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Hughes D, McQuillan J, Holmes S. Quantitative analysis of diplopia following orbital fracture repair. Br J Oral Maxillofac Surg 2023; 61:202-208. [PMID: 36805788 DOI: 10.1016/j.bjoms.2023.01.004] [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: 11/28/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
Orbital fractures can result in devastating functional complications to sight and well-being, yet our understanding of functional sequelae post reconstruction is not well understood in the literature. This research retrospectively analysed the activity of a specialist orbital surgeon over five years to evaluate the incidence of, and risk factors for, debilitating complications such as diplopia and restriction of extraocular movement. Orbital fracture cases repaired between 1 January 2015 and 31 December 2019 were retrospectively analysed. Demographics, orthoptic assessment, injury classification, timing, operative details, outcomes, and complications were recorded. Preoperative and postoperative binocular single vision scores (BSV) were recorded to calculate the effect of orbital repair on residual diplopia. Of 582 patients undergoing orbital access, 472 cases of orbital wall reconstruction satisfied the inclusion criteria, of which 162 (34%) were Jaquiéry 4 or 5. Overall, 10.6% had complications, 4.9% had diplopia, and 5.7% were returned to theatre. All those with residual diplopia had had it preoperatively, and had evidence of an improvement in BSV score. Time to surgery, material, and pure orbital fractures had a significant impact on the incidence of diplopia. Defect size did not. Whilst complication rates were low we conclude that strict adherence to a defined surgical protocol, postoperative imaging, and objective assessment of postoperative function are central to maintaining these standards. Objective orthoptic analysis of patients before and after orbital repair is critical to our understanding of this pathology. Whilst preoperative prediction of the persistence of long-term diplopia currently eludes us, further research should target it.
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Affiliation(s)
- Declan Hughes
- Oral and Maxillofacial surgery department, Royal London Hospital, Whitechapel, London E1 1FR, United Kingdom.
| | - Joe McQuillan
- Oral and Maxillofacial surgery department, Royal London Hospital, Whitechapel, London E1 1FR, United Kingdom
| | - Simon Holmes
- Oral and Maxillofacial surgery department, Royal London Hospital, Whitechapel, London E1 1FR, United Kingdom
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Ritschl LM, Wittmann M, von Bomhard A, Koerdt S, Unterhuber T, Kehl V, Deppe H, Wolff KD, Mücke T, Fichter AM. Results of a Clinical Scoring System Regarding Symptoms and Surgical Treatment of Isolated Unilateral Zygomatico-Orbital Fractures: A Single-Centre Retrospective Analysis of 461 Cases. J Clin Med 2022; 11:jcm11082187. [PMID: 35456282 PMCID: PMC9032597 DOI: 10.3390/jcm11082187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/29/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Systematic assessment of computed tomography (CT) scans and clinical symptoms is necessary to quickly indicate the correct treatment of zygomatico-orbital (ZMO) fractures. For this purpose, a clinical scoring system (=Clinical Score) was developed and correlated with CT scans to analyse its validity. Every operated, isolated, and unilateral ZMO fracture between January 2012 and December 2016 was screened retrospectively, including patient and treatment data. All available CT scans were analysed, and the grade of dislocation was measured for each case and plane. Four hundred and sixty-one cases were included and showed a median surgery time of 66.0 min (5.0−361.0) and a median postoperative hospital stay of three days (0−25). The distribution of gender, aetiologies and age groups was significantly different (each p = 0.001), and the aetiology had a significant influence on the Clinical Score (p = 0.038). The degree of dislocation in the coronary and sagittal planes correlated significantly with the Clinical Score with regard to the orbital involvement (p < 0.001, ρ = 0.566; p < 0.001, ρ = 0.609). The simple, quick, and easy-to-apply Clinical Score showed a significant correlation with the most important planes in CT scans as well as with the clinical course. It may facilitate fast risk stratification of the patient. However, the validity of the proposed score in determining indications must now be evaluated in a prospective setting, including both operated and non-operated fractures.
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Affiliation(s)
- Lucas M. Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
- Correspondence: ; Tel.: +49-89-4140-2932
| | - Matthias Wittmann
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Achim von Bomhard
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Berlin Institute of Health, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany;
| | - Tobias Unterhuber
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Victoria Kehl
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Grillparzerstrasse 18, 81675 Munich, Germany;
| | - Herbert Deppe
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Thomas Mücke
- Department of Oral and Maxillofacial Surgery, St. Josefs Hospital, 47441 Moers, Germany;
| | - Andreas M. Fichter
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
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Valencia MR, Miyazaki H, Ito M, Nishimura K, Kakizaki H, Takahashi Y. Radiological findings of orbital blowout fractures: a review. Orbit 2021; 40:98-109. [PMID: 32212885 DOI: 10.1080/01676830.2020.1744670] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/11/2020] [Indexed: 06/10/2023]
Abstract
Purpose: To summarize the radiological findings in patients with orbital blowout fractures. Methods: We reviewed the published literature on radiological findings of orbital blowout fractures that were searched on PubMed and included our own radiologic findings on patients with orbital blowout fractures that were seen at our hospital. Results: Radiologic examination reveals a variety of findings in each case. However, common radiological findings of orbital blowout fractures include comminuted/unhinged, hinged, and linear fractures. These fractures are usually located in the orbital floor medial to the infraorbital nerve and in the medial orbital wall. Orbital fat is frequently herniated in the paranasal sinus or incarcerated at the fracture site. Orbital emphysema and haematoma sometimes occur as complications. Conclusions: This review will provide surgeons with a better understanding of various radiological findings, which could be helpful in the management of patients with orbital blowout fracture.
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Affiliation(s)
- Ma ReginaPaula Valencia
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital , Aichi, Japan
- Section of Orbital Surgery and Section of Oculoplastic and Lacrimal Surgery, The Medical City Eye and Vision Institute , Metro Manila, Philippines
| | - Hidetaka Miyazaki
- Department of Oral and Maxillofacial Surgery, Graduate School Tokyo Medical and Dental University , Tokyo, Japan
| | - Makoto Ito
- Departments of Radiology, Aichi Medical University , Aichi, Japan
| | | | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital , Aichi, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital , Aichi, Japan
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Orbital Bone Fractures in a Central London Trauma Center: A Retrospective Study of 582 Patients. J Craniofac Surg 2021; 32:1334-1337. [PMID: 33405442 DOI: 10.1097/scs.0000000000007384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The aim of the present study was to evaluate the injury patterns and etiology of orbital bone fractures treated at a busy level one trauma center.Between 2015 and 2019, patients with orbital bone fractures from the Department of Oral and Maxillofacial Surgery at the Royal London Hospital, were evaluated in a retrospective analysis. A pro-forma was used to collect data from electronic patient records. Parameters included age, gender, maxillofacial fracture, mechanism of injury, and length of hospital admission.Of 582 patients, 82% (n = 476) were male and 18% (n = 106) were female, with those in the age group 20 to 29 years most affected (36%; n = 212). The most common etiology was interpersonal violence (55%; n = 320), followed by falls (20%; n = 118) and road traffic accidents (12%, n = 68). The most common isolated orbital bone fracture site was the orbital floor (40%; n = 234). Of the impure orbital fractures, the zygoma was the most commonly involved structure adjacent to the orbit (19%, n = 110).In our department, the authors see high numbers of complex orbital bone requiring surgical treatment. Interpersonal violence is a significant cause of orbital bone fractures with young males most affected. This study provides an insight into the current trends in etiology, demographics, and clinical findings of orbital fractures that will help guide prevention and treatment strategies.
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