattern, presence and type of intracranial lesion (if any), and cause of death.
RESULTS
Out of the patients, 242 (77.8%) were male and 69 (22.2%) were female. Accidents accounted for 235 (75.6%) of the incidents, with in-vehicle traffic accidents causing 117 (37.6%). In 221 cases (71.1%), intracranial lesions and skull fractures were observed together. The most common fractures were base fractures (171 cases) and temporal bone fractures (153 cases). The rate of intracranial hemorrhage was lower in the adult age group (69.7%) compared to the older age group (92.6%).
CONCLUSION
The results obtained in this study indicate that the cause of the incident, type of fracture, presence of skull base fracture, and multiple skull fractures increase the likelihood of fatalities. The occurrence of skull fractures reduces intracranial pressure, thereby decreasing the incidence of intracranial lesions. The development and effective enforcement of road traffic safety policies and regulations will reduce the incidence of fatalities.
Topics: Adult; Humans; Male; Female; Aged; Retrospective Studies; Craniocerebral Trauma; Skull Fractures; Incidence; Autopsy; Accidents, Traffic
PubMed: 38506383
DOI: 10.14744/tjtes.2024.32463 -
Turkish Neurosurgery 2024To examine the effects of regulating increased blood glucose levels on plasma ET-1 levels after severe head trauma in rats.
AIM
To examine the effects of regulating increased blood glucose levels on plasma ET-1 levels after severe head trauma in rats.
MATERIAL AND METHODS
Traumatic diffuse brain injury-induced rats were followed for 7 days and were randomly divided into two groups of 36 rats. Pre- and posttraumatic blood glucose and ET-1 levels were measured in group 1 (control). Posttraumatic blood glucose levels were maintained at normal levels using insulin and both blood glucose and ET-1 levels were measured at 2, 6, 12, 24, and 48 h and 7 days posttrauma in group 2. The study excluded animals that died and had skull fractures.
RESULTS
Posttraumatic plasma ET-1 levels (n=36) were significantly higher than baseline values in group 1 (p < 0.05). ET-1 levels in group 2 at the 7-day follow-up after trauma were significantly higher than baseline values (n=36) (p < 0.05). However, the increased ET-1 levels were statistically significantly lower in group 2 than in group 1 (p < 0.05).
CONCLUSION
The increased ET-1 levels were significantly prevented by keeping blood glucose levels within normal limits with insulin after severe head trauma. Thus, secondary injury to cerebral blood flow can be prevented by reducing the occurrence of vasospasm that starts in the early posttraumatic period or by stimulating the release of nitric oxide. Therefore, further studies on the role of ET-1 and insulin in developing secondary injuries after severe head trauma would be beneficial.
Topics: Rats; Animals; Endothelin-1; Blood Glucose; Craniocerebral Trauma; Brain Injuries; Insulins
PubMed: 38497179
DOI: 10.5137/1019-5149.JTN.43318-23.2 -
Fukushima Journal of Medical Science Apr 2024Diffuse idiopathic skeletal hyperostosis (DISH) frequently occurs in the spine, resulting in unstable fractures. Treating thoracolumbar fractures in patients with DISH...
A reduction method for anterior opening displacement in thoracolumbarvertebral fractures with diffuse idiopathic skeletal hyperostosis using the skull clamp-assisted position.
Diffuse idiopathic skeletal hyperostosis (DISH) frequently occurs in the spine, resulting in unstable fractures. Treating thoracolumbar fractures in patients with DISH is often difficult because the anterior opening of the vertebral body is exacerbated by dislocation in the prone position, making reduction difficult. In this study, we introduced a novel skull clamp-assisted positioning (SAP) technique. The patient is placed in a supine position with a skull clamp used in cervical spine surgery before surgery to prevent the progression of dislocation and to restore the patient's position. Using this method, the mean difference in local kyphosis angle improved from -2.9 (±8.4)° preoperatively to 10.9 (±7.7)° postoperatively. Furthermore, posterior displacement decreased from a preoperative mean of 5.5 (±4.3) mm to 0.3 (±0.7) mm postoperatively. Complications such as neurological sequelae, implant fracture, and surgical site infection were not observed through one year of postoperative follow-up. SAP may decrease invasiveness and complications. Longer-term studies and larger sample sizes are needed to establish long-term efficacy and benefits.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Hyperostosis, Diffuse Idiopathic Skeletal; Lumbar Vertebrae; Patient Positioning; Skull; Spinal Fractures; Thoracic Vertebrae
PubMed: 38494730
DOI: 10.5387/fms.23-00014