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Bashir MT, Bouamra O, Kirwan JF, Lecky FE, Bourne RRA. Ocular injuries among patients with major trauma in England and Wales from 2004 to 2021. Eye (Lond) 2024; 38:2761-2767. [PMID: 38789787 PMCID: PMC11427661 DOI: 10.1038/s41433-024-03116-y] [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: 11/19/2023] [Revised: 04/08/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Ocular trauma is a significant cause of blindness and is often missed in polytrauma. No contemporary studies report eye injuries in the setting of severe trauma in the UK. We investigated ocular injury epidemiology and trends among patients suffering major trauma in England and Wales from 2004 to 2021. METHODS We conducted a retrospective study utilising the Trauma Audit and Research Network (TARN) registry. Major trauma cases with concomitant eye injuries were included. Major trauma was defined as Injury Severity Score >15. Ocular injuries included globe, cranial nerve II, III, IV, and VI, and tear duct injuries. Orbital fractures and adnexal and lid injuries were not included. Demographics, injury profiles, and outcomes were extracted. We report descriptive statistics and 3-yearly trends. RESULTS Of 287 267 major trauma cases, 2368 (0.82%) had ocular injuries: prevalence decreased from 1.87% to 0.66% over the 2004-2021 period (P < 0.0001). Males comprised 72.2% of ocular injury cases, median age was 34.5 years. The proportion of ocular injuries from road traffic collisions fell from 43.1% to 25.3% while fall-related injuries increased and predominated (37.6% in 2019/21). Concomitant head injury occurred in 86.6%. The most common site of ocular injury was the conjunctiva (29.3%). Compared to previous TARN data (1989-2004), retinal injuries were threefold more prevalent (5.9% vs 18.5%), while corneal injuries were less (31.0% vs 6.6%). CONCLUSIONS Whilst identifying eye injuries in major trauma is challenging, it appears ocular injury epidemiology in this setting has shifted, though overall prevalence is low. These findings may inform prevention strategies, guideline development and resource allocation.
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Affiliation(s)
| | - Omar Bouamra
- The Trauma Audit & Research Network, University of Manchester, Manchester, UK
| | - James F Kirwan
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
| | - Fiona E Lecky
- The Trauma Audit & Research Network, University of Manchester, Manchester, UK
- Centre for Urgent and Emergency Care Research (CURE), School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rupert R A Bourne
- Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
- Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK
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Bartimote C, Hoskin AK, Fraser CL, Watson S. Globe and adnexal trauma at Australian trauma centres. Injury 2024; 55:110976. [PMID: 37563048 DOI: 10.1016/j.injury.2023.110976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/05/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION In multisystem trauma, the assessment and management of globe and adnexal trauma is often complex. Ophthalmology input may assist managing such patients. To understand the role of ophthalmology in tertiary trauma centres we report on the management of globe and adnexal trauma at two tertiary trauma centres in Sydney, Australia. METHOD A retrospective case series was completed at Royal North Shore Hospital (RNSH) and Royal Prince Alfred Hospital (RPAH) on patients admitted between January 2015 and December 2019. International Classification of Disease, Tenth Revision codes, diagnostic and procedural coding data were used to identify patients admitted with globe and/or adnexal trauma. Data extracted from medical records included demographics, mechanism of injury, ocular examination and specialist ophthalmic referral. RESULTS Over 5-years, 773 patients, average age of 53.2years and 62% male, were admitted to RNSH and RPAH with globe and/or adnexal trauma. Most patients (83%) first presented to RNSH or RPAH. The most common mechanism of injury was falls (45%) followed by burns (13%). Two-hundred and thirty-five patients had multisystem trauma, of these patients, 121 (51%) suffered globe trauma with 49 (21%) classified as severe. Three patients were not diagnosed initially due to delayed ophthalmology referral. CONCLUSION Falls followed by burns were common causes of globe and adnexal trauma in Sydney, Australia. The presence of orbital/mid-facial injury may indicate a patient has globe trauma. In multisystem trauma, globe trauma may be diagnosed late or not identified. Ophthalmology review has an important role in diagnosing and managing globe trauma in multisystem trauma.
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Affiliation(s)
- C Bartimote
- Department of Ophthalmology, The Sydney and Sydney Eye Hospital, Sydney, NSW, Australia; Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales Australia.
| | - A K Hoskin
- Department of Ophthalmology, University of Western Australia, Nedlands, Western Australia, Australia; Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales Australia; Lions Eye Institute, Nedlands, Western Australia, Australia
| | - C L Fraser
- Department of Ophthalmology, The Sydney and Sydney Eye Hospital, Sydney, NSW, Australia; Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales Australia
| | - S Watson
- Department of Ophthalmology, The Sydney and Sydney Eye Hospital, Sydney, NSW, Australia; Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales Australia
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Papadiochos I, Petsinis V, Sarivalasis SE, Strantzias P, Bourazani M, Goutzanis L, Tampouris A. Acute orbital compartment syndrome due to traumatic hemorrhage: 4-year case series and relevant literature review with emphasis on its management. Oral Maxillofac Surg 2023; 27:101-116. [PMID: 35083570 DOI: 10.1007/s10006-021-01036-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Blindness in craniomaxillofacial (CMF) injuries may occur due to acute orbital compartment syndrome (AOCS). Primarily, this article aimed to retrospectively review our 4-year experience in the management of patients diagnosed with AOCS secondary to an orbital hematoma (OH). Furthermore, this paper included up-to-date information regarding the prevalence, diagnosis, management, and prognosis of AOCS. MATERIALS AND METHODS We retrospectively screened the medical records of patients who visited our hospital's emergency department (ED) and were examined by an oromaxillofacial surgeon for CMF injuries, between September 1, 2013, and September 31, 2017. The electronic hospital's database was searched to retrieve all cases of CMF trauma admitted or referred to our clinic during this period. RESULTS Over a 49-month period, 3,514 patients were managed for CMF injuries in ED; 9 cases (0.26%) were attributed to OCS caused by an OH. This group comprised 5 males and 4 females aged between 32 and 91 years old (mean 65.7, median 70). Seven out of 9 patients were subjected to lateral canthotomy and inferior cantholysis (LCIC), whereas septolysis was applied in 6 of them. Sight was preserved in 3 out of 8 patients (37.5%), since a patient died from a serious intracranial injury. Seven out of 9 patients (77.7%) of the OCS group had a history of hypocoagulable state. CONCLUSIONS LCIC, septolysis, and careful dissection within inferotemporal orbital quadrant constitute a reliable approach for emergent orbital decompression. CT scan offers differential diagnosis of acute traumatic proptosis, but it should preferably follow LCIC. In case of OHs without pupillary abnormalities and/or impairment of visual acuity, close monitoring allowing for timely interventions is highly recommended to patients with a history of hypocoagulative status, (uncontrolled or severe) hypertension, head trauma, and decreased level of consciousness or in elderly patients suffering from dementia or without rapid access to follow-up medical care. Clinicians dealing with ED services must maintain high skills in AOCS diagnosis and in LCIC execution.
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Affiliation(s)
- Ioannis Papadiochos
- Attikon" University General Hospital, Chaidari, Medical School of Athens, Athens, Greece.
| | - Vasileios Petsinis
- School of Dentistry, Athens, Greece
- OMFS Clinic of "Evaggelismos" Gereral Hospital, Athens, Greece
| | | | - Paschalis Strantzias
- OMFS Clinic of "Panagiotis and Aglaia Kyriakou" Children's Hospital of Athens, Athens, Greece
| | | | - Lampros Goutzanis
- School of Dentistry, Athens, Greece
- OMFS Clinic of "Panagiotis and Aglaia Kyriakou" Children's Hospital of Athens, Athens, Greece
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Nguyen HH, Vu TT, Bui AM, Dao GV, Tran HTT, Do LN. MOXAIC: A classification of major maxillofacial wounds, concerning 310 cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e569-e575. [PMID: 34958966 DOI: 10.1016/j.jormas.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/16/2021] [Accepted: 10/08/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Although classification for facial fractures have been extensively described in the literature, corresponding systems for major maxillofacial wounds (MMW) are few. We would like to present MOXAIC: a new classification system for MMW. MATERIAL AND METHODS A retrospective study of 310 patients with MMW who underwent emergency operation between January 2005 and December 2016. MMW was defined as a facial wound longer than 10 cm, which includes damage to the craniofacial bone or other important facial structures such as the carotid arteries, facial nerves, parotid gland, Stensen's duct, or the eye. All the patients were followed at least 36 months. RESULT Based on the shape of the wound, the severity, and the mechanism of injury we were able to classify the MMW into five types: O, X, A, I, C. For each wound type we then looked at the treatment required and the outcome, objectively classified as good, satisfactory, or poor, concerning anatomical correction, aesthetics, and function. + Type OCircumferential wound: 81.6% result good. + Type X-Oblique wound: only 48.1% good, despite initial multidisciplinary approach. + Type A-Transverse facial wound: 78.1% good. + Type I-Direct wound: Immediate airway management and hemorrhage control are important. 48.8% good. + Type CCut wound: 88.1% good. The above classification was named MOXAIC which is a mnemonic of 'Maxillofacial' and the five wound types: O, X, A, I, C. CONCLUSION This classification is highly reproducible, easy to use, and allows quick treatment work up and prognosis. However, this classification requires further specialist review and study.
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Affiliation(s)
- Ha H Nguyen
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam.
| | - Truc T Vu
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam
| | - Anh M Bui
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam
| | - Giang V Dao
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam
| | - Huyen T T Tran
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam
| | - Linh N Do
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Viet Nam
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Cho DY, Willborg BE, Lu GN. Management of Traumatic Soft Tissue Injuries of the Face. Semin Plast Surg 2021; 35:229-237. [PMID: 34819804 DOI: 10.1055/s-0041-1735814] [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: 10/20/2022]
Abstract
Facial soft tissue injuries encompass a broad spectrum of presentations and often present significant challenges to the craniofacial surgeon. A thorough and systematic approach to these patients is critical to ensure that the patient is stabilized, other injuries identified, and the full extent of the injuries are assessed. Initial management focuses on wound cleaning with irrigation, hemostasis, and debridement of nonviable tissue. Definitive management is dependent on the region of the face involved with special considerations for critical structures such as the globe, lacrimal apparatus, facial nerve, and parotid duct. Following sound surgical principles, these injuries can be managed to maximize both functional and aesthetic outcomes while minimizing complications.
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Affiliation(s)
- Daniel Y Cho
- Division of Plastic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Brooke E Willborg
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - G Nina Lu
- Department of Otolaryngology-Head and Neck Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
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Bartimote C, Fraser CL, Watson S. Integration of ophthalmology in ocular trauma to improve patient care: A narrative review. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211030793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Ocular trauma can cause significant morbidity and is a leading cause of unilateral blindness. In multi-trauma, life- and sight-threatening injuries can co-occur causing increased complexity in the assessment and management of ocular injuries as the competing priorities in the severely injured must be balanced. We conducted a narrative review to determine how ophthalmology may be further integrated into a trauma service and/or the organisation of an ocular trauma service. Methods The literature was reviewed via EMBASE, MEDLINE, CINAHL and Google Scholar utilising comprehensive search strategies and keyword searches. Our review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results The search yielded 437 articles, 30 studies met selection criteria and were included in the review. The included literature comprised guidelines, observational studies and reviews of registry data from Australia, England, the United States, Singapore, Iran and Israel. Conclusion The Australian Trauma Model has clear guidelines for referral of trauma patients to ensure appropriate care of the severely injured. However, there are no clear guidelines for the integration of ophthalmology into trauma. Therefore, early referral to ophthalmology and streamlining of referral pathways of specialist care would improve the care of patients with ocular trauma.
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Affiliation(s)
- Christopher Bartimote
- Royal North Shore Hospital, Sydney, NSW, Australia
- Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, NSW, Australia
| | - Clare L Fraser
- Sydney Eye Hospital, Sydney, NSW, Australia
- Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, NSW, Australia
| | - Stephanie Watson
- Sydney Eye Hospital, Sydney, NSW, Australia
- Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, NSW, Australia
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Abstract
PURPOSE OF REVIEW Management of midface trauma is complex and challenging and requires a clear understanding of the facial buttress system, subunit anatomy and inter-relationships. Too often clinicians attempt surgical repair without adequate knowledge of the common complications associated with poor reduction and improper sequencing of fracture repair. This review outlines a working approach to the identification and management of such injuries, and the definitive management of common injury patterns. RECENT FINDINGS Midface trauma, with or without life-threatening and sight-threatening complications, may arise following isolated injury, or be associated with significant injuries elsewhere. Assessment needs to be both systematic and repeated, with the establishment of clearly stated priorities in overall care. SUMMARY Accurate and precise relocation of bony subunits and resuspension of soft tissues is vital in achieving acceptable functional and aesthetic outcomes.
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Abstract
Facial trauma varies widely in its severity and is also frequently associated with other injuries which can make prioritisation of injuries difficult. An effective method of triage is important to ensure this. This article describes one such approach and discusses the application of damage control principles to facial injuries. Both these issues commonly impact on the management of multiply injured patients with coexisting facial injuries during the initial stages of resuscitation or soon afterwards. Understanding facial trauma is based in part, on parallels with orthopaedic trauma.
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Affiliation(s)
- Mike Perry
- Consultant oral and maxillofacial surgeon, Northwick Park Hospital, UK
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Chou C, Lou YT, Hanna E, Huang SH, Lee SS, Lai HT, Chang KP, Wang HMD, Chen CW. Diagnostic performance of isolated orbital CT scan for assessment of globe rupture in acute blunt facial trauma. Injury 2016; 47:1035-41. [PMID: 26944178 DOI: 10.1016/j.injury.2016.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/27/2015] [Accepted: 01/16/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We determine the diagnostic performance of emergent orbital computed tomography (CT) scans for assessing globe rupture in patients with blunt facial trauma. METHODS We performed a retrospective cohort study based on prospectively collected trauma registry and acute care surveillance data in a tertiary-care hospital. Patients aged at least 18 years who underwent isolated orbital CT scanning for assessing potential ocular trauma were examined. Analyses were performed to evaluate the magnitude of agreement between diagnosis by CT scanning and ophthalmic assessment, including globe rupture. RESULTS Our study cohort comprised 136 patients, 30% of whom (41 patients) sustained orbital wall fractures. Concordance for orbital CT diagnosis and the ophthalmic assessment of globe rupture was substantial (k=0.708). The relative risk of globe rupture was 0.692 (95% confidence interval (CI): 0.054-8.849) for superior wall fractures, 0.459 (95% CI: 0.152-1.389) for inferior wall fractures, 2.286 (95% CI: 1.062-4.919) for lateral wall fractures, and 0.637 (95% CI: 0.215-1.886) for medial wall fractures. According to multivariate analysis, lateral wall fractures were an independent risk factor for globe ruptures (adjusted odds ratio (OR)=12.01, P=0.011), and medial or inferior wall fracture was a protective factor (adjusted OR=0.14, P=0.012). In the stratified analysis of diagnostic performance of CT scan, specificity was highest among patients with orbital wall fractures (97.2%), followed by negative predictive volume (NPV, 97%), and accuracy (95.1%). CONCLUSION Among patients with blunt facial trauma who underwent isolated orbital CT scanning as part of ocular trauma assessment, the diagnostic performance of CT in detecting globe rupture is more accurate in patients with orbital wall fractures. Nevertheless, isolated orbital CT alone does not have a sufficiently high diagnostic performance to be reliable to rule out all globe ruptures. Lateral orbital wall fractures in blunt facial trauma patients, in particular, should prompt thorough evaluation by an ophthalmologist.
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Affiliation(s)
- Chieh Chou
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Plastic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Yun-Ting Lou
- Department of Ophthalmology, EDA Hospital, I-Shou University, Kaohsiung, Taiwan.
| | - Eissa Hanna
- Department of Ophthalmology, University to Washington, Seattle, WA, USA.
| | - Shu-Hung Huang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Plastic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Su-Shin Lee
- Department of Plastic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Hsin-Ti Lai
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Plastic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Kao-Ping Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Plastic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Hui-Min David Wang
- Department of Fragrance and Cosmetic Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Chao-Wen Chen
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Warburton RE, Brookes CCD, Golden BA, Turvey TA. Orbital apex disorders: a case series. Int J Oral Maxillofac Surg 2015; 45:497-506. [PMID: 26725107 DOI: 10.1016/j.ijom.2015.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/05/2015] [Accepted: 10/16/2015] [Indexed: 12/27/2022]
Abstract
Orbital apex syndrome is an uncommon disorder characterized by ophthalmoplegia, proptosis, ptosis, hypoesthesia of the forehead, and vision loss. It may be classified as part of a group of orbital apex disorders that includes superior orbital fissure syndrome and cavernous sinus syndrome. Superior orbital fissure syndrome presents similarly to orbital apex syndrome without optic nerve impairment. Cavernous sinus syndrome includes hypoesthesia of the cheek and lower eyelid in addition to the signs seen in orbital apex syndrome. While historically described separately, these three disorders share similar causes, diagnostic course, and management strategies. The purpose of this study was to report three cases of orbital apex disorders treated recently and to review the literature related to these conditions. Inflammatory and vascular disorders, neoplasm, infection, and trauma are potential causes of orbital apex disorders. Management is directed at the causative process. The cases described represent a rare but important group of conditions seen by the maxillofacial surgeon. A review of the clinical presentation, etiology, and management of these conditions may prompt timely recognition and treatment.
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Affiliation(s)
- R E Warburton
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C C D Brookes
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - B A Golden
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T A Turvey
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Delpachitra SN, Rahmel BB. Orbital fractures in the emergency department: a review of early assessment and management. Emerg Med J 2015; 33:727-31. [DOI: 10.1136/emermed-2015-205005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/21/2015] [Indexed: 01/13/2023]
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DeAngelis AF, Barrowman RA, Harrod R, Nastri AL. Review article: Maxillofacial emergencies: Maxillofacial trauma. Emerg Med Australas 2014; 26:530-7. [PMID: 25292416 DOI: 10.1111/1742-6723.12308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2014] [Indexed: 11/27/2022]
Abstract
Fractures of the facial skeleton are a common reason for patients to present to EDs and general medical practice in Australia. Trauma to the maxillofacial region can lead to airway obstruction, intracranial injuries, loss of vision or long term cosmetic and functional deficits. This article focuses on the emergency assessment, triage and non-specialist management of traumatic injuries of the orbit and facial skeleton.
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Affiliation(s)
- Adrian F DeAngelis
- Maxillofacial Surgery Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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13
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Maxillofacial trauma in the emergency department: A review. Surgeon 2014; 12:106-14. [DOI: 10.1016/j.surge.2013.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/06/2013] [Accepted: 07/08/2013] [Indexed: 12/16/2022]
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Roccia F, Boffano P, Guglielmi V, Forni P, Cassarino E, Nadalin J, Fea A, Gerbino G. Role of the maxillofacial surgeon in the management of severe ocular injuries after maxillofacial fractures. J Emerg Trauma Shock 2011; 4:188-93. [PMID: 21769204 PMCID: PMC3132357 DOI: 10.4103/0974-2700.82204] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 07/19/2010] [Indexed: 11/16/2022] Open
Abstract
Aim: This study was designed to evaluate the incidence of severe ocular injuries associated to maxillofacial fractures and report their management in the Emergency Department. Patients and Methods: Among the 1779 patients admitted for maxillofacial fractures, those with partial or total loss of vision at the time of emergency consultation were included in the study. Data collected from the patients’ medical records included age, gender, mechanism of injury, location and type of facial fractures, type of ocular injuries and cause of blindness, methods of treatment, and days of hospitalization. Results: Forty patients (2.2%), 32 men and 8 women, ranging from 17 to 85 years of age, presented with severely reduced vision or blindness associated to fractures of the facial middle third with involvement of one or more orbital walls, mainly caused by motor vehicle and work accidents. In 18 patients, severe ocular injuries were determined by direct lesion of the globe, in 14 by direct or indirect traumatic optic neuropathy and in 8 by a retrobulbar hematoma. Direct lesion of the eyeball was treated by prompt repair or enucleation of the globe, though no or little recovery of vision was obtained. Ophthalmologic and/or maxillofacial treatment of the anterior compartment lesions of the eye allowed a partial or total recovery of the vision. A partial or total recovery of the vision was observed in almost all the patients with indirect traumatic optic neuropathy after administration of steroids according to NASCIS II protocol. Likewise, an evident improvement of the vision was obtained by immediate drainage of retrobulbar hematoma. Conclusions: Early diagnosis of the nature of the ophthalmic injury and treatment are important, and involvement of the ophthalmologist is mandatory.
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Affiliation(s)
- Fabio Roccia
- Head & Neck Department, Division of Maxillofacial Surgery, San Giovanni Battista Hospital, Turin, Italy
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15
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Emergency Department Assessment and Management of Facial Trauma From War-Related Injuries. J Craniofac Surg 2010; 21:1002-8. [DOI: 10.1097/scs.0b013e3181e1e7e0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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16
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BE R, RG H. Training Australian military health care personnel in the primary care of maxillofacial wounds from improvised explosive devices. J ROY ARMY MED CORPS 2010. [DOI: 10.1136/jramc-156-02-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Perry M. Maxillofacial trauma--developments, innovations and controversies. Injury 2009; 40:1252-9. [PMID: 19486969 DOI: 10.1016/j.injury.2008.12.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 12/07/2008] [Accepted: 12/17/2008] [Indexed: 02/02/2023]
Abstract
Despite seat belt and alcohol legislation, craniofacial trauma still remains a common health problem and significant workload in many maxillofacial units. Although management has evolved considerably from "wiring teeth together", complex fractures can still result in cosmetic and functional deformity. Today's challenge is to consistently restore patients back to their pre-injury form and function-but this is not always possible. Greater understanding and developments have significantly improved outcomes, although controversy still exists in some areas. This review outlines some of these topics.
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Affiliation(s)
- Michael Perry
- Consultant Oral and Maxillofacial Surgeon, Ulster Hospital, Dundonald, Belfast, Northern Ireland, UK.
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