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Wu KY, Khan S, Liao Z, Marchand M, Tran SD. Biopolymeric Innovations in Ophthalmic Surgery: Enhancing Devices and Drug Delivery Systems. Polymers (Basel) 2024; 16:1717. [PMID: 38932068 PMCID: PMC11207407 DOI: 10.3390/polym16121717] [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: 05/01/2024] [Revised: 05/30/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
The interface between material science and ophthalmic medicine is witnessing significant advances with the introduction of biopolymers in medical device fabrication. This review discusses the impact of biopolymers on the development of ophthalmic devices, such as intraocular lenses, stents, and various prosthetics. Biopolymers are emerging as superior alternatives due to their biocompatibility, mechanical robustness, and biodegradability, presenting an advance over traditional materials with respect to patient comfort and environmental considerations. We explore the spectrum of biopolymers used in ophthalmic devices and evaluate their physical properties, compatibility with biological tissues, and clinical performances. Specific applications in oculoplastic and orbital surgeries, hydrogel applications in ocular therapeutics, and polymeric drug delivery systems for a range of ophthalmic conditions were reviewed. We also anticipate future directions and identify challenges in the field, advocating for a collaborative approach between material science and ophthalmic practice to foster innovative, patient-focused treatments. This synthesis aims to reinforce the potential of biopolymers to improve ophthalmic device technology and enhance clinical outcomes.
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Affiliation(s)
- Kevin Y. Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrook, QC J1G 2E8, Canada; (K.Y.W.); (M.M.)
| | - Sameer Khan
- Department of Biology, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Zhuoying Liao
- Department of Biology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Michael Marchand
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrook, QC J1G 2E8, Canada; (K.Y.W.); (M.M.)
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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Hassan B, Hricz N, Er S, Yoon J, Resnick E, Liang F, Yang R, Manson PN, Grant MP. Development and validation of a risk calculator for postoperative diplopia following orbital fracture repair in adults. Sci Rep 2024; 14:3654. [PMID: 38351033 PMCID: PMC10864303 DOI: 10.1038/s41598-024-54121-w] [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: 10/12/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
Postoperative diplopia is the most common complication following orbital fracture repair (OFR). Existing evidence on its risk factors is based on single-institution studies and small sample sizes. Our study is the first multi-center study to develop and validate a risk calculator for the prediction of postoperative diplopia following OFR. We reviewed trauma patients who underwent OFR at two high-volume trauma centers (2015-2019). Excluded were patients < 18 years old and those with postoperative follow-up < 2 weeks. Our primary outcome was incidence/persistence of postoperative diplopia at ≥ 2 weeks. A risk model for the prediction of postoperative diplopia was derived using a development dataset (70% of population) and validated using a validation dataset (remaining 30%). The C-statistic and Hosmer-Lemeshow tests were used to assess the risk model accuracy. A total of n = 254 adults were analyzed. The factors that predicted postoperative diplopia were: age at injury, preoperative enophthalmos, fracture size/displacement, surgical timing, globe/soft tissue repair, and medial wall involvement. Our predictive model had excellent discrimination (C-statistic = 80.4%), calibration (P = 0.2), and validation (C-statistic = 80%). Our model rules out postoperative diplopia with a 100% sensitivity and negative predictive value (NPV) for a probability < 8.9%. Our predictive model rules out postoperative diplopia with an 87.9% sensitivity and a 95.8% NPV for a probability < 13.4%. We designed the first validated risk calculator that can be used as a powerful screening tool to rule out postoperative diplopia following OFR in adults.
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Affiliation(s)
- Bashar Hassan
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nicholas Hricz
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Seray Er
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joshua Yoon
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Eric Resnick
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fan Liang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Paul N Manson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael P Grant
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 S Paca Street, Suite 4-S-124, Baltimore, MD, 21201, USA.
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Wu KY, Fujioka JK, Daigle P, Tran SD. The Use of Functional Biomaterials in Aesthetic and Functional Restoration in Orbital Surgery. J Funct Biomater 2024; 15:33. [PMID: 38391886 PMCID: PMC10889948 DOI: 10.3390/jfb15020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
The integration of functional biomaterials in oculoplastic and orbital surgery is a pivotal area where material science and clinical practice converge. This review, encompassing primary research from 2015 to 2023, delves into the use of biomaterials in two key areas: the reconstruction of orbital floor fractures and the development of implants and prostheses for anophthalmic sockets post-eye removal. The discussion begins with an analysis of orbital floor injuries, including their pathophysiology and treatment modalities. It is noted that titanium mesh remains the gold standard for orbital floor repair due to its effectiveness. The review then examines the array of materials used for orbital implants and prostheses, highlighting the dependence on surgeon preference and experience, as there are currently no definitive guidelines. While recent innovations in biomaterials show promise, the review underscores the need for more clinical data before these new materials can be widely adopted in clinical settings. The review advocates for an interdisciplinary approach in orbital surgery, emphasizing patient-centered care and the potential of biomaterials to significantly enhance patient outcomes.
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Affiliation(s)
- Kevin Y Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrook, QC J1G 2E8, Canada
| | - Jamie K Fujioka
- Faculty of Medicine, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Patrick Daigle
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrook, QC J1G 2E8, Canada
| | - Simon D Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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Hassan B, Liang F, Grant MP. Pediatric Orbital Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:585-596. [PMID: 37302946 DOI: 10.1016/j.coms.2023.05.002] [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: 06/13/2023]
Abstract
The unique anatomy and physiology of the growing craniofacial skeleton predispose children to different fracture patterns as compared to adults. Diagnosis and treatment of pediatric orbital fractures can be challenging. A thorough history and physical examination are essential for the diagnosis of pediatric orbital fractures. Physicians should be aware of symptoms and signs suggestive of trapdoor fractures with soft tissue entrapment including symptomatic diplopia with positive forced ductions, restricted ocular motility (regardless of conjunctival abnormalities), nausea/vomiting, bradycardia, vertical orbital dystopia, enophthalmos, and hypoglobus. Equivocal radiologic evidence of soft tissue entrapment should not withhold surgery. A multidisciplinary approach is recommended for the accurate diagnosis and proper management of pediatric orbital fractures.
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Affiliation(s)
- Bashar Hassan
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 South Paca Street, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, USA
| | - Fan Liang
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 South Paca Street, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, USA
| | - Michael P Grant
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 South Paca Street, Baltimore, MD, USA.
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Hardisty M, Wei YT, Hontscharuk R, Ibrahimi A, Antonyshyn O, Edwards G, Mainprize JG, Whyne CM. Accuracy of Orbital Shape Reconstruction-Comparative Analysis of Errors in Implant Shape Versus Implant Positioning: A Cadaveric Study. J Craniofac Surg 2023; 34:1727-1731. [PMID: 37552131 DOI: 10.1097/scs.0000000000009566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 05/24/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Orbital blowout fractures are commonly reconstructed with implants shaped to repair orbital cavity defects, restore ocular position and projection, and correct diplopia. Orbital implant shaping has traditionally been performed manually by surgeons, with more recent use of computer-assisted design (CAD). Accuracy of implant placement is also key to reconstruction. This study compares the placement accuracy of orbital implants, testing the hypothesis that CAD-shaped implants indexed to patient anatomy will better restore orbit geometry compared with manually shaped implants and manually placed implants. METHODS The placement accuracy of orbital implants was assessed within a cadaveric blowout fracture model (3 skulls, 6 orbits) via 3-dimensional CT analysis. Defects were repaired with 4 different techniques: manually placed-manually shaped composite (titanium-reinforced porous polyethylene), manually placed CAD composite, indexed placed CAD composite, and indexed placed CAD titanium mesh. RESULTS Implant placement accuracy differed significantly with the implant preparation method ( P =0.01). Indexing significantly improved the placement accuracy ( P =0.002). Indexed placed titanium mesh CAD implants (1.42±0.33 mm) were positioned significantly closer to the intact surface versus manually placed-manually shaped composite implants (2.12±0.39 mm). DISCUSSION Computer-assisted design implants indexed to patient geometry yielded average errors below the acceptable threshold (2 mm) for enophthalmos and diplopia. This study highlights the importance of adequately indexing CAD-designed implants to patient geometry to ensure accurate orbital reconstructions.
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Affiliation(s)
- Michael Hardisty
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute
- Physical Sciences, Sunnybrook Research Institute
- Department of Surgery
| | - Yuan Tao Wei
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute
- Biomedical Engineering, University of Toronto
| | | | - Amani Ibrahimi
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute
| | - Oleh Antonyshyn
- Department of Surgery
- Division of Plastic Surgery, Sunnybrook Health Sciences Centre
- Calavera Surgical Design, Toronto, Ontario, Canada
| | | | - James G Mainprize
- Physical Sciences, Sunnybrook Research Institute
- Calavera Surgical Design, Toronto, Ontario, Canada
| | - Cari M Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute
- Physical Sciences, Sunnybrook Research Institute
- Department of Surgery
- Biomedical Engineering, University of Toronto
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Ageing increases risk of lower eyelid malposition after primary orbital fracture reconstruction. Br J Oral Maxillofac Surg 2022; 60:1391-1396. [PMID: 36244868 DOI: 10.1016/j.bjoms.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/21/2022] [Accepted: 08/17/2022] [Indexed: 12/31/2022]
Abstract
Lower eyelid malposition (LEM) is a common sequela after orbital fracture reconstruction. This study aimed to analyse the development of LEM, specifically ectropion and entropion, following primary orbital fracture reconstruction, to identify predictive factors for LEM, and to assess the effect of the eyelid complication on patients' daily lives. The retrospective cohort comprised patients who had undergone orbital floor and/or medial wall fracture reconstruction for recent trauma. Demographics, fracture type and site, surgery and implant-related variables, follow-up time and number of visits, type and severity of LEM, subsequent surgical correction, and patient satisfaction, were analysed. The overall occurrence of LEM was 8%, with ectropion in 6% and entropion in 2% of patients. Older age, complex fractures, transcutaneous approaches, preoperative traumatic lower lid wounds, and implant material were associated with the development of LEM. Of all patients, 3% needed surgical correction of LEM. Six of the 13 patients (46%) who developed LEM required surgical correction. The transconjunctival approach and patient-specific implants should be preferred, especially in elderly patients and those with more complex fractures. LEM often requires subsequent surgical correction, and the treatment period is substantially prolonged, with multiple extra visits to the clinic.
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Maher DI, Hall AJ, Gwini S, Ben Artsi E. Patient-specific Implants for Orbital Fractures: A Systematic Review. Ophthalmic Plast Reconstr Surg 2022; 38:417-424. [PMID: 34750315 DOI: 10.1097/iop.0000000000002089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Orbital fractures are common facial fractures that can be challenging to repair and require careful attention to avoid unacceptable ophthalmic complications. Customized implants that are unique to an individual patient, or patient-specific implants (PSIs), have been increasingly used to repair orbital wall fractures. This systematic review summarizes the current evidence regarding custom-made orbital wall implants. METHODS A keyword search of published literature from January 2010 to September 2021 was performed using Ovid MEDLINE, PubMed, and the Cochrane Library databases. Original articles that included more than 3 human subjects with an orbital fracture repaired with a PSI were included. The search results were reviewed, duplicates were removed and relevant articles were included for analysis. RESULTS Fifteen articles meeting the inclusion criteria. The articles were categorized into 3 separate groups based on the method of PSI fabrication: manual molding of a PSI on a 3D-printed orbital model (53%), directly from a 3D printer (27%), or via a template fabricated from a 3D printer (20%). Three primary postoperative outcomes were assessed: rates of diplopia, enophthalmos, and orbital volume. Postoperative rates of diplopia and enophthalmos improved regardless of the PSI technique, and postoperative orbital volumes were reduced compared with their preoperative state. When PSIs were compared to conventional implants, patient outcomes were comparable. CONCLUSIONS This review of existing PSI orbital implant literature highlights that while PSI can accurately and safely repair orbital fractures, patient outcomes are largely comparable to orbital fractures repaired by conventional methods, and PSI do not offer a definitive benefit over conventional implants.
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Affiliation(s)
- Dominic I Maher
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anthony J Hall
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - StellaMay Gwini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elad Ben Artsi
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
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Canzi G, Corradi F, Novelli G, Bozzetti A, Sozzi D. "6 Anatomical Landmarks" Technique for Satisfactory Free-Hand Orbital Reconstruction With Standard Preformed Titanium Mesh. Craniomaxillofac Trauma Reconstr 2022; 15:51-57. [PMID: 35265278 PMCID: PMC8899354 DOI: 10.1177/19433875211007614] [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: 11/15/2022] Open
Abstract
Study Design Retrospective study. Objective Resolution of clinical signs and symptoms following orbital fractures depends on the accurate restoration of the orbital volume. Computer-Assisted procedures and Patient Specific Implants represent modern solutions, but they require additional resources. A more reproducible option is the use of standard preformed titanium meshes, widely available and cheaper; with their use quality of results is proportional to the accuracy with which they are positioned. This work identifies 6 reproducible and constant anatomical landmarks, as an intraoperative guide for the precise positioning of titanium preformed meshes. Methods 90 patients treated at the Maxillofacial Surgery Department, Niguarda Trauma Center, Milan, for unilateral orbital reconstruction (January 2012 to December 2018), were studied. In all cases reconstruction was performed respecting the 6 proposed anatomical landmarks. The outcomes analyzed are: post-operative CT adherence to the 6 anatomical markers and symmetry achieved respect to controlateral orbit; number/year of re-interventions and duration of surgery; resolution of clinical defects (at least 12-months follow-up); incidence of complications. Results Satisfactory results were obtained in terms of restoration of orbital size, shape and volume. Clinical defects early recovered with a low incidence of complications and re-interventions. Operating times and radiological accuracy have shown a progressive improvement during years of application of this technique. Conclusions The proposed "6 anatomical landmarks" is an easy free-hand technique that allows everyone to obtain high levels of reconstructive accuracy and it should be a skill of all surgeons who deal with orbital reconstruction in daily clinical activity.
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Affiliation(s)
- Gabriele Canzi
- Maxillofacial Surgery Unit, Emergency Department, ASST-GOM Niguarda, Niguarda Hospital, Milan, Italy,Gabriele Canzi, MD, Maxillofacial Surgery Unit, Emergency Department, ASST-GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
| | - Federica Corradi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giorgio Novelli
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Alberto Bozzetti
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Davide Sozzi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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Wraparound nylon foil implant for isolated orbital floor fractures. Am J Otolaryngol 2022; 43:103229. [PMID: 34537506 DOI: 10.1016/j.amjoto.2021.103229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE There are a variety of implant materials available for orbital floor fracture repair. Implant selection is guided by surgeon experience, availability, and patient specific needs. The purpose of this study is to describe a "wraparound" technique for nylon foil implant placement for large, isolated floor fractures that provides excellent results with low incidence of enophthalmos or other complications. MATERIALS AND METHODS A retrospective chart review from 2012 to 2020 was conducted in patients who underwent isolated orbital floor fracture repair with the use of the "wraparound" nylon foil implant. The surgical technique is described. Preoperative CT scans were assessed, and the patients were divided into groups based on the size of the floor fracture. Postoperative data was collected including Hertel measurements and complications related to the implant. RESULTS There were eighty patients who underwent orbital floor fracture repair with the described technique and had adequate follow-up. There were 18 (22.5%) small-sized fractures, 32 (40%) medium-sized fractures, and 30 (37.5%) large-sized fractures in the study group. One patient (3.33%) in the large fracture group had clinically significant enophthalmos of 2 mm postoperatively. There were no other patients with clinically significant enophthalmos. There were no instances of any complications related to the implant, and no patients required implant removal. CONCLUSIONS The "wraparound" technique for a nylon foil implant provides excellent results for isolated orbital floor fractures. It provides more support and stability than traditional nylon implants for larger fractures and has minimal complication rates.
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Ngo HX, Bai Y, Sha J, Ishizuka S, Toda E, Osako R, Kato A, Morioka R, Ramanathan M, Tatsumi H, Okui T, Kanno T. A Narrative Review of u-HA/PLLA, a Bioactive Resorbable Reconstruction Material: Applications in Oral and Maxillofacial Surgery. MATERIALS 2021; 15:ma15010150. [PMID: 35009297 PMCID: PMC8746248 DOI: 10.3390/ma15010150] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/13/2022]
Abstract
The advent of bioresorbable materials to overcome limitations and replace traditional bone-reconstruction titanium-plate systems for bone fixation, thus achieving greater efficiency and safety in medical and dental applications, has ushered in a new era in biomaterial development. Because of its bioactive osteoconductive ability and biocompatibility, the forged composite of uncalcined/unsintered hydroxyapatite and poly L-lactic acid (u-HA/PLLA) has attracted considerable interest from researchers in bone tissue engineering, as well as from clinicians, particularly for applications in maxillofacial reconstructive surgery. Thus, various in vitro studies, in vivo studies, and clinical trials have been conducted to investigate the feasibility and weaknesses of this biomaterial in oral and maxillofacial surgery. Various technical improvements have been proposed to optimize its advantages and limit its disadvantages. This narrative review presents an up-to-date, comprehensive review of u-HA/PLLA, a bioactive osteoconductive and bioresorbable bone-reconstruction and -fixation material, in the context of oral and maxillofacial surgery, notably maxillofacial trauma, orthognathic surgery, and maxillofacial reconstruction. It simultaneously introduces new trends in the development of bioresorbable materials that could used in this field. Various studies have shown the superiority of u-HA/PLLA, a third-generation bioresorbable biomaterial with high mechanical strength, biocompatibility, and bioactive osteoconductivity, compared to other bioresorbable materials. Future developments may focus on controlling its bioactivity and biodegradation rate and enhancing its mechanical strength.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Takahiro Kanno
- Correspondence: ; Tel.: +81-(0)853-20-2301; Fax: +81-(0)853-20-2299
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Blessing NW, Rong AJ, Tse BC, Erickson BP, Lee BW, Johnson TE. Orbital Bony Reconstruction With Presized and Precontoured Porous Polyethylene-Titanium Implants. Ophthalmic Plast Reconstr Surg 2021; 37:284-289. [PMID: 32976336 PMCID: PMC7982351 DOI: 10.1097/iop.0000000000001829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Complex bony orbital defects are reconstructively challenging due to loss of intraoperative anatomical landmarks and adjacent support. Presized and precontoured porous polyethylene-titanium implants (Medpor Titan 3D Orbital Floor Implant) are designed to reestablish normal orbital floor and medial wall anatomy and are modeled after anatomically averaged orbits. This is the first study to report clinical outcomes with this implant. METHODS This retrospective case series reviewed clinical data and outcomes for patients undergoing orbital reconstruction with a presized and precontoured porous polyethylene-titanium orbital implant from January 2016 to June 2018. RESULTS A total of 34 orbits of 33 patients were identified (mean age: 43 ± 16 years, 70% men). Most bony defects were a result of trauma and included large orbital floor deformities (100%), medial wall defects (74%), disrupted inferomedial struts (68%), and broken posterior ledges (82%). Symptomatic diplopia (73%) and enophthalmos (89%, mean: 3.7 ± 2.1 mm) were common preoperatively. Many cases were revisions (44%). Mean follow up was 7.8 ± 6.7 months. All patients had improved globe positioning, enophthalmos, and hypoglobus. Seven patients had persistent postoperative diplopia: 6 responded to prism therapy and 1 required strabismus surgery. One patient required retrobulbar hematoma drainage and 1 patient required implant explantation due to chronic infection. CONCLUSIONS Commercially available presized and precon toured porous polyethylene-titanium implants are useful for complex orbital bony defects and can achieve functional improve ments in diplopia, enophthalmos, and extraocular motility with a low incidence of postoperative complications or revisional surgery.
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Affiliation(s)
- Nathan W. Blessing
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
- Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Andrew J. Rong
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Brian C. Tse
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Benjamin P. Erickson
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
- Byers Eye Institute, Stanford University School of Medicine, Stanford, California
| | - Bradford W. Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas E. Johnson
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Low-Cost, Three-Dimensionally-Printed, Anatomical Models for Optimization of Orbital Wall Reconstruction. Plast Reconstr Surg 2021; 147:162-166. [PMID: 33370061 DOI: 10.1097/prs.0000000000007495] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Orbital blowout fracture reconstruction often requires an implant, which must be shaped at the time of surgical intervention. This process is time-consuming and requires multiple placement trials, possibly risking complications. Three-dimensional printing technology has enabled health care facilities to generate custom anatomical models to which implants can be molded to precisely match orbital anatomy. The authors present their early experience with these models and their use in optimizing orbital fracture fixation. METHODS Maxillofacial computed tomographic scans from patients with orbital floor or wall fractures were prospectively obtained and digitally reconstructed. Both injured-side and mirrored unaffected-side models were produced in-house by stereolithography printing technique. Models were used as templates for molding titanium reconstruction plates, and plates were implanted to reconstruct the patients' orbital walls. RESULTS Nine patients (mean age, 15.5 years) were included. Enophthalmos was present in seven patients preoperatively and resolved in six patients with surgery. All patients had excellent conformation of the implant to the fracture site on postoperative computed tomographic scan. Postoperative fracture-side orbital volumes were significantly less than preoperative, and not significantly different from unfractured-side orbital volumes. Total model preparation time was approximately 10 hours. Materials cost was at most $21. Plate bending time was approximately 60 seconds. CONCLUSIONS Patient-specific orbital models can speed the shaping of orbital reconstruction implants and potentially improve surgical correction of orbital fractures. Production of these models with consumer-grade technology confers the same advantages as commercial production at a fraction of the cost and time. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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13
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Park JH, Kim I, Son JH. Incidence and management of retrobulbar hemorrhage after blowout fracture repair. BMC Ophthalmol 2021; 21:186. [PMID: 33888073 PMCID: PMC8063338 DOI: 10.1186/s12886-021-01943-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retrobulbar hemorrhage (RBH) is a rare complication after orbital surgery but associated with ocular complications including blindness. The aim of this study was to identify clinical characteristics of patients with RBH requiring emergent orbital decompression after blowout fracture repair. METHOD A retrospective review of 426 blowout fracture patients at a tertiary oculoplastic clinic provided data regarding demographics, physical examination findings, and computed tomography (CT) images. Extraocular motility had been recorded in patient charts on a scale from 0 to - 4. Patients requiring emergent orbital decompression due to RBH after surgery (RBH group) were compared with those who did not (Control group), using the Mann-Whitney U-test. Incidences of RBH according to primary or secondary surgery were also investigated, using Fisher's exact test. RESULT Five (1.2%) of the 426 patients who underwent blowout fracture repair developed RBH requiring emergent intervention. All RBH patients fully recovered after the decompression procedure or conservative treatment. Number of days to surgery was significantly longer in the RBH group (97.0 ± 80.1) than in the Control group (29.0 ± 253.0) (p = 0.05). Preoperative enophthalmos was also significantly greater in the RBH group (RBH vs. Control group, 3.6 ± 1.7 mm versus 1.2 ± 1.3 mm (p = 0.003)). The incidence of RBH was significantly higher in patients that underwent secondary surgery (odds ratio = 92.9 [95% confidence interval, 11.16-773.23], p = 0.001). CONCLUSIONS Surgeons should pay more attention to hemostasis and postoperative care in patients with a large preoperative enophthalmic eye, when time from injury to surgery is long and in revision cases. When RBH occurs, time to intervention and surgical decompression is critical for visual recovery and preventing blindness. TRIAL REGISTRATION The institutional review board of the Yeungnam University Medical Center approved this study ( YUMC 2018-11-010 ), which was conducted in accord with the Declaration of Helsinki.
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Affiliation(s)
- Jae Hwi Park
- Department of Oculoplasty, Nune Eye Hospital, Daegu, South Korea
| | - Inhye Kim
- Department of Ophthalmology, Yeungnam University Medical Center, 317-1, Daemyung dong, Nam-Gu, Daegu, 705-035, South Korea
| | - Jun Hyuk Son
- Department of Ophthalmology, Yeungnam University Medical Center, 317-1, Daemyung dong, Nam-Gu, Daegu, 705-035, South Korea.
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Suller AL, Parikh RN, Zhao J, Mahoney NR, Campbell AA, Siadati S, Eberhart CG, Fu R. Chocolate Cysts Associated With Porous Polyethylene Orbital Implants. Ophthalmic Plast Reconstr Surg 2021; 37:e75-e80. [PMID: 32826826 DOI: 10.1097/iop.0000000000001797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Late-onset orbital hemorrhage is a rare complication of alloplastic implant use in orbital wall reconstruction following trauma. The authors report 3 patients with chocolate cysts presenting 3 to 9 years after orbital fracture repair with porous polyethylene implants. All patients were managed by implant removal and evacuation of cyst contents. Complete excision of the cyst was performed in 1 patient, while partial excision of the capsule was performed in 2 patients. Improvement of symptoms associated with the mass effects of the cyst was noted after surgical intervention. The authors also report the first case of orbital volume expansion from a chocolate cyst associated with a nonbarriered porous polyethylene implant. Delayed hemorrhage with capsule formation, although extremely rare, is a possible complication following orbital fracture repair with porous polyethylene implants.
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Affiliation(s)
- Armida L Suller
- Department of Ophthalmology and Visual Sciences, University of the Philippines Manila - College of Medicine and Philippine General Hospital, Manila, Philippines
| | - Rupin N Parikh
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Jiawei Zhao
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Nicholas R Mahoney
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Ashley A Campbell
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Sepideh Siadati
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Charles G Eberhart
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Roxana Fu
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A
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Utilizing 3D-Printed Orbital Floor Stamps to Create Patient-Specific Implants for Orbital Floor Reconstruction. Ophthalmic Plast Reconstr Surg 2021; 37:81-85. [PMID: 32433352 DOI: 10.1097/iop.0000000000001734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study seeks to test a novel technique of custom-printed midface contour models with orbital floor "stamps" to guide reconstruction of orbital floor blowout fractures, with or without concomitant zygomaticomaxillary complex injury. METHODS A series of 4 consecutive patients with orbital floor blowout fractures (including 3 with zygomatic maxillary complex fractures) were retrospectively examined for outcomes associated with orbital floor reconstruction using 3-dimensional-printed stamps and midface models. Data collected included demographics, pre- and postoperative visual globe malposition, motility, and visual field disturbances. Three-dimensional printing methodology is reported, as well as associated costs and time required to generate the models and stamps. RESULTS The cost of producing a midface-contour model and orbital floor stamps was $131, inclusive of labor and materials. Cases averaged 170 minutes to segment, design, and print. Patients with preoperative diplopia and motility restrictions had resolution of their symptoms. Two patients had resolution of their enophthalmos, while one patient with a concomitant zygomaticomaxillary fracture had persistent mild enophthalmos. CONCLUSIONS Midface contour models and orbital floor stamps may be produced in a timely and cost-effective manner. Use of these "homemade" stamps allows for patient-specific custom-contoured orbital floor reconstruction. Further studies are warranted to examine long-term visual and esthetic outcomes for these patients.
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Schreurs R, Dubois L, Klop C, Beenen LFM, Habets PEMH, Maal TJJ, Becking AG. Surgical instrument to improve implant positioning in orbital reconstruction: a feasibility study. Br J Oral Maxillofac Surg 2021; 59:826-830. [PMID: 34256960 DOI: 10.1016/j.bjoms.2021.02.023] [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: 06/10/2020] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
Adequate positioning of an orbital implant during orbital reconstruction surgery is essential for restoration of the pre-traumatised anatomy, but visual appraisal of its position is limited by the keyhole access and protruding soft tissues. A positioning instrument that attaches to the implant was designed to provide feedback outside the orbit. The goal of this study was to evaluate the accuracy of placement with the instrument and compare it with the accuracy of placement by visual appraisal. Ten orbits in five human cadaver heads were reconstructed twice: once using visual appraisal and once using the instrument workflow. No significant improvement was found for the roll (5.8° vs 3.4°, respectively, p=0.16), pitch (2.1° vs 1.5°, p=0.56), or translation (2.9 mm vs 3.3 mm, p=0.77), but the yaw was significantly reduced if the instrument workflow was used (15.3° vs 2.9°, p=0.02). The workflow is associated with low costs and low logistical demands, and may prevent outliers in implant positioning in a clinical setting when intraoperative navigation or patient-specific implants are not available.
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Affiliation(s)
- R Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - L Dubois
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - C Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - L F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P E M H Habets
- Department of Medical Biology, Section Clinical Anatomy and Embryology, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - T J J Maal
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - A G Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Ocular motility and diplopia measurements following orbital floor fracture repair. Am J Otolaryngol 2021; 42:102879. [PMID: 33429179 DOI: 10.1016/j.amjoto.2020.102879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/24/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE Diplopia and ocular motility restriction following orbital fracture repair are common complications. The reported rates in the literature differ greatly, in part due to varying definitions of diplopia and methods of measurement. The purpose of this study is to describe a practical and efficient in-office method for examining ocular motility and diplopia in orbital trauma patients and to report the outcomes in a series of patients who underwent orbital floor fracture repair. MATERIALS AND METHODS A retrospective chart review from 2012 to 2019 was conducted in patients who underwent isolated orbital floor fracture repair within 3 weeks of trauma. All patients had examinations to assess extraocular motility and subjective diplopia using the described techniques. RESULTS Ninety-three patients underwent orbital floor fracture repair and had adequate follow-up. Preoperatively, 71 (76%) patients had some restriction in motility and 59 (63%) patients complained of diplopia. Postoperatively, only 1 patient (1.09%) had clinically significant diplopia. Five (5.4%) additional patients demonstrated mild restriction in supraduction upon detailed ophthalmic examination that was not discovered upon subjective history. No patients had worsening of diplopia or motility after surgery. CONCLUSIONS Diplopia and motility restriction following orbital fracture repair can be a persistent problem for some patients. It is important to perform a careful ophthalmic examination to detect motility deficits and diplopia that can be significant to the patient. The true rate of restriction and diplopia may be higher using detailed ophthalmic diagnostic techniques compared to subjective patient history.
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18
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Yamanaka Y, Watanabe A, Rajak SN, Nakayama T, Sotozono C. The trend of recovery period on postoperative eye movement in orbital blowout fractures. J Craniomaxillofac Surg 2021; 49:688-693. [PMID: 33608201 DOI: 10.1016/j.jcms.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/09/2020] [Accepted: 02/07/2021] [Indexed: 11/25/2022] Open
Abstract
To investigate the trend of restoration of postoperative eye movements after orbital blowout fractures by analyzing the percentage of Hess area ratio (HAR%). This was a retrospective study of patients who underwent orbital blow out reconstruction surgery within 28-days post injury. Eye movements were measured preoperatively and 3, 6, and 12 months post operatively by Hess chart. Orbital fractures were classified into three shapes: trap-door fracture with muscle entrapment, trap-door fracture with incarcerated tissue, and depressed fracture. Correlations between fracture shapes, regions, reconstruction implant, age and HAR% were analyzed. This study involved 125 eyes (64 right eyes and 61 left eyes) of 125 isolated orbital fracture cases (95 males, 30 females, mean age: 27.2, range 4-85 years old). Of the total 125 cases, 96 patients had orbital floor fractures, 18 had orbital medial wall fractures, and 11 had combined orbital medial wall and floor fractures. Three had trap-door fractures with muscle entrapment, 42 had trap-door fractures with incarcerated tissue, and 80 had orbital depressed fractures. The overall mean HAR% improved significantly from 76.0 pre-operatively to 95.5 post-12 months (P < 0.01). The mean HAR% in orbital floor fracture improved significantly from 76.7 pre-operatively to 92.9 and 94.7 at 3, 6 months respectively. There was a non-significant improvement in the HAR% in medial wall fractures from 83.2 pre-operatively to 89.5 at 3 months and a significant improvement to 93.2 at 6 months (p < 0.05). Orbital fractures were reconstructed with either Unsintered hydroxyapatite particles/poly l-lactide composite sheet (u-HA/PLLA composite sheet) (91 patients), a silicone silastic sheet (20 patients) a combination of sheets (7 patients) or without an implant (7 patients). There was no significant difference in the HAR% improvement between the different implants. The HAR% improvement was significantly greater in patients <18 years old than in those aged 18 or over. The HAR% is an effective method of the objective assessment of recovery after orbital fracture. Patients and surgeons should be aware that the recovery after medial wall fractures is slower than after floor fractures and continues after three months post-surgery and that a longer period of observation without further intervention may be required for medial wall fractures, whilst floor fractures are likely to have achieved their maximal recovery by three months.
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Affiliation(s)
- Yukito Yamanaka
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan; Department of Ophthalmology, Meiji University of Integrative Medicine, Kyoto, Japan
| | - Akihide Watanabe
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan.
| | - Saul N Rajak
- The Sussex Eye Hospital, Brighton and Sussex University Hospital, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK
| | - Tomomichi Nakayama
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan
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Watanabe A, Yamanaka Y, Rajak SN, Nakayama T, Ueda K, Sotozono C. Assessment of a Consecutive Series of Orbital Floor Fracture Repairs With the Hess Area Ratio and the Use of Unsintered Hydroxyapatite Particles/Poly l-Lactide Composite Sheets for Orbital Fracture Reconstruction. J Oral Maxillofac Surg 2021; 79:420-428. [DOI: 10.1016/j.joms.2020.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022]
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North VS, Reshef ER, Lee NG, Lefebvre DR, Freitag SK, Yoon MK. Lower eyelid malposition following repair of complex orbitofacial trauma. Orbit 2020; 41:193-198. [PMID: 33353453 DOI: 10.1080/01676830.2020.1862245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To compare the incidence of lower eyelid malposition following repair of isolated orbital floor fractures with that of complex orbitofacial fractures (defined as multi-wall fractures or prior orbital fracture repairs requiring revision) by oculofacial plastic surgeons via a transconjunctival or swinging eyelid approach.Methods: Retrospective review of 175 patients who underwent surgical repair of orbital fractures at our institution. The primary outcomes were the occurrence of lower eyelid malposition (ectropion, entropion, and eyelid retraction) and the need for subsequent surgical correction.Results: Of 95 patients with isolated orbital floor fractures, 4 developed eyelid malposition (4.2%), 1 of which required surgical repair (1.1%). Of 80 patients with complex orbitofacial fractures (48 multi-wall fractures, 32 secondary revisions), 10 had pre-operative eyelid malposition and were excluded from further analysis. Fourteen of the remaining 70 patients developed postoperative eyelid malposition (20%), 3 of which required surgical repair (4.3%). The difference in the occurrence of eyelid malposition between groups was statistically significant (p = .001), but the difference in rates of those requiring subsequent repair was not (p = .182). There was no statistically significant difference in the occurrence of eyelid malposition when considering other surgical factors including lateral canthotomy, conjunctival closure, implant material, or anterior rim screws.Conclusions: The incidence of lower eyelid malposition following orbital fracture repair via a fornix-based approach was significantly higher for the repair of complex orbitofacial fractures than for isolated floor fractures. However, very few patients in either group required surgical repair for eyelid malposition. Surgical factors including implant material did not affect outcomes.
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Affiliation(s)
- Victoria S North
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Edith R Reshef
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Nahyoung Grace Lee
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Daniel R Lefebvre
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Michael K Yoon
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Xu QH, Yu JH, Wang YH, Wang AA, Liao HF. Analysis of the effect of repair materials for orbital blowout fracture on complications. Int J Ophthalmol 2019; 12:1746-1750. [PMID: 31741864 DOI: 10.18240/ijo.2019.11.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/20/2019] [Indexed: 01/14/2023] Open
Abstract
AIM To investigate the effect of repair materials for orbital blowout fractures on the occurrence of postoperative complications. METHODS The clinical data and follow-up data of 54 subjects with orbital blowout fractures were retrospectively analyzed. The study was divided into three groups according to the used repair materials: titanium mesh (16 cases), Medpor (12 cases), and Medpor titanium mesh (26 cases). All test data were analyzed using the SPSS version 23.0 statistical software. The mean age and duration of disease between the groups were compared through one-way analysis of variance. The Chi-square (χ 2) test was used to compare the number of males and females, different fracture types, and different surgical approaches among groups. The χ 2 test was used to compare the frequencies for complications in each group. RESULTS The baseline characteristics of age and gender in each group were matched (F=1.763, P=0.172; χ 2=0.026, P=0.987). In addition, there was no difference in the type of fracture and surgical approach (χ 2=0.460, P=0.977; χ 2=0.691, P=0.952), or the incidence of complications (χ 2=0.081, P=0.960) between the three groups. CONCLUSION Although there is no difference in effect of various repair materials on the incidence of complications, the effect of repair materials on postoperative complications of orbital blowout fractures should not be ignored.
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Affiliation(s)
- Qi-Hua Xu
- Department of Ocular Trauma, Orbital Disease, Affiliated Eye Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jin-Hai Yu
- Jiangxi Research Institute of Ophthalmology & Visual Sciences, Nanchang 330006, Jiangxi Province, China
| | - Yao-Hua Wang
- Department of Ocular Trauma, Orbital Disease, Affiliated Eye Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - An-An Wang
- Department of Ocular Trauma, Orbital Disease, Affiliated Eye Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Hong-Fei Liao
- Department of Ocular Trauma, Orbital Disease, Affiliated Eye Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Reconstruction of Medial Wall Blowout Fracture Defect with a Combination of Resorbable Meshed Plate and Cancellous Bone Allograft. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2656503. [PMID: 31737658 PMCID: PMC6815640 DOI: 10.1155/2019/2656503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/04/2019] [Accepted: 08/11/2019] [Indexed: 11/21/2022]
Abstract
Background Various materials are available for the reconstruction of bone defects in cases of medial wall blowout fracture. This study was conducted to assess the efficacy of the combination of a resorbable meshed plate and cancellous bone allograft. Methods From March 2014 to March 2017, a total of 111 patients were evaluated. Sixty-three patients received reconstruction surgery with porous polyethylene plates (control group) and the other forty-eight patients underwent operation with a resorbable meshed plate plus allogenic cancellous bone (combined group). The results were assessed by exophthalmometric measurements, width, and volume discrepancies as compared with the unaffected orbit, and operation time. Results The difference in exophthalmometric measurements between the affected and unaffected orbits were 0.94 ± 0.70 mm in the control group and 1.05 ± 0.73 mm in the combined group without statistical significance (p = 0.425). In the analysis of computed tomography images, the width discrepancy was 1.55 ± 0.86 mm and 1.08 ± 0.69 mm, respectively (p = 0.003); however, the volume discrepancy demonstrated no statistically significant difference (2.58 ± 1.40 cm3 versus 2.20 ± 1.80 cm3; p = 0.209). Operation time was significantly shorter in the combined group as compared with the control group (43.0 ± 7.0 versus 38.3 ± 7.0 minutes; p = 0.001). Conclusion The combination material composed of resorbable meshed plate and cancellous bone allograft made reconstruction surgery of medial wall blowout fracture easier and quicker to perform with long-lasting results.
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Pechetov AA, Revishvili AS, Esakov YS, Makov MA, Volchansky DA, Khlan TN. [Combined thoracoplasty using titanium mesh implant in patients with total sternal instability following postoperative sternomediastinitis]. Khirurgiia (Mosk) 2019:13-19. [PMID: 31714524 DOI: 10.17116/hirurgia201911113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the results of chest wall reconstruction with titanium mesh implant in patients with total sternal instability following postoperative sternomediastinitis. MATERIAL AND METHODS There were 100 patients with total sternal instability for the period from January 2016 to December 2018. Median of age was 62 (58; 68) years. Male/female ratio was 82/18. All patients were treated in accordance with standardized protocol. Postoperative complications were assessed using Clavien-Dindo scale. Staged surgical treatment including one or more debridement procedures before the final thoracoplasty was performed in 62 (62%) out of 100 patients. Aseptic sternal instability was observed in 38 patients. RESULTS Follow-up period ranged from 3 weeks to 35 months after the final thoracoplasty. Complicated postoperative period occurred in 15 (15%) out of 100 patients (95% CI 9.3-23.3). One patient died in 9 days after surgery from acute heart failure. Complications without need for redo surgery, postoperative wound suppuration and seroma were noted in 3 patients. Redo surgery was required in 11 patients due to postoperative wound suppuration, eventration after thoracoomentoplasty, intermuscular hematoma and delayed divergence of major pectoral muscles. Removal of mesh implant was performed in 1 out of 100 patient (95% CI 0.2-5.5) in 7 days after surgery due to suppuration. There was no recurrent sternal instability within 30 days. CONCLUSION Anterior chest wall reconstruction using titanium mesh implant is an effective and safe procedure in patients with postoperative sternal instability following postoperative sternomediastinitis.
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Affiliation(s)
- A A Pechetov
- Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of Russia, Moscow, Russia
| | - A Sh Revishvili
- Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of Russia, Moscow, Russia
| | - Yu S Esakov
- Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of Russia, Moscow, Russia
| | - M A Makov
- Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of Russia, Moscow, Russia
| | - D A Volchansky
- Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of Russia, Moscow, Russia
| | - T N Khlan
- Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of Russia, Moscow, Russia
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Cox JT, Tian J, Merbs S, Mahoney NR. Blood Collection within the Maxillary Sinus following Orbital Fracture Repair: The Impact of Mesh Implants and Drains. Craniomaxillofac Trauma Reconstr 2019; 12:167-173. [PMID: 31428239 DOI: 10.1055/s-0038-1676636] [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: 01/15/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022] Open
Abstract
This article aimed to assess the effects of (1) mesh (e.g., uncoated anatomic titanium plates) versus non-mesh (e.g., porous polyethylene-coated titanium sheets) implant materials and (2) drain placement on the accumulation of blood within the maxillary sinus following surgical repair of orbital floor fractures. Ninety-two patients who received orbital floor fracture repair between 2008 and 2014 were selected, with equal case numbers between categories: (1) non-mesh implant, without drain; (2) non-mesh implant, with drain; (3) mesh implant, without drain; and (4) mesh implant, with drain. Lesion-mapping software was used to measure blood and sinus volumes in postoperative computed tomographic images. Average postoperative maxillary sinus filling was 49% ± 29%. Average sinus filling was similar between mesh and non-mesh implant materials; this was true in cases with a drain (45 vs. 40%, respectively) and without (57 vs. 52%, respectively). Orbital drain placement was associated with a significant reduction ( p = 0.048) in maxillary sinus filling of 12%. Mesh and non-mesh implant materials allow for similar drainage of orbital blood into the maxillary sinus postoperatively. In the majority of cases, space is available within the maxillary sinus to allow for drainage of orbital blood. Intraoperative drain placement is associated with reduced blood pooling within the maxillary sinus, suggesting it allows for drainage of orbital blood to the outside world.
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Affiliation(s)
- Jacob T Cox
- Division of Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jing Tian
- Biostatistics Consulting Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Shannath Merbs
- Division of Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicholas R Mahoney
- Division of Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Vollkommer T, Henningsen A, Friedrich RE, Felthaus OH, Eder F, Morsczeck C, Smeets R, Gehmert S, Gosau M. Extent of Inflammation and Foreign Body Reaction to Porous Polyethylene In Vitro and In Vivo. In Vivo 2019; 33:337-347. [PMID: 30804110 DOI: 10.21873/invivo.11479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM High-density porous polyethylene (PP) offers possibilities for reconstruction in craniofacial surgery. The purpose of this study was to evaluate the extent of inflammation and foreign body reactions to PP in vitro and in vivo. MATERIALS AND METHODS Cell attachment, proliferation and expression of inflammatory cytokines were assessed using murine macrophages (RAW 264.7) on two different PP materials in vitro. In vivo, Balb/c mice received PP implants at their dorsum. After sacrifice, samples were analyzed histologically and real-time PCR was used to assess expression of inflammatory cytokines. RESULTS Cells showed a significantly decreased proliferation (p<0.001) after 48 h and a significantly increased expression of TNF-α (p<0.05) at 24, 48 and 72 h. All animals showed foreign body cell reactions and signs of chronic inflammation. Expression of all but one of the investigated cytokines dropped to non-significant levels after an initial increase. CONCLUSION Application of porous polyethylene can cause local chronic inflammatory reactions. Although clinical application seems to be immunologically safe, indication and risks should be evaluated carefully when using PP implants.
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Affiliation(s)
- Tobias Vollkommer
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anders Henningsen
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany .,Department of Oral and Maxillofacial Surgery, Division of Regenerative Orofacial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Oral and Maxillofacial Surgery, German Armed Forces Hospital, Hamburg, Germany
| | - Reinhard E Friedrich
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Heinrich Felthaus
- Department of Plastic, Hand and Restoration Surgery, Caritas Hospital St. Josef, Regensburg, Germany
| | | | - Christian Morsczeck
- Department of Oral and Maxillofacial Surgery, University Medical Center-Regensburg, Regensburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Oral and Maxillofacial Surgery, Division of Regenerative Orofacial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Gehmert
- Department of Orthopaedics, University Children's Hospital Basel, Basel, Switzerland
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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26
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Balaji SM, Balaji P. Surgical Correction of Diplopia in Orbital Fracture: Influence of Material and Design. Ann Maxillofac Surg 2019; 9:129-134. [PMID: 31293941 PMCID: PMC6585195 DOI: 10.4103/ams.ams_45_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The purpose of this study is to compare the association of diplopia after orbital fracture repair using titanium mesh and high-density polyethylene-coated titanium mesh. Materials and Methods Retrospective review of records of consecutive patients who presented for primary/secondary correction of orbital fracture attending author's institute was done. Patients attending the institution between January 2013 and December 2017 (5 years' period) fulfilling the inclusion and exclusion criteria were included for this study. Results In all, 44 patients, who fulfilled the inclusion and exclusion criteria, were included in the study. The mean age was 31.86 ± 9.1 years and the mean period of follow-up was 9.37 ± 2.1 months postoperatively, with a range of 6.5-24 months. There were 65.91% males, and the most common etiology was road traffic accident (50%). In all, 11 (25%) cases had postoperative diplopia. Of the 11 cases that had diplopia, 6 had Class 1 and 5 had Class 2 diplopia. Of these 11 cases, 8 cases had completion or partial resolution of diplopia by the end of 8 weeks' period, and in 3 cases, it persisted even after 3 months of care. The occurrence of diplopia was compared by demographic factor using Chi-square test, and the mesh type was only statistically significant (P = 0.026). Discussion The present study indicates that both types of mesh provide reliable, clinically better results. However, with passage of time, it was clinically observed that removing uncoated mesh poses extreme difficulty by the adherences and growth penetrating the meshes. In certain instances, clinically, it was observed that such adhesions may be a cause of compromise of eyeball movement. Conclusion Noncoated titanium orbital implants may lead to the adherence of orbital and periorbital structures, resulting in restrictive diplopia. High-density polyethylene-coated titanium mesh shows better performance as compared to noncoated mesh in preventing adherence situations.
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Affiliation(s)
- S M Balaji
- Director and Consultant, Oral and Craniomaxillofacial Surgeon, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India
| | - Preetha Balaji
- Director and Consultant, Oral and Craniomaxillofacial Surgeon, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India
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Natsis K, Piagkou M, Chryssanthou I, Skandalakis GP, Tsakotos G, Piagkos G, Politis C. A simple method to estimate the linear length of the orbital floor in complex orbital surgery. J Craniomaxillofac Surg 2018; 47:185-189. [PMID: 30497949 DOI: 10.1016/j.jcms.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 06/29/2018] [Accepted: 11/02/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The orbital floor (OrF) and infraorbital rim (IOR) repair in cases of complete destruction is challenging mainly due to the fact that the defect length cannot be measured. The aim of the current study is to develop a method of calculating the Orf length by using the gender and the lengths of the medial, superior and lateral orbital walls (OrW) of the same orbit. MATERIAL AND METHODS Ninety-seven (59 male and 38 female) European adult dry skulls were classified according to age: 20-39, 40-59 and 60 years and above. The length of each OrW was measured by using the direct distance between the optic foramen and a landmark in each orbital rim. RESULTS A side asymmetry was detected for the lengths of the inferior, superior and medial OrW. Although a gender dimorphism was detected, no correlation with the age was found. Using the Stepwise multiple regression analysis two formulas were developed, one for the right and one for the left OrF with coefficient of determination R2 0.43 and 0.57, respectively. CONCLUSIONS The proposed formulas represent a simple, applicable and individualized method to calculate the OrF linear length in cases of complete destruction of the IOR and OrF, with accuracy and without the use of expertise material. Such data may improve the surgery planning of orbital floor fractures and complex orbital reconstructions.
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Affiliation(s)
- Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, (Chairperson: Professor Dr. K. NATSIS), Medical School, Aristotle University of Thessaloniki, Greece
| | - Maria Piagkou
- Department of Anatomy, (Chairperson: Professor Dr. P. SKANDALAKIS), Medical School, National and Kapodistrian University of Athens, Greece.
| | - Ioannis Chryssanthou
- Department of Anatomy, (Chairperson: Professor Dr. P. SKANDALAKIS), Medical School, National and Kapodistrian University of Athens, Greece
| | - Georgios P Skandalakis
- Department of Anatomy, (Chairperson: Professor Dr. P. SKANDALAKIS), Medical School, National and Kapodistrian University of Athens, Greece
| | - Georgios Tsakotos
- Department of Anatomy, (Chairperson: Professor Dr. P. SKANDALAKIS), Medical School, National and Kapodistrian University of Athens, Greece
| | - Giannoulis Piagkos
- Department of Anatomy, (Chairperson: Professor Dr. P. SKANDALAKIS), Medical School, National and Kapodistrian University of Athens, Greece
| | - Constantinus Politis
- OMFS-IMPATH Research Group Department of Imaging and Pathology, (Chairperson: Professor Dr. C. Politis), Belgium; Department of Oral and Maxillofacial Surgery, Hasselt University, Diepenbeek, Belgium
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Foletti JM, Martinez V, Haen P, Godio-Raboutet Y, Guyot L, Thollon L. Finite element analysis of the human orbit. Behavior of titanium mesh for orbital floor reconstruction in case of trauma recurrence. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 120:91-94. [PMID: 30453103 DOI: 10.1016/j.jormas.2018.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/22/2018] [Accepted: 11/11/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The authors' main purpose was to simulate the behavior of a titanium mesh implant (TMI) used to reconstruct the orbital floor under the stress of a blunt trauma. MATERIALS AND METHODS The orbital floor of a previously validated finite element model (FEM) of the human orbit was numerically fractured and reconstructed by a simplified TMI. Data from a CT scan of the head were computed with MICMICS (Materialise, Louvain, Belgium) software to re-create the skull's geometry. The meshing production, the model's properties management and the simulations of blunt traumas of the orbit were conducted on HYPERWORKS® software (Altair Engineering, Detroit, MI, USA). Some of the elements of the orbital floor were selected and removed to model the fracture; these elements were duplicated, their characteristics being changed by those of titanium to create a TMI covering this fracture. A 3D FEM composed of 640,000 elements was used to perform 21 blunt trauma simulations on the reconstructed orbit. RESULTS In 90.4% (19/21) of the tests conducted, the TMI, whether free from any bony attachment or screwed to the orbital rim, has tended to move in the orbit and/or to deform. DISCUSSION In the event of traumatic recurrence, which is not rare, TMIs may deform in a "blow-in" motion and threaten intra-orbital structures.
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Affiliation(s)
- J M Foletti
- Aix Marseille université, AP-HM, IFSTTAR, LBA, hôpital de la Conception, service de chirurgie maxillo-faciale, 13015 Marseille, France.
| | - V Martinez
- Aix Marseille université, IFSTTAR, LBA, 13015 Marseille, France.
| | - P Haen
- Aix Marseille université, HIA Laveran, service de chirurgie maxillo-faciale, 13013 Marseille, France.
| | - Y Godio-Raboutet
- Aix Marseille université, IFSTTAR, LBA, 13015 Marseille, France.
| | - L Guyot
- AP-HM, CNRS, EFS, hôpital de la Conception, service de chirurgie maxillo-faciale, 13015 Marseille, France.
| | - L Thollon
- Aix Marseille université, IFSTTAR, LBA, 13015 Marseille, France.
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Kärkkäinen M, Wilkman T, Mesimäki K, Snäll J. Primary reconstruction of orbital fractures using patient-specific titanium milled implants: the Helsinki protocol. Br J Oral Maxillofac Surg 2018; 56:791-796. [DOI: 10.1016/j.bjoms.2018.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/14/2018] [Indexed: 01/22/2023]
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Autologous Fat Graft for the Treatment of Sighted Posttraumatic Enophthalmos and Sunken Upper Eyelid. Ophthalmic Plast Reconstr Surg 2018; 34:381-386. [PMID: 29369151 DOI: 10.1097/iop.0000000000001028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The treatment of enophthalmos and sunken upper eyelid is challenging. Although autologous fat graft has been widely used in breast augmentation, buttock contouring, and facial rejuvenation, its application in enophthalmos and sunken upper eyelid is not yet widely utilized. The clinical safety and value of autologous fat graft in sighted patients with enophthalmos and sunken upper eyelid are unclear. This study retrospectively analyzed the cosmetic results and safety of autologous fat graft in the correction of sighted traumatic enophthalmos and sunken upper eyelid. METHODS Autologous fat graft was performed in 9 patients with posttraumatic enophthalmos and sunken upper eyelid. The visual acuity, orbital swelling, eye movement, enophthalmos, and sunken upper eyelid were observed. RESULTS Eight to 24 months after autologous fat graft, enophthalmos and sunken upper eyelid in 9 patients improved significantly. Although orbital swelling occurred in the early postoperative period, no vision loss, eye movement limitation, or fat embolism had occurred. CONCLUSION Autologous fat graft is an effective, predictable, scarless, and minimally invasive surgery for the correction of the sighted posttraumatic enophthalmos and sunken upper eyelid. The possible risk of fat embolization and blindness from the compression of the optic nerve should not be neglected. Further studies and more cases must be performed.
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Jacobs SM, McInnis CP, Kapeles M, Chang SH. Incidence, Risk Factors, and Management of Blindness after Orbital Surgery. Ophthalmology 2018; 125:1100-1108. [PMID: 29551422 DOI: 10.1016/j.ophtha.2018.01.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Severe vision loss is a risk of orbital surgery which physicians should counsel patients about, but the overall risk rate is unknown. This research was conducted to determine the risk of severe vision loss related to orbital surgery. DESIGN Retrospective review. PARTICIPANTS Patients who underwent orbital surgery at either of 2 academic medical centers between January 1994 and December 2014. METHODS A billing database search was conducted to identify all patients who had orbital surgery during the study period, cross-checked against diagnostic codes related to vision loss. Charts were screened to determine baseline demographic and medical history, surgical procedure, intraoperative and perioperative management, and visual acuity. Patients with preoperative visual acuity ≥20/200 that worsened ≤20/400 after orbital surgery were included for detailed review. Statistical analysis was conducted to identify factors posing particular risk or benefit to visual outcome in these patients. MAIN OUTCOME MEASURES Visual acuity after orbital surgery. RESULTS A total of 1665 patients underwent orbital surgery during the inclusion period, with 14 patients sustaining severe vision loss ranging from counting fingers at 1 foot to no light perception (overall risk, 0.84%). The causes of vision loss included retrobulbar hemorrhage, malpositioned implant, optic nerve ischemia, or direct optic nerve insult. When stratified by surgical approach, the risk of a blinding surgical complication was significantly higher for patients undergoing orbital floor repair in the setting of multiple facial fractures (subgroup risk, 6.45%), bony decompression of the optic canal (subgroup risk, 15.6%), or intracranial approach to the orbital roof (subgroup risk, 18.2%). Seven of 8 patients with a potentially reversible cause of postoperative vision loss underwent urgent repeat surgery, and 2 regained substantial vision (20/20 and 20/25). Administration of intravenous corticosteroids had no significant effect on visual acuity outcome. CONCLUSIONS The overall risk of severe vision loss after orbital surgery is 0.84%. The subgroup risk is higher in patients undergoing facial polytrauma repair, optic canal decompression, or orbital apex surgery from an intracranial approach. Close postoperative monitoring and urgent assessment and management of acute vision loss may improve visual outcome in some patients.
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Affiliation(s)
- Sarah M Jacobs
- Department of Ophthalmology, University of Washington, Seattle, Washington; Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Colin P McInnis
- Department of Ophthalmology, University of Washington, Seattle, Washington; Department of Ophthalmology and Vision Science, University of Arizona, Tucson, Arizona
| | - Matthew Kapeles
- Department of Ophthalmology, University of Washington, Seattle, Washington; Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Shu-Hong Chang
- Department of Ophthalmology, University of Washington, Seattle, Washington
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Abstract
Traumatic panfacial fracture repair is one of the most complex and challenging reconstructive procedures to perform. Several principles permeate throughout literature regarding the repair of panfacial injuries in a stepwise fashion. The primary goal of management in most of these approaches is to restore the occlusal relationship at the beginning of sequential repair so that other structures can fall into alignment. Through proper positioning of the occlusion and the mandibular-maxillary unit with the skull base, the spatial relationships and stability of midface buttresses and pillars can then be re-established. Here, the authors outline the sequencing of panfacial fracture repair for the restoration of anatomical relationships and the optimization of functional and structural outcomes.
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Affiliation(s)
- Kausar Ali
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Salvatore C Lettieri
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN and Plastic Surgery, Maricopa Integrated Health System, Phoenix, Arizona
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