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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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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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Ophthalmic Complications Associated with Zygomatic Complex Fractures: A Randomised Descriptive Clinical Study. J Maxillofac Oral Surg 2022; 21:386-395. [DOI: 10.1007/s12663-020-01441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022] Open
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Panshak TE, Akhiwu BI, Ramyil AV, Saleh N, Wade P, Ladeinde AL, Mpyet C. Ophthalmic Injuries in Patients with Maxillofacial Trauma Presenting to a Teaching Hospital in North Central Nigeria. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:17-23. [PMID: 36388734 PMCID: PMC9641739 DOI: 10.4103/jwas.jwas_91_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Ophthalmic injuries in patients with maxillofacial trauma are potential causes of a permanent visual loss. These injuries can easily be missed; hence, there is a need for the ophthalmic evaluation of patients with maxillofacial trauma. The main objective of this study was to determine the prevalence, patterns, etiology, and risk factors of ophthalmic injuries in patients presenting with maxillofacial trauma in a teaching hospital in North Central Nigeria. MATERIALS AND METHODS The study was a hospital-based, descriptive, cross-sectional study of 67 patients with maxillofacial trauma recruited over a 6-month study period. Information on the sociodemographic and clinical characteristics of the study participants was obtained. The data were analysed using SPSS version 20 statistical software. Pearson's chi-square test was used to test for statistical significance. RESULTS Ophthalmic involvement was seen in 77.6% of the study participants, with males and individuals aged 21-30 years being more commonly affected. The leading cause of ophthalmic injuries in patients with maxillofacial trauma was road traffic accident (RTA) (75.5%). Others included assaults and fall from heights. Amongst the RTA cases, 71.4% was due to motorcycle-related accident with 91.9% of the patients with ophthalmic injuries observed not to use helmet/seat belt. The use of alcohol and not wearing protective gears were seen as the risk factors. Simple zygomatic complex fracture was the most common trauma observed (44.2%). CONCLUSION Ophthalmologic assessment should be conducted for all patients presenting with maxillofacial trauma. The laws on the use of protective gears such as helmets and seat belts should be enforced.
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Affiliation(s)
| | - Benjamin Idemudia Akhiwu
- Department of Oral and Maxillofacial Surgery, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria,Address for correspondence: Dr. Benjamin Idemudia Akhiwu, Department of Oral and Maxillofacial Surgery, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria. E-mail:
| | - Alice Venyir Ramyil
- Ophthalmology Department, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Naomi Saleh
- Ophthalmology Department, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Patricia Wade
- Ophthalmology Department, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Akinola Ladipo Ladeinde
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Caleb Mpyet
- Ophthalmology Department, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
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Zygomaticomaxillary Fractures. Facial Plast Surg Clin North Am 2021; 30:47-61. [PMID: 34809886 DOI: 10.1016/j.fsc.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fractures of the zygomaticomaxillary complex and zygomatic arch are common athletic injuries. Fracture displacement can lead to midfacial retrusion and widening, causing noticeable deformity. Associated signs and symptoms include hypoesthesia of the infraorbital nerve distribution, trismus, and subjective malocclusion. Operative treatment is indicated in cases of significant displacement or functional disturbance. The approach and details of osteosynthesis are catered to the specific characteristics of the fracture. Technology, such as virtual surgical planning, intraoperative navigation, and intraoperative imaging, has the potential to improve accuracy of treating challenging fractures.
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Aman HM, Alenezi A, Ducic Y, Reddy LV. Secondary Reconstruction of the Zygomaticomaxillary Complex. Semin Plast Surg 2020; 34:254-259. [PMID: 33380910 DOI: 10.1055/s-0040-1721761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zygomaticomaxillary (ZMC) fractures are the second most common facial fractures after nasal bone fractures. The zygoma, with its location and multiple points of articulations, lends itself to both facial structure and esthetics. Secondary ZMC deformities are complications of inadequate primary correction, delayed repair, or lack of repair. Secondary revisions of ZMC aim to correct ZMC displacement and projection and to address orbital discrepancies. Extensive correction involving significant orbital and malar defects requires zygomatic repositioning osteotomies and would greatly benefit from the utilization of virtual surgical planning, intraoperative navigation, and imaging. Minor corrections in malar projection can be corrected by onlay grafting and soft tissue augmentation and resuspension. Isolated or minor orbital corrections can be managed by autogenous or alloplastic material to restore lost orbital volume and anatomy.
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Affiliation(s)
- Hessah M Aman
- Department of Oral and Maxillofacial, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Abdulrahman Alenezi
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Manitoba, Canada
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Likith V Reddy
- Department of Oral and Maxillofacial, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
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Orbital Fractures and Associated Ocular Injuries in Operation Iraqi Freedom and Operation Enduring Freedom Referred to a Tertiary Care Military Hospital and the Effect on Final Visual Acuity. Ophthalmic Plast Reconstr Surg 2020; 36:55-60. [DOI: 10.1097/iop.0000000000001461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Is the pure and impure distinction of orbital fractures clinically relevant with respect to ocular and periocular injuries? A retrospective study of 473 patients. J Craniomaxillofac Surg 2019; 47:1935-1942. [DOI: 10.1016/j.jcms.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/17/2019] [Accepted: 10/13/2019] [Indexed: 11/21/2022] Open
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Fernández-Ferro M, Fernández-Fernández M, Fernández-Sanromán J, Costas-López A, López-Betancourt A. Management of a Penetrating Orbital Trauma from an Unusual Foreign Body with Associated Eye Injury. Ann Maxillofac Surg 2019; 9:214-217. [PMID: 31293958 PMCID: PMC6585210 DOI: 10.4103/ams.ams_25_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The aim of this article is to describe the principles that should guide the management of an orbital trauma with ocular injury through an updated review of the literature and the study of a clinical case involving an 80-year-old woman who presented with a penetrating orbital wound due to a wooden foreign body with a closed ocular trauma. Satisfactory and stable results over time are determined by systematically analyzing and evaluating each aspect of the case following a surgical strategy based on the most current protocols.
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Affiliation(s)
| | | | | | - Alberto Costas-López
- Department of Oral and Maxillofacial Surgery, Povisa Hospital, Vigo, Pontevedra, Spain
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