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The Open Dentistry Journal 2017Orbital fractures are classified as diseases usually related to common midface trauma. It represents the most challenging treatment due to the complex anatomy,...
BACKGROUND
Orbital fractures are classified as diseases usually related to common midface trauma. It represents the most challenging treatment due to the complex anatomy, physiology, and aesthetic role. A midface trauma involves also the zygomatic complex and the nose, however the orbit fracture seems to be a more frequent disease due to its anatomical features.
OBJECTIVE
The purpose of this work is to retrospectively evaluate and record the frequency of the midfacial traumas and orbital fractures observed in the North Eastern Sicily. The results of the present data may be useful for the clinicians in order to recognize the kind of fracture just from the first general visit having a quick diagnosis and management.
METHODS
In the years between 2001 and 2016, about 1200 patients with midfacial trauma and about 100 patients involving the orbital floor have been evaluated. All those patients underwent the surgical fracture reduction and a CT scan follow up control at one month, three months, six months and one year.
RESULTS
Data showed high percentage of orbital floor, nose and mandibular body and ramus fractures; moreover the most frequent causes of fractures seem to be related to motor vehicle accident, followed by assaults, work and fall.
CONCLUSION
The results have highlighted the changing trends in the causes of facial injuries, particularly the increasing incidence of assaults and the falling incidence of motor vehicle accidents in developed countries. The quick diagnosis and management proved fundamental for the successful treatment. Clinicians should be able to recognize the first symptoms in order to avoid possible complications.
PubMed: 29238415
DOI: 10.2174/1874210601711010546 -
Archives of Craniofacial Surgery Aug 2019The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be...
The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.
PubMed: 31462011
DOI: 10.7181/acfs.2019.00255 -
Archives of Craniofacial Surgery Apr 2023Complex orbital fractures are impure orbital fractures because they involve the orbital walls and mid-facial bones. The author reported an orbital wall restoration...
BACKGROUND
Complex orbital fractures are impure orbital fractures because they involve the orbital walls and mid-facial bones. The author reported an orbital wall restoration technique in which the primary orbital wall fragments were restored to their prior position in complex orbital fractures in 2020. As a follow-up to a previous preliminary study, this study retrospectively reviewed the surgical results of complex orbital wall fractures over a 4-year period and compared the surgical outcomes by dividing them into groups with and without balloon restoration.
METHODS
Data of 939 patients with facial bone fractures between August 2018 and August 2022 were reviewed. Of these, 154 had complex orbital fractures. Among them, 44 and 110 underwent reduction with and without the balloon technique respectively. Pre- and postoperative Naugle exophthalmometer (Good-Lite Co.) scales were evaluated. The orbital volume and orbital volume ratio were calculated from preoperative and 6 months postoperative computed tomography images.
RESULTS
Among 154 patients with complex orbital fractures, 44 patients underwent restoration with the balloon technique, and 110 patients underwent restoration without it. The Naugle scale did not differ significantly between the two groups, but the orbital volume ratio significantly decreased by 3.32% and 2.39% in groups with and without the balloon technique and the difference in OVR was significantly greater in patients in the balloon restoration group compared with the control group. Postoperative balloon rupture occurred in six out of 44 cases (13.64%). None of the six patients with balloon rupture showed significant enophthalmos at 6 months of follow-up.
CONCLUSION
The balloon rupture rate was 13.64% (6/44 cases) with marginal screw fixation, blunt screws, and extra protection with a resorbable foam dressing. Furthermore, we restored the orbital wall with primary orbital fragments using balloon support in complex orbital wall fractures.
PubMed: 37150525
DOI: 10.7181/acfs.2022.01116 -
Craniomaxillofacial Trauma &... Sep 2021Retrospective chart review of pediatric and globe injuries associated with orbital fractures.
STUDY DESIGN
Retrospective chart review of pediatric and globe injuries associated with orbital fractures.
OBJECTIVE
Our study seeks to examine these injuries and their association with orbital fractures at our trauma center to gain a better understanding of how to approach pediatric patients with orbital fractures.
METHODS
A retrospective review of all facial fractures in pediatric patients at an urban level 1 trauma center was performed for the years 2002 to 2014. Patient demographics were collected, as well as orbital fracture location, mechanism of injury, concomitant injuries, ophthalmologic documentation, imaging, and perioperative records.
RESULTS
One hundred sixteen pediatric patients over a 12-year period sustained an orbital fracture. The orbital floor was the most commonly fractured orbital bone in our series (60%). Thirty-four (30%) of the pediatric patients with orbital fractures had documented periorbital and/or globe injuries at the time of presentation. The most common periorbital injury was entrapment related to orbital floor fractures. Significant eyelid lacerations were present in seven patients, with five of these patients had canalicular injuries and two had canthal malposition. Five pediatric patients presented with traumatic optic neuropathy. Two patients had ruptured globes requiring enucleation.
CONCLUSIONS
Periorbital soft tissue and globe injuries associated with orbital fractures occurs in a substantial number of pediatric patients. There are no guidelines for treatment of these type of injuries in the pediatric population. Further research should be performed to better understand the appropriate management of periorbital injuries in conjunction with surgical management of the orbital fractures.
PubMed: 34471473
DOI: 10.1177/1943387520933697 -
Insights Into Imaging Mar 2020In patients with facial trauma, multidetector computed tomography is the first-choice imaging test because it can detect and characterize even small fractures and their... (Review)
Review
In patients with facial trauma, multidetector computed tomography is the first-choice imaging test because it can detect and characterize even small fractures and their associated complications quickly and accurately. It has helped clinical management and surgical planning, so radiologists must communicate their findings to surgeons effectively. In Le Fort fractures, there is a breach between the pterygoid plates and the posterior maxilla. These fractures are classified in three basic patterns that can be combined and associated with various complications. Conceptualized when low-speed trauma was predominant, the Le Fort classification system has become less relevant giving more importance on maxillary occlusion-bearing segments. The classification of naso-orbito-ethmoid depends on the extent of injury to the attachment of the medial canthal tendon, with possible complications like nasofrontal duct disruption. Displaced fractures of the zygomaticomaxillary complex often widen the angle of the lateral orbital wall, resulting in increased orbital volume and sometimes in enophthalmos. Severe comminution or angulation can lead to wide surgical exposure. In orbital fractures, entrapment of the inferior rectus muscles can lead to diplopia, so it is important to assess its positioning and morphology. Orbital fractures can also result in injuries to the globe or infraorbital nerve. Frontal sinus fractures that extend through the posterior sinus wall can create a communication with the anterior cranial fossa resulting in leakage of cerebrospinal fluid, intracranial bleeding. It is essential to categorize fracture patterns and highlight features that may affect fracture management in radiology reports of facial trauma.
PubMed: 32193796
DOI: 10.1186/s13244-020-00847-w -
CMAJ : Canadian Medical Association... Feb 2021
Topics: Humans; Orbital Fractures; Tomography, X-Ray Computed
PubMed: 33619069
DOI: 10.1503/cmaj.200657 -
Journal of Clinical Medicine Jun 2021(1) Background: The aim of the present study was to compare lower eyelid post-operative complications, such as ectropion, entropion, and scleral show of orbital floor...
(1) Background: The aim of the present study was to compare lower eyelid post-operative complications, such as ectropion, entropion, and scleral show of orbital floor fractures, associated to the subciliary vs transconjunctival approaches. (2) Materials and Methods: A retrospective comparative study of patients who underwent surgery for orbital fractures by means of a transconjunctival or a subciliary approach at the Clinic of Dentistry and Maxillofacial Surgery of the University of Verona from January 2013 through September 2018 was designed. Data related to the trauma and to surgical procedures were retrieved, as well as a series of anthropometric parameters extrapolated from standardized photographs. Statistical analysis was performed on the outcomes. (3) Results: 33 patients underwent surgery by means of a transconjunctival approach and 36 patients by means of a subciliary approach. Ectropion was observed to a greater extent in the subciliary group, however the difference resulted to be not statistically significant. Patients in which osteosynthesis devices were used presented with a greater incidence of scleral show with respect to the remaining patients. No statistically significant difference was observed for any of the parameters taken into account. (4) Conclusions: Since the two approaches does not seem to be associated with remarkable differences in terms of outcomes, the choice of technique should be tailored to the patient's features and the surgeon's experience.
PubMed: 34202783
DOI: 10.3390/jcm10132775 -
Craniomaxillofacial Trauma &... Mar 2020There are multiple approaches to repairing orbital floor fractures. This study compares the postoperative complications of the subciliary and transconjunctival...
BACKGROUND
There are multiple approaches to repairing orbital floor fractures. This study compares the postoperative complications of the subciliary and transconjunctival approaches.
METHODS
The electronic medical records from 2 hospitals were screened for CPT codes associated with orbital floor reconstruction. A total of 184 patients were identified and included in the study. Patient characteristics and complications were compared by surgical approach.
RESULTS
Of the 184 patients, 82 (44.6%) were in the subciliary group and 102 (55.4%) were in the transconjunctival group. The overall postoperative complication rate was 25.5%. The most common of these were diplopia (11.4%), corneal injury (7.1%), proptosis (5.4%), and enopthalmos (4.9%). The complication rate was not statistically significant between the 2 groups.
CONCLUSION
Subciliary and transconjunctival approaches to orbital floor repair are equally safe. This study is limited by a smaller sample size, and a larger study will likely be necessary to fully address this question.
PubMed: 32642031
DOI: 10.1177/1943387520904893 -
Craniomaxillofacial Trauma &... Mar 2022Post-traumatic reconstruction of the orbit can pose a challenge due to inherent intraoperative problems. Intra-orbital adipose tissue is difficult to manipulate and... (Review)
Review
Post-traumatic reconstruction of the orbit can pose a challenge due to inherent intraoperative problems. Intra-orbital adipose tissue is difficult to manipulate and retract making visualization of the posterior orbital contents difficult. Rapid prototyping (RP) is a cost-effective method of anatomical model production allowing the surgeon to produce a patient specific implant (PSI) which can be pre-surgically adapted to the orbital defect with exact reconstruction. Intraoperative imaging allows immediate assessment of reconstruction at the time of surgery. Utilization and combination of both technologies improves accuracy of reconstruction with orbital implants and reduces cost, surgical time, and the rate of revision surgery.
PubMed: 35265282
DOI: 10.1177/19433875211004314 -
Journal of Maxillofacial and Oral... Sep 2019Orbital fractures with orbital wall defects are common facial fractures encountered by oral-maxillofacial surgeons, because of the exposed position and thin bony walls... (Review)
Review
Orbital fractures with orbital wall defects are common facial fractures encountered by oral-maxillofacial surgeons, because of the exposed position and thin bony walls of the midface. The primary goal of surgery is to restore the pre-injury anatomy and volume of hard tissue, and to free incarcerated or prolapsed orbital tissue from the fracture by bridging the bony defects with reconstructive implant material and restoring the maxillofacial-orbital skeleton. Numerous studies have reported orbital fracture repair with a wide variety of implant materials that offer various advantages and disadvantages. The ideal orbital implant material will allow conformation to individual patients' anatomical characteristics, remain stable over time, and are radiopaque, especially for the reconstruction of relatively large and/or complex bony walls. Based on these requirements, novel uncalcined and unsintered hydroxyapatite (u-HA) particles and poly-L-lactide (PLLA; u-HA/PLLA) composite sheets could be used as innovative, bioactive, and osteoconductive/bioresorbable implant materials for orbital reconstruction. In addition, intraoperative navigation is a powerful tool. Navigation- and computer-assisted surgeries have improved execution and predictability, allowing for greater precision, accuracy, and minimal invasiveness during orbital trauma reconstructive surgery of relatively complex and large orbital wall defects with ophthalmological malfunctions and deformities. This review presents an overview of navigation-assisted orbital trauma reconstruction using a bioactive, osteoconductive/bioresorbable u-HA/PLLA system.
PubMed: 31371870
DOI: 10.1007/s12663-019-01207-y