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Dinu C, Tamas T, Agrigoroaei G, Stoia S, Opris H, Bran S, Armencea G, Manea A. Prospective Evaluation of Intraorbital Soft Tissue Atrophy after Posttraumatic Bone Reconstruction: A Risk Factor for Enophthalmos. J Pers Med 2022; 12:jpm12081210. [PMID: 35893304 PMCID: PMC9394391 DOI: 10.3390/jpm12081210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/21/2022] [Accepted: 07/24/2022] [Indexed: 11/16/2022] Open
Abstract
Orbital fractures are a common finding in facial trauma, and serious complications may arise when orbital reconstruction is not performed properly. The virtual planning can be used to print stereolithographic models or to manufacture patient-specific titanium orbital implants (PSIs) through the process of selective laser melting. This method is currently considered the most accurate technique for orbital reconstruction. Even with the most accurate techniques of bone reconstruction, there are still situations where enophthalmos is present postoperatively, and it may be produced by intraorbital soft tissue atrophy. The aim of this paper was to evaluate the orbital soft tissue after posttraumatic reconstruction of the orbital walls’ fractures. Ten patients diagnosed and treated for unilateral orbital fractures were included in this prospective study. A postoperative CT scan of the head region with thin slices (0.6 mm) and soft and bone tissue windows was performed after at least 6 months. After data processing, the STL files were exported, and the bony volume, intraorbital fat tissue volume, and the muscular tissue volume were measured. The volumes of the reconstructed orbit tissues were compared with the volumes of the healthy orbit tissues for each patient. Our findings conclude that a higher or a lower grade of fat and muscular tissue loss is present in all cases of reconstructed orbital fractures. This can stand as a guide for primary or secondary soft tissue augmentation in orbital reconstruction.
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Retrospective Cohort Study of Frequency and Patterns of Orbital Injuries on Whole-Body CT with Maxillofacial Multi-Slice CT. Tomography 2021; 7:373-386. [PMID: 34449735 PMCID: PMC8396321 DOI: 10.3390/tomography7030033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background: High-impact trauma frequently leads to injuries of the orbit, but literature focusing on the viscerocranium rather than the neurocranium is underrepresented. Methods: Retrospective cohort study (2006–2014) at an urban level 1 trauma center assessing the frequency and typical patterns of orbital injuries on whole-body computed tomography (WBCT) with maxillofacial multi-slice CT (MSCT) after severe trauma. (1) Screening of consecutive WBCT cases for dedicated maxillofacial MSCT. (2) Examination by two independent experts’ radiologists for (peri-/)orbital injuries. (3) Case review for trauma mechanisms. Results: 1061 WBCT were included revealing 250 (23.6%) patients with orbital injuries. Less than one-quarter (23.3%) of patients showed osseous and 9.5% showed soft tissue injuries. Combined osseous and soft tissue lesions were present in 39.2% of orbital injuries, isolated soft tissue injuries were rare. Single- or two-wall fractures of the orbit were prevalent, and the orbital floor was affected in 67% of fractures. Dislocated extraocular muscles (44.6%), deformation of the ocular globe (23.8%), and elongation of the optic nerve (12.9%) were the most frequently soft tissue findings. Vascular trauma was suspected in 15.8% of patients. Conclusions: Orbital trauma was confirmed in 23.6% of cases with suspected facial injuries after severe trauma. Concomitant soft tissue injuries should be excluded explicitly in cases with orbital fractures to prevent loss of vision or ocular motility.
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Ko AC, Satterfield KR, Korn BS, Kikkawa DO. Eyelid and Periorbital Soft Tissue Trauma. Oral Maxillofac Surg Clin North Am 2021; 33:317-328. [PMID: 34210399 DOI: 10.1016/j.coms.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Facial trauma often involves injuries to the eyelid and periorbital region. Management of these injuries can be challenging due to the involvement of multiple complex anatomic structures that are in close proximity. Restoration of normal anatomic relationships of the eyelids and periocular structures is essential for optimum functional and aesthetic outcome after trauma. This review provides an overview of the current literature involving soft tissue trauma of the eyelid and periorbital tissue, and highlights key steps in patient evaluation and management with various types of injuries.
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Affiliation(s)
- Audrey C Ko
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, 9415 Campus Point Drive, La Jolla, CA 92093, USA
| | - Kellie R Satterfield
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, 9415 Campus Point Drive, La Jolla, CA 92093, USA
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, 9415 Campus Point Drive, La Jolla, CA 92093, USA; Division of Plastic Surgery, UC San Diego Department of Surgery, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, 9415 Campus Point Drive, La Jolla, CA 92093, USA; Division of Plastic Surgery, UC San Diego Department of Surgery, 9500 Gilman Drive, La Jolla, CA 92093, USA.
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Schreurs R, Klop C, Maal TJJ. Advanced Diagnostics and Three-dimensional Virtual Surgical Planning in Orbital Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2020; 29:79-96. [PMID: 33516541 DOI: 10.1016/j.cxom.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centres (location AMC), Meibergdreef 9, Amsterdam, AZ 1105, The Netherlands; Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centres (location AMC), Meibergdreef 9, Amsterdam, AZ 1105, The Netherlands; Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - Thomas J J Maal
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centres (location AMC), Meibergdreef 9, Amsterdam, AZ 1105, The Netherlands; Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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Ning Q, Yu X, Gao Q, Xie J, Yao C, Zhou K, Ye J. An accurate interactive segmentation and volume calculation of orbital soft tissue for orbital reconstruction after enucleation. BMC Ophthalmol 2019; 19:256. [PMID: 31842802 PMCID: PMC6916112 DOI: 10.1186/s12886-019-1260-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 11/27/2019] [Indexed: 12/18/2022] Open
Abstract
Background Accurate measurement and reconstruction of orbital soft tissue is important to diagnosis and treatment of orbital diseases. This study applied an interactive graph cut method to orbital soft tissue precise segmentation and calculation in computerized tomography (CT) images, and to estimate its application in orbital reconstruction. Methods The interactive graph cut method was introduced to segment extraocular muscle and intraorbital fat in CT images. Intra- and inter-observer variability of tissue volume measured by graph cut segmentation was validated. Accuracy and reliability of the method was accessed by comparing with manual delineation and commercial medical image software. Intraorbital structure of 10 patients after enucleation surgery was reconstructed based on graph cut segmentation and soft tissue volume were compared within two different surgical techniques. Results Both muscle and fat tissue segmentation results of graph cut method showed good consistency with ground truth in phantom data. There were no significant differences in muscle calculations between observers or segmental methods (p > 0.05). Graph cut results of fat tissue had coincidental variable trend with ground truth which could identify 0.1cm3 variation. The mean performance time of graph cut segmentation was significantly shorter than manual delineation and commercial software (p < 0.001). Jaccard similarity and Dice coefficient of graph cut method were 0.767 ± 0.045 and 0.836 ± 0.032 for human normal extraocular muscle segmentation. The measurements of fat tissue were significantly better in graph cut than those in commercial software (p < 0.05). Orbital soft tissue volume was decreased in post-enucleation orbit than that in normal orbit (p < 0.05). Conclusion The graph cut method was validated to have good accuracy, reliability and efficiency in orbit soft tissue segmentation. It could discern minor volume changes of soft tissue. The interactive segmenting technique would be a valuable tool for dynamic analysis and prediction of therapeutic effect and orbital reconstruction.
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Affiliation(s)
- Qingyao Ning
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Xiaoyao Yu
- State Key Lab of CAD & CG, Zhejiang University, No. 886 Yuhangtang Road, Hangzhou, 310058, Zhejiang Province, China
| | - Qi Gao
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Jiajun Xie
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Chunlei Yao
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Kun Zhou
- State Key Lab of CAD & CG, Zhejiang University, No. 886 Yuhangtang Road, Hangzhou, 310058, Zhejiang Province, China.
| | - Juan Ye
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.
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Chronopoulos A, Ong JM, Thumann G, Schutz JS. Occult globe rupture: diagnostic and treatment challenge. Surv Ophthalmol 2018; 63:694-699. [DOI: 10.1016/j.survophthal.2018.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022]
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