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Plastic and Reconstructive Surgery.... May 2023Orbital fractures constitute a significant percentage of all midface injuries. Here, we present a contemporary evidence-based review of the major surgical approaches for... (Review)
Review
UNLABELLED
Orbital fractures constitute a significant percentage of all midface injuries. Here, we present a contemporary evidence-based review of the major surgical approaches for orbital wall fractures and analyze the literature to compare all major surgical procedures and their complication rates.
METHOD
A systematic review was conducted to compare surgical approaches (subciliary, transcaruncular, transconjunctival, subtarsal, and endoscopic) and postoperative complications in patients who underwent surgical fixation of orbital wall fractures. A database search in PubMed (PubMed Central, MEDLINE and Bookshelf) was performed for all articles containing the terms "orbital," "wall," "fracture," and "surgery" with different combinations.
RESULTS
A total of 950 articles were obtained and 25 articles were included, representing an analysis of 1137 fractures. The most frequent surgical approach was the endoscopic (33.3%) followed by the external surgical approaches, specifically transconjunctival (32.8%), subciliary (13.5%), subtarsal (11.5%), and transcaruncular (8.9%). The transconjunctival approach had a statistically significantly higher rate of complications (36.19%), followed by the subciliary (21.4%), and endoscopic approach (20.2%, < 0.0001). The subtarsal approach had a statistically significantly lower rate of complications (8.2%) followed by the transcaruncular approach (14.0%, < 0.0001).
CONCLUSION
The subtarsal and transcaruncular approaches were observed to have the lowest rates of complications, whereas the transconjunctival, subciliary, and endoscopic approaches were reported to have higher rates of complications.
PubMed: 37197012
DOI: 10.1097/GOX.0000000000004967 -
Atlas of the Oral and Maxillofacial... Mar 2021
Review
Topics: Humans; Orbital Fractures; Orthoptics
PubMed: 33516539
DOI: 10.1016/j.cxom.2020.10.002 -
Clinical Ophthalmology (Auckland, N.Z.) 2015Many specialists encounter and treat orbital fractures. The management of these fractures is often challenging due to the impact that they can have on vision. Acute... (Review)
Review
Many specialists encounter and treat orbital fractures. The management of these fractures is often challenging due to the impact that they can have on vision. Acute treatment involves a thorough clinical examination and management of concomitant ocular injuries. The clinical and radiographic findings for each individual patient must then be analyzed for the need for surgical intervention. Deformity and vision impairment can occur from these injuries, and while surgery is intended to prevent these problems, it can also create them. Therefore, surgical approach and implant selection should be carefully considered. Accurate anatomic reconstruction requires complete assessment of fracture margins and proper implant contouring and positioning. The implementation of new technologies for implant shaping and intraoperative assessment of reconstruction will hopefully lead to improved patient outcomes.
PubMed: 26604678
DOI: 10.2147/OPTH.S80463 -
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 -
Orbit (Amsterdam, Netherlands) Jun 2023To evaluate the incidence of severe ocular injury requiring emergent ophthalmic evaluation in visually asymptomatic patients presenting with orbital fractures.
PURPOSE
To evaluate the incidence of severe ocular injury requiring emergent ophthalmic evaluation in visually asymptomatic patients presenting with orbital fractures.
METHODS
We performed a retrospective chart review of all adult and pediatric orbital fractures between 2012-2022 at a level 1 trauma center. Ocular injuries were categorized into severe, moderate, and mild. We evaluated symptoms, mechanism of injury, visual acuity (VA), and severity of injuries using the Cochran-Armitage and linear-by-linear tests.
RESULTS
Of the 2495 cases, 1534 had ophthalmology evaluation. The mean ± standard deviation age was 40.4 ± 20.4 years. Most patients were male (73.1%) and Caucasian (75.9%). The mean time to evaluation was 0.6 ± 2.5 days. 486 (31.7%) were visually symptomatic, 760 (49.5%) were asymptomatic, and 288 (18.8%) were unknown. Of the symptomatic, 135 (27.8%) had severe injuries, 108 (22.2%) had moderate injuries, 216 (44.4%) had mild injuries, and 27 (5.6%) had no injuries. Of the asymptomatic, 67 (8.8%) had severe injuries, 183 (24.1%) had moderate injuries, 468 (61.6%) had mild injuries, and 42 (5.5%) had no injuries. Symptoms correlated with injury severity (-value <.001). The most common mechanism of injury were falls (24.0%), assaults (22.2%), and motor vehicle accidents (14.8%).
CONCLUSIONS
Visually asymptomatic orbital fractures were less likely to have severe ocular injuries; however, many patients were unable to express symptoms. Emergent ophthalmology evaluation should be considered in all patients presenting with orbital fractures, especially patients with visual symptoms or are unable to report symptoms.
Topics: Humans; Adult; Male; Child; Young Adult; Middle Aged; Female; Orbital Fractures; Incidence; Retrospective Studies; Eye Injuries; Visual Acuity
PubMed: 35801838
DOI: 10.1080/01676830.2022.2095648 -
European Archives of... Jun 2023The present study aims to investigate how well CT images correlate to surgical findings in orbital floor fractures and to the presence of diplopia.
PURPOSE
The present study aims to investigate how well CT images correlate to surgical findings in orbital floor fractures and to the presence of diplopia.
METHODS
In this cross-sectional study, 27 consecutive patients already selected for surgery due to an orbital floor fracture underwent a routine CT scan (axial, coronal, sagittal). An ophthalmologist established any presence of diplopia. Extent of fracture/injury seen on CT was compared to that discovered during surgery.
RESULTS
In the surgeons´ opinions CT-images were in concordance with surgical findings in 71% of the cases. Agreement for pure blow out fractures was high (92%). Tetrapod fractures as a cause of an orbital floor fracture was only identified as such by surgeons in three of 11 cases, all subjected to orbital exploration, not only a closed reduction. Diplopia showed a significant correlation to rounding of the inferior rectus muscle at coronal CT. "Rounding" significantly correlated with the presence of a floor defect, to herniation of soft tissues and to the volume of displaced tissue.
CONCLUSIONS
The results imply that the joint professional interaction between neuroradiology and surgery is important and would benefit from the use of an easy and well-defined classification system of orbital floor fractures. In Sweden a national record to collect data on all zygomaticomaxillary complex fractures assessed is to be started aiming at making general statements possible by time.
Topics: Humans; Orbital Fractures; Diplopia; Cross-Sectional Studies; Oculomotor Muscles; Tomography, X-Ray Computed
PubMed: 36625866
DOI: 10.1007/s00405-022-07801-0 -
Seminars in Plastic Surgery Nov 2021Zygomaticomaxillary complex fracture is one of the most commonly treated facial fractures. Accurate reduction and stable fixation of the zygoma are required to restore... (Review)
Review
Zygomaticomaxillary complex fracture is one of the most commonly treated facial fractures. Accurate reduction and stable fixation of the zygoma are required to restore facial symmetry and projection and avoid functional sequalae from changes in orbital volume. Achieving optimal outcome is challenging due to the complex three-dimensional anatomy and limited visualization of all affected articulations of the zygoma. This article provides an updated overview of the evaluation and management of zygomaticomaxillary complex fractures based on available evidence and clinical experience at our center. The importance of soft tissue management is emphasized, and approaches to internal orbital reconstruction are discussed. While evidence remain limited, intraoperative imaging and navigation may prove to be useful adjuncts in the treatment of zygomaticomaxillary fractures.
PubMed: 34819807
DOI: 10.1055/s-0041-1735812 -
Journal of Stomatology, Oral and... Sep 2021Orbital wall fractures consider one of the most common fractures in the maxillofacial trauma. These fractures caused by two mechanisms, the buckling mechanism and...
INTRODUCTION
Orbital wall fractures consider one of the most common fractures in the maxillofacial trauma. These fractures caused by two mechanisms, the buckling mechanism and hydraulic mechanism. This study aims to compare between the two mechanisms in terms of intensity and extension using the finite elements method.
MATERIAL AND METHODS
Three-dimensional model of the skull was generated using computed tomography data of young male patient. Virtual loads were applied on the eyeball and the infra-orbital rim separately. Von Mises stresses were examined in each simulation.
RESULTS
The simulation predicted fractures on the infra-orbital rim and orbital floor when simulating the hydraulic mechanism, and on the orbital floor and mesial wall when simulating the buckling mechanism.
CONCLUSION
Biomechanical studies are essential part in understanding maxillofacial fractures mechanisms. The results confirmed and ascertained what is seen clinically, and explained clearly the two mechanisms of orbital fractures.
Topics: Biomechanical Phenomena; Computer Simulation; Humans; Male; Orbit; Orbital Fractures; Skull
PubMed: 33385578
DOI: 10.1016/j.jormas.2020.12.008 -
Saudi Journal of Ophthalmology :... Jul 2012Orbital trapdoor fractures are commonly encountered in children. Awareness of trapdoor fractures is of particular importance. This is because early recognition and...
Orbital trapdoor fractures are commonly encountered in children. Awareness of trapdoor fractures is of particular importance. This is because early recognition and treatment are necessary to prevent permanent motility abnormities. In this article, we will provide a brief overview of orbital fractures. The clinical and radiographic features of trapdoor fractures will then be reviewed, followed by a discussion on their proper management.
PubMed: 23961006
DOI: 10.1016/j.sjopt.2012.05.008 -
Indian Journal of Ophthalmology Jul 2019The purpose of this systematic review is to investigate the most common indications, treatment, and outcomes of computer-assisted surgery (CAS) in ophthalmological... (Review)
Review
The purpose of this systematic review is to investigate the most common indications, treatment, and outcomes of computer-assisted surgery (CAS) in ophthalmological practice. CAS has evolved over the years from a neurosurgical tool to maxillofacial as well as an instrument to orbitofacial surgeries. A detailed and organized scrutiny in relevant electronic databases, journals, and bibliographies of the cited articles was carried out. Clinical studies with a minimum of two study cases were included. Navigation surgery, posttraumatic orbital reconstruction, computer-assisted orbital surgery, image-guided orbital decompression, and optic canal decompression (OCD) were the areas of interest. The search generated 42 articles describing the use of navigation in facial surgery: 22 on orbital reconstructions, 5 related to lacrimal sac surgery, 4 on orbital decompression, 2 articles each on intraorbital foreign body and intraorbital tumors, 2 on faciomaxillary surgeries, 3 on cranial surgery, and 2 articles on navigation-guided OCD in traumatic optic neuropathy. In general, CAS is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were related to trauma. Treatment of complex orbital fractures was greatly improved by the use of CAS compared with empirically treated control groups. CAS seems to add a favourable potential to the surgical armamentarium. Planning details of the surgical approach in a three-dimensional virtual environment and execution with real-time guidance can help in considerable enhancement of precision. Financial investments and steep learning curve are the main hindrances to its popularity.
Topics: Decompression, Surgical; Humans; Imaging, Three-Dimensional; Orbital Fractures; Plastic Surgery Procedures; Surgery, Computer-Assisted; Tomography, X-Ray Computed
PubMed: 31238394
DOI: 10.4103/ijo.IJO_807_18