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Ear, Nose, & Throat Journal Jan 2022Orbital cellulitis is an uncommon condition with risks to sight and life. As a complication of maxillofacial injuries, the literature suggests this is only possible with...
Orbital cellulitis is an uncommon condition with risks to sight and life. As a complication of maxillofacial injuries, the literature suggests this is only possible with fractures or direct inoculation, and there are no reports to the contrary. Here, we make the first report of a possible etiology by which orbital cellulitis developed in a 14-year-old boy even without skin breach or bony fractures; as well as a rare causative pathogen. He presented with facial abscess and progressive orbital cellulitis after blunt facial trauma, requiring functional endoscopic sinus surgery with needle aspiration of facial abscess externally. Cultures showed growth of , and he received further antibiotics with full recovery.The pathophysiology of orbital cellulitis in this patient is attributed to vascular congestion and local pressure from maxillofacial contusion and maxillary hemoantrum, with impaired paranasal sinus ventilation encouraging anaerobic bacterial growth. Further progression led to facial abscess formation and intraorbital spread with orbital cellulitis. The pediatric demographic is injury-prone, and self-reporting of symptoms can be delayed. Hence, increased suspicion of complicated injuries and orbital cellulitis may be required when managing maxillofacial contusions so that prompt treatment can be given.
PubMed: 35023786
DOI: 10.1177/01455613211064002 -
Arquivos Brasileiros de Oftalmologia 2022We aimed to study the characteristics of ocular trauma, an important but largely preventable global cause of blindness, in the United States.
PURPOSE
We aimed to study the characteristics of ocular trauma, an important but largely preventable global cause of blindness, in the United States.
METHODS
Retrospective chart review of the National Trauma Data Bank (2008-2014) was performed. All patients with ocular trauma were identified using ICD-9CM codes. The collected data were statistically analyzed with student's t-test, Chi-squared test, and logistic regression analysis performed using the SPSS software. The significance was set at p<0.05.
RESULTS
It was found that 316,485 (5.93%) of the 5,336,575 admitted trauma patients had ocular injuries. Their mean (SD) age was 41.8 (23) years, and most of them were men (69.4%). Race/ethnicity distribution was White 66.1%, Black 15.1%, and Hispanic 12.3%. The common injuries were orbital 39.5% and eye/adnexa contusions 34%. Associated traumatic brain injury was present in 58.2%. The frequent mechanisms were falls 25.5%, motor vehicle accident-occupant 21.8%, and struck by/against 17.6%. Patients <21 years of age had higher odds of cut/pierce injuries (OR=3.29, 95%CI=3.07-3.51) than the other age groups, those aged 21-64 years had higher odds of motor vehicle accident-cyclist (OR=4.95, 95%CI=4.71-5.19), and those >65 years had higher odds of falls (OR=16.75, 95%CI=16.39-17.12); p<0.001. The Blacks had a greater likelihood of firearm injuries (OR=3.24, 95%CI=3.10-3.39) than the other racial/ethnic groups, the Hispanics experienced more of cut/pierce injuries (OR=2.01, 95%CI=1.85-2.18), and the Whites experienced more of falls (OR=2.3, 95%CI=2.3-2.4); p<0.001. The Blacks (OR=3.41, 95%CI=3.34-3.48) and Hispanics (OR=1.75, 95%CI=1.71-1.79) mostly suffered assaults, while the Whites suffered unintentional injuries (OR=2.78 95%CI=2.74-2.84); p<0.001. Optic nerve/visual pathway injuries had the greatest association with very severe injury severity scores (OR=3.27, 95%CI=3.05-3.49) and severe Glasgow Coma Scores (OR=3.30, 95%CI=3.08-3.54); p<0.001. The mortality rate was 3.9%.
CONCLUSIONS
Male preponderance and falls, motor vehicle accident-occupant, and struck by/against mechanisms agree with the previous reports. The identified demographic patterns underscore the need to develop group-specific preventive measures.
Topics: Adult; Eye Injuries; Female; Firearms; Humans; Injury Severity Score; Male; Retrospective Studies; United States; Wounds, Gunshot; Young Adult
PubMed: 34586236
DOI: 10.5935/0004-2749.20220035 -
Journal of Oral and Maxillofacial... Jan 2021Early operative reconstruction using titanium mesh is a technique often used for preventing sequelae after an orbital fracture. We sought to examine the utility of...
PURPOSE
Early operative reconstruction using titanium mesh is a technique often used for preventing sequelae after an orbital fracture. We sought to examine the utility of patient-specific molding of the mesh with a biomodel via virtual mirroring of the nonaffected side.
METHODS
We retrospectively assessed the clinical and radiological outcomes of orbital fracture reconstruction using a customized titanium mesh shaped on 3D-printed biomodels in 34 unilateral orbital fracture cases. Preoperative virtual orbital reconstruction images, using the mirroring technique, were superimposed on postoperative 3D images, and clinical data from patient charts were analyzed. Orbital reconstructions were rated, and the intention to revise results intraoperatively, or during inpatient or outpatient phases, was assessed by 2 consultants and 2 residents.
RESULTS
We found that most fractures arose from falls of <3 meters or from interpersonal violence. Ophthalmic injuries included subconjunctival bleeding, ocular contusion, enophthalmos, and diplopia. Long-term sequelae at last followup were diplopia (8.8%) and mild enophthalmos (11.8%).
CONCLUSION
Interrater reliabilities regarding consultants' intention to revise results were substantial to almost perfect at any time point. Therefore, using the mirroring technique for the virtual reconstruction of a fractured orbit and a 3D-printed biomodel to customize commercial titanium implants yields good and reliable results, enhances surgical precision, and decreases the need for intraoperative revision, as well as long-term sequelae of orbital fractures.
Topics: Dental Implants; Enophthalmos; Humans; Orbit; Orbital Fractures; Printing, Three-Dimensional; Plastic Surgery Procedures; Retrospective Studies; Surgical Mesh; Titanium; Tomography, X-Ray Computed
PubMed: 33010215
DOI: 10.1016/j.joms.2020.09.001 -
Ceska a Slovenska Oftalmologie :... 2021Orbital fractures may be accompanied with severe damage of the eye bulb and other intraorbital tissues. Early clinical findings can be very mild, therefore it is vital...
Orbital fractures may be accompanied with severe damage of the eye bulb and other intraorbital tissues. Early clinical findings can be very mild, therefore it is vital to actively seek not only for any damage done to the soft tissues of the orbit, but also for extraorbital complications such as liquorrhea or meningitis. We report a relatively rare case of blow-in fracture of orbital roof in eleven years old boy. Patient was admitted to the emergency care after falling off a bicycle without impaired consciousness. During admission ophthalmologist evaluated the condition as severe contusion of the left bulb, with hemophthalmia and retinal comotosis. Due to significant swelling of eye lids and periorbital hematoma, it was not possible to perform specific tests to objectify possible oculomotor disorder and diplopia. CT scan findings show dislocated fracture of orbital roof with fragments reaching into the musculus rectus superior. For high risk of bulbus penetration and muscle damage a surgical intervention with bone fragments removal was performed using endoscopic assisted frontal orbitotomy. After operation patient had no signs of functional eye disorder.
Topics: Child; Diplopia; Humans; Male; Orbit; Orbital Fractures; Tomography, X-Ray Computed
PubMed: 33740867
DOI: 10.31348/2021/5 -
Scientific Reports Nov 2022Electric bicycles and scooters have gained popularity among riders; studies assessing these device-related injuries have not specified ocular trauma. Our study examined...
Electric bicycles and scooters have gained popularity among riders; studies assessing these device-related injuries have not specified ocular trauma. Our study examined the types and risk factors for ocular and periocular injuries associated with electric devices compared to motorcycle accidents. The study was conducted on the National Trauma Registry database from 20 trauma centers, including patients involved in accidents with electric bicycles, scooters, and motorcycles between 2014 to 2019. Injured riders were assigned into two groups: motorcycle group (M) and electric bicycle & scooter group (E). Data such as gender, age, protective gear use, ocular injury type, injury severity score (ISS), and ocular surgery were captured. Logistic regression models were conducted for injury types and the need for surgery. 8181 M-riders and 3817 E-riders were involved in an accident and hospitalized. E-riders suffered from ocular injury more than M-riders. Males were most vulnerable and the ages of 15-29. Orbital floor fracture was the most common injury, followed by ocular contusion, eyelid laceration, and other ocular wounds. Electric bicycle and scooter riders are more likely to suffer from ocular injury than motorcycle riders. Riders without helmets are at greater risk for injuries, specifically orbital floor fractures. ISS of 16 + was associated with injury demanding ocular surgery.
Topics: Male; Humans; Motorcycles; Eye Injuries; Transportation; Injury Severity Score; Orbital Fractures
PubMed: 36446787
DOI: 10.1038/s41598-022-23860-z -
California Medicine Nov 1958The cervical spine, usually regarded as a supporting structure for the head, is also an important viaduct of vessels and nerves which must function with little clearance...
The cervical spine, usually regarded as a supporting structure for the head, is also an important viaduct of vessels and nerves which must function with little clearance in a congested and moving space bounded by bone. Pressure in this viaduct is an important cause of headache.The cervical foramina although apparently roomy, are constricted by cartilage, by the vertebral artery and its adnexae, and by the lateral intervertebral joints. Osteophytosis, swelling or adhesion in this constricted space almost inevitably causes painful vascular or neural disorder. In certain postures of the neck the vertebral artery is constricted or even occluded. Traction or sprain may likewise cause headache through disturbance of the vertebral arterial nerves, the posterior cervical autonomic system or the spinal accessory nerves which originate in delicate filaments from all points of the cervical spinal cord.A syndrome described by Skillern-migraine-like suboccipital and retro-orbital headache-is due to disturbance of the second cervical nerve, which communicates with the first division of the trigeminal nerve. Headache due apparently to a minor scalp contusion may really be due to irritation of a trigger area at the site of an old scalp injury.
Topics: Arteries; Cervical Vertebrae; Head; Headache; Humans; Migraine Disorders; Neck; Spinal Cord Diseases; Trigeminal Nerve; Vascular Diseases; Vertebral Artery
PubMed: 13585154
DOI: No ID Found -
Medicine Oct 2021Reconstruction of complex craniofacial defects in fronto-orbital region has been reported to be extremely few. In this study, we report 2 cases with fronto-orbital...
RATIONAL
Reconstruction of complex craniofacial defects in fronto-orbital region has been reported to be extremely few. In this study, we report 2 cases with fronto-orbital defects of different etiologies in one-stage surgical reconstruction with polyetheretherketone (PEEK) prosthesis using computer-assisted design and computer-assisted manufactured (CAD-CAM) techniques.
PATIENT CONCERNS
One patient was a 49-year-old man, who admitted with a depressed and comminuted fracture in the left fronto-orbital region as a result of a motor vehicle collision. The other patient was a 45-year-old woman who was hospitalized with an unexpected diagnosis of a fronto-orbital bone tumor during a head CT examination in a minor traumatic brain injury. None of them had a significant past medical history.
DIAGNOSES
The first patient's head computed tomography (CT) showed multiple depressed comminuted fractures in the right fronto-orbital region with localized frontal lobe contusion, and the diagnosis was clear when combined with the mechanism of traumatic head injuries. The second patient's head CT and magnetic resonance image suggested a right lateral orbital neoplastic lesion that distorted peripheral bone, the postoperative pathological examination demonstrated an osteoma with fibromatous hyperplasia, and thus the women's diagnosis was confirmed.
INTERVENTIONS
A three-dimensional image of both patients' skull bone were collected from a high-resolution CT. A virtual surgical planning for lesion excision and defect remodeling based on CAD-CAM techniques was undertaken, and than the reconstruction surgery was performed in a single procedure using PEEK prosthesis. Antibacterial treatment was prescribed routinely.
OUTCOMES
Postoperatively, both patients achieved excellent aesthetic restoration as well as functional recovery of the orbital cavity without neurological or infectious complications during an average 22 months follow-up.
LESSONS
The CAD-CAM PEEK implants could be a preferred option for reconstruction of patients with various complex fronto-orbital defects.
Topics: Adult; Computer-Aided Design; Female; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Middle Aged; Orbital Fractures; Orbital Implants; Orbital Neoplasms; Osteoma; Plastic Surgery Procedures; Tomography, X-Ray Computed
PubMed: 34622866
DOI: 10.1097/MD.0000000000027452 -
JAMA Ophthalmology Dec 2019Gun violence represents a substantial public health issue, and firearm-related injuries rank second among the causes of injury-related deaths in children aged 0 to 17...
IMPORTANCE
Gun violence represents a substantial public health issue, and firearm-related injuries rank second among the causes of injury-related deaths in children aged 0 to 17 years in the United States. Ocular trauma from firearm-related injuries can lead to devastating vision loss, but little is known to date about the specific demographics and characteristics of such injuries in children.
OBJECTIVE
To evaluate the epidemiologic pattern of pediatric firearm-related ocular injuries.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective analysis used deidentified data from the National Trauma Data Bank, the largest national registry of hospitalized trauma cases in the United States. The firearm-related ocular injuries (n = 1972) of pediatric patients (defined as those younger than 21 years) hospitalized between January 1, 2008, and December 31, 2014, were analyzed. Statistical analyses were conducted from July 15, 2017, to June 15, 2019.
EXPOSURE
Firearm-related ocular trauma.
MAIN OUTCOMES AND MEASURES
Pediatric patients with firearm-related ocular injuries were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes and external causes of injury codes. Patient demographics (age, sex, and race/ethnicity), type of ocular injury, injury intent, geographic location, length of hospital admission, health insurance status, disposition at discharge, Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) score were collected.
RESULTS
A total of 8715 firearm-related ocular injuries were identified. Of these injuries, 1972 (22.6%) occurred in pediatric patients, most of whom were male (1678 [85.1%]) and adolescents (1037 [52.6%]), with a mean (SD) age of 15.2 (5) years. Common locations of injury were home (761 [38.6%]) and street (490 [24.8%]). Mean (SD) hospital length of stay was 7.6 (12) days, ISS was 16 (13.1), and GCS score was 11 (5.1). The most common types of firearm-related ocular injuries were open wound of the eyeball (820 [41.6%]) and ocular adnexa (502 [25.5%]), orbital injuries or fractures (591 [30.0%]), and contusion of the eye or adnexa (417 [21.1%]). Patients aged 0 to 3 years had greater odds of unintentional injuries (odds ratio [OR], 4.41; 95% CI, 2.51-7.75; P < .001) and injuries occurring at home (OR, 5.39; 95% CI, 2.81-10.38; P < .001), and those aged 19 to 21 years had greater odds of assault injuries (OR, 2.17; 95% CI, 1.77-2.66; P < .001) and injuries occurring on the street (OR, 1.61; 95% CI, 1.3-1.98; P < .001). Black patients had the greatest odds of having injuries with assault intention (OR, 4.53; 95% CI, 3.68-5.59; P < .001), and white patients had the greatest likelihood for self-inflicted injury (OR, 7.1; 95% CI, 5.92-9.51; P < .001). Traumatic brain injury resulted mostly from self-inflicted trauma (OR, 5.99; 95% CI, 4.16-8.63; P < .001), as did visual pathway injuries (OR, 2.86; 95% CI, 1.95-4.20; P < .001). The inpatient mortality rate was 12.2%.
CONCLUSIONS AND RELEVANCE
This study found that pediatric firearm-related ocular injuries from 2008 through 2014 were predominantly sight-threatening and associated with traumatic brain injury. If the possible risk factors, including sex, age, race/ethnicity, and injury intention, can be confirmed for 2015 through 2019, these findings may be useful in developing strategies to prevent pediatric firearm-related ocular injuries.
Topics: Adolescent; Age Distribution; Child; Child, Preschool; Databases, Factual; Ethnicity; Eye Injuries, Penetrating; Female; Humans; Infant; Infant, Newborn; Injury Severity Score; International Classification of Diseases; Male; Registries; Retrospective Studies; Risk Factors; Sex Distribution; United States; Vision Disorders; Wounds, Gunshot
PubMed: 31600369
DOI: 10.1001/jamaophthalmol.2019.3562