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European Journal of Trauma and... Apr 2022The aim of this study was to retrospectively review the midface and orbital floor fractures treated at our institution with regard to epidemiological aspects, surgical...
OBJECTIVE
The aim of this study was to retrospectively review the midface and orbital floor fractures treated at our institution with regard to epidemiological aspects, surgical treatment options and postoperative complications and discuss this data with the current literature.
STUDY DESIGN
One thousand five hundred and ninety-four patients with midface and orbital fractures treated at the Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery of the Goethe University Hospital in Frankfurt (Germany) between 2007 and 2017 were retrospectively reviewed. The patients were evaluated by age, gender, etiology, fracture pattern, defect size, surgical treatment and complications.
RESULTS
The average patient age was 46.2 (± 20.8). Most fractures (37.5%) occurred in the age between 16 and 35. Seventy-two percent of patients were male while 28% were female. The most common cause of injury was physical assault (32.0%) followed by falls (30.8%) and traffic accidents (17.0%). The average orbital wall defect size was 297.9 mm (± 190.8 mm2). For orbital floor reconstruction polydioxanone sheets (0.15 mm 38.3%, 0.25 mm 36.2%, 0.5 mm 2.8%) were mainly used, followed by titanium meshes (11.5%). Reconstructions with the 0.15 mm polydioxanone sheets showed the least complications (p < 0.01, r = 0.15). Eighteen percent of patients who showed persistent symptoms and post-operative complications: 12.9% suffered from persistent hypoesthesia, 4.4% suffered from post-operative diplopia and 3.9% showed intra-orbital hematoma.
CONCLUSION
Results of the clinical outcome in our patients show that 0.15 mm resorbable polydioxanone sheets leads to significantly less post-operative complications for orbital floor defects even for defects beyond the recommended 200 mm.
Topics: Adolescent; Adult; Diplopia; Female; Fractures, Multiple; Humans; Male; Orbital Fractures; Polydioxanone; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 34128084
DOI: 10.1007/s00068-021-01716-x -
Journal of Ayub Medical College,... 2017Juvenile Angiofibroma (JNA) is a benign tumour that tends to bleed and occur in the nasopharynx with most cases occurring in pre-pubertal and adolescent males 10-20...
Juvenile Angiofibroma (JNA) is a benign tumour that tends to bleed and occur in the nasopharynx with most cases occurring in pre-pubertal and adolescent males 10-20 years. We present the case of a 50-year-old male shopkeeper who consulted the ENT out patients' department (OPD) of Khyber Teaching Hospital (KTH) with the chief complaint of right sided nasal obstruction for the last 2.5 months which was associated with two episodes of epistaxis and diplopia which started 2 months back. He complained of right sided frontal and periorbital pain for the last 15 days. Past medical and surgical history was insignificant. Computerized Tomography (CT) scan without contrast and magnetic resonance imaging (MRI) showed finding consistent with a pedunculated tumour like growth. After baseline investigations, surgery was done and a Wilson's incision was given and the mass was excised and sent to the lab for histopathological report which showed angiofibroma. The age of the patient shows that this is a very rare case of angiofibroma. Dissection of such tumours is important as they have propensity to bleed. Excision along with biopsy is the method of choice. Proper surgical techniques and use of better medical technology are required to make and early diagnosis. Further studies/case reports around the world would assert our findings that a nasopharyngeal angiofibroma can also be found in middle aged men.
Topics: Angiofibroma; Diplopia; Epistaxis; Humans; Male; Middle Aged; Nasal Obstruction; Nasopharyngeal Neoplasms
PubMed: 29076693
DOI: No ID Found -
Journal of AAPOS : the Official... Dec 2019To describe frequency of postoperative diplopia after strabismus surgery in nondiplopic adults with childhood-onset strabismus and to report health-related...
PURPOSE
To describe frequency of postoperative diplopia after strabismus surgery in nondiplopic adults with childhood-onset strabismus and to report health-related quality-of-life (HRQOL) outcomes.
METHODS
We prospectively enrolled 79 adults with no diplopia in any gaze who had childhood-onset strabismus and were scheduled for strabismus surgery. Diplopia was assessed preoperatively and at 6 weeks and 1 year postoperatively using a standardized diplopia questionnaire with 5 response options in 7 gaze positions. HRQOL was assessed using the Adult Strabismus-20 (AS-20) questionnaire, with self-perception, interactions, reading function, and general function domains.
RESULTS
Constant diplopia in straight-ahead distance and reading gaze occurred in 1 patient (1% [95% CI, 0%-7%] at 6 weeks and 2% [95% CI, 0%-10%] at 1 year). Regarding the rate of any diplopia (including rarely) in any gaze, 15 of 78 patients (19%) reported diplopia at 6 weeks, of whom 13 had diplopia in straight-ahead distance gaze; 8 (10%), in reading gaze. At 1 year, 8 of 51 patients (16%) reported any diplopia (including rarely) in any gaze, of whom 7 had diplopia in straight-ahead distance gaze and 4 (8%) in reading gaze. Mean AS-20 scores improved at 1 year overall (by 32, 19, 14, and 15 points, resp., per domain) and for the 8 diplopic patients (by 21, 13, 16, and 11 points).
CONCLUSIONS
In adults with nondiplopic strabismus, constant postoperative diplopia is rare, although the rate of intermittent diplopia is higher. Even when postoperative diplopia occurs, HRQOL often improves.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Diplopia; Female; Follow-Up Studies; Health Status; Humans; Male; Middle Aged; Oculomotor Muscles; Postoperative Period; Prospective Studies; Strabismus; Vision, Binocular; Visual Acuity; Young Adult
PubMed: 31586582
DOI: 10.1016/j.jaapos.2019.07.005 -
Medicina (Kaunas, Lithuania) Sep 2021In patients with orbital floor blowout fracture (OFBF), accurate diagnosis of ocular motility disorder is important for decisions about conservative or surgical...
In patients with orbital floor blowout fracture (OFBF), accurate diagnosis of ocular motility disorder is important for decisions about conservative or surgical therapy. However, the accuracy of the traditional test for detecting binocular diplopia/ocular motility disorder using a moving pencil or finger (hereinafter, "finger test") has been generally accepted as correct and has not been subject to scrutiny so far. Hence, its accuracy relative to full orthoptic examination is unknown. In this paper, the results of the "finger test" were compared with those derived from a complex examination by orthoptic tests (considered "true" value in patients with OFBF). "Finger test" detected ocular motility disorder in 23% of patients while the full orthoptic examination proved much more efficient, detecting ocular motility disorder in 65% of patients. Lancaster screen test and test with color filters were the most important tests in the battery of the orthoptic tests, capable of identifying 97.7% and 95.3% of patients with ocular motility disorder, respectively. Still, none of the tests were able to correctly detect all patients with ocular motility disorder in itself. As the presence of ocular motility disorder/binocular diplopia is an important indication criterion for the surgical solution of the orbital floor blowout fracture, we conclude that a complex orthoptic evaluation should be always performed in these patients.
Topics: Diplopia; Humans; Ocular Motility Disorders; Orbital Fractures; Orthoptics
PubMed: 34577912
DOI: 10.3390/medicina57090989 -
Journal of Healthcare Engineering 2022To observe and analyze the occurrence rate, improvement time, and influencing factors of diplopia after intermittent exotropia in children.
OBJECTIVE
To observe and analyze the occurrence rate, improvement time, and influencing factors of diplopia after intermittent exotropia in children.
METHODS
A total of 135 children with intermittent exotropia treated in our hospital from February 2019 to April 2021 were recruited. A reasonable surgical plan was exerted according to the preoperative examination of the children, the children were divided into groups according to their age, degree of strabismus, visual acuity, and binocular visual function, and the postoperative diplopia occurrence rate and improvement time of diplopia in different groups were observed and compared.
RESULTS
Postoperative diplopia occurred in 74 of 135 children with intermittent exotropia, and the postoperative incidence of diplopia was 54.81%. All diplopia occurred on the first day after the operation. There were 62 cases of contradictory diplopia (83.78%) and 12 cases of fusion of powerless diplopia (16.22%). Except for 1 case of amalgamated powerless diplopia, diplopia was not significantly improved after 6 months, which seriously affected the life of the children after the second operation, and all the others were significantly improved within 90 days. The improvement time of diplopia was 3-90 days, and the average improvement time of diplopia was 13.25 ± 3.16 days. According to their age, the children were divided into the 3-6 years old group ( = 69), the 7-10 years old group ( = 47), and the 11-14 years old group ( = 19). Postoperative diplopia occurred in 25 cases (36.23%) in the 3-6 years old group, 34 cases (72.34%) in the 7-10 years old group, and 16 cases (84.21%) in the 11-14 years old group. There was a significant difference in the incidence of postoperative diplopia among the three groups ( < 0.05). There was a significant difference in the improvement time of diplopia among the three groups ( < 0.05). According to the degree of strabismus before the operation, the children were divided into the <50△ group ( = 74) and the ≥50△ group ( = 61). Postoperative diplopia occurred in 32 cases (43.24%) in the <50△ group and 43 cases (70.49%) in the ≥50△ group. There was a significant difference in the incidence of postoperative diplopia between the two groups ( < 0.05). There was a significant difference in the improvement time of diplopia among the three groups ( < 0.05). According to the results of the visual acuity examination, the patients were divided into the ≥0.8 (naked eye) group ( = 21), the ≥0.8 (ametropia) group ( = 32), and the <0.8 (amblyopia) group ( = 32). Among them, diplopia occurred in 10 cases (47.62%) in the ≥0.8 (naked eye) group, 40 cases (48.78%) in the ≥0.8 (ametropia) group, and 24 cases (75.00%) in the <0.8 (amblyopia) group. The incidence of diplopia in the <0.8 (amblyopia) group was significantly higher than that in the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group, and the difference was statistically significant ( < 0.05). The postoperative diplopia improvement time in the <0.8 (amblyopia) group was significantly higher than that in the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group, and the difference was statistically significant ( < 0.05). There was no significant difference in diplopia occurrence rate and diplopia improvement time between the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group ( > 0.05). According to the results of binocular visual function examination, 92 cases had a primary function, 45 cases (48.91%) had diplopia after the operation, the average recovery time of diplopia was 12.58 ± 3.16, 43 cases had no primary function, and 30 cases (69.77%) had diplopia after the operation. The average recovery time of diplopia was 13.02 ± 3.84. There was a significant difference in the incidence of diplopia between the two groups ( = 5.162). There was no significant difference in the recovery time of diplopia between the two groups ( = 0.570, < 0.05). In 80 cases with secondary function, diplopia occurred in 36 cases (45.00%), and the average recovery time of diplopia was 10.14 ± 2.88; in 55 cases without secondary function, diplopia occurred in 39 cases (70.91%), and the average recovery time of diplopia was 14.86 ± 3.73. There was a significant difference in the incidence of diplopia between the two groups ( = 8.861, < 0.002). There was a significant difference in the recovery time of diplopia between the two groups ( = 6.469, < 0.001). In 77 cases with tertiary function, diplopia occurred in 32 cases (41.56%), and the average recovery time of diplopia was 9.61 ± 2.39; in 58 cases without tertiary function, diplopia occurred in 43 cases (74.14%), and the average recovery time of diplopia was 13.11 ± 3.05. There was a significant difference in the incidence of diplopia between the two groups ( = 14.221 < 0.001). There was a significant difference in the recovery time of diplopia between the two groups ( = 5.355, < 0.001).
CONCLUSIONS
The age, degree of strabismus, visual acuity, and binocular visual function of children with intermittent exotropia are significant factors affecting the occurrence rate and recovery time of diplopia after the operation. The younger the age, the smaller the degree of strabismus, the better the vision and the second or third grade of visual function, the smaller the occurrence rate of diplopia, and the shorter the recovery time of diplopia. Thus, the above influencing factors have a certain guiding significance in predicting the improvement of postoperative diplopia and the time of diplopia disappearance. The purpose of intermittent exotropia surgery in children is not only to correct eye position and improve appearance but also to establish normal retinal correspondence in order to obtain binocular monocular function. Furthermore, postoperative diplopia in children with concomitant exotropia is very common; therefore, careful examination, comprehensive analysis, and surgical plan should be designed according to the above factors. Stereoscopic vision training as early as possible after the operation is beneficial to the establishment of normal retinal correspondence and the elimination of diplopia.
Topics: Adolescent; Amblyopia; Child; Child, Preschool; Chronic Disease; Diplopia; Exotropia; Humans; Ophthalmologic Surgical Procedures; Refractive Errors; Strabismus
PubMed: 35320998
DOI: 10.1155/2022/2611225 -
PloS One 2017To investigate the factors affecting recovery of diplopia and limited ocular motility in pediatric patients who underwent surgery for orbital wall fracture.
OBJECTIVES
To investigate the factors affecting recovery of diplopia and limited ocular motility in pediatric patients who underwent surgery for orbital wall fracture.
DESIGN
Retrospective observational case series.
METHODS
In this retrospective observational case series, 150 pediatric patients (1-18 years old) who were diagnosed with orbital medial wall or floor fracture and underwent corrective surgery between 2004 and 2016 at Seoul National University Bundang Hospital were included. The medical records of patients with orbital medial wall or floor fracture were reviewed, including sex, age, diplopia, ocular motility, preoperative computed tomographic finding, and surgical outcomes. Factors affecting recovery of diplopia and ocular motility limitation were analyzed.
RESULTS
Of the 150 patients (134 boys; mean age, 14.4 years) who underwent corrective surgery for orbital wall fracture, preoperative binocular diplopia was found in 76 (50.7%) patients and limited ocular motility in 81 (54.0%). Presence of muscle incarceration or severe supraduction limitation delayed the recovery of diplopia. In case of ocular motility limitation, presence of muscle incarceration and retrobulbar hemorrhage were related with the delayed resolution. Multivariate analysis revealed supraduction limitation (Hazard ratio [HR] = 1.74, 95% confidence interval [CI] = 1.19-2.55), larger horizontal orbital floor defects (HR = 1.22, 95% CI = 1.07-1.38), and shorter time interval to first visit (HR = 0.73) as negative prognostic factors for the recovery of diplopia. In addition, muscle incarceration (HR = 3.53, 95% CI = 1.54-8.07) and retrobulbar hemorrhage (HR = 3.77, 95% CI = 1.45-9.82) were found as negative prognostic factors for the recovery of motility limitation.
CONCLUSIONS
Presence of muscle incarceration and retrobulbar hemorrhage, horizontal length of floor fracture, supraduction limitation, and time interval from trauma to first visit were correlated with the surgical outcomes in pediatric orbital wall fracture patients. These results strengthen that the soft tissue damage associated with bony fracture affects the orbital functional unit. When managing children with orbital wall fracture, meticulous physical examination and thorough preoperative computed tomography based evaluation will help physicians to identify damage of orbital functional unit.
Topics: Adolescent; Adult; Child; Diplopia; Eye Movements; Female; Humans; Male; Oculomotor Muscles; Orbital Fractures; Prognosis
PubMed: 29095826
DOI: 10.1371/journal.pone.0184945 -
Continuum (Minneapolis, Minn.) Aug 2014Determining which cranial nerve(s) is (are) involved is a critical step in appropriately evaluating a patient with diplopia. (Review)
Review
PURPOSE OF REVIEW
Determining which cranial nerve(s) is (are) involved is a critical step in appropriately evaluating a patient with diplopia.
RECENT FINDINGS
New studies have looked at the various etiologies of cranial nerve palsies in the modern imaging era. The importance of the C-reactive protein test in evaluating the possibility of giant cell arteritis has recently been emphasized.
SUMMARY
Dysfunction of the oculomotor (third), trochlear (fourth), or abducens (sixth) cranial nerve will produce ocular misalignment and resultant binocular diplopia or binocular blur. A misalignment in the vertical plane of as small as 200 μm is enough to produce diplopia. Diagnosing diplopia from a cranial nerve abnormality requires an understanding of structure (the anatomy of the cranial nerves from nucleus to muscle), function (the movements controlled by the cranial nerves), possible etiologies, and exceptions to the rules.
Topics: Abducens Nerve; Aged, 80 and over; Cranial Nerve Diseases; Diplopia; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Ocular Motility Disorders
PubMed: 25099103
DOI: 10.1212/01.CON.0000453309.44766.b4 -
Journal of Neuromuscular Diseases 2019In this study we quantitatively describe ocular weakness patterns in myasthenia gravis (MG) to help neurologists in making the clinical diagnosis and to investigate how...
INTRODUCTION
In this study we quantitatively describe ocular weakness patterns in myasthenia gravis (MG) to help neurologists in making the clinical diagnosis and to investigate how the current outcome measures reflect ocular weakness in MG.
METHODS
We investigated ptosis and diplopia patterns in a retro- and prospective cohort of 306 MG patients. Diplopia was systematically examined by testing extra-ocular muscle (EOM) fatigability in two horizontal and four oblique directions for 60 seconds.
RESULTS
Of patients with initial symmetric ptosis, 40% developed asymmetric ptosis at the second visit. Changes in form of ptosis occurred less often in seronegative MG patients (50%) than in patients with acetylcholine receptor (AChR) antibodies (70%) or muscle-specific kinase (MuSK) antibodies (69%) (p = 0.038). Of patients with diplopia on the first visit, double vision contained both a vertical and horizontal component in 95%. At the second visit, 83% manifested diplopia in other gaze directions. The mean time (in seconds) to diplopia was 11.6±14.0 and the mean time to ptosis was 27.6±19.8. Diplopia or ptosis manifested within 30 seconds in 87% and 58%, respectively. Patients who manifested diplopia after 30 seconds, reported no limitations due to diplopia.
DISCUSSION
Changes in the gaze directions in which diplopia occurs or ptosis side occur frequently in MG. In diagnostically challenging cases, we recommend testing ptosis and diplopia in multiple gaze directions for 30-60 seconds during at least two follow-up visits to maximize the chance of observing changes in ocular weakness patterns.
Topics: Aged; Blepharoptosis; Diplopia; Female; Humans; Male; Middle Aged; Muscle Weakness; Myasthenia Gravis; Oculomotor Muscles; Prospective Studies
PubMed: 31424417
DOI: 10.3233/JND-190407 -
Ophthalmology Dec 2007Quantification of diplopia is important for describing severity of strabismus, measuring change over time, and reporting surgical outcomes. The cervical range of motion... (Comparative Study)
Comparative Study
PURPOSE
Quantification of diplopia is important for describing severity of strabismus, measuring change over time, and reporting surgical outcomes. The cervical range of motion (CROM) method has been proposed as a simple, inexpensive alternative to the Goldmann perimeter for quantifying diplopia. The purpose of this study was to compare these 2 techniques and describe advantages and disadvantages.
DESIGN
Cohort study.
PARTICIPANTS
Seventy-six consecutive patients with binocular diplopia associated with any type of strabismus.
METHODS
Patients underwent diplopia assessment with the CROM method and Goldmann perimeter; diplopia was scored between 0 and 100 based on previously published scoring systems. Where CROM and Goldmann results were disparate by >20 points, the medical record was reviewed independently by 2 clinicians to determine the most likely reason for the discrepancy.
MAIN OUTCOME MEASURES
(1) Measure of agreement between diplopia scores using the CROM and Goldmann methods using the kappa test and (2) the reasons for any disagreement between tests of >20 points.
RESULTS
Overall agreement between the 2 tests was good (intraclass correlation coefficient, 0.65; 95% confidence interval, 0.50-0.77). In 49 (64%) of 76 tests, the CROM and Goldmann results were within 20 points. Of the 27 (36%) showing a more than 20-point discrepancy, 17 were worse using the Goldmann technique and 10 were worse using the CROM technique. The most frequent reason for worse diplopia using the Goldmann technique was poorer ability to fuse or suppress in the Goldmann apparatus compared with the real-world targets used in free space for the CROM method. Worse diplopia using the CROM method most often was the result of the deviation being present for distance only. In some cases, differences were the result of the greater weighting of primary position using the current scoring system for the CROM method.
CONCLUSIONS
In most cases, the CROM and Goldmann methods provide equivalent measures of diplopia severity. However, the Goldmann method seems to overestimate diplopia in patients with fragile fusion or tenuous suppression and seems to underestimate diplopia in deviations present for distance only. The CROM method may be more representative of diplopia severity as experienced in everyday life.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Diplopia; Female; Humans; Male; Middle Aged; Range of Motion, Articular; Reproducibility of Results; Strabismus; Visual Field Tests
PubMed: 17512980
DOI: 10.1016/j.ophtha.2007.01.033 -
BMC Ophthalmology Jan 2023There have been several studies on inflammatory ophthalmic diseases; however, few studies have reported neuro-ophthalmological symptoms, such as diplopia and ocular...
BACKGROUND
There have been several studies on inflammatory ophthalmic diseases; however, few studies have reported neuro-ophthalmological symptoms, such as diplopia and ocular motor nerve palsy, after coronavirus disease 2019 (COVID-19) vaccination. Therefore, this study aimed to report neuro-ophthalmological symptoms in patients after COVID-19 vaccination.
METHODS
This was a retrospective study based on the medical records of 10 patients who visited our ophthalmology clinic in 2021 with symptoms, such as diplopia (nine patients) and decreased visual acuity (one patient), and showed findings, such as ocular motor nerve palsy, after vaccination against COVID-19.
RESULTS
One patient had third nerve palsy, two had sixth nerve palsy, and five had fourth nerve palsy. One patient complained of subjective binocular diplopia but all test results were normal. One patient presented with decreased visual acuity accompanied by a sudden increase in intraocular pressure and orbital cellulitis in the other eye. The symptoms improved gradually in most patients. Compared with previous studies, this study reported three cases of antiplatelet therapy that was initiated due to the older age of the patients and underlying diseases.
CONCLUSION
As COVID-19 vaccines can cause neuro-ophthalmological diseases, such as ocular motor nerve palsy, patients' age and underlying diseases should be considered while administering them.
Topics: Humans; Abducens Nerve Diseases; COVID-19; COVID-19 Vaccines; Diplopia; Paralysis; Retrospective Studies
PubMed: 36604664
DOI: 10.1186/s12886-022-02747-7