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Australian Journal of General Practice Jul 2022Ocular trauma may result in pathology of the ocular surface and adnexa, extraocular muscles, orbital walls, eye and optic nerve. Detailed history followed by a... (Review)
Review
BACKGROUND
Ocular trauma may result in pathology of the ocular surface and adnexa, extraocular muscles, orbital walls, eye and optic nerve. Detailed history followed by a complete ocular and, if indicated, radiological examination is therefore a crucial part of any trauma assessment. It is important to determine whether a patient with ocular trauma can be reassured or requires immediate referral for further investigation and surgical repair.
OBJECTIVE
This review examines chemical eye injuries, orbital fractures, superficial corneal foreign bodies, closed globe injury and suspected open globe injury with or without intra-ocular foreign bodies. A structured approach to the history and examination is provided. The aim of this article is to enhance clinician confidence when encountering these patients.
DISCUSSION
Ocular trauma can lead to serious sight‑ and eye-threatening consequences. Accurate history-taking and astute observation are paramount for timely treatment or referral that may prevent blindness. This review discusses the management and referral pathways for common presentations of ocular trauma.
Topics: Eye; Eye Injuries; Foreign Bodies; Humans
PubMed: 35773155
DOI: 10.31128/AJGP-03-21-5921 -
Tidsskrift For Den Norske Laegeforening... Apr 2022
Topics: Humans; Orbital Fractures; Tomography, X-Ray Computed
PubMed: 35383443
DOI: 10.4045/tidsskr.21.0586 -
Seminars in Plastic Surgery Nov 2021Orbital fractures are common in facial trauma and can be a challenge to treat. Understanding anatomy of the orbit, the clinical evaluation, indications for surgery,... (Review)
Review
Orbital fractures are common in facial trauma and can be a challenge to treat. Understanding anatomy of the orbit, the clinical evaluation, indications for surgery, surgical approaches, complications, and postoperative are essential in providing appropriate treatment for patients who have sustained orbital fractures. In this article, the authors review the diagnostic evaluation, acute management, treatment options, and common complications of orbital fractures, as well as recent advancements in orbital fracture repairs.
PubMed: 34819809
DOI: 10.1055/s-0041-1735815 -
Seminars in Plastic Surgery May 2019The orbit is contained within a complex bony architecture with overlying soft tissue that involves many important anatomical structures. Orbital trauma is a frequent... (Review)
Review
The orbit is contained within a complex bony architecture with overlying soft tissue that involves many important anatomical structures. Orbital trauma is a frequent cause of damage to these structures. The authors review the literature on reconstructive techniques focusing on fractures of the orbital rim, orbital roof, orbital floor, medial orbital wall, and naso-orbito-ethmoid complex. A thorough literature review was conducted using PubMed analyzing articles relevant to the subject matter. Various search terms were used to identify articles regarding orbital trauma presentation, diagnosis, management, as well as postoperative complications. Articles were examined by all authors and pertinent information was gleaned for the purpose of generating this review. Orbital trauma can result in a wide variety of complications in form and function. Not all orbital fractures require operative repair. However, bony disruption can cause enophthalmos, hypophthalmos, telecanthus, epiphora, cerebrospinal fluid leaks, orbital hematoma, and even blindness to name a few. Timing of operative repair as well as reconstructive method is dictated by the patient's individual presentation. Successful fracture management requires a detailed understanding of the anatomy and pathophysiology to ensure restoration of the patients' preoperative state. Orbital trauma encompasses a wide variety of mechanisms of injury and resulting fracture patterns. A variety of surgical approaches to the orbit exist as has been discussed allowing the surgeon access to all area of interest. Regardless of the fracture complexity, the principles of atraumatic technique, anatomic reduction, and stable fixation apply in all cases.
PubMed: 31037047
DOI: 10.1055/s-0039-1685477 -
Seminars in Plastic Surgery May 2017Facial fractures are a common source of emergency department consultations for the plastic surgeon. A working understanding of evaluation, assessment, management, and... (Review)
Review
Facial fractures are a common source of emergency department consultations for the plastic surgeon. A working understanding of evaluation, assessment, management, and prevention of further injury when dealing with these fractures is vital. This two-part series detailing the management of midface fractures serves as a guide for the appropriate workup and management of the wide variety of fracture patterns that are commonly encountered.
PubMed: 28496388
DOI: 10.1055/s-0037-1601372 -
Seminars in Plastic Surgery Feb 2017Orbital fractures are very common after facial trauma. The assessment of a patient with a suspected orbital wall injury includes a detailed oculofacial examination as... (Review)
Review
Orbital fractures are very common after facial trauma. The assessment of a patient with a suspected orbital wall injury includes a detailed oculofacial examination as well as radiologic imaging. Surgical repair with or without an implant may be indicated for diplopia, enophthalmos, or both. Cicatricial eyelid malposition is an iatrogenic complication commonly due to poor orbitotomy technique. Optimal repair involves direct exposure of the perimeter of the fractures' site through surgical planes that minimally scar the eyelids. A wide variety of implant options exist; however, thin, pliable, nonadherent materials such as nylon foil may offer several advantages. The authors describe the evaluation and management of orbital wall fractures.
PubMed: 28255287
DOI: 10.1055/s-0037-1598191 -
Archives of Craniofacial Surgery Sep 2016The medial wall and floor of the bony orbit are frequently fractured because of the delicate anatomy. To optimize functional and aesthetic results, reconstructive... (Review)
Review
The medial wall and floor of the bony orbit are frequently fractured because of the delicate anatomy. To optimize functional and aesthetic results, reconstructive surgeons should understand the anatomy and pathophysiology of orbital fractures. Appropriate treatment involves optimal timing of intervention, proper indications for operative repair, incision and dissection, release of herniated tissue, implant material and placement, and wound closure. The following review will discuss the management of orbital floor fractures, with the operative method preferred by the author. Special considerations in operation technique and the complication are also present in this article.
PubMed: 28913267
DOI: 10.7181/acfs.2016.17.3.111 -
Craniomaxillofacial Trauma &... Mar 2013It is wise to recall the dictum "children are not small adults" when managing pediatric orbital fractures. In a child, the craniofacial skeleton undergoes significant... (Review)
Review
It is wise to recall the dictum "children are not small adults" when managing pediatric orbital fractures. In a child, the craniofacial skeleton undergoes significant changes in size, shape, and proportion as it grows into maturity. Accordingly, the craniomaxillofacial surgeon must select an appropriate treatment strategy that considers both the nature of the injury and the child's stage of growth. The following review will discuss the management of pediatric orbital fractures, with an emphasis on clinically oriented anatomy and development.
PubMed: 24436730
DOI: 10.1055/s-0032-1332213 -
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