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Takabayashi K, Maeda Y, Kataoka N, Kagokawa H, Nagamine M, Ota I, Fujita T. Algorithm for pediatric orbital blowout fractures: a 20-year retrospective cohort study. Braz J Otorhinolaryngol 2023; 89:447-455. [PMID: 36754674 PMCID: PMC10164772 DOI: 10.1016/j.bjorl.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: 08/09/2022] [Revised: 11/02/2022] [Accepted: 01/19/2023] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Pediatric orbital blowout fractures can include pathologies that seem mild but require urgent release; serious sequelae can occur with standby surgery or conservative treatment. We sought to validate an algorithm for the treatment of pediatric orbital blowout fractures. METHODS This retrospective cohort study included 61 pediatric patients, aged 18 years or younger, treated for pure orbital blowout fractures according to the algorithm from April 1, 2000, to August 31, 2020, at the Japanese Red Cross Asahikawa Hospital. RESULTS There were 52 males (85%). Median age was 14 years (range, 5-18 years). There were 9 patients categorized as needing urgent release, 16 as needing repair, and 36 as needing conservative treatment. Mean follow-up ocular movement was 98.0 (95% Confidence Interval [95% CI], 96.8-99.2). Postoperative diplopia was not observed in 96% (79.6%-99.9%) of patients, better than in previous studies. A higher proportion of patients aged 0-12 years needed urgent repair than those aged 13-18 years (Odds Ratio [OR] = 14.2; 95% CI 1.6-683.4; p = 0.0046). There were no differences in Hess area ratio by age group. CONCLUSION Clinical results with the algorithm were satisfactory. The algorithm is suitable for treatment of pediatric orbital blowout fractures. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Kosuke Takabayashi
- Japanese Red Cross Asahikawa Hospital, Department of Otorhinolaryngology, Asahikawa City, Hokkaido, Japan
| | - Yohei Maeda
- Osaka University Graduate School of Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Suita City, Osaka, Japan; Japan Community Health Care Organization Osaka Hospital, Department of Otorhinolaryngology, Osaka City, Osaka, Japan.
| | - Nobuya Kataoka
- Japanese Red Cross Asahikawa Hospital, Department of Ophthalmology, Asahikawa City, Hokkaido, Japan
| | - Hiroyuki Kagokawa
- Japanese Red Cross Asahikawa Hospital, Department of Otorhinolaryngology, Asahikawa City, Hokkaido, Japan
| | - Masayoshi Nagamine
- Japanese Red Cross Asahikawa Hospital, Department of Ophthalmology, Asahikawa City, Hokkaido, Japan
| | - Isao Ota
- Japanese Red Cross Asahikawa Hospital, Department of Otorhinolaryngology, Asahikawa City, Hokkaido, Japan
| | - Taketoshi Fujita
- Japanese Red Cross Asahikawa Hospital, Department of Otorhinolaryngology, Asahikawa City, Hokkaido, Japan
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Park J, Baek S. Management of pediatric orbital wall fractures. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2018.1560266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jinhwan Park
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Sehyun Baek
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Abstract
INTRODUCTION The use of resorbable materials is becoming more popular for pediatric orbital floor reconstruction. The purpose of this systematic review is to evaluate the effectiveness and safety of the various materials used in pediatric orbital floor reconstruction. METHODS A systematic literature search was performed to identify all relevant articles reporting complications following pediatric orbital floor reconstruction. The search included published articles in three electronic databases-Ovid MEDLINE, EMBASE, and PubMed starting from database establishment to July 2017. Primary endpoints were enophthalmos, diplopia, and infection. Resorbable material was compared to autologous grafts and nonresorbable material. RESULTS A total of 14 studies containing 248 patients were included in this review. Fifty-four (21.8%) patients had reconstruction performed with autologous grafts, 72 (29.0%) patients with resorbable material, and 122 (49.2%) patients with nonresorbable material. Resorbable materials had the lowest rate of postoperative enophthalmos (3/52; 5.8%) and the highest rate of postoperative diplopia (19/72; 26.4%). In contrast, nonresorbable materials had the lowest rate of postoperative diplopia (5/122; 4.1%), the highest rate of postoperative enophthalmos (14/102; 13.7%). Autologous reconstruction was associated with an 11.1% (4/36) rate of postoperative enophthalmos and a 22.2% (12/54) rate of postoperative diplopia. Nine cases (8.8%) of postoperative infection were documented with nonresorbable materials. No cases of infection were reported with autologous grafts or resorbable materials. CONCLUSION Newer resorbable implants are safe and have a similar complication profile as traditional autologous grafts in pediatric orbital floor reconstruction.
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Wang JM, Fries FN, Hendrix P, Brinker T, Loukas M, Tubbs RS. Orbital Blowout Fracture with Complete Dislocation of the Globe into the Maxillary Sinus. Cureus 2017; 9:e1728. [PMID: 29201577 PMCID: PMC5707172 DOI: 10.7759/cureus.1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This rare case report describes the diagnosis and treatment of an isolated left-sided orbital floor fracture with a complete dislocation of the globe into the maxillary sinus and briefly discusses the indications of surgery and recovery for orbital floor fractures in general. Complete herniation of the globe through an orbital blow-out fracture is uncommon. However, the current case illustrates that such an occurrence should be in the differential diagnosis and should be considered, especially following high speed/impact injuries involving a foreign object. In these rare cases, surgical intervention is required.
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Affiliation(s)
- Joy Mh Wang
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
| | - Fabian N Fries
- Ophthalmology, Saarland University Medical Center, Germany
| | | | | | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
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Zieliński R, Malińska M, Kozakiewicz M. Classical versus custom orbital wall reconstruction: Selected factors regarding surgery and hospitalization. J Craniomaxillofac Surg 2017; 45:710-715. [PMID: 28318927 DOI: 10.1016/j.jcms.2017.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/04/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Nowadays, in orbital wall reconstruction, maxillofacial surgeons have the possibility to treat patients in modern ways such as with individual implants. Nevertheless, conventional treatment including standard titanium mesh shaped during the surgical procedure is also widely used. The aim of this study was to compare the above methods of orbital wall reconstructions. MATERIALS AND METHODS In the first group (39 cases), patients were treated by means of computer-aided design/computer-aided manufacturing (CAD/CAM) milled individual implants made of ultra-high-molecular-weight polyethylene, dioxide zirconium and rapid prototyping titanium mesh pre-bent on an ABS model made by a three-dimensional (3D) printer. In the second group (54 cases), intraoperative bending of titanium mesh was implemented. RESULTS Ophthalmologic outcomes were the same in both groups. In patients who had greater destruction of the orbit, surgical procedures were longer regardless of the material used for individual implants (p < 0.05). Time of surgery was shorter in patients in whom individual implants were used. Intraoperative bleeding was higher in patients who were treated using intraoperative bending titanium mesh (p < 0.01). CONCLUSION Application of CAD/CAM techniques do not give better ophthalmologic results in reference center but improve patient condition postoperatively. For this reason, CAD/CAM is a safer treatment method for patients.
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Affiliation(s)
- Rafał Zieliński
- Department of Maxillofacial Surgery (Head: Prof. Marcin Kozakiewicz, DDS), Medical University of Lodz, 1st Haller pl., 90-647 Lodz, Poland.
| | | | - Marcin Kozakiewicz
- Department of Maxillofacial Surgery (Head: Prof. Marcin Kozakiewicz, DDS), Medical University of Lodz, 1st Haller pl., 90-647 Lodz, Poland
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Park IH, Lee HM, Yanagi K. Endoscopic transantral and transnasal repair of orbital floor fracture with the ballooning technique, and classification and characterization of orbital floor fractures. Am J Rhinol Allergy 2016; 29:445-8. [PMID: 26637585 DOI: 10.2500/ajra.2015.29.4222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The level of difficulty during an endoscopic approach for an inferior orbital fracture depends on the fracture pattern and the presence of a ruptured membrane (orbital periosteum and sinus mucosa). The purpose of our study was to examine fracture patterns according to age group and to determine the relationship between the type of fracture and the type of membrane injury. METHODS We reviewed the records of 30 patients who, from 2006 to 2010, underwent endoscopic transantral and transnasal approach with a balloon catheter technique to repair orbital floor fracture. The procedure was done through middle or inferior meatal antrostomy and two small antrostomies made in the anterior wall of the maxillary sinus by using an endoscope and specially designed curved dissectors. RESULTS There were 3 linear, 20 trapdoor-type and 7 blowout fractures. There was a tendency toward a higher incidence of linear fractures at younger ages and of blowout fractures in older patients. All linear fractures had rupture of both membranes, whereas both membranes were intact in 15 of the 20 patients with trapdoor fractures. Among blowout fractures, there was no membrane rupture in five and both membranes were ruptured in two patients. No patient reported diplopia after fracture repair. CONCLUSIONS Rupture of the periosteum, which makes visualization and reduction of orbital tissue difficult for the surgeon during endoscopic repair of the orbital floor fracture, was observed in 3 of 3 linear fractures and 5 of 20 trapdoor fractures. We found that linear fractures were more common in pediatric patients. Care of pediatric orbital floor fracture requires particular caution.
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Affiliation(s)
- Il-Ho Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
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Abstract
Orbital emphysema is typically a benign condition that occurs following forceful injection of air into the orbital soft tissue spaces. In many cases there is a history of trauma and fracture of an orbital bone, which permits air entry. However, other mechanisms of orbital emphysema have been reported including infection, pulmonary barotrauma, injury from compressed-air hoses, and complications from surgery including dental procedures. Here, we describe a report of a teenager who suffered an isolated medial orbital wall fracture while playing basketball, and several hours later developed orbital emphysema acutely after sneezing. We will review the radiological evaluation of orbital fractures and emphysema.
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Satyarthee GD, Sharma BS. Posttraumatic orbital emphysema in a 7-year-old girl associated with bilateral raccoon eyes: Revisit of rare clinical emergency, with potential for rapid visual deterioration. J Pediatr Neurosci 2015; 10:166-8. [PMID: 26167226 PMCID: PMC4489066 DOI: 10.4103/1817-1745.159199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Orbital emphysema is usually considered as self-limiting condition, rarely carries a risk of vision loss as catastrophic consequences due to occlusion of the central retinal artery. It can occur as a consequence of head trauma associated with fracture of the orbit, previous surgery, infection or exposure to high-pressure air jet. Authors report an interesting 7-year-old girl who presented with proptosis of left eye, associated with swelling of eyelids of both eyes. Computerized tomography scan head and orbit revealed orbital emphysema in the left eye with fracture of medial wall of left orbit and fracture of orbit roof with small pneumocephalus over left basifrontal region. Fortunately, she responded well to conservative therapy. Current article reminds uncommon condition to prevent potential visual loss, describing briefly management options.
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Affiliation(s)
| | - B S Sharma
- Department of Neurosurgery, Neurosciences Centre, AIIMS, New Delhi, India
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Orbital fractures in children: A review of outcomes. Br J Oral Maxillofac Surg 2013; 51:789-93. [DOI: 10.1016/j.bjoms.2013.05.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 05/12/2013] [Indexed: 11/21/2022]
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Mukherjee CG, Mukherjee U. Maxillofacial trauma in children. Int J Clin Pediatr Dent 2012; 5:231-6. [PMID: 25206176 PMCID: PMC4155887 DOI: 10.5005/jp-journals-10005-1174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/15/2012] [Indexed: 11/24/2022] Open
Abstract
Pediatric trauma involving the bones of the face is associated with severe injury and disability. Although much is known about the epidemiology of facial fractures in adults, little is known about injury patterns and outcomes in children. The most common facial fractures were mandible, nasal and maxillary/zygoma. The most common mechanisms of injury are motor vehicle collisions, violence and falls. These fracture patterns and mechanisms of injury varies with age. Cranial and central facial injuries are more common among toddlers and infants, and mandible injuries are more common among adolescents. Although bony craniofacial trauma is relatively uncommon among the pediatric population, it remains a substantial source of mortality, morbidity and hospital admissions. Continued efforts toward injury prevention are warranted. An overview of various types of fractures and their management modalities is discussed, with case reports. How to cite this article: Mukherjee CG, Mukherjee U. Maxillofacial Trauma in Children. Int J Clin Pediatr Dent 2012;5(3):231-236.
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Affiliation(s)
- Chitrita Gupta Mukherjee
- Professor, Department of Pedodontia, Buddha Institute of Dental Sciences and Hospital, Gandhi Nagar, Kankarbagh, Patna-800020, Bihar India, e-mail:
| | - Uday Mukherjee
- Professor, Department of Oral and Maxillofacial Surgery, Buddha Institute of Dental Sciences and Hospital, Kankarbagh, Patna, Bihar, India
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Roul-Yvonnet F, Tabchouri N, Cassier S, Constantinescu G, Vazquez MP, Picard A, Kadlub N. [Children orbital floor fracture: retrospective study, about 34 cases]. ANN CHIR PLAST ESTH 2012; 57:240-4. [PMID: 22575771 DOI: 10.1016/j.anplas.2012.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Orbital fractures represent 30 % of children facial fractures. Nausea and vomiting are more predictive of entrapment than local trauma stigmatisms. Entrapment and diplopia are more frequent in adults. Delay for surgery is unclear in literature varying from 6 hours to days. The aim of this study is to summarise the aspects of orbital floor fractures in children with regard to clinical and radiological presentation, management, and outcomes. PATIENTS AND METHODS We conducted a retrospective study including 34 children presenting isolated orbital floor fracture. Clinical, radiological, ophthalmological, surgical data and outcomes were analyzed. RESULTS Mean age was 9.4 years. In 15% of cases, no local stigmatism of trauma was present. Entrapment fracture was the most frequent, with 81% of fat or muscles entrapment. In all, 27% of the patient had residual diplopia. Residual diplopia developed after trap-door fracture with muscle entrapment and a more than 24 hours delay for surgery. CONCLUSION Trap-door fracture is frequent in childhood population. Clinical diagnosis can be difficult. However, surgical treatment should be considered before 24 hours to avoid complication as residual diplopia.
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Affiliation(s)
- F Roul-Yvonnet
- Service de chirurgie maxillo-faciale et chirurgie plastique, hôpital d'enfants Armand-Trousseau, groupe hospitalier HUEP, 26 avenue du Docteur-Arnold-Netter, Paris cedex 12, France
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Wei LA, Durairaj VD. Pediatric orbital floor fractures. J AAPOS 2011; 15:173-80. [PMID: 21596296 DOI: 10.1016/j.jaapos.2011.02.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 01/25/2011] [Accepted: 02/05/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To summarize the unique aspects of orbital floor fractures in children with regard to clinical presentation, management, and outcomes. METHODS MEDLINE was searched using PubMed for English-language articles on orbital floor fractures in children. All 154 indexed articles pertaining to floor fractures in patients under 18 years of age in PubMed were reviewed. Studies looking at primarily complex fractures and case reports and studies that included pediatric patients but did not analyze them separately were excluded. Overall, 25 studies were included for the review. RESULTS Inferior trapdoor fractures with muscle and soft tissue incarceration are the most common type of orbital fracture in children (27.8%-93%). They often present uniquely with severely restricted extraocular motility and diplopia (44%-100%), nausea and vomiting (14.7-55.6%), and minimal signs of external trauma. The majority of studies (83%) that analyzed time to surgery in relation to outcomes found that children who present early after initial injury and undergo prompt surgical repair appear to recover faster and have better postoperative motility than those receiving delayed treatment. CONCLUSIONS Our understanding of pediatric orbital floor fractures continues to evolve. For young patients with symptomatic diplopia with positive forced ductions, soft tissue entrapment confirmed by computed axial tomography, and/or trapdoor fracture plus restricted ocular movement, having surgery within 2-5 days has been shown to result in better postoperative outcomes. It is recommended that surgery be considered within 48 hours of diagnosis. Long-term prospective studies are still needed to further characterize orbital floor fractures in children.
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Affiliation(s)
- Leslie A Wei
- Department of Ophthalmology, University of Colorado, School of Medicine, Denver Colorado, USA
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Guyot L, Lari N, Benso-Layoun C, Denis D, Chossegros C, Thiery G. [Orbital fractures in children]. J Fr Ophtalmol 2011; 34:265-74. [PMID: 21420194 DOI: 10.1016/j.jfo.2010.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 11/04/2010] [Indexed: 11/29/2022]
Abstract
The aim of this article is to review data concerning paediatric orbital fractures. These fractures exhibit strong specificities because they occur in a growing face. Due to the craniofacial growing pattern and the peumatization of paranasal sinuses, there are differences in the anatomical location of orbital fracture with the age: before the age of seven they are mostly orbital roof and after seven they involve the orbital floor. The clinical diagnosis is confirmed with a computed tomography scan (CT scan), gold standard for the imaging in the orbital fractures. The magnetic resonance imaging (MRI) offers a better soft-tissue depiction and is useful when clinical data are not consistent with CT scan findings. The orbital fractures in children are rarely operated. In emergency the main surgical indications are the trap-door fracture involving the ocular muscles and the compressive haematomas. We hypothesize that the periosteum more likely than the bony structure is involved in the responsible trap-door fractures: the thickness and the elasticity of the periosteum leads to reposition the floor or the medial wall of the orbit to its initial position.
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Affiliation(s)
- L Guyot
- Service de chirurgie maxillofaciale et plastique de la face, CHU Nord, chemin des Bourrely, 13015 Marseille, France.
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Iatrou I, Theologie-Lygidakis N, Tzerbos F. Surgical protocols and outcome for the treatment of maxillofacial fractures in children: 9 years' experience. J Craniomaxillofac Surg 2010; 38:511-6. [DOI: 10.1016/j.jcms.2010.02.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 01/28/2010] [Accepted: 02/05/2010] [Indexed: 12/01/2022] Open
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Parbhu KC, Galler KE, Li C, Mawn LA. Underestimation of Soft Tissue Entrapment by Computed Tomography in Orbital Floor Fractures in the Pediatric Population. Ophthalmology 2008; 115:1620-5. [PMID: 18440640 DOI: 10.1016/j.ophtha.2008.02.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2006] [Revised: 02/05/2008] [Accepted: 02/26/2008] [Indexed: 11/17/2022] Open
Affiliation(s)
- Keshini C Parbhu
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee 37203, USA
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