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Danish Medical Journal Mar 2018Isolated fractures of the orbital floor or medial wall are often referred to as blowout fractures (BOFs). Debilitating double vision and aesthetic deformity may affect... (Review)
Review
Isolated fractures of the orbital floor or medial wall are often referred to as blowout fractures (BOFs). Debilitating double vision and aesthetic deformity may affect the patients' quality of life and daily living skills, for instance, working or driving a car. The management of blowout fractures is, however, challenging, since not all fractures demand surgery. Some patients may have symptoms which subside, or may never develop symptoms. Due to a lack of evidence, there are still considerable differences in opinion on the criteria for surgery. The selection of patients for surgery is therefore crucial for optimal patient outcomes. The aims of this PhD project were to elucidate and investigate various clinical aspects of blowout fractures and to examine the anatomy of the orbital cavity, which included studying the symmetry of the two orbits, the location of orbital arteries, and the pathophysiology of blowout fractures. Several clinical specialties and basic research fields study the orbital cavity. The studies in this PhD project are based on collaboration between the Departments of Otorhinolaryngology, Ophthalmology and Radiology at the Copenhagen University Hospital Rigshospitalet and the Departments of Odontology and Anatomy (Cellular and Molecular Medicine) at the University of Copenhagen. We assessed the current treatment of blowout fractures at the Ear Nose and Throat (ENT) Department at our tertiary hospital in a retrospective study, and found that a third of the patients had persistent double vision 3 months post-trauma, irrespective of whether they had been managed surgically or conservatively (Paper I). We found that the left and right orbit are symmetrical with regards to various morphometrics of both the bony orbit and the intraorbital contents, e.g. volume, surface area and volume of fat and extraocular muscles, and distance to the ethmoidal arteries (Papers II, III and IV). This knowledge may be used in blowout fracture studies on surgical decision-making and orbital reconstruction and also in presurgical planning to avoid iatrogenic damage to the ethmoidal arteries in orbital surgery. In the first longitudinal MRI study of blowout fractures, dynamic post-traumatic changes in the intraorbital soft tissue were detected, i.e. to the best of our knowledge, for the first time indicative of an edema. We conclude that an edema subsides in the days following a blowout fracture and recommend a watchful waiting period before deciding on whether or not to operate (Paper III). The 24-12-6 mm rule of thumb determines orbital distances from the anterior lacrimal crest to the ethmoidal arteries and the optic canal. We questioned the applicability of this rule to all patients and investigated whether or not it is feasible to measure the distances on CT images. We found large inter-individual differences in the distances to the ethmoidal arteries and found that preoperative measurements on CT images are feasible and produce results with a low intra- and inter-observer variability.
Topics: Clinical Decision-Making; Congenital Abnormalities; Diplopia; Humans; Magnetic Resonance Imaging; Orbit; Orbital Fractures; Quality of Life; Plastic Surgery Procedures; Tomography, X-Ray Computed
PubMed: 29510812
DOI: No ID Found -
Archives of Craniofacial Surgery Apr 2020Due to the different handling properties of unsintered hydroxyapatite particles/poly-L-lactic acid (uHA/PLLA) and polycaprolactone (PCL), we compared the surgical...
BACKGROUND
Due to the different handling properties of unsintered hydroxyapatite particles/poly-L-lactic acid (uHA/PLLA) and polycaprolactone (PCL), we compared the surgical outcomes and the postoperative implantation accuracy between uHA/PLLA and PCL meshes in orbital fracture repair.
.METHODS
Patients undergoing orbital wall reconstruction with PCL and uHA/PLLA mesh, between 2017 and 2019, were investigated retrospectively. The anatomical accuracy of the implant in bony defect replacement and the functional outcomes such as diplopia, ocular motility, and enophthalmos were evaluated.
.RESULTS
No restriction of eye movement was reported in any patient (n=30 for each group), 6 months postoperatively. In the PCL group, no patient showed diplopia or enophthalmos, while the uHA/PLLA group showed two patients with diplopia and one with enophthalmos. Excellent anatomical accuracy of implants was observed in 27 and 22 patients of the PCL and uHA/PLLA groups, respectively. However, this study showed that there were neither any significant differences in the surgical outcomes like diplopia and enophthalmos nor any complications with the two well-known implants.
.CONCLUSION
PCL implants and uHA/PLLA implants are safe and have similar levels of complications and surgical outcomes in orbital wall reconstruction.
PubMed: 32380809
DOI: 10.7181/acfs.2020.00010 -
Craniomaxillofacial Trauma &... Mar 2021Retrospective comparative interventional series of all patients who had undergone orbital fracture repair by 2 senior orbital surgeons in a single tertiary trauma center...
STUDY DESIGN
Retrospective comparative interventional series of all patients who had undergone orbital fracture repair by 2 senior orbital surgeons in a single tertiary trauma center from January 2005 to December 2014.
OBJECTIVE
To compare the outcomes of different implants used for various types of orbital fractures.
METHODS
Patients were evaluated by age, gender, etiology of fracture, clinical findings, type of fractures, and implant used. Main outcome measures included restoration of premorbid state without morbidity and complications including enophthalmos, diplopia, infraorbital hypoesthesia, and ocular motility restriction 1 year after fracture repair. Implant-related complications were collected for analysis.
RESULTS
There were a total of 274 patients with 307 orbits reconstructed. Thirty-three (12.0%) patients sustained bilateral injuries; 58.0% ( = 178) of orbits had simple fractures (isolated orbital floor, medial wall, or combined floor and medial wall). The distribution of implants used were bioresorbable ( = 117, 38.1%) and prefabricated titanium plates ( = 98, 31.9%) depending upon the nature of fracture. Bioresorbables, titanium plate, and porous polyethylene were used significantly more than titanium mesh for simple fractures, and prefabricated anatomic titanium implants were used significantly more than the other implants for complex fractures. There was a statistically significant improvement in diplopia, enophthalmos, ocular motility, and infraorbital hypoesthesia (-value < 0.001) 1 year following orbital fracture reconstruction.
CONCLUSIONS
When used appropriately, diverse alloplastic materials used in orbital fracture repair tailored to the indication aid orbital reconstruction outcomes with each material having its own unique characteristics.
PubMed: 33613837
DOI: 10.1177/1943387520939032 -
Medical Journal of the Islamic Republic... 2022Three-dimensional models are used to guide residents and physicians in accessing specific anatomical areas and types of fractures and better diagnosis of anomalies....
Three-dimensional models are used to guide residents and physicians in accessing specific anatomical areas and types of fractures and better diagnosis of anomalies. These models are useful for illuminating complex anatomical areas, such as orbit, especially limited space with sensitive access. The aim of this study was to design a three-dimensional visualization educational modeling for ophthalmology residents' training. This study is a product-oriented application that uses radiological images of anatomy, anomalies, and orbital fractures based on actual CT scans of patients. These CT scans were carefully selected from the Picture Archiving and Communication System of Ghaem Hospital of Mashhad University of Medical Sciences. To produce twelve 3D models, the CT scan files were converted to 3D printer output. Then, the models were presented to residents at a training session by an ophthalmologist. These models created all major fractures associated with the orbit area and most disorders, anomalies of this area and several normal anatomical. The features of 3D models were mentioned. The strengths and weaknesses of the educational modeling, the level of satisfaction with the use of three-dimensional models, suggestions and criticisms were assessed qualitatively by the residents. Satisfaction was reported 100% by residents. Suggestions for future 3D models were presented, and the only criticism was fear of exams and grades. Real-size 3D modeling help to understand the spatial and mental imagery of anatomy and orbital pathology and to touch different anatomical areas creates a clear image in the minds of residents, especially in the orbit.
PubMed: 36447537
DOI: 10.47176/mjiri.36.115 -
Archiwum Medycyny Sadowej I Kryminologii 2019The aim of the study was to evaluate the prevalence of effects equivalent to moderate and severe impairment to health within the meaning of the Penal Code in patients...
AIM OF THE STUDY
The aim of the study was to evaluate the prevalence of effects equivalent to moderate and severe impairment to health within the meaning of the Penal Code in patients with zygomatico-maxillo-orbital fractures and isolated orbital floor fractures. In addition, the study addressed the possibilities of applying the presented results in the preparation of medicolegal opinions in cases provided for in Articles 158 and 160 of the PC with respect to evaluating the plausibility of inflicting such bodily injuries and causing moderate and severe health impairment.
MATERIAL AND METHODS
The study covered a total of 124 patients operated on in the then Clinic of Cranio-Maxillofacial Surgery, Medical Academy of Lodz, in 1996-2001, because of fractures involving the inferior orbital wall including zygomatico-maxillo-orbital fractures (95 cases) and isolated orbital floor fractures (29 cases). The group was analyzed in a statistical and descriptive manner.
RESULTS
All the study patients (100%) with both types of fractures involving the inferior orbital wall exhibit symptoms and disorders which, pursuant to the PC, would constitute at least moderate, or possibly even severe, impairment to health.
CONCLUSIONS
Punches or kicks to the orbital region create a real danger of causing both types of orbital fracture under study, and resulting in at least moderate health impairment.
Topics: Absorbable Implants; Female; Fracture Fixation, Internal; Humans; Male; Maxillary Fractures; Maxillofacial Injuries; Orbital Fractures; Poland; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome; Violence; Zygomatic Fractures
PubMed: 31769263
DOI: 10.5114/amsik.2019.89234 -
Oral and Maxillofacial Surgery Jun 2023The purpose of this study is to execute an evidence-based review answering the following question (PICO): "Do patient-specific implants (PSI), manufactured or designed... (Meta-Analysis)
Meta-Analysis Review
The purpose of this study is to execute an evidence-based review answering the following question (PICO): "Do patient-specific implants (PSI), manufactured or designed using computer-assisted technology, improve outcomes (orbital volume change, enophthalmos, diplopia, and operative duration) compared to conventional methods in orbital reconstruction following traumatic orbital injury in the adult patient population?" We performed a systematic review and meta-analysis in accordance with PRISMA guidelines. Inclusion criteria included any comparative paper whereby computer-assisted technology was used in the prefabrication or design process of implants for use in post-traumatic orbital reconstruction. Paediatric patient populations were excluded. Eight databases were systematically searched for relevant studies. Risk of bias was assessed through the NOS and RoB2 tools. Random-effects models were used to identify differences in outcomes between groups where possible. Analysis was performed using R 4.0.0. Eleven of 4784 identified studies were included, comprising 628 adult patients, with 302 and 326 patients in the patient-specific and conventional groups, respectively. Weighted mean difference between unaffected and post-operative orbital volume was 0.32 ml (SD 0.75) and 0.95 ml (SD 1.03) for patient-specific and conventional groups, respectively. Significant improvement was identified in post-operative orbital volume reconstitution with the use of PSI, compared to conventional implants, in 3 of the 5 reporting studies. Equally, post-operative enophthalmos trended towards lower severity in the patient-specific group, with 11.2% of patients affected in the patient-specific group and 19.2% in the conventional group, and operative duration was significantly reduced with the use of PSI in 3 of the 6 reporting studies. Despite a tendency to favour PSI, no statistically significant differences in key outcomes were identified on meta-analysis. Although there is some encouraging data to support improved outcomes with the use of patient-specific orbital implants in post-traumatic reconstruction, there is, at present, no statistically significant evidence to objectively support their use over conventional implants based on the currently available comparative studies. Based on the results of this study, the choice of implant used should, thus, be left to the discretion of the surgeon.
Topics: Adult; Child; Humans; Enophthalmos; Orbit; Dental Implants; Orbital Fractures
PubMed: 35589881
DOI: 10.1007/s10006-022-01074-x -
Taiwan Journal of Ophthalmology 2023To characterize the epidemiology, associated complications, and risk factors of orbital floor fractures in a nationwide longitudinal health insurance database.
PURPOSE
To characterize the epidemiology, associated complications, and risk factors of orbital floor fractures in a nationwide longitudinal health insurance database.
MATERIALS AND METHODS
Claims data from a million randomly selected registered residents from the Taiwan National Health Insurance Research Database were analyzed between 2001 and 2011 as part of a retrospective cohort review. Patients were identified using the International Classification of Disease-9 diagnosis codes for orbital floor fracture (closed: 802.6; open: 802.7). The cases were categorized as surgical or nonsurgical based on the procedure codes and compared statistically.
RESULTS
From 2001 to 2011, 663 patients were diagnosed with orbital floor fractures out of a total population at risk of 9,836,431 person-years (average incidence: 6.78 persons/100,000/year) with overall increasing incidence. Surgical treatments were performed in 213 (32%) patients. Patients who received surgical treatment were younger than those who did not (mean age 25.3 ± 13.6 years vs. 34.2 ± 18.6 years, < 0.001). The diagnosis with diplopia was a significantly associated factor for surgical treatment (2.2% in nonsurgery group vs. 6.6% in surgery group, = 0.007). Male gender (adjusted hazard ratios [aHR] = 2.1, 95% confidence interval [CI]: 1.79-2.49) and low monthly income (aHR = 1.76, 95% CI: 1.16-2.67) were the risk factors for orbital floor fracture.
CONCLUSION
The incidence of orbital floor fractures increased in the Taiwanese population between 2001 and 2011. Men and low income patients were at increased risk of orbital floor fracture. More research is necessary to clarify what factors are driving the escalating incidence of orbital fractures in this national population.
PubMed: 37484620
DOI: 10.4103/tjo.TJO-D-23-00005 -
Clinical and Experimental Emergency... Mar 2017This study aimed to evaluate the injury patterns in pediatric patients with an orbital wall fracture (OWF) and to identify the differences in injury patterns between...
OBJECTIVE
This study aimed to evaluate the injury patterns in pediatric patients with an orbital wall fracture (OWF) and to identify the differences in injury patterns between preschool and school-aged patients with OWF who presented to the emergency department.
METHODS
We performed a retrospective observational study in the emergency department of a tertiary hospital between January 2004 and March 2014. A total of 177 pediatric patients (<18 years) with OWF who underwent facial bone computed tomography scans with specific discharge codes were included. Patients were categorized into preschool (≤7 years) and school-aged (>7 years) pediatric groups.
RESULTS
The inferior wall was the most common fracture site in both the preschool and school-aged pediatric groups (50.0% vs. 64.4%, P=0.15). The male-to-female ratio and the mechanism of injury showed significant differences between the two age groups. Violence was the most common mechanism of injury in the school-aged pediatric group (49.3%), whereas falls from a height caused OWF in approximately half of the patients in the preschool pediatric group (42.9%). Concomitant injuries and facial fractures had a tendency to occur more frequently in the school-aged pediatric group.
CONCLUSION
Significant differences according to the sex and mechanisms of injury were identified in preschool and school-aged pediatric patients with OWF.
PubMed: 28435900
DOI: 10.15441/ceem.16.153 -
Annals of Medicine and Surgery (2012) Jul 2023Orbital fractures are a common sequela of maxillofacial zone trauma. Rapid assessment and management are essential for successful reconstruction. The selected treatment...
UNLABELLED
Orbital fractures are a common sequela of maxillofacial zone trauma. Rapid assessment and management are essential for successful reconstruction. The selected treatment method depends on fracture types, accompanied injuries, and intervention time. Implantable grafts used to be from autologous materials. The study aimed to evaluate the effectiveness of using the auricular conchal cartilage taken from the ear to repair orbital floor fractures in cases of minimal bone loss, less than (2×2) cm.
MATERIAL AND METHODS
A prospective single-arm, nonrandomised clinical trial was conducted during the past 4 years (from 2018 to 2022). A total of 15 cases, who had visited the department of oral and maxillofacial surgery department with orbital floor fractures, were enrolled. The participants underwent conchal cartilage grafting for orbital floor fracture reconstruction. The time factor to perform the surgery after trauma had been considered. Patients were closely monitored for the development of double vision (diplopia) at 15 days, 1 month, and 3 months postsurgery.
RESULTS
The results showed statistically significant differences during the follow-up period following the surgical procedure. They appeared to have complete restoration of eye movements, restoration of the normal positioning of the eyeball affected by the orbital floor fracture compared to the healthy eyeball, and regression of double vision (diplopia) throughout the follow-up period.
CONCLUSION
Using the auricular conchal cartilage graft in repairing fractures of the orbital floor resulted in the improvement of the functional aspect of the eyeball and the restoration of the esthetic aspect.
PubMed: 37427204
DOI: 10.1097/MS9.0000000000000980 -
Journal of Clinical Medicine Aug 2023This systematic review summarizes recent literature on the use of extended reality, including augmented reality (AR), mixed reality (MR), and virtual reality (VR), in... (Review)
Review
BACKGROUND
This systematic review summarizes recent literature on the use of extended reality, including augmented reality (AR), mixed reality (MR), and virtual reality (VR), in preoperative planning for orbital fractures.
METHODS
A systematic search was conducted in PubMed, Embase, Web of Science and Cochrane on 6 April 2023. The included studies compared extended reality with conventional planning techniques, focusing on computer-aided surgical simulation based on Computed Tomography data, patient-specific implants (PSIs), fracture reconstruction of the orbital complex, and the use of extended reality. Outcomes analyzed were technical accuracy, planning time, operative time, complications, total cost, and educational benefits.
RESULTS
A total of 6381 articles were identified. Four articles discussed the educational use of VR, while one clinical prospective study examined AR for assisting orbital fracture management.
CONCLUSION
AR was demonstrated to ameliorate the accuracy and precision of the incision and enable the better identification of deep anatomical tissues in real time. Consequently, intraoperative imaging enhancement helps to guide the orientation of the orbital reconstruction plate and better visualize the precise positioning and fixation of the PSI of the fractured orbital walls. However, the technical accuracy of 2-3 mm should be considered. VR-based educational tools provided better visualization and understanding of craniofacial trauma compared to conventional 2- or 3-dimensional images.
PubMed: 37629251
DOI: 10.3390/jcm12165203