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Shikha N, Reghunadhan P, Upasi AP, Rai KK, Kocher V. Simplified practice for ophthalmologist consultation in malar fractures: A retrospective study. J Craniomaxillofac Surg 2024; 52:297-301. [PMID: 38220496 DOI: 10.1016/j.jcms.2024.01.001] [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: 05/22/2023] [Revised: 09/28/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024] Open
Abstract
Zygomatic bone contributes to the orbital walls, and therefore associated injuries carry a high risk of severe dysfunction of the visual apparatus. The aim of our study was to retrospectively assess the spectrum and frequency of ophthalmic involvement in patients presenting with malar fracture, and the need for referral to an ophthalmologist for evaluation. In total, 102 patients presenting with malar fracture between January 2008 and August 2017 at Bapuji Dental College and Hospital, Davangere, Karnataka were enrolled in this study. Patients with confirmed malar fracture were categorized according to Henderson's classification, and associated ocular injuries were recorded. Assessment of the spectrum and frequency of ophthalmic involvement in patients presenting with different types of malar fracture was then carried out, followed by categorization of the need for referral to the ophthalmologist with regard to the associated ocular injury, as per the Al-Qurainy et al. (1991) scoring system, allocating the patients to early, routine, and non-referral categories. Statistically significant differences in proportions of various types of ophthalmic involvement were found between categories of malar fracture, and in degrees of ophthalmic involvement within each category of malar fracture, except in the Type II group of patients. The most severe ocular injuries were noted in Type VII followed by Type V, with the least severe injuries noted in Type II patients. According to the Al-Qurainy et al. (1991) scoring system, eight patients required early referral, 10 patients needed routine referral, and 84 patients were in the non-referral category. Categorization of referral of patients to an ophthalmologist in hospitals lacking ophthalmology departments can be based on the Al-Qurainy et al. classification of referral for Henderson's Type III, IV, and VI. Henderson's Type I and II patients need to be referred only in medicolegal cases. Henderson's Type VII and V patients require mandatory referral.
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Affiliation(s)
- Nirdhum Shikha
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka, India.
| | - Parvathy Reghunadhan
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Amarnath P Upasi
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Kirthi Kumar Rai
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Varun Kocher
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka, India
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Locatelli D, Veiceschi P, Arosio AD, Agosti E, Peris-Celda M, Castelnuovo P. 360 Degrees Endoscopic Access to and Through the Orbit. Adv Tech Stand Neurosurg 2024; 50:231-275. [PMID: 38592533 DOI: 10.1007/978-3-031-53578-9_8] [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] [Indexed: 04/10/2024]
Abstract
The treatment of pathologies located within and surrounding the orbit poses considerable surgical challenges, due to the intricate presence of critical neurovascular structures in such deep, confined spaces. Historically, transcranial and craniofacial approaches have been widely employed to deal with orbital pathologies. However, recent decades have witnessed the emergence of minimally invasive techniques aimed at reducing morbidity. Among these techniques are the endoscopic endonasal approach and the subsequently developed endoscopic transorbital approach (ETOA), encompassing both endonasal and transpalpebral approaches. These innovative methods not only facilitate the management of intraorbital lesions but also offer access to deep-seated lesions within the anterior, middle, and posterior cranial fossa via specific transorbital and endonasal corridors. Contemporary research indicates that ETOAs have demonstrated exceptional outcomes in terms of morbidity rates, cosmetic results, and complication rates. This study aims to provide a comprehensive description of endoscopic-assisted techniques that enable a 360° access to the orbit and its surrounding regions. The investigation will delve into indications, advantages, and limitations associated with different approaches, while also drawing comparisons between endoscopic approaches and traditional microsurgical transcranial approaches.
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Affiliation(s)
- Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
- Head and Neck and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Research Center for Pituitary Adenoma and Sellar Pathology, University of Insubria, Varese, Italy
| | - Pierlorenzo Veiceschi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
| | - Alberto Daniele Arosio
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
| | - Edoardo Agosti
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
- Unit of Neurosurgery, Spedali Civili Hospital, Brescia, Italy
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Paolo Castelnuovo
- Head and Neck and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Research Center for Pituitary Adenoma and Sellar Pathology, University of Insubria, Varese, Italy
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, "Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy
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Cascino F, Cerase A, Gennaro P, Latini L, Fantozzi V, Gabriele G. Multidisciplinary evaluation of orbital floor fractures: dynamic MRI outcomes. Orbit 2023; 42:592-597. [PMID: 36541287 DOI: 10.1080/01676830.2022.2155974] [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: 08/11/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Orbital floor fractures can cause functional disorders such as limitation of ocular motility. The dysfunction of the extrinsic muscles was studied with the Hess-Lancaster test; although we expected a large percentage of inferior rectus muscle dysfunction, the results showed 52% superior rectus muscle dysfunction. METHODS In light of these results, we began testing five patients with functional deficits evidenced by the Hess-Lancaster test with magnetic resonance imaging to assess the change in thickness of the affected muscle compared to the contralateral healthy muscle during standardized eye movements. RESULTS This investigation showed an increase in the size of the inferior rectus muscle on the affected side during the fraction of time when the patient was asked to look up, probably due to post-traumatic fibrosis. According to our hypothesis, muscle thickness would condition the correct release of the inferior rectus muscle to such an extent that it would also influence the contraction of the superior rectus muscle, which would then be deficient. CONCLUSIONS Based on our experience, a multidisciplinary approach and longer follow-up with thorough investigations should be considered for patients with orbital floor fractures. Furthermore, our results suggest the need for early surgical treatment, in contrast to current guidelines that aim to delay restorative surgery.
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Affiliation(s)
- Flavia Cascino
- Department of Maxillo-Facial Surgery, Azienda ospedaliero-universitaria Senese "Santa Maria alle Scotte", Siena, Italy
| | - Alfonso Cerase
- Unit of Neuroimaging-Diagnostic and Functional Neuroradiology, Department of Neurological and Motor Sciences, Azienda ospedaliero-universitaria Senese "Santa Maria alle Scotte", Siena, Italy
| | - Paolo Gennaro
- Department of Maxillo-Facial Surgery, Azienda ospedaliero-universitaria Senese "Santa Maria alle Scotte", Siena, Italy
| | - Linda Latini
- Department of Maxillo-Facial Surgery, Azienda ospedaliero-universitaria Senese "Santa Maria alle Scotte", Siena, Italy
| | - Vittoria Fantozzi
- Department of Maxillo-Facial Surgery, Azienda ospedaliero-universitaria Senese "Santa Maria alle Scotte", Siena, Italy
| | - Guido Gabriele
- Department of Maxillo-Facial Surgery, Azienda ospedaliero-universitaria Senese "Santa Maria alle Scotte", Siena, Italy
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Gokharman FD, Kadirhan O, Celik Aydin O, Yalcin AG, Kosar P, Aydin S. A Comprehensive Look at Maxillofacial Traumas: On the Basis of Orbital Involvement. Diagnostics (Basel) 2023; 13:3429. [PMID: 37998566 PMCID: PMC10670346 DOI: 10.3390/diagnostics13223429] [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: 09/17/2023] [Revised: 10/28/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Orbital wall fractures that may develop in maxillofacial traumas (MFTs) may cause ophthalmic complications (OCs). The aim of this study is to determine the frequency of orbital fractures (OFs) accompanying MFTs and findings suspicious for orbital traumatic involvement. MATERIALS AND METHODS Computed tomography (CT) images of 887 patients who presented to the emergency department within a 1-year period with a history of MFT were retrospectively scanned. During the examination, patients with orbital wall fractures, craniofacial bone fractures, and posttraumatic soft tissue changes were recorded. RESULTS OF was observed in 47 (5.3%) of the patients admitted for MFT. In cases with OFs, accompanying nasal (25.5%), ethmoid (2.1%), frontal (19.1%), maxillary (38%), and zygomatic bone fracture (10.6%), sphenoid (4.3%), and soft tissue damage (55.3%) were observed. It was observed that the pathologies mentioned at these levels were significantly higher than in patients without orbital involvement (p < 0.05). In our study, mild (48.9%) and moderate-severe (2.12-4.25%) OCs accompanying OFs were observed after MFT. CONCLUSIONS The frequency of MFT varies depending on various factors, and such studies are needed to take preventive measures. Knowing the risk and frequency of orbital damage accompanying MFTs may help reduce complications by allowing rapid and accurate diagnosis.
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Affiliation(s)
- Fatma Dilek Gokharman
- Department of Radiology, SBU Ankara Education and Research Hospital, Ankara 06660, Turkey; (A.G.Y.); (P.K.)
| | - Ozlem Kadirhan
- Department of Radiology, Erzincan University, Erzincan 24100, Turkey; (O.K.); (S.A.)
| | - Ozlem Celik Aydin
- Department of Pharmacology, Erzincan University, Erzincan 24100, Turkey;
| | - Arzu Gulsah Yalcin
- Department of Radiology, SBU Ankara Education and Research Hospital, Ankara 06660, Turkey; (A.G.Y.); (P.K.)
| | - Pınar Kosar
- Department of Radiology, SBU Ankara Education and Research Hospital, Ankara 06660, Turkey; (A.G.Y.); (P.K.)
| | - Sonay Aydin
- Department of Radiology, Erzincan University, Erzincan 24100, Turkey; (O.K.); (S.A.)
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Eng JF, Younes S, Crovetti BR, Williams KJ, Haskins AD, Hernandez DJ, Yen MT, Olson KL, Allen RC, Sivam SK. Characteristics of Orbital Injuries Associated with Maxillofacial Trauma. Laryngoscope 2022. [DOI: 10.1002/lary.30477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Affiliation(s)
- James F. Eng
- Department of Otolaryngology—Head and Neck Surgery Baylor College of Medicine Houston Texas USA
| | - Sami Younes
- School of Medicine Baylor College of Medicine Houston Texas USA
| | | | - Katherine J. Williams
- Department of Ophthalmology Cullen Eye Institute, Baylor College of Medicine Houston Texas USA
| | - Angela D. Haskins
- Department of Otolaryngology—Head and Neck Surgery Baylor College of Medicine Houston Texas USA
| | - David J. Hernandez
- Department of Otolaryngology—Head and Neck Surgery Baylor College of Medicine Houston Texas USA
| | - Michael T. Yen
- Department of Ophthalmology Cullen Eye Institute, Baylor College of Medicine Houston Texas USA
| | - Krista L. Olson
- Department of Otolaryngology—Head and Neck Surgery Baylor College of Medicine Houston Texas USA
| | - Richard C. Allen
- Department of Ophthalmology Cullen Eye Institute, Baylor College of Medicine Houston Texas USA
| | - Sunthosh K. Sivam
- Department of Otolaryngology—Head and Neck Surgery Baylor College of Medicine Houston Texas USA
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Jain SM, Gehlot N, KV A, Prasad P, Mehta P, Paul TR, Dupare A, CVNS CS, Rahman S. Ophthalmic Complications in Maxillofacial Trauma: A Prospective Study. Cureus 2022; 14:e27608. [PMID: 36059327 PMCID: PMC9433813 DOI: 10.7759/cureus.27608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives: To determine the incidence and types of ophthalmic complications associated with maxillofacial trauma over a period of 24 months. Methods: An institutional prospective study was conducted on 62 patients presenting with maxillofacial trauma to study the correlation between facial trauma and ophthalmic complications. Results: Road traffic accidents were reported to be the primary etiologic factor for most trauma cases studied. Zygomaticomaxillary complex (ZMC) fracture was associated with more ophthalmic complications while fractures involving the orbital rims and walls were associated with severe complications. Conclusions: Maxillofacial trauma, particularly those associated with midface, including ZMC fracture, Le Fort II, Le Fort III, and naso-orbito-ethmoidal fractures, can commonly cause ophthalmic complications and blindness in rare cases. Hence, every patient with maxillofacial trauma should undergo an ophthalmic examination and should be placed under close observation for necessary treatment when required.
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Xu G, Zhang X, Wang P, Long J. Application of optimized three-dimensional digital surgical guide plates for complex midfacial fractures. Injury 2022; 53:2005-2015. [PMID: 35321792 DOI: 10.1016/j.injury.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 02/21/2022] [Accepted: 03/05/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The treatment of midfacial fractures is always difficult. The purpose of this study was to verify whether optimized three-dimensional (3D) digital surgical guide plates combined with preformed titanium plates improved the treatment effect in complex midfacial fractures. PATIENTS AND METHODS Twenty-six patients with complex midfacial fractures were recruited and randomized into three groups: ten for Group A, eight for Group B, and eight for Group C. Group A was treated with a combination of preformed titanium plates and optimized 3D digital surgical guide plates. Group B was treated with preformed titanium plates only. Group C was treated conventionally. Clinical effects, patient-reported outcome measures (PROMs), midfacial contour, facial symmetry, surgical accuracy, △orbital volume (the absolute value of the bilateral orbital volume difference), and maximum deviation were evaluated in each of the three groups. RESULTS Group A had the best postoperative clinical effects and patient-reported outcomes. Significant improvements in midfacial contour (L1[0.72±0.29 mm, P = 0.001], L2[1.04±0.46 mm, P < 0.001]), facial symmetry (S1[0.71±0.30 mm, P < 0.001], S2[0.96±0.58 mm, P < 0.001], S3[0.86±0.40 mm, P < 0.001], S5[0.81±0.16 mm, P = 0.003], S8[0.95±0.30 mm, P < 0.001], S9[1.03±0.38 mm, P < 0.001], S11[0.64±0.46 mm, P < 0.001]) and surgical accuracy (M1[R, 0.82±0.31 mm, P < 0.001], M2[R, 0.87±0.44 mm, P < 0.001], M3[L, 0.88±0.22 mm, P = 0.004], M3[R, 1.06±0.31 mm, P = 0.003], M4[L, 0.96±0.45 mm, P = 0.008], M4[R, 1.11±0.57 mm, P = 0.003], M5[R, 0.76±0.26 mm, P < 0.001], M6[L, 1.00±0.46 mm, P = 0.003], M6[R, 1.00±0.58 mm, P = 0.001], M7[0.87±0.53 mm, P = 0.001], M8[R, 0.91±0.53 mm, P < 0.001], M9[R, 0.81±0.32 mm, P = 0.010], M10[R, 1.19±0.42 mm, P = 0.009], M11[L, 0.85±0.51 mm, P = 0.021], M11[R, 0.96±0.49 mm, P = 0.003]) were found in Group A compared with the other two groups. The results of △orbital volume and maximum deviation analysis showed an ideal surgical treatment effect in Group A. CONCLUSION Optimized 3D digital guide plates can accurately locate preformed titanium plates and effectively improve the treatment effect in complex midfacial fractures.
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Affiliation(s)
- Guikun Xu
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu 610041, China; National Engineering Laboratory for Oral Regenerative Medicine, Chengdu 610041, China
| | - Xiaojie Zhang
- Stomatology Hospital, Zhejiang University School of Medicine, 310000, China
| | - Peihan Wang
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu 610041, China; National Engineering Laboratory for Oral Regenerative Medicine, Chengdu 610041, China
| | - Jie Long
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu 610041, China; Engineering Research Center of Oral Translational Medicine, Ministry of Education, Chengdu 610041, China.
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Fomete B, Adebayo ET, Agbara R, Osunde DO, Abah ER. Pattern of Ocular Involvement in Midface Injuries Seen at a Tertiary Care Hospital in Northern Nigeria. Niger J Surg 2021; 27:33-37. [PMID: 34012239 PMCID: PMC8112374 DOI: 10.4103/njs.njs_21_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/19/2020] [Accepted: 07/23/2020] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of the study was to report the etiology, pattern, and spectrum of ocular injuries in patients with maxillofacial injuries seen at a tertiary care hospital in northern Nigeria. Patients and Methods: This is a retrospective evaluation of the etiology, spectrum, and treatment of ocular injures seen in patients with midfacial fractures, who presented at Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria, a tertiary care hospital in northern Nigeria. Cases were seen at the oral and maxillofacial clinic for those presenting with midfacial fractures, whereas those presenting with ocular injuries due to midfacial injuries were referred from the ophthalmology department. Data were collected on their demographics, etiology of injuries, body part(s) involved, and treatment. Results: A total of 256 patients had midfacial injuries during the period, of which 219 patients had 357 associated ocular injuries. The age range was between 3 and 76 years. There were more males (83.8%) than females (16.2%), giving a male-to-female ratio of 5.2:1; the 21–30 years' age bracket was most frequently affected (38.4%). The predominant etiology of injuries was road traffic accidents (RTAs) (90.1%), followed by assault (4.9%). Zygomatic complex fractures (38.6%) and orbital wall fractures (24.7%) were the common midfacial injuries. There were 357 ocular injuries, giving a patient: injury ratio of 1:1.6, with subconjunctival hemorrhage (32.5%) and ruptured globe (20.0%) being common. Treatments performed were reduction and immobilization of midfacial fractures plus evisceration (32.0%), followed by reduction and immobilization of fractures alone (23.9%) and reduction and immobilization plus grafting of soft tissues (21.2%). Conclusion: Ocular injuries are quite common in patients with midfacial injuries, with a ratio of 1.6:1. RTA was the most common etiology, with zygomatic complex fractures as the most common midfacial injury. Subconjunctival hemorrhage was the most common ocular injury manifestation, with young adults (21–30 years of age) being most affected. Treatment often involved reduction and immobilization of midface fractures with evisceration and grafting of ocular tissues.
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Affiliation(s)
- Benjamin Fomete
- Department of Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Ezekiel Taiwo Adebayo
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Medical Sciences, Ondo, Nigeria
| | - Rowlan Agbara
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Jos, Jos, Nigeria
| | - Daniel Otasowie Osunde
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Calabar, Calabar, Nigeria
| | - Emmanuel R Abah
- Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
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Umarane S, Kale T, Tenagi A, Manavadaria Y, Motimath AS. A Clinical Study of the Evaluation and Assessment of the Etiology and Patterns of Ocular Injuries in Midfacial Trauma in a Tertiary Care Hospital. Cureus 2020; 12:e10216. [PMID: 33042662 PMCID: PMC7537660 DOI: 10.7759/cureus.10216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Aims The aim is to study the pattern of ocular injuries in midfacial trauma and to evaluate the overall incidence of ophthalmic injury of any severity following maxillofacial trauma. Methods and Materials The maxillofacial surgeon conducted routine facial examination of patients with midfacial fractures, which also included a detailed ophthalmologic examination of patients, at the time of initial presentation. These patients were then further evaluated by an ophthalmologist for thorough examination of the eye. Results The total number of recorded midface maxillofacial trauma cases was 181. Out of 181 patients, 161 had ocular injuries. Among 181 cases, 161 (88.95%) cases were due to road traffic accidents, which was the prime etiologic factor. Out of total 181 patients, 172 (95.03%) were males and 9 (4.97%) were females. The maximum number of cases were of zygomaticomaxillary complex fractures (44.75%) followed by nasal bone fractures (21.5%). Periorbital ecchymosis accounted for the maximum number of cases, amounting to 61.88%. Loss of vision or blindness was seen in eight (4.42%) patients. Conclusions The study stresses further on the importance of long-term and continuous data collection and record management of trauma patients, which may help health care providers with necessary information to develop treatment protocols and device measures for the prevention of complications.
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Affiliation(s)
- Shrikar Umarane
- Oral and Maxillofacial Surgery, KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, IND
| | - Tejraj Kale
- Oral and Maxillofacial Surgery, KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, IND
| | - Arvind Tenagi
- Ophthalmology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, IND
| | - Yash Manavadaria
- Oral and Maxillofacial Surgery, KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, IND
| | - Abhishek S Motimath
- Oral and Maxillofacial Surgery, KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, IND
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10
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Blumer M, Rostetter C, Johner JP, Ebner JJ, Wiedemeier D, Rücker M, Gander T. Associated Ophthalmic Injuries in Patients With Fractures of the Midface. Craniomaxillofac Trauma Reconstr 2020; 13:168-173. [PMID: 33456682 DOI: 10.1177/1943387520922056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose Concomitant ophthalmic injuries are common in patients with facial fractures, though frequency varies widely in the literature. Major ophthalmic injuries can have drastic consequences for patients, and permanent visual impairment cannot be prevented in all cases. This study analyzed the frequency and distribution pattern of associated ophthalmic injuries in patients who received operative treatment for fractures of the midface. Material and Methods The clinical information system was searched for patients with midface fractures that were treated operatively between December 2014 and November 2017. Demographic, fracture-related, and ophthalmic data were assessed and statistically analyzed. Results This study included 282 patients. The most common fracture types were zygomaticomaxillary complex fractures and orbital floor fractures. Falls and violence were the most common causes of fractures (43.3% and 24.5%, respectively). Chemosis and subconjunctival bleeding were the most common associated eye injuries. The most prevalent long-term eye injury was diplopia, which was identified in 18.4% of cases preoperatively. Postoperative diplopia persisted in 36 cases (12.8%) at 3-month follow-up. Optic neuropathy, enophthalmos, exophthalmos, and retrobulbar hematomas were identified infrequently. Conclusion Minor ophthalmic injuries, including chemosis and subconjunctival bleeding, are more frequently associated with midface trauma. These minor injuries tend to heal quickly and without sequela. Major ophthalmic injuries, including retinal detachment, optic neuropathy, and retrobulbar hematomas, are identified less frequently. Special attention should be paid to patients with diplopia, as this condition may persist and have long-term occupational consequences. Therefore, close interdisciplinary collaboration is essential when treating patients with fractures of the midface to prevent permanent visual impairment.
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Affiliation(s)
- Michael Blumer
- Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Switzerland
| | - Claudio Rostetter
- Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Switzerland
| | - Jean-Pierre Johner
- Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Switzerland
| | - Julian J Ebner
- Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Switzerland
| | - Daniel Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Switzerland
| | - Martin Rücker
- Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Switzerland
| | - Thomas Gander
- Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Switzerland
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Jørgensen M, Savran MM, Christakopoulos C, Bek T, Grauslund J, Toft PB, Ziemssen F, Konge L, Sørensen TL, Subhi Y. Development and validation of a multiple-choice questionnaire-based theoretical test in direct ophthalmoscopy. Acta Ophthalmol 2019; 97:700-706. [PMID: 30816642 DOI: 10.1111/aos.14065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/02/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Direct ophthalmoscopy can reveal systemic, neurologic and ophthalmic conditions, but is poorly mastered among young physicians. A theoretical test is needed to measure effect of educational interventions. We developed and gathered validity evidence for a multiple-choice questionnaire (MCQ)-based theoretical test in direct ophthalmoscopy. METHODS The MCQ was developed by interviewing experts. Then, validity evidence was evaluated using Messick's validity framework. Content was ensured by inviting the experts to contribute in a Delphi-like process. Response process was ensured by piloting and by streamlining all instructions. Then, the test was taken by ophthalmologists and by medical students without experience in direct ophthalmoscopy. Results were used to evaluate internal structure (item quality analysis and internal consistency), relations to other variables (correlation of test scores to experience level) and consequences (establishment of pass-fail score and the consequences of its use). RESULTS The first phase of the study yielded 100 MCQs. In second phase, we identified that 60 items fulfilled predefined relevance and item quality requirements. These items demonstrated very high internal consistency (Cronbach's alpha = 0.95), significantly discriminated medical students from specialists (p < 0.001, independent samples t-test) and the established pass-fail score of 50 (83%) correct answers resulted in no false positives (students passing) and no false negatives (specialists failing). A Decision study identified that sampling 15 items suffice for certification. CONCLUSION We developed and validated an MCQ-based theoretical test in direct ophthalmoscopy that enables an evidence-based approach to measuring, evaluating and certifying the theoretical knowledge necessary for direct ophthalmoscopy.
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Affiliation(s)
- Morten Jørgensen
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- CAMES – Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Mona Meral Savran
- CAMES – Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Copenhagen Denmark
- Department of Obstetrics and Gynaecology Copenhagen University Hospital Amager and Hvidovre Hvidovre Denmark
| | | | - Toke Bek
- Department of Ophthalmology Aarhus University Hospital Aarhus Denmark
| | - Jakob Grauslund
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Department of Clinical Research Faculty of Healthy Science University of Southern Denmark Odense Denmark
| | - Peter Bjerre Toft
- Department of Ophthalmology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Focke Ziemssen
- Center for Ophthalmology Eberhard‐Karl University Tübingen Tübingen Germany
| | - Lars Konge
- CAMES – Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Torben Lykke Sørensen
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Yousif Subhi
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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12
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Bouaoud J, Olivetto M, Bettoni J, Devauchelle B. Muscle entrapment in orbito-zygomatico-maxillary complex fracture. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:605-607. [PMID: 30826428 DOI: 10.1016/j.jormas.2019.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/11/2019] [Accepted: 02/21/2019] [Indexed: 11/16/2022]
Affiliation(s)
- J Bouaoud
- Department of maxillofacial surgery, university hospital of Amiens, avenue Laennec 80000, Amiens cedex 1, France; Department of maxillo-facial surgery and stomatology, Pitié-Salpétrière Hospital, Pierre et Marie Curie University Paris 6, Sorbonne Paris Cite University, AP-HP, Paris, 75013, France.
| | - M Olivetto
- Department of maxillofacial surgery, university hospital of Amiens, avenue Laennec 80000, Amiens cedex 1, France
| | - J Bettoni
- Department of maxillofacial surgery, university hospital of Amiens, avenue Laennec 80000, Amiens cedex 1, France
| | - B Devauchelle
- Department of maxillofacial surgery, university hospital of Amiens, avenue Laennec 80000, Amiens cedex 1, France
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13
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Johnson NR, Singh NR, Oztel M, Vangaveti VN, Rahmel BB, Ramalingam L. Ophthalmological injuries associated with fractures of the orbitozygomaticomaxillary complex. Br J Oral Maxillofac Surg 2018; 56:221-226. [PMID: 29506872 DOI: 10.1016/j.bjoms.2018.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 02/12/2018] [Indexed: 11/26/2022]
Abstract
Our aim was to evaluate ophthalmological injuries associated with fractures of the orbitozygomaticomaxillary complex that required operative treatment, and we collected data retrospectively over a period of five years (2012-2016 inclusive). Of the 190 patients, 162 were male with a median age of 31 (IQR 25 -39) years. Assault was the most common mechanism of injury (125/190, 66%). Minor ophthalmic injuries (those unlikely to cause permanent visual disturbance) and major ophthalmic injuries (those with the potential to cause permanent visual disturbance) were recorded. The common minor ophthalmic injuries were: diplopia, enophthalmos, proptosis, subconjunctival haemorrhage, and restriction of the extraocular muscles. Commotio retinae, traumatic mydriasis, retro-orbital haemorrhage, and hyphaema were the common major ophthalmic injuries. All 13 different major ophthalmic injuries were recorded in the group who had had orbital fractures reconstructed, which suggested that more intraocular damage can be caused by this type of fracture than by others. Visual acuity was reduced in 26/190 patients with only four having persistent postoperative changes at six weeks. The odds ratio for those patients who had a major ophthalmological injury and were unable to drive was 0.07 (95% CI 0.02 to 0.21, p=0.001), which was highly significant. Ophthalmological assessment is strongly recommended for patients with fractures of the orbitozygomaticomaxillary complex.
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Affiliation(s)
- Nigel R Johnson
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.
| | - Navin R Singh
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Mehmet Oztel
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Venkat N Vangaveti
- James Cook University, College of Medicine and Dentistry, Townsville, Queensland, Australia
| | - Benjamin B Rahmel
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Lakshmi Ramalingam
- Maxillofacial Department, The Townsville Hospital, Townsville, Queensland, Australia
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14
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Pérez-Flores I, Santos-Armentia E, Fernández-Sanromán J, Costas-López A, Fernández-Ferro M. Diplopia secondary to orbital fracture in adults. ACTA ACUST UNITED AC 2017; 93:174-181. [PMID: 28893438 DOI: 10.1016/j.oftal.2017.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the incidence and evolution of diplopia as a complication of orbital fractures in adults. PATIENTS AND METHODS A review was conducted on medical records of all consecutive adults with orbital fracture referred between January 2014 and December 2015. An analysis was made of the incidence of diplopia secondary to fracture in the acute phase and its evolution. A descriptive study was performed on the variables related to patients, fractures, and fracture and diplopia treatment. RESULTS The study included 39patients with a mean age of 48years (17-85). Of all the patients, 17 (43.6%) presented with diplopia in the acute phase. Differences were found between the groups with and without diplopia in relation to muscle entrapment diagnosed by orbital computed tomography, duction limitation, and fracture surgery ≤1week (P=.02, P=.00, P=.04, respectively). Out of the 17patients with diplopia, 12 had a mean follow-up of 18weeks (1-72), and in 10 (83.3%) diplopia was resolved in a mean time of 10weeks (1-72). There were spontaneous resolution in 4 (33.3%) patients, and resolution after fracture surgery in 4 (57%) of the 7 that underwent surgery. In 4cases (33.3%) prisms were prescribed, and 2 (16.6%) required strabismus surgery. CONCLUSIONS Diplopia secondary to orbital fracture in adults is frequent, but it is resolved in most cases spontaneously or after fracture surgery. A few patients will require prisms and/or strabismus surgery.
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Affiliation(s)
- I Pérez-Flores
- Servicio de Oftalmología, Hospital POVISA, Vigo, Pontevedra, España.
| | - E Santos-Armentia
- Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, España
| | | | - A Costas-López
- Servicio de Cirugía Maxilofacial, Hospital POVISA, Vigo, Pontevedra, España
| | - M Fernández-Ferro
- Servicio de Cirugía Maxilofacial, Hospital POVISA, Vigo, Pontevedra, España
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