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Annals of Anatomy = Anatomischer... Jun 2024Orbital floor fractures result in critical changes in the shape and inferior rectus muscle (IRM) position. Radiological imaging of IRM changes can be used for surgical...
BACKGROUND
Orbital floor fractures result in critical changes in the shape and inferior rectus muscle (IRM) position. Radiological imaging of IRM changes can be used for surgical decision making or prediction of ocular symptoms. Studies with a systematic consideration of the orbital floor defect ratio in this context are missing in the literature. Accordingly, this study on human cadavers aimed to systematically investigate the impact of the orbital floor defect ratio on changes in the IRM and the prediction of posttraumatic enophthalmos.
METHODS
Seventy-two orbital floor defects were placed in cadaver specimens using piezosurgical removal. The orbital defect area (ODA), orbital floor area (OFA), position and IRM shape, and enophthalmos were measured using computed tomography (CT) scans.
RESULTS
The ODA/OFA ratio correlated significantly (p < 0.001) with the shape (Spearman's rho: 0.558) and position (Spearman's rho: 0.511) of the IRM, and with enophthalmos (Spearman's rho: 0.673). Increases in the ODA/OFA ratio significantly rounded the shape of the IRM (ß: 0.667; p < 0.001) and made a lower position of the IRM more likely (OR: 1.093; p = 0.003). In addition, increases in the ODA/OFA ratio were significantly associated with the development of relevant enophthalmos (OR: 1.159; p = 0.008), adjusted for the defect localization and shape of the IRM. According to receiver operating characteristics analysis (AUC: 0.876; p < 0.001), a threshold of ODA/OFA ratio ≥ 32.691 for prediction of the risk of development of enophthalmos yielded a sensitivity of 0.809 and a specificity of 0.842.
CONCLUSION
The ODA/OFA ratio is a relevant parameter in the radiological evaluation of orbital floor fractures, as it increases the risk of relevant enophthalmos, regardless of fracture localization and shape of the IRM. Therefore, changes in the shape and position of the IRM should be considered in surgical treatment planning. A better understanding of the correlates of isolated orbital floor fractures may help to develop diagnostic scores and standardize therapeutic algorithms in the future.
PubMed: 38889825
DOI: 10.1016/j.aanat.2024.152294 -
Clinical Case Reports Jun 2024The most frequently reported adverse reaction to zoledronic acid is an acute phase reaction resembling influenza. While rarer adverse events such as osteonecrosis of the...
The most frequently reported adverse reaction to zoledronic acid is an acute phase reaction resembling influenza. While rarer adverse events such as osteonecrosis of the jaw and atypical femoral fractures have gained significant recognition, the ocular adverse effects, particularly scleritis, are not yet fully comprehended. Here, we present the case of a 75-year-old female patient with osteoporosis who developed bilateral redness and intense eye pain 48 h after receiving a 5 mg intravenous dose of zoledronic acid. Clinical presentation suggested bilateral conjunctivitis, but treatment with levofloxacin eye drops and acyclovir ophthalmic gel exacerbated the symptoms over 2 days, predominantly affecting the left eye. Ocular ultrasonography revealed thickening of the left eyeball wall with a "T" sign, while an orbital CT scan showed increased thickness of the left sclera. Treatment with methylprednisolone 80 mg intravenous infusion twice daily led to gradual symptom improvement and eventual resolution of inflammation. This report, based on a review of relevant literature, investigates the treatment and outcomes of zoledronic acid-induced scleritis, emphasizing the importance for clinicians to promptly identify and manage this rare and serious ocular adverse reaction.
PubMed: 38855089
DOI: 10.1002/ccr3.9068 -
Cureus Apr 2024Zygomaticomaxillary complex (ZMC) fractures typically result from traumatic injuries, such as motor vehicle-related incidents, assaults, falls, and sports-related...
Zygomaticomaxillary complex (ZMC) fractures typically result from traumatic injuries, such as motor vehicle-related incidents, assaults, falls, and sports-related injuries. These fractures characteristically occur along suture lines where the zygomatic bone borders the frontal bone, maxilla, temporal bone, and sphenoid bone, resulting in a "tetrapod" fracture pattern that can be surgically fixated utilizing one, two, and three-point plate and screw fixation. However, fractures with complete loss of bone stock are less common, and standardized methods of fixation are not suitable for such complex fractures. Here, we present an interesting case of implantation of a custom-made alloplastic implant in a patient with complex ZMC fractures with loss of bone stock. A 52-year-old male sustained a traumatic gunshot wound to the face, resulting in significant destruction of bones involving the left orbital floor, left lateral orbital wall, and left zygomatic arch. Routine plating was not feasible, so a custom spanning plating system by DePuy Synthes (Synthes USA Products, LLC, West Chester, PA) was designed using the patient's CT scans. The patient recovered well with no complications. This case illustrates the successful application of patient-specific custom plates for complex ZMC fractures when standard plating methods are not suitable.
PubMed: 38817507
DOI: 10.7759/cureus.59379 -
Plastic and Reconstructive Surgery.... May 2024Superior orbital fissure syndrome (SOFS) is a rare complication of craniofacial fracture, caused by damage to cranial nerves Ⅲ, Ⅳ, Ⅴ, and Ⅵ, which typically is...
Superior orbital fissure syndrome (SOFS) is a rare complication of craniofacial fracture, caused by damage to cranial nerves Ⅲ, Ⅳ, Ⅴ, and Ⅵ, which typically is associated with ophthalmoplegia, blepharoptosis, pupil dilatation and fixation, and upper eyelid and forehead hypesthesia. However, we here describe a very unusual case of craniofacial fracture with SOFS in the absence of pupil symptoms, involving a patient who was injured when he fell while riding his bicycle. Upon medical examination, we observed mild blepharoptosis and ophthalmoplegia of the right eye without pupillary symptoms. Computed tomography (CT) revealed basal skull and zygomatic fractures. After the patient had been treated conservatively for his skull base fracture, facial bone reduction was performed at our hospital. Because ophthalmoplegia and blepharoptosis remained after the surgery, we checked the preoperative CT images again and discovered stenosis of the superior orbital fissure. Postoperative CT revealed a widening of the superior orbital fissure after the facial bone reduction, and therefore, the patient was given steroid treatment without additional surgery. At 6 months postoperatively, the cranial nerves had completely recovered. Our finding emphasizes that, in contrast to common theory, trauma-induced SOFS can result in pupil-sparing oculomotor nerve palsy.
PubMed: 38798927
DOI: 10.1097/GOX.0000000000005828 -
Journal of Personalized Medicine Apr 2024Enophthalmos is a severe complication of primary reconstruction following orbital floor fractures, oncological resections, or maxillo-facial syndromes. The goal of...
Enophthalmos is a severe complication of primary reconstruction following orbital floor fractures, oncological resections, or maxillo-facial syndromes. The goal of secondary orbital reconstruction is to regain a symmetrical globe position to restore function and aesthetics. In this article, we present a method of computer-assisted orbital floor reconstruction using a mirroring technique and a custom-made titanium or high-density polyethylene mesh printed using computer-aided manufacturing techniques. This reconstructive protocol involves four steps: mirroring of the healthy orbit computer tomography files at the contralateral affected site, virtual design of a customized implant, computer-assisted manufacturing (CAM) of the implant using Direct Metal Laser Sintering (DMLS) or Computer Numerical Control (CNC) methods, and surgical insertion of the device. Clinical outcomes were assessed using 3dMD photogrammetry and computed tomography measures in 13 treated patients and compared to a control group treated with stock implants. An improvement of 3.04 mm (range 0.3-6 mm) in globe protrusion was obtained for the patients treated with patient-specific implants (PSI), and no major complications have been registered. The technique described here appears to be a viable method for correcting complex orbital floor defects needing delayed reconstruction.
PubMed: 38793041
DOI: 10.3390/jpm14050459 -
Frontiers in Bioengineering and... 2024In this study, we attempted to demonstrate the actual process of orbital floor fracture visually and computationally in anatomically reconstructed structures and to...
In this study, we attempted to demonstrate the actual process of orbital floor fracture visually and computationally in anatomically reconstructed structures and to investigate them using finite element analysis. A finite element model of the skull and cervical vertebrae was reconstructed from computed tomography data, and an eyeball surrounded by extraocular adipose was modeled in the orbital cavity. Three-dimensional volume mesh was generated using 173,894 of the 4-node hexahedral solid elements. For the cases where the impactor hit the infraorbital foramen, buckling occurred at the orbital bone as a result of the compressive force, and the von Mises stress exceeded 150 MPa. The range of stress components included inferior orbital rim and orbital floor. For the cases where the impactor hit the eyeball first, the orbital bone experienced less stress and the range of stress components limited in orbital floor. The critical speeds for blowout fracture were 4 m/s and 6 m/s for buckling and hydraulic mechanism. Each mechanism has its own fracture inducing energy and its transmission process, type of force causing the fracture, and fracture pattern. It is possible to determine the mechanism of the fracture based on whether an orbital rim fracture is present.
PubMed: 38774815
DOI: 10.3389/fbioe.2024.1354944 -
Diagnostics (Basel, Switzerland) Apr 2024The aim of this study was to present the demographic and clinical characteristics of sports-related pure (rim-sparing) orbital blowout fractures and to analyze these...
The aim of this study was to present the demographic and clinical characteristics of sports-related pure (rim-sparing) orbital blowout fractures and to analyze these differences by type of sport. Ten years of sports-related orbital fracture data were accumulated. Patients were classified into similar sports (i.e., soccer and futsal) wherein orbital blowout fractures were obtained, producing 14 groups. This study included 377 sides from 374 patients. The majority of patients were male (83.4%), and the mean population age was 20.9 ± 10.8 years. The most common sports causing injuries were baseball/softball, rugby/football, and martial arts. Single-wall fractures were found in 78.8% of patients, but baseball/softball had a higher frequency of multiple-wall fractures ( = 0.035). Concomitant ocular and periocular injuries occurred in 18.6% of patients, which were frequently caused by baseball/softball ( < 0.001). The field of binocular single vision (BSV) included primary gaze in 84.2% of patients. Surgical management was conducted in 52.1% of patients. This study showed that baseball and softball had the highest rate of multi-wall fractures and concomitant ocular and periocular injuries. The field of BSV measured during the first examination was acceptable in most cases.
PubMed: 38732327
DOI: 10.3390/diagnostics14090913 -
Journal of Clinical Medicine May 2024The Festival of Sacrifice, commonly known as Eid al-Adha, has a profound religious and cultural impact on nations with a Muslim majority. This festival is celebrated...
The Festival of Sacrifice, commonly known as Eid al-Adha, has a profound religious and cultural impact on nations with a Muslim majority. This festival is celebrated every year in Muslim countries; however, it is a time in which patients present to the emergency department with serious injuries. In our study, we examined current injuries occurring during Eid al-Adha in one of the largest hospitals in Türkiye, providing the largest patient population to date. This included mapping tendon and maxillofacial injuries, a first in the literature. To the best of our knowledge, this is the largest case series of injuries sustained during Eid al-Adha. The significance of this study lies in its potential to significantly benefit patients and healthcare systems by providing reference data. Patients admitted to Ankara City Hospital during Eid al-Adha between 2019 and 2023 were examined. The demographic characteristics, injury patterns, and injury sites of patients admitted on the four days of Eid al-Adha were collected and analyzed. Maxillofacial traumas during the festival were analyzed. Tendon injuries on the left hand, which is the most commonly injured body part in the literature, were mapped into a figure. To compare the change in the number of patients, a comparison was made with the number of patients in our hospital for four consecutive days 2 weeks before Eid. Statistical analysis was performed using IBM SPSS Statistics for Windows. A total of 610 patients, including 101 female and 509 male patients, were included in this study. A statistically significant increase ( < 0.001 for all years) in hospital admission due to injury was observed. Individuals between the ages of 30 and 40 years were the most frequently admitted patients ( = 182, 29.8%). Knife injuries were significantly more common in all patients ( < 0.001). When the total number of patients was evaluated in terms of injured areas where patients present to the emergency department, left-hand injuries were found to be significantly more common than injuries in other areas ( < 0.001 for all). The extensor pollicus longus tendon was the most commonly injured tendon among all extensor and flexor tendon injuries ( = 104). The most commonly injured tendon was the flexor tendon in zone 2 of the first finger ( = 45). This study showed that injuries to the extensor tendon in zone 1 of the fifth finger, the flexor tendon in zone 4 of the first finger, and the flexor tendon in zone 1 of the fifth finger were never seen. Twenty-five patients with maxillofacial injuries were admitted to the hospital. Orbital floor fractures were the most common type of maxillofacial injury. The anesthesia technique we preferred for all patients was local anesthesia ( = 267). Wide-awake local anesthesia no tourniquet (WALANT) was the second most preferred anesthetic technique. The number of patients who were selected in a random 4-day period for each year were compared with the number of patients who came during Eid al-Adha. The Mann-Whitney U tests revealed a significant increase in injuries on the first day of Eid al-Adha compared to non-festival days ( < 0.001). However, no significant differences were observed on the subsequent days or in the overall injury counts during the festival period ( = 0.841 for day 2, = 0.151 for day 3, = 0.310 for day 4). According to this study, which is the largest known case series in the literature, the number of patients admitted to the hospital increased annually. In our study, we observed a significant increase in injuries only on the first day of Eid al-Adha compared to a randomly selected 4-day period of the same year. Left-hand extensor tendon injuries from a knife were the most common injuries in middle-aged men. The extensor pollicis longus tendon was the most commonly injured extensor tendon, with zones 3 and 4 being the most commonly affected. The flexor pollicis longus tendon was the most commonly injured flexor tendon in zone 2. During this period, patients may not only need hand surgery but also maxillofacial plastic surgery. We recommend, in addition to the indications I,n the literature that during Eid al-Adha, the WALANT technique should be widely adopted in patients where local anesthesia will be insufficient. We also recommend utilizing a diagram to manage the patient load during Eid al-Adha and prevent overburdening the healthcare system.
PubMed: 38731232
DOI: 10.3390/jcm13092704 -
Cureus Apr 2024Orbital fractures in the pediatric population are rare. A trapdoor fracture is a special anatomic type of orbital fracture associated with herniation of orbital contents...
Orbital fractures in the pediatric population are rare. A trapdoor fracture is a special anatomic type of orbital fracture associated with herniation of orbital contents and entrapment of extraocular muscles entrapment with no signs of any soft tissue trauma. A delay in diagnosis can lead to a life-threatening condition known as oculocardiac reflex, characterized by nausea, vomiting, bradycardia, and syncope. Many authors recommend early surgical intervention, but some patients may delay for various reasons. We hereby represent three cases of orbital fracture to prevent long-term persistent diplopia. Depending on the case scenario, two cases were operated on in which an autogenous iliac cortical graft was placed in one patient to prevent postoperative herniation of orbital content, and in one patient, only release of entrapped muscles was done. One patient was managed conservatively with a regular follow-up visit.
PubMed: 38725748
DOI: 10.7759/cureus.57915 -
International Journal of Ophthalmology 2024To explore the combined application of surgical navigation nasal endoscopy (NNE) and three-dimensional printing technology (3DPT) for the adjunctive treatment of orbital...
AIM
To explore the combined application of surgical navigation nasal endoscopy (NNE) and three-dimensional printing technology (3DPT) for the adjunctive treatment of orbital blowout fractures (OBF).
METHODS
Retrospective analysis was conducted on the data of patients with OBF who underwent surgical treatment at the Affiliated Eye Hospital of Nanchang University between July 2012 and November 2022. The control group consisted of patients who received traditional surgical treatment (=43), while the new surgical group (=52) consisted of patients who received NNE with 3DPT. The difference in therapeutic effects between the two groups was evaluated by comparing the duration of the operation, best corrected visual acuity (BCVA), enophthalmos difference, recovery rate of eye movement disorder, recovery rate of diplopia, and incidence of postoperative complications.
RESULTS
The study included 95 cases (95 eyes), with 63 men and 32 women. The patients' age ranged from 5 to 67y (35.21±15.75y). The new surgical group and the control group exhibited no statistically significant differences in the duration of the operation, BCVA and enophthalmos difference. The recovery rates of diplopia in the new surgical group were significantly higher than those in the control group at 1mo [OR=0.03, 95%CI (0.01-0.15), <0.0000] and 3mo [OR=0.11, 95%CI (0.03-0.36), <0.0000] post-operation. Additionally, the recovery rates of eye movement disorders at 1 and 3mo after surgery were OR=0.08, 95%CI (0.03-0.24), <0.0000; and OR=0.01, 95%CI (0.00-0.18), <0.0000. The incidence of postoperative complications was lower in the new surgical group compared to the control group [OR=4.86, 95%CI (0.95-24.78), <0.05].
CONCLUSION
The combination of NNE and 3DPT can shorten the recovery time of diplopia and eye movement disorder in patients with OBF.
PubMed: 38721501
DOI: 10.18240/ijo.2024.03.21