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Clinical Ophthalmology (Auckland, N.Z.) Jan 2011THIS REVIEW OF ORBITAL FRACTURES HAS THREE GOALS: 1) to understand the clinically relevant orbital anatomy with regard to periorbital trauma and orbital fractures, 2) to...
THIS REVIEW OF ORBITAL FRACTURES HAS THREE GOALS: 1) to understand the clinically relevant orbital anatomy with regard to periorbital trauma and orbital fractures, 2) to explain how to assess and examine a patient after periorbital trauma, and 3) to understand the medical and surgical management of orbital fractures. The article aims to summarize the evaluation and management of commonly encountered orbital fractures from the ophthalmologic perspective and to provide an overview for all practicing ophthalmologists and ophthalmologists in training.
PubMed: 21339801
DOI: 10.2147/OPTH.S14972 -
Craniomaxillofacial Trauma &... Sep 2020To perform a comprehensive review and analysis of surgically treated orbital fractures. (Review)
Review
OBJECTIVE
To perform a comprehensive review and analysis of surgically treated orbital fractures.
STUDY DESIGN
Retrospective cohort chart review study for surgically treated orbital fractures during 5 years.
RESULTS
A total of 173 patients (average age 41.6 years) were diagnosed with orbital fractures. Most were male with a ratio of 3.3:1. Most fractures were caused by assault (39.3%); 22.5% of the cases were bilateral. The left orbit (40.5%) was fractured more than the right. The orbital floor (97.1%) was the most common anatomic location and the maxilla (65.3%) was the most commonly involved bone. The average time from trauma to surgical intervention was 8.7 ± 14.6 days and the average time from surgical intervention to discharge was 5.1 ± 9.0 days. The transconjunctival incision (63%) was the most commonly used incision, and nonresorbable implant (92.7%) was the most commonly used implant. Finally, the length of stay for the repair of a simple orbital fracture was less than for complex orbital fracture (1.5 days and 5.9 days, respectively).
CONCLUSION
Understanding the patterns and mechanisms of injury associated with orbital fractures can assist in developing standardized treatment protocols across all surgical specialties. This would ultimately allow for a uniform high quality of surgical care for patients with maxillofacial fractures.
PubMed: 33456683
DOI: 10.1177/1943387520924515 -
PloS One 2017To investigate the factors affecting recovery of diplopia and limited ocular motility in pediatric patients who underwent surgery for orbital wall fracture.
OBJECTIVES
To investigate the factors affecting recovery of diplopia and limited ocular motility in pediatric patients who underwent surgery for orbital wall fracture.
DESIGN
Retrospective observational case series.
METHODS
In this retrospective observational case series, 150 pediatric patients (1-18 years old) who were diagnosed with orbital medial wall or floor fracture and underwent corrective surgery between 2004 and 2016 at Seoul National University Bundang Hospital were included. The medical records of patients with orbital medial wall or floor fracture were reviewed, including sex, age, diplopia, ocular motility, preoperative computed tomographic finding, and surgical outcomes. Factors affecting recovery of diplopia and ocular motility limitation were analyzed.
RESULTS
Of the 150 patients (134 boys; mean age, 14.4 years) who underwent corrective surgery for orbital wall fracture, preoperative binocular diplopia was found in 76 (50.7%) patients and limited ocular motility in 81 (54.0%). Presence of muscle incarceration or severe supraduction limitation delayed the recovery of diplopia. In case of ocular motility limitation, presence of muscle incarceration and retrobulbar hemorrhage were related with the delayed resolution. Multivariate analysis revealed supraduction limitation (Hazard ratio [HR] = 1.74, 95% confidence interval [CI] = 1.19-2.55), larger horizontal orbital floor defects (HR = 1.22, 95% CI = 1.07-1.38), and shorter time interval to first visit (HR = 0.73) as negative prognostic factors for the recovery of diplopia. In addition, muscle incarceration (HR = 3.53, 95% CI = 1.54-8.07) and retrobulbar hemorrhage (HR = 3.77, 95% CI = 1.45-9.82) were found as negative prognostic factors for the recovery of motility limitation.
CONCLUSIONS
Presence of muscle incarceration and retrobulbar hemorrhage, horizontal length of floor fracture, supraduction limitation, and time interval from trauma to first visit were correlated with the surgical outcomes in pediatric orbital wall fracture patients. These results strengthen that the soft tissue damage associated with bony fracture affects the orbital functional unit. When managing children with orbital wall fracture, meticulous physical examination and thorough preoperative computed tomography based evaluation will help physicians to identify damage of orbital functional unit.
Topics: Adolescent; Adult; Child; Diplopia; Eye Movements; Female; Humans; Male; Oculomotor Muscles; Orbital Fractures; Prognosis
PubMed: 29095826
DOI: 10.1371/journal.pone.0184945 -
The Open Ophthalmology Journal 2017To determine whether prophylactic antibiotic use in patients with orbital fracture prevent orbital infection.
PURPOSE
To determine whether prophylactic antibiotic use in patients with orbital fracture prevent orbital infection.
DESIGN
Retrospective cohort study.
PARTICIPANTS
All patients diagnosed with orbital fracture between January 1, 2008 and March 1, 2014 at The George Washington University Hospital and Clinics.
MAIN OUTCOME MEASURES
Development of orbital infection.
RESULTS
One hundred seventy-two patients with orbital fracture met our inclusion and exclusion criteria. No orbital infections were documented. Twenty subjects (12%) received no prophylactic antibiotic, and two (1%) received only one dose of antibiotics pre-operatively for surgery. For primary antibiotic, 136 subjects (79%) received oral antibiotics, and 14 (8%) received intravenous (IV) antibiotics (excluding cefazolin). Cephalexin and amoxicillin-clavulanate were the most prescribed oral antibiotics that are equally effective. Five-to-seven day courses of antibiotics had no increased infections compared to ten-to-fourteen day courses. Calculated boundaries for effectiveness of prophylactic antibiotics ranged from a Number Needed to Treat (NNT) of 75 to a Number Needed to Harm (NNH) of 198.
CONCLUSION
Antibiotics for prevention of orbital infection in patients with orbital fractures have become widely used. Coordination between trauma teams and specialists is needed to prevent patient overmedication and antibiotic resistance. Should antibiotics be used, shorter courses and avoidance of broad spectrum agents are recommended. Additional studies are needed.
PubMed: 28400887
DOI: 10.2174/1874364101711010011 -
Archives of Plastic Surgery May 2016Recently, diagnoses of and operations for medial orbital blowout fracture have increased because of the development of imaging technology. In this article, the authors... (Review)
Review
Recently, diagnoses of and operations for medial orbital blowout fracture have increased because of the development of imaging technology. In this article, the authors review the literature, and overview the accumulated knowledge about the orbital anatomy, fracture mechanisms, surgical approaches, reconstruction materials, and surgical methods. In terms of surgical approaches, transcaruncular, transcutaneous, and transnasal endoscopic approaches are discussed. Reconstruction methods including onlay covering, inlay implantation, and repositioning methods are also discussed. Consideration and understanding of these should lead to more optimal outcomes.
PubMed: 27218019
DOI: 10.5999/aps.2016.43.3.229 -
Journal of Maxillofacial and Oral... Jun 2022The purpose of this study was to assess the use and accuracy of the titanium micromesh for primary internal orbital reconstruction in cases of either pure or impure...
AIMS AND OBJECTIVE
The purpose of this study was to assess the use and accuracy of the titanium micromesh for primary internal orbital reconstruction in cases of either pure or impure orbital blowout fractures.
DESIGN
Retrospective case series of 21 patients with a mean follow-up of 12 months.
PLACE
Department of Dental Surgery of a teaching tertiary medical college Hospital.
MATERIAL AND METHODS
Twenty-one consecutive patients who underwent surgical reconstruction of orbital floor/or Combination of floor and rim fractures using titanium micromesh.
OUTCOME AND EVALUATION
Persistence of diplopia, orbital dystopia, implant extrusion, enophthalmos, infection, and complications. The recorded data included age, gender, cause of trauma, diplopia, enophthalmos, ocular motility, preoperative orbital PNS/CT, and postoperative paranasal sinus view skull preoperative and postoperative ophthalmological examination.
RESULTS
Most of the patients were males and resulted from trauma inflicted during RTA, sport injuries or assault. The most Common fracture pattern was impure Blow out fractures, and commonly associated other facial fractures were midfacial fractures. Clinical examination along with diagnostic aids such as computed tomography of orbital fractures was used. Orbital floor exploration was performed in 21 cases due to functional or aesthetic deficits. All orbital floor bone defects required reconstruction. In these cases, orbital floor was reconstructed with .3 mm titanium micromesh implant. We did not encounter any major complications related to the incisions or implant material, though sample size was small. The rate of complication in which correction was difficult (diplopia) was lower [4%, 1 case].
CONCLUSION
Titanium mesh gives excellent result in orbital floor fractures. Surgical anatomical landmarks knowledge is very important to prevent any intra- or postoperative complications.
PubMed: 35712422
DOI: 10.1007/s12663-020-01407-x -
Journal of Clinical and Experimental... Oct 2023The aim of this study was to examine the incidence and demographic characteristics of patients with orbital walls fractures who were treated in the department of oral...
BACKGROUND
The aim of this study was to examine the incidence and demographic characteristics of patients with orbital walls fractures who were treated in the department of oral and maxillofacial surgery of a tertiary hospital in Jordan.
MATERIAL AND METHODS
A retrospective cohort study of patients with a diagnosis of with selected orbital walls fracture was designed and implemented, during a two-year period between January 2020 and December 2021. Information on patients treated for orbital walls fractures were retrieved and analyzed regarding age, sex, etiology, anatomical site, and treatment modality. Descriptive data presented as simple frequencies and percentages.
RESULTS
A total of 76 patients with 100 orbital wall fractures, age range was 4-68 years old with a mean age 28 (SD±12), of whom were 53 (69.7%) were male and 23(30.3%) were female, with male:female ratio was 2:1. The most common etiology of all orbital walls fractures was RTA in 47 patients (61.8%; ≤0.021), followed by violence in male patients. The most prevalent age-group was 21-30 years old with 16 patients (21.05%; ≤0.235), and single orbital wall fractures 56 (56%) were more common than combined orbital wall fractures.
CONCLUSIONS
In conclusion, this study will contribute to identifying the best clinical therapy and protective techniques for individuals with orbital fractures. Orbital fracture, Etiology, Orbital trauma, Road traffic accidents, Trauma.
PubMed: 37933392
DOI: 10.4317/jced.60894 -
Chang Gung Medical Journal 2010Trapdoor-type orbital fractures usually associated with marked motility restriction are common in the pediatric age group. We reviewed the characterization and surgical...
BACKGROUND
Trapdoor-type orbital fractures usually associated with marked motility restriction are common in the pediatric age group. We reviewed the characterization and surgical outcomes of orbital blow-out fracture in children.
METHOD
This is a retrospective review study. From Jan. 1997 to Dec. 2006, 75 patients under 18 years of age with orbital blow-out fractures were seen in the department of ophthalmology, Chang Gung Memorial Hospital. The medical records and computed tomography scans of these patients were reviewed.
RESULTS
Forty-one patients were identified whose records were adequate to compare data. The mean age of the patients was 12.7 years and the mean duration of follow-up was 6.5 months. The most common causes of injury were assault (43.9%) and motor vehicle accidents (29.3%). Ninety-five percent of the patients had diplopia and ninety-three percent had extraocular muscle limitation. The incidence of trapdoor fracture in pediatric orbital fracture was 68.3%. Orbital blow-out fractures in these children most frequently involved the isolated orbital floor. The average time to surgical intervention was 23 days after injury; 53.8% patients received immediate (0-2 days) or early (3- 14 days) repair. Improvement from preoperative supraduction limitation was statistically significant in the immediate (0-2 days), early (3-14 days) and delayed (15-30 days) surgical groups.
CONCLUSION
Orbital blow-out fractures in our pediatric patients were usually the result of assault or motor vehicle accident. Surgical repair within one month of injury led to better improvement and more complete resolution of ocular motility limitation and diplopia than late repairs.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Male; Orbital Fractures; Postoperative Complications; Time Factors
PubMed: 20584509
DOI: No ID Found -
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 -
Craniomaxillofacial Trauma &... Mar 2016We evaluate the safety and efficacy of the transcaruncular approach for reconstruction of medial orbital wall fractures and the combined...
We evaluate the safety and efficacy of the transcaruncular approach for reconstruction of medial orbital wall fractures and the combined transcaruncular-transconjunctival approach for reconstruction of large orbital defects involving the medial wall and floor. A retrospective review of the clinical and radiographic data of patients who underwent either a transcaruncular or a combined transcaruncular-transconjunctival approach by a single surgeon for orbital fractures between June 2007 and June 2013 was undertaken. Seven patients with isolated medial wall fractures underwent a transcaruncular approach, and nine patients with combined medial wall and floor fractures underwent a transcaruncular-transconjunctival approach with a lateral canthotomy. Reconstruction was performed using a porous polyethylene implant. All patients with isolated medial wall fractures presented with enophthalmos. In the combined medial wall and floor group, five out of eight patients had enophthalmos with two also demonstrating hypoglobus. The size of the medial wall defect on preoperative computed tomography (CT) scan ranged from 2.6 to 4.6 cm(2); the defect size of combined medial wall and floor fractures was 4.5 to 12.7 cm(2). Of the 11 patients in whom postoperative CT scans were obtained, all were noted to have acceptable placement of the implant. All patients had correction of enophthalmos and hypoglobus. One complication was noted, with a retrobulbar hematoma having developed 2 days postoperatively. The transcaruncular approach is a safe and effective method for reconstruction of medial orbital floor fractures. Even large fractures involving the orbital medial wall and floor can be adequately exposed and reconstructed with a combined transcaruncular-transconjunctival-lateral canthotomy approach. The level of evidence of this study is IV (case series with pre/posttest).
PubMed: 26889348
DOI: 10.1055/s-0035-1563390