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Plastic and Reconstructive Surgery.... Mar 2022Orbital fractures can often result in enophthalmos or diplopia. Orbital reconstruction with titanium meshes is the current treatment modality. Adapting the titanium...
Orbital fractures can often result in enophthalmos or diplopia. Orbital reconstruction with titanium meshes is the current treatment modality. Adapting the titanium orbital floor mesh is often challenging due to the complex anatomy of the orbital floor. Here, a stepwise free hand bending technique of a titanium orbital floor mesh is described. The bending can be done preoperatively, and mesh fit can be checked against a dry anatomical skull before sterilization. The methodical approach to free hand bending of titanium orbital floor mesh minimizes the intraoperative adjustments and permits quick orbital reconstruction. Trainees and less-experienced surgeons can benefit from the methodical approach to free hand bending of titanium orbital floor mesh.
PubMed: 35265441
DOI: 10.1097/GOX.0000000000004159 -
Journal of Medicine and Life 2014The unique and complex anatomy of the orbit requires significant contouring of the implants to restore the proper anatomy. Fractures of the orbital region have an...
The unique and complex anatomy of the orbit requires significant contouring of the implants to restore the proper anatomy. Fractures of the orbital region have an incidence of 10-25% from total facial fractures and the most common age group was the third decade of life. The majority of cases require reconstruction of the orbital floor to support the globe position and restore the shape of the orbit. The reason for this is that the bony walls are comminuted and/or bone fragments are missing. Therefore, the reconstruction of missing bone is important rather than reducing bone fragments. This can be accomplished using various materials. There is hardly any anatomic region in the human body that is so controversial in terms of appropriate material used for fracture repair: nonresorbable versus resorbable, autogenous/allogenous/xenogenous versus alloplastic material, non-prebent versus preformed (anatomical) plates, standard versus custom-made plates, nonporous versus porous material, non-coated versus coated plates. Thus, the importance of material used for reconstruction becomes more challenging for the ophthalmologist and the oral and maxillofacial surgeon.
Topics: Biocompatible Materials; Humans; Orbit; Orbital Fractures; Wound Healing
PubMed: 27057250
DOI: No ID Found -
Clinical Ophthalmology (Auckland, N.Z.) 2013Although trauma is one of the main causes of orbital apex syndrome (OAS), reports of OAS associated with orbital fractures are relatively rare. We recently treated two...
Although trauma is one of the main causes of orbital apex syndrome (OAS), reports of OAS associated with orbital fractures are relatively rare. We recently treated two patients who sustained severe visual impairment with damage to multiple cranial nerves (third to sixth) associated with inferomedial orbital wall fractures. In these patients, posterior movement of the globe caused neuropathy of the cranial and optic nerves by posterior globe edema and hemorrhage, or direct impact between the globe and wall, which might then have induced OAS in the cases described in this report. Steroid therapy was unsuccessful for optic neuropathy due to the delay between injury and administration. When treating patients with inferomedial orbital blowout fractures due to globe-to-wall contact, it is necessary to routinely assess and monitor visual acuity since there may be a delay between the injury and OAS onset.
PubMed: 23487509
DOI: 10.2147/OPTH.S42811 -
GMS Ophthalmology Cases 2019Traumatic superior orbital fissure syndrome is a rare complication that occurs in association with craniofacial trauma. In the present case, there were no associated...
Traumatic superior orbital fissure syndrome is a rare complication that occurs in association with craniofacial trauma. In the present case, there were no associated orbital fractures or other lesions to explain. We present a-16-year-old patient with total ophthalmoplegia, ptosis, and anesthesia of the upper eyelid and forehead 6 hours after a reported trauma to the left eye. We measured the width of the superior orbital fissure on the horizontal plane including the optic canal using computed tomography scans. Radiological examinations did not reveal any orbital fractures. However, the superior orbital fissure on the affected side was only 1.86 mm, increasing susceptibility to indirect trauma. A narrow superior orbital fissure may play a role for superior orbital fissure syndrome altering the transmitted force from the trauma and edema.
PubMed: 30984510
DOI: 10.3205/oc000099 -
Journal of Ophthalmology 2019To validate the potential of bioresorbable implantation in secondary revisional reconstruction after inadequate primary orbital fracture repair, with assessment of pre-...
PURPOSE
To validate the potential of bioresorbable implantation in secondary revisional reconstruction after inadequate primary orbital fracture repair, with assessment of pre- and postoperative clinical characteristics and computed tomography image findings.
METHODS
A retrospective chart review was conducted on 16 consecutive patients treated for orbital fractures at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, with inadequate prior surgeries between July 2010 and June 2017; patients who had suffered orbital blowout fractures had undergone primary surgeries elsewhere. Secondary repair of orbital fractures used bioresorbable material following unsatisfactory primary orbital repair. Patients' demographics, degree of enophthalmos, ocular motility, diplopia test results, primary implants, and surgical complications were reviewed.
RESULTS
All 16 patients had primary orbital implants consisting of Medpor, titanium mesh, hydroxyapatite, or poly-L-lactide. Of the 16 cases, 14 had malpositioned implants posteriorly and two had implant infections. Findings following primary surgery included enophthalmos (12/16), diplopia (9/16), intraorbital abscess (2/16), and ocular movement pain (1/16). Mean preoperative enophthalmos was 3.8 ± 0.8 mm. Secondary reconstruction resulted in a mean reduction of enophthalmos by 3.1 ± 0.9 mm ( < 0.01). Nine in ten patients experienced improvements in postoperative ocular motility and diplopia following secondary surgery. Intraorbital abscesses and eyeball movement-associated pain were cured.
CONCLUSIONS
This study demonstrates that secondary orbital reconstruction of previously repaired orbital fractures using bioresorbable material can achieve excellent functional and aesthetic results with minimal complications. Bioresorbable material should be considered in secondary orbital reconstruction when clinically indicated.
PubMed: 30863628
DOI: 10.1155/2019/8715314 -
Journal of Personalized Medicine Aug 2022Proper treatment of the two-wall fractured orbit is still controversial. Specifically, there is no consensus on the issue of the necessity of medial orbital wall repair....
Proper treatment of the two-wall fractured orbit is still controversial. Specifically, there is no consensus on the issue of the necessity of medial orbital wall repair. With anatomically critical structures at risk during the surgical approach, surgeons' view on the necessity of medial orbital wall repair often is restricted and an aesthetically disturbing enophthalmos is more likely to be accepted. Therefore, treatment options range from leaving the medial wall without repair to reconstruction with autogenous tissue or alloplastic materials, which can lead to moderate to severe side effects. However, emerging technologies such as patient-specific implants (PSI) offer a reliable and anatomically correct reconstruction of the bony orbit. This study aimed to evaluate the outcome of full orbital reconstruction using PSIs compared to only orbital floor repair using PDS (bioresorbable polydioxanone) foils leaving the medial orbital wall untouched in traumatic two-wall orbital fractures. Of all patients treated at the University Hospital of Düsseldorf between 2017 and 2019 who suffered from traumatic orbital fracture, only patients with a two-wall orbital fracture involving both the orbital floor and the medial wall (n = 68) were included. Patients were treated either with a PSI (n = 35) or a PDS foil (n = 33). Primary outcome parameters were ophthalmological disturbances analyzed via clinical investigation and intra-orbital angles, volumes and implant position analyzed with radiological 3D-datasets. While a two-wall reconstruction using PSIs led to a significant improvement of the enophthalmos, the rate of postoperative enophthalmos was significantly increased in cases of only orbital floor repair with PDS foils. Radiologically, a significant reconstruction of the three-dimensional bony orbit succeeded with the simple use of PSIs leading to a significant reduction in the traumatically enlarged orbital volume. PSI also led to a significant reduction in the traumatically enlarged medial angle of the orbit. This was not the case for single-floor repair with PDS foil. The results of this study suggest that complex orbital fractures can be reconstructed at an even higher degree of accuracy with selective laser-melted PSIs than PDS foils. In order to achieve a true to original reconstruction of the bony orbit, surgical treatment of the medial orbital wall can be advocated for in the long term depending on the indication.
PubMed: 36143174
DOI: 10.3390/jpm12091389 -
BMJ Open Sep 2016This study aimed to determine orbital wall fracture (OWF) patterns and associated facial injuries in elderly patients and compare them with those in their younger adult...
OBJECTIVES
This study aimed to determine orbital wall fracture (OWF) patterns and associated facial injuries in elderly patients and compare them with those in their younger adult counterparts.
DESIGN
A retrospective case-control study.
SETTING
An emergency department of a university-affiliated hospital located in an urban area.
PARTICIPANTS
A total of 1378 adult patients with OWF diagnosed by CT from 1 January 2004 through 31 March 2014 were enrolled. Patients were categorised into elderly (≥65 years) and non-elderly (<65 years) groups.
RESULTS
The elderly group (n=146) had a mean age of 74.0 years compared with 37.5 years in the non-elderly group (n=1232). Slipping was the most common cause of OWF in the elderly group (43.8%, p<0.001), whereas violence was the most common cause in the non-elderly group (37.3%, p<0.001). The lateral orbital wall was the more common site of fracture in the elderly group, and their injuries were more often associated with concurrent facial bone fractures, including the mandible, maxilla and zygoma, compared with the non-elderly group. After adjusting for sex and the mechanism of injury, inclusion in the elderly group was a significant risk factor for fracture of the lateral wall (OR 1.658; 95% CI 1.074 to 2.560) and concomitant facial bone fractures of the maxilla (OR 1.625; 95% CI 1.111 to 2.377) and zygoma (OR 1.670; 95% CI 1.126 to 2.475).
CONCLUSIONS
Elderly patients were vulnerable to facial trauma, and concurrent facial bone fracture associated with OWF was more commonly observed in this age group. Therefore, a high index of suspicion and thorough investigation, including CT, for OWF-associated facial bone fractures are important.
Topics: Accidental Falls; Adult; Aged; Case-Control Studies; Emergency Service, Hospital; Facial Injuries; Female; Humans; Length of Stay; Male; Orbital Fractures; Retrospective Studies; Tomography, X-Ray Computed; Urban Population
PubMed: 27645553
DOI: 10.1136/bmjopen-2016-011110 -
BMC Medical Education Jun 2023Three-dimensional printing is an underutilized technology in ophthalmology training; its use must be explored in complex educational scenarios. This study described a...
BACKGROUND
Three-dimensional printing is an underutilized technology in ophthalmology training; its use must be explored in complex educational scenarios. This study described a novel approach to trainee education of orbital fracture repair utilizing three-dimensional (3D) printed models as a teaching tool.
METHODS
Ophthalmology residents and oculoplastic fellows from multiple training institutions underwent an educational session on orbital fractures, learning through four different models. Participants analyzed orbital fractures through computerized tomography (CT) imaging alone and then utilizing CT imaging with the aid of a 3D printed model. Participants completed a questionnaire assessing their understanding of the fracture pattern and surgical approach. After the training, participants were surveyed on the impact of the educational session. Components of the training were rated by participants on a 5-point Likert scale.
RESULTS
A statistically significant difference (p < .05) was found in participant confidence conceptualizing the anatomic boundaries of the fracture and planning the orbital fracture approach for repair of three out of four models on pre-test post-test analysis. On exit questionnaire, 84.3% of participants thought the models were a useful tool for surgical planning, 94.8% of participants thought the models were a useful tool for conceptualizing the anatomic boundaries of the fracture, 94.8% of participants thought the models were a useful tool for orbital fracture training, and 89.5% of participants thought the exercise was helpful.
CONCLUSION
This study supports the value of 3D printed models of orbital fractures as an effective tool for ophthalmology trainee education to improve understanding and visualization of complex anatomical space and pathology. Given the limited opportunities trainees may have for hands-on orbital fracture practice, 3D printed models provide an accessible way to enhance training.
Topics: Humans; Orbital Fractures; Learning; Tomography, X-Ray Computed; Printing, Three-Dimensional; Models, Anatomic
PubMed: 37349755
DOI: 10.1186/s12909-023-04436-5 -
Oral and Maxillofacial Surgery Jun 2023We present our experience of titanium-milled two-piece patient-specific implants (PSIs) for primary reconstructions of extensive orbital floor and medial wall fractures...
PURPOSE
We present our experience of titanium-milled two-piece patient-specific implants (PSIs) for primary reconstructions of extensive orbital floor and medial wall fractures (EOFMFs) and evaluate their postoperative functional and aesthetic outcomes in relation to commercially available implants.
METHODS
We included all patients with primary reconstructions (< 22 days from injury) of EOFMFs treated in our department between January 2011 and October 2020. Extensive orbital floor and medial wall fracture was defined as involvement of orbital floor, medial wall and maxilloethmoidal junction; a fracture defect 5 mm or more; defect size more than a third of both inferior and medial walls; and Jaquiéry classification III or more. Patient characteristics, details of fracture defects and surgeries, postoperative outcomes and implant positions were retrospectively evaluated and compared between study groups.
RESULTS
Nineteen patients were included: 5 with two-piece PSIs and 14 with commercial implants. Implant position was good in 4/5 patients with two-piece PSIs and 2/14 with commercial implants. Revision surgery, globe malposition (GMP) > 2 mm, significant diplopia and poor implant position were more frequent in patients with commercial implants than two-piece PSIs. None of the patients with a good overall implant position had any significant postoperative symptoms.
CONCLUSION
Extensive orbital fracture reconstructions are somewhat rare, and surgical treatment is associated with a high rate of complications and postoperative symptoms. Titanium-milled two-piece PSIs are well suited for primary reconstructions of EOFMFs, as they lead to more precise reconstructions and fewer postoperative symptoms than commercially available implants.
Topics: Humans; Orbital Fractures; Retrospective Studies; Titanium; Plastic Surgery Procedures; Dental Implants; Esthetics, Dental; Orbit; Treatment Outcome
PubMed: 35585440
DOI: 10.1007/s10006-022-01065-y -
Journal of Maxillofacial and Oral... Mar 2021Diplopia in children is uncommon. However a small group of patients present with diplopia and severe restriction of upward globe movement which requires early diagnosis...
AIMS AND OBJECTIVES
Diplopia in children is uncommon. However a small group of patients present with diplopia and severe restriction of upward globe movement which requires early diagnosis and prompt intervention. This study aims to evaluate the timing of intervention and functional outcome in the management of white-eyed blowout fractures.
METHODOLOGY
The study was conducted in a tertiary level trauma center. There were a total of 46 orbital floor injuries over a period of 2 years out of which 4 patients with white-eyed blowout fractures were identified. Details of each case were entered on a standard data base and analysed with respect to age, mode of injury, extent of limitation of gaze, timing of intervention, pre and post-operative diplopia. Minimum follow up period for every case was 1year.
RESULTS
All of them had sports related injuries. Three of the four patients had complete recovery from diplopia with full range of eye movements. However one child with delayed presentation didn't recover fully and had persistence of symptoms within the functional range.
CONCLUSION
White-eyed orbital blowout fracture in kids though uncommon need prompt diagnosis and management for complete recovery. The initial clinical presentation mimics that of head injury and hence can be missed, leading to a delay in diagnosis resulting in incomplete recovery.
PubMed: 33584039
DOI: 10.1007/s12663-020-01393-0