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Ambat JM, Someda SK, Takahashi Y. Clinical characteristics and associated features of pure orbital roof fractures: A ten-year retrospective review. J Plast Reconstr Aesthet Surg 2024; 94:32-37. [PMID: 38754270 DOI: 10.1016/j.bjps.2024.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 04/25/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE To present the demographics and clinical characteristics of pure (rim-sparing) orbital roof fractures. METHODS This retrospective observational study used 10 years of data from a single institution. Patient age, sex, laterality, field of binocular single vision, associated injuries, and radiologic features were analyzed. Orbital roof fractures were categorized into four groups: comminuted/open, hinged, trapdoor, and linear. These were further subdivided into blow-in (-down) and blow-out (-up) fractures. Injury etiology was classified into fall, traffic accidents, sports injuries, assault, work-related, and others. RESULTS Data documented a low incidence rate of 2.5% (27 patients) in 1074 patients. Most patients were male (81%). The most common cause of injury was fall (48%), followed by traffic accidents (22%). Comminuted/open fractures constituted the bulk of fracture types (54%), followed by hinged, and linear fractures. Blow-in and blow-out fractures had an incidence rate of 50% each. Concomitant fractures of the medial and inferior orbital walls were predominant. Low surgical intervention was noted owing to acceptable field of binocular single vision outcomes, and the field of binocular single vision included the primary position of gaze in 88% of patients. CONCLUSION Pure orbital roof fractures occurred in 2.5% of patients with pure orbital fractures. Patients were predominantly male with trauma caused by high energy forces, which regularly caused comminution of the roof and fractures of the medial and inferior orbital walls. Most patients were managed conservatively.
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Affiliation(s)
- Jose M Ambat
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan
| | - Steffani K Someda
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan.
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2
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Kang BH, Sun JT, Fan CM, Tsai KC, Chang CJ. Black eyebrow sign: a clue to occult orbital wall fracture. QJM 2024; 117:49-50. [PMID: 37522884 DOI: 10.1093/qjmed/hcad186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 07/28/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
- B-H Kang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, 22060, Taiwan
| | - J-T Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, 22060, Taiwan
| | - C-M Fan
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, 22060, Taiwan
| | - K-C Tsai
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, 22060, Taiwan
| | - C-J Chang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, 22060, Taiwan
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Jeyaraj P. Successful Management of Post-Traumatic Residual Orbital Roof Defects with Cosmetic Disfigurement and Functional Deficits Using Innovative Titanium Plate Orbitoplasty. J Maxillofac Oral Surg 2023; 22:1040-1051. [PMID: 38105810 PMCID: PMC10719227 DOI: 10.1007/s12663-022-01744-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/26/2022] [Indexed: 10/18/2022] Open
Abstract
Introduction Late presentations of post-traumatic residual orbital roof deformities ensuing from old, unaddressed orbital injuries, can be extremely challenging to manage and quite complicated to correct, owing to proximity of the brain and frontal sinus, malunion or bony fusion of the displaced, delicate orbital fracture fragments, necrosis of entrapped extraocular muscles and progressive intraorbital soft tissue fibrosis and adhesions. There exists a paucity in literature on delayed repair of displaced and comminuted orbital roof fractures and late reconstruction of the three-dimensional architecture of the orbital frame and internal orbit. Aim & Objectives To present an unusual case of severe post-traumatic residual orbital roof deformity, resulting in longstanding aesthetic disfigurement and persisting functional deficits, and its successful management. Material & Methods The patient had sustained orbital injuries sixteen months ago, on being punched in the face at a boxing tournament. The increased orbital volume produced by an impure blowout fracture of the left orbital roof, with comminution of the upper and lower orbital rims, had resulted in considerable cosmetic deformity, discomfort as well as functional debility, all of which were successfully and efficaciously managed by an innovative use of a Titanium Orbital Plate for orbital roof reconstruction. Discussion Overlooked, undetected or ignored derangements in intraorbital volume and contour, can lead to severe cosmetic disfigurement in the form of enophthalmos, hypoglobus, entropion, telecanthus, palpebral fissure width narrowing and ptosis; in addition to crippling functional deficits, such as diplopia, blurred vision, levator dysfunction, restricted ocular motility and reduced visual range and acuity. Results & Conclusions An innovative Titanium mesh orbitoplasty enabled achievement of both, the aesthetic and functional goals of reconstruction of the distorted bony orbit, with successful correction of severe functional and aesthetic deficits.
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Cellina M, Cè M, Marziali S, Irmici G, Gibelli D, Oliva G, Carrafiello G. Computed tomography in traumatic orbital emergencies: a pictorial essay-imaging findings, tips, and report flowchart. Insights Imaging 2022; 13:4. [PMID: 35022818 PMCID: PMC8755868 DOI: 10.1186/s13244-021-01142-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
Computed tomography (CT) is considered the gold standard technique for the assessment of trauma patients with suspected involvement of the eye and orbit. These traumas can result in dramatic consequences to visual function, ocular motility, and aesthetics. CT is a quick and widely available imaging modality, which provides a detailed evaluation of the orbital bony and soft tissue structures, an accurate assessment of the globes, and is used to guide the patients’ treatment planning. For a timely and accurate diagnosis, radiologists should be aware of fracture patterns and possible associated complications, ocular detachments and hemorrhages, and different appearances of intraorbital foreign bodies. This educational review aims to describe all post-traumatic orbital abnormalities that can be identified on CT, providing a list of tips and a diagnostic flowchart to help radiologists deal with this complex condition.
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Affiliation(s)
- Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20121, Milan, Italy
| | - Maurizio Cè
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, MI, Italy
| | - Sara Marziali
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, MI, Italy.
| | - Giovanni Irmici
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, MI, Italy
| | - Daniele Gibelli
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Giancarlo Oliva
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20121, Milan, Italy
| | - Gianpaolo Carrafiello
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, MI, Italy.,Radiology Department, Policlinico di Milano Ospedale Maggiore, Fondazione IRCCS Ca' Granda, Via Francesco Sforza, 35, 20122, Milan, MI, Italy
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5
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Sandhu PS, Bucur S, Good C, Cutler M, Rajak S. The Management of Orbital Roof Fractures and Defects: A Review. Ophthalmic Plast Reconstr Surg 2022; 38:8-16. [PMID: 34293784 DOI: 10.1097/iop.0000000000002025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the anatomy, etiopathogenesis, diagnosis and classification, current evidence on intervention and the surgical management of orbital roof fractures and defects (ORFD) for oculoplastic surgeons presented with such cases. METHODS A review of the current literature through the MEDLINE database using the following search terms: "orbital roof fracture (+treatment/management)," "orbital roof defect (+treatment/management)," "orbital roof erosion (+treatment/management)," "orbital roof repair," "orbital roof," "orbital fracture," "pediatric orbital roof (defect/fracture/erosion)," "orbital anatomy," and "orbital roof anatomy" was conducted. As relatively little has been published on this topic, inclusion criteria were broad and peer-reviewed articles judged to be of clinical importance, relevant to the aims of this review, were included. Non-English abstracts were also included if relevant. Year of publication was not a strict exclusion criterion, and older articles were judged for their suitability based on clinical importance and relevance to current practice. Additional references were obtained from citations in key articles and recommendations from the coauthors based on their areas of expertise. RESULTS The etiopathogenesis of ORFD varies. Classification systems have been formulated to guide management decisions and can range from conservative management to complex neurosurgery. Eyelid approaches have also been described. This review provides a summary of the evidence for each and a management framework oculoplastic surgeons can use when presented with ORFD. CONCLUSION Oculoplastic surgeons can be involved, either alone or as part of a multidisciplinary team, in the management of ORFD, and for some, conduct orbital approach reconstructive surgery.
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Affiliation(s)
| | | | - Catriona Good
- Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Mark Cutler
- Department of Head & Neck Prosthetics, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| | - Saul Rajak
- Orbital and Oculoplastics Department, Sussex Eye Hospital
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Lucas JP, Allen M, Nguyen BK, Svider PF, Folbe AJ, Carron M. Orbital Roof Fractures: An Evidence-Based Approach. Facial Plast Surg Aesthet Med 2020; 22:471-480. [DOI: 10.1089/fpsam.2020.0029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jordyn P. Lucas
- Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Meredith Allen
- Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Brandon K. Nguyen
- Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Peter F. Svider
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Adam J. Folbe
- Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Michael Carron
- Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Otolaryngology, John Dingell Veterans Affairs Medical Center, Detroit, Michigan, USA
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8
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Yu BH, Han SM, Sun T, Guo Z, Cao L, Wu HZ, Shi YH, Wen JX, Wu WJ, Gao BL. Dynamic changes of facial skeletal fractures with time. Sci Rep 2020; 10:4001. [PMID: 32132591 PMCID: PMC7055228 DOI: 10.1038/s41598-020-60725-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/17/2020] [Indexed: 12/02/2022] Open
Abstract
To investigate the characteristics of imaging changes with time of facial fractures, patients with facial fractures who had computed tomographic scan were enrolled including 500 patients who were divided into six groups based on the time of scanning: super early (<3 d), early (4–7 d), early-to-medium (8–14 d), medium (15–21d), medium-to-late (22d–2 months) and late stage (>2 months). The data were compared and analyzed. Forty two patients with frontal bone fractures had high-energy impact as the reason of fractures. The fracture line was clear and sharp within one week but blunt and sclerotic due to bone absorption at 2–3 weeks, and might exist for a long time. All patients had soft tissue swelling and paranasal sinus effusion at 1–2 weeks after injury. Air might gather in the adjacent soft tissues and/or intracranially within 3 days of injury if the fracture involved the frontal or other sinuses. Twelve of the 42 patients (28.6%) had intracranial hematoma, and five (11.9%) had epidural effusion. Subarachnoid hemorrhage was mostly absorbed within one week while epidural hematoma was completely absorbed over 3 weeks. Significant changes (P < 0.05) in the fracture lines, effusion of paranasal sinuses, soft tissue swelling and pneumocephalus were observed during the study period. For patients with medial orbital wall fractures, the fracture line was sharp and clear at early stages with concurrent sphenoid sinus effusion, and the fracture line became depressed 3 weeks later with disappearance of sphenoid sinus effusion. Significant changes (P < 0.05) were observed in the sharp fracture line, soft tissue swelling, sphenoid sinus effusion and smooth depression at fracture sites. For nasal fractures, the fracture line was sharp and clear at early stages with concurrent soft tissue swelling which disappeared one week later. The fracture line became smooth three weeks later. A significant (P < 0.05) difference was demonstrated in the changes of fracture line and soft tissue swelling with time. In conclusion, facial fractures have some dynamic alterations with time and identification of these characteristics may help reaching a correct clinical diagnosis with regard to fracture severity and time.
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Affiliation(s)
- Bao-Hai Yu
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Shu-Man Han
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Tao Sun
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Zhe Guo
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Lei Cao
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Hui-Zhao Wu
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Yun-Heng Shi
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Jin-Xu Wen
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
| | - Wen-Juan Wu
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China.
| | - Bu-Lang Gao
- Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China
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Abstract
The orbit is contained within a complex bony architecture with overlying soft tissue that involves many important anatomical structures. Orbital trauma is a frequent cause of damage to these structures. The authors review the literature on reconstructive techniques focusing on fractures of the orbital rim, orbital roof, orbital floor, medial orbital wall, and naso-orbito-ethmoid complex. A thorough literature review was conducted using PubMed analyzing articles relevant to the subject matter. Various search terms were used to identify articles regarding orbital trauma presentation, diagnosis, management, as well as postoperative complications. Articles were examined by all authors and pertinent information was gleaned for the purpose of generating this review. Orbital trauma can result in a wide variety of complications in form and function. Not all orbital fractures require operative repair. However, bony disruption can cause enophthalmos, hypophthalmos, telecanthus, epiphora, cerebrospinal fluid leaks, orbital hematoma, and even blindness to name a few. Timing of operative repair as well as reconstructive method is dictated by the patient's individual presentation. Successful fracture management requires a detailed understanding of the anatomy and pathophysiology to ensure restoration of the patients' preoperative state. Orbital trauma encompasses a wide variety of mechanisms of injury and resulting fracture patterns. A variety of surgical approaches to the orbit exist as has been discussed allowing the surgeon access to all area of interest. Regardless of the fracture complexity, the principles of atraumatic technique, anatomic reduction, and stable fixation apply in all cases.
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Affiliation(s)
- Kirkland N Lozada
- Department of Otolaryngology Head & Neck Surgery, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Patrick W Cleveland
- Department of Otolaryngology Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jesse E Smith
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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10
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Kim YJ, Ahn S, Seo DW, Sohn CH, Lee HJ, Park IJ, Yang DJ, Ryoo SM, Kim WY, Lim KS. Patterns and injuries associated with orbital wall fractures in elderly patients who visited the emergency room: a retrospective case-control study. BMJ Open 2016; 6:e011110. [PMID: 27645553 PMCID: PMC5030573 DOI: 10.1136/bmjopen-2016-011110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Shin Ahn
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong-Woo Seo
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyung-Joo Lee
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - In-June Park
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong-Jin Yang
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung Soo Lim
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Ha AY, Mangham W, Frommer SA, Choi D, Klinge P, Taylor HO, Oyelese AA, Sullivan SR. Interdisciplinary Management of Minimally Displaced Orbital Roof Fractures: Delayed Pulsatile Exophthalmos and Orbital Encephalocele. Craniomaxillofac Trauma Reconstr 2016; 10:11-15. [PMID: 28210402 DOI: 10.1055/s-0036-1584395] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/20/2016] [Indexed: 10/21/2022] Open
Abstract
Traumatic orbital roof fractures are rare and are managed nonoperatively in most cases. They are typically associated with severe mechanisms of injury and may be associated with significant neurologic or ophthalmologic compromise including traumatic brain injury and vision loss. Rarely, traumatic encephalocele or pulsatile exophthalmos may be present at the time of injury or develop in delayed fashion, necessitating close observation of these patients. In this article, we describe two patients with minimally displaced blow-in type orbital roof fractures that were later complicated by orbital encephalocele and pulsatile exophthalmos, prompting urgent surgical intervention. We also suggest a management algorithm for adult patients with orbital roof fractures, emphasizing careful observation and interdisciplinary management involving plastic surgery, neurosurgery, and ophthalmology.
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Affiliation(s)
- Austin Y Ha
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - William Mangham
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sarah A Frommer
- Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Providence, Rhode Island
| | - David Choi
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island
| | - Petra Klinge
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island
| | - Helena O Taylor
- Division of Plastic and Reconstructive Surgery, Mount Auburn Hospital, Cambridge, Massachusetts
| | | | - Stephen R Sullivan
- Division of Plastic and Reconstructive Surgery, Mount Auburn Hospital, Cambridge, Massachusetts
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