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Lee JH, Ryu JY, Lee JS, Yang JD, Chung HY, Cho BC, Choi KY. Treatment of Sagittal Fracture of the Zygomatic Arch Root. J Craniofac Surg 2023; 34:2252-2256. [PMID: 37485955 DOI: 10.1097/scs.0000000000009534] [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: 11/07/2022] [Accepted: 05/20/2023] [Indexed: 07/25/2023] Open
Abstract
A sagittal fracture at the temporal root of the zygomatic arch (ZAR) often occurs as a component of zygomaticomaxillary complex (ZMC) fractures. However, this area is difficult to access, and anchorage is limited due to the unstable structure around it. Therefore, a preauricular approach using single-screw fixation is proposed, and this study reports its results and usefulness. Forty-four patients with sagittal fractures of ZAR occurring with ZMC fractures were evaluated from 2012 to 2021. Open reduction and internal fixation were performed on all patients with ZMC fractures. Closed reduction using Dingman incision and external finger pressure in group A (indirect approach; 30 patients) and single-screw fixation using a preauricular approach in group B (direct approach; 14 patients) were performed to address sagittal fractures in ZAR. For single-screw fixation, the additional mean operation time was 11.34±3.25 minutes. On postoperative 3-dimensional computed tomography and plain radiographs, group B showed more accurate reduction and less deformity and trismus ( P <0.05). Moreover, a normal diet was initiated more quickly in group B than in group A ( P <0.05). Some cases in group A showed nonunion or malunion. This study revealed that a direct approach (group B) toward sagittal fractures of ZAR is recommended due to more accurate results and fewer complications than those observed with the indirect approach (group A). Moreover, the total operation time and complications may be lesser than those with the bicoronal approach.
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Affiliation(s)
- Jung Ho Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
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Yu Y, Zhang W, Sun Q, Peng X. Modified individualized titanium mesh in orbital floor reconstruction for preventing exposure. Laryngoscope Investig Otolaryngol 2023; 8:1196-1202. [PMID: 37899872 PMCID: PMC10601557 DOI: 10.1002/lio2.1148] [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] [Received: 07/07/2022] [Revised: 05/12/2023] [Accepted: 05/26/2023] [Indexed: 10/31/2023] Open
Abstract
Objective To describe a novel method of medial fixation of titanium mesh with a right-angled screwdriver for orbital floor and maxillary reconstruction and to compare the reconstruction outcome of orbital floor reconstruction with modified and traditional methods. Methods The data of 23 patients who underwent maxillectomy and orbital floor defect reconstruction by individualized titanium mesh in Peking University School and Hospital of Stomatology between 2018 and 2021 were retrospectively reviewed. While eight patients received modified orbital floor reconstruction with titanium mesh and angled screwdriver (group A), 15 patients received traditional orbital floor reconstruction (group B). The contact area with buccal flap for titanium mesh in groups A and B was calculated. Titanium mesh deformation, fracture or exposure was recorded. Postoperative ophthalmic function and success of esthetic restoration were assessed. Results Mean follow-up was for 15.7 months (range, 9-22 months). The contact area with buccal flap for the modified titanium mesh in group A (13.11 ± 1.41 cm2) was significantly less than that of the traditional titanium mesh in group B (21.83 ± 1.23 cm2; p < .05). The exposure of titanium mesh occurred in two patients in group B. The self-evaluation of facial symmetry for 23 patients showed no significant difference between group A (7.75 ± 0.71) and group B (6.68 ± 1.30; p > .05). No specific complications were reported. Conclusion We propose a novel method of zygomatic medial fixation of titanium mesh with a right-angled screwdriver for orbital floor and maxillary reconstruction, which has the potential to prevent the postoperative exposure of titanium mesh. Level of Evidence Level III (Retrospective comparative study).
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Affiliation(s)
- Yao Yu
- Department of Oral and Maxillofacial SurgeryPeking University School and Hospital of StomatologyBeijingChina
| | - Wen‐Bo Zhang
- Department of Oral and Maxillofacial SurgeryPeking University School and Hospital of StomatologyBeijingChina
| | - Qian Sun
- Department of Oral and Maxillofacial SurgeryPeking University School and Hospital of StomatologyBeijingChina
| | - Xin Peng
- Department of Oral and Maxillofacial SurgeryPeking University School and Hospital of StomatologyBeijingChina
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Han C, Zhang X, Li K, Huang D, Liu L. Application of customized integration titanium mesh in the treatment of complicated zygomatic complex fractures: A prospective randomized clinical study. J Craniomaxillofac Surg 2022; 50:304-309. [PMID: 35341692 DOI: 10.1016/j.jcms.2022.03.004] [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: 03/26/2021] [Revised: 01/11/2022] [Accepted: 03/15/2022] [Indexed: 02/07/2023] Open
Abstract
The present study aimed to quantitatively evaluate the outcomes of the application of customized integration titanium mesh (CITM) in treating unilateral complicated zygomatic complex fractures. A prospective, randomized, controlled clinical study was conducted. Patients were randomly divided into the experimental group who underwent treatment with CITM, and the control group who underwent treatment just with traditional titanium plates. The X2 test and student t-test were used for statistical analyses. Twenty patients who required surgery for unilateral complicated zygomatic complex fracture were included in this study. The results showed that the mean of average distance (AD) between pre- and postoperative CT measurements was 0.487 mm in the experimental group and 1.173 mm in the control group (P < 0.001). Compared with the control group, the experimental group had superior zygomatico-facial symmetry (P<0.05), a shorter average operation time (150 min versus 229 min; P < 0.001), and a higher rate of anatomic reduction (80.0% versus 30.0%; P<0.05). In conclusion, CITM deserves to be promoted for the treatment of complicated zygomatic complex fractures. TRIAL REGISTRATION: www.chictr.org.cn (ChiCTR1800016818).
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Affiliation(s)
- Chaoying Han
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China; The Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, PR China
| | - Xiao Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China
| | - Kaide Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China
| | - Dou Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China
| | - Lei Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China.
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Sivam A, Enninghorst N. The Dilemma of Reconstructive Material Choice for Orbital Floor Fracture: A Narrative Review. MEDICINES 2022; 9:medicines9010006. [PMID: 35049939 PMCID: PMC8778999 DOI: 10.3390/medicines9010006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/06/2022] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
Abstract
The aim of this study is to present a narrative review of the properties of materials currently used for orbital floor reconstruction. Orbital floor fractures, due to their complex anatomy, physiology, and aesthetic concerns, pose complexities regarding management. Since the 1950s, a myriad of materials has been used to reconstruct orbital floor fractures. This narrative review synthesises the findings of literature retrieved from search of PubMed, Web of Science, and Google Scholar databases. This narrative review was conducted of 66 studies on reconstructive materials. Ideal material properties are that they are resorbable, osteoconductive, resistant to infection, minimally reactive, do not induce capsule formation, allow for bony ingrowth, are cheap, and readily available. Autologous implants provide reliable, lifelong, and biocompatible material choices. Allogenic materials pose a threat of catastrophic disease transmission. Newer alloplastic materials have gained popularity. Consideration must be made when deliberating the use of permanent alloplastic materials that are a foreign body with potential body interactions, or the use of resorbable alloplastic materials failing to provide adequate support for orbital contents. It is vital that surgeons have an appropriate knowledge of materials so that they are used appropriately and reduce the risks of complications.
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Affiliation(s)
- Akash Sivam
- Oral and Maxillofacial Surgery Department, Royal Hobart Hospital, Hobart, TAS 7000, Australia
- Correspondence: ; Tel.: +61-43-322-9835
| | - Natalie Enninghorst
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia;
- Royal Newcastle Centre, John Hunter Hospital, Newcastle, NSW 2310, Australia
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Moura LB, Jürgens PC, Gabrielli MAC, Pereira Filho VA. Dynamic three-dimensional finite element analysis of orbital trauma. Br J Oral Maxillofac Surg 2020; 59:905-911. [PMID: 34281736 DOI: 10.1016/j.bjoms.2020.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/15/2020] [Indexed: 11/27/2022]
Abstract
This study comprises a dynamic finite element (FE) analysis of the mechanisms of orbital trauma, specifically buckling and hydraulic theories. A digital model of the orbital cavity - including the eyeball, fatty tissue, extraocular muscles, and the bone orbit - was created from magnetic resonance imaging and computed tomographic data from a real patient. An impactor hit the FE model following two scenarios: one was a hydraulic mechanism for direct impact to the eyeball and the other a buckling mechanism for direct impact over the infraorbital rim. The first principal stress was calculated to determine the stress distribution over the orbital walls. The FE model presented more than 900,000 elements and time of simulation was 4.8 milliseconds (ms) and 0.6 ms, for the hydraulic and buckling mechanisms, respectively. The stress distribution in the hydraulic mechanism affected mainly the medial wall with a high stress area of 99.08 mm2, while the buckling mechanism showed a high stress area of 378.70 mm2 in the orbital floor. The presence of soft tissue absorbed the energy, especially in the hydraulic mechanism. In conclusion, the applied method of segmentation allowed the construction of a complete orbital model. Both mechanisms presented results that were similar to classic experiments. However, the soft tissue in the hydraulic mechanism absorbed the impact, demonstrating its role in orbital pathophysiology.
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Affiliation(s)
- L B Moura
- Catholic University of Pelotas, Pelotas, RS, Brazil; School of Dentistry, São Paulo State University (Unesp), Araraquara, Brazil; Department of Cranio-Maxillofacial Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - P C Jürgens
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - M A C Gabrielli
- School of Dentistry, São Paulo State University (Unesp), Araraquara, Brazil.
| | - V A Pereira Filho
- School of Dentistry, São Paulo State University (Unesp), Araraquara, Brazil.
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Abstract
Purpose: Vision loss after orbital surgery is one of the most dreaded complications faced by the orbitofacial surgeon. This literature review was conducted in an attempt to determine the risk factors for severe vision loss and discuss the applied anatomy related to various types of orbital surgery - orbital tumor excisions, orbital decompression, and post-traumatic orbital reconstruction.Methods: A literature search was conducted via PubMed and Google Scholar. All cases of vision loss following orbital tumor biopsy or excision, orbital decompression, and orbital trauma reconstruction were reviewed.Results: The incidence of postoperative blindness appears to be more after orbital tumor excisions (4.7%), compared to post-traumatic orbital reconstruction (2.08%) and orbital decompressions for thyroid orbitopathy (0.15%).The causes of vision loss include ischemic optic neuropathy, traumatic optic neuropathy, retinal and ophthalmic artery occlusions, and orbital compartment syndrome.Conclusion: Apart from careful patient selection, proper counseling about the risk of postoperative blindness is of utmost importance. Detailed preoperative treatment planning, meticulous atraumatic intraoperative dissection under direct visualization, with attention to the danger zones and vital structures, close intraoperative and postoperative monitoring, and urgent management of potentially reversible compressive causes of vision loss can improve outcomes.
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Affiliation(s)
- Prerana Kansakar
- Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital Singapore, Singapore.,Department of Ophthalmology, Grande International Hospital, Kathmandu, Nepal
| | - Gangadhara Sundar
- Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore
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Kang YF, Liang J, He Z, Zhang L, Shan XF, Cai ZG. Orbital floor symmetry after maxillectomy and orbital floor reconstruction with individual titanium mesh using computer-assisted navigation. J Plast Reconstr Aesthet Surg 2019; 73:337-343. [PMID: 31477492 DOI: 10.1016/j.bjps.2019.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/24/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The present study aimed to evaluate the symmetry of the orbital floor after maxillectomy and orbital floor reconstruction with individual titanium mesh using a computer-assisted navigation system. PATIENTS AND METHODS Nineteen patients who underwent orbital floor reconstruction with individual titanium mesh were included in this study. Postoperative computed tomography scans recorded after three-dimensional (3D) reconstruction were used to evaluate the symmetry of the orbital floor, including orbital floor height, orbital floor eminence, globe projection, orbital volume, and surface deviation. RESULTS The average orbital floor height of the reconstructed and the unaffected side was 37.7 ± 2.3 and 37.8 ± 2.7 mm, respectively (P = .47). The average orbital floor eminence of the reconstructed and the unaffected side was 40.1 ± 5.5 and 39.6 ± 5.3 mm, respectively (P = .17). The average globe projection of the reconstructed and the unaffected side was 15.5 ± 3.2 and 15.3 ± 3.0 mm, respectively (P = .27). The average orbital volume of the reconstructed and the unaffected side was 25.9 ± 4.4 and 26.3 ± 4.4 cm3, respectively (P = .29). Repeatability between the reconstructed and the unaffected side was 88.3% ± 2.6% at within 1 mm and 98.6% ± 0.9% at within 2 mm. The average of maximum deviation was 2.4 ± 0.2 mm. CONCLUSION Individual titanium mesh is one of the best techniques for orbital floor reconstruction, as it can be placed precisely and helps achieve desirable esthetic outcomes through virtual surgical planning and using a computer-assisted navigation system.
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Affiliation(s)
- Yi-Fan Kang
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, #22 Zhongguancun Avenue South, Haidian District, Beijing 100081, PR China
| | - Jie Liang
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, #22 Zhongguancun Avenue South, Haidian District, Beijing 100081, PR China
| | - Zheng He
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, #22 Zhongguancun Avenue South, Haidian District, Beijing 100081, PR China
| | - Lei Zhang
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, #22 Zhongguancun Avenue South, Haidian District, Beijing 100081, PR China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, #22 Zhongguancun Avenue South, Haidian District, Beijing 100081, PR China.
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, #22 Zhongguancun Avenue South, Haidian District, Beijing 100081, PR China.
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Kuusisto N, Huumonen S, Kotiaho A, Haapea M, Rekola J, Vallittu P. Intensity of artefacts in cone beam CT examinations caused by titanium and glass fibre-reinforced composite implants. Dentomaxillofac Radiol 2019; 48:20170471. [PMID: 30084258 PMCID: PMC6476382 DOI: 10.1259/dmfr.20170471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 07/16/2018] [Accepted: 08/01/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES: The aim was to compare titanium and glass fibre-reinforced composite (FRC) orbital floor implants using cone beam CT (CBCT). FRC implants are nonmetallic and these implants have not been analysed in CBCT images before. The purpose of this study is to compare the artefact formation of the titanium and the FRC orbital floor implants in CBCT images. METHODS: One commercially pure titanium and one S-glass FRC with bioactive glass particles implant were imaged with CBCT using the same imaging values (80 kV, 1 mA, FOV 60 × 60 mm). CBCT images were analysed in axial slices from three areas to determine the magnitude of the artefacts in the vicinity of the implants. Quantified results based on the gray values of images were analysed using analysis-of-variance. RESULTS: Compared to the reference the gray values of the titanium implant are more negative in every region of interest in all slices (p < 0.05) whereas the gray values of the FRC implant differ statistically significantly in less than half of the examined areas. CONCLUSIONS: The titanium implant caused artefacts in all of the analysed CBCT slices. Compared to the reference the gray values of the FRC implant changed only slightly and this feature enables to use wider imaging options postoperatively.
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Affiliation(s)
| | | | | | | | - Jami Rekola
- Department of Otorhinolaryngology, Turku University Hospital, Turku, Finland
| | - Pekka Vallittu
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre – TCBC, Institute of Dentistry and BioCity, University of Turku and City of Turku, Welfare Division, Turku, Finland
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Clinical Utility of Postoperative Computed Tomography Imaging in Orbital Floor Fracture Management. Ann Plast Surg 2019; 83:43-47. [DOI: 10.1097/sap.0000000000001777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fu K, Liu Y, Gao N, Cai J, He W, Qiu W. Reconstruction of Maxillary and Orbital Floor Defect With Free Fibula Flap and Whole Individualized Titanium Mesh Assisted by Computer Techniques. J Oral Maxillofac Surg 2017; 75:1791.e1-1791.e9. [PMID: 28463685 DOI: 10.1016/j.joms.2017.03.054] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We sought to investigate the clinical application of free fibula flap and individualized titanium mesh through the use of a virtual planning and guiding template to assist the reconstruction of maxilla and orbital floor defects. PATIENTS AND METHODS Between 2015 and 2016, a total of 6 adult patients with maxillary and orbital floor defects were enrolled in this study. Preoperative virtual planning, including virtual maxillary resection and fibular reconstruction, was performed in all cases according to 3-dimensional radiographic and clinical findings. A 3-dimensionally printed resin model and prebent templates were used to guide the harvesting and positioning of the fibula flap during surgery. Then, an individualized titanium mesh was used to support the orbital floor and restore the maxillary contour. The results were confirmed by postoperative computed tomography scans and clinical follow-up. RESULTS Preoperative virtual planning and prebent templates can be used to guide the harvesting and positioning of the fibula flap, as well as the forming and positioning of the individualized titanium mesh, with satisfactory results. All flaps survived, and symmetrical facial contours were achieved with normal lower jaw movement and proper vertical distance for dental implants in all patients. CONCLUSIONS Computer-aided techniques such as virtual planning, 3-dimensionally printed models, and prebent guide templates can be used to harvest and position a free fibula flap, form personalized titanium mesh, and ultimately improve the clinical efficacy of maxillary and orbital floor reconstruction.
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Affiliation(s)
- Kun Fu
- Attending, Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yiming Liu
- Attending, Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ning Gao
- Attending, Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinghua Cai
- Resident, Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei He
- Professor and Department Head, Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weiliu Qiu
- Professor and Academician Expert, Department of Stomatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; and Academician Expert Workstation of Head and Neck Tumor of Henan Province, Department of Oral & Maxillofacial Surgery, Ninth People's Hospital, and School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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de Moraes Ferreira ACR, Muñoz XMJP, Okamoto R, Pellizer EP, Garcia IR. Postoperative Complications in Craniomaxillofacial Reconstruction With Medpor. J Craniofac Surg 2016; 27:425-8. [PMID: 26963299 DOI: 10.1097/scs.0000000000002325] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Bone reconstruction in craniofacial surgery is a challenge for surgeons, who most commonly adopt the autogenous bone grafting and alloplastic implants in such procedures. Among the alloplastic materials, the high-density porous polyethylene is highlighted-Medpor (Medpor, Porex Surgical Inc, Newman, GA), considered to be pure polyethylene, with only 1 manufacturing process and standard pore size. The purpose of the current study has been to present through a review of literature and the types of complications derived from the use of Medpor in craniomaxillofacial bone surgery. A specific and sensitive database was initially created via PubMed, focusing on studies published in English peer-reviewed journals between 2004 and 2014, including case reports, experimental studies in humans, and prospective and retrospective studies. Forty articles were found at PubMed database. After analyzing their abstracts, 19 were selected, totaling 1453 patients and 121 complications, being the most commonly reported diplopia with 56 patients and infection with 6 patients. Most of the complications reported in the articles used for the development of the current review are not directly related to the use of the Medpor implant. The only complications directly related to the use of this biomaterial were cases of infection.
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Affiliation(s)
- Ana Carulina Rezende de Moraes Ferreira
- *São Paulo State University †College of Dentistry ‡Department of Dental Materials and Prosthodontics at the State University of São Paulo (UNESP) - College of Dentistry, São Paulo, Brazil
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12
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Johari M, Ghavimi MA, Mahmoudian H, Javadrashid R, Mirakhor Samani S, Fouladi DF. A comparable study of the diagnostic performance of orbital ultrasonography and CBCT in patients with suspected orbital floor fractures. Dentomaxillofac Radiol 2016; 45:20150311. [PMID: 27074346 DOI: 10.1259/dmfr.20150311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES: To compare the diagnostic performance of ultrasonography and CBCT against CT in detecting orbital floor fractures. METHODS: A total of 120 orbits with clinical suspicion of isolated orbital floor fractures underwent multislice CT scanning with coronal reconstruction; orbital ultrasonography using a standard machine equipped with a 7- to 10-MHz linear transducer; and CBCT. Patients with severe head and face injuries were not included. The diagnostic performance of ultrasonography and CBCT was reported assuming conventional CT as the imaging method of choice. RESULTS: According to CT findings, fractures of the floor were present in 39 orbits. The sensitivity, specificity, positive-predictive value and negative-predictive value of ultrasonography in detecting orbital floor fractures were 87.2%, 100%, 100% and 94.2%, respectively. The corresponding values for CBCT were 97.4%, 97.5%, 95.0%, and 98.8%, respectively. Areas under the receiver operator characteristics curves of orbital floor fracture detection were 0.94 for ultrasonography and 0.98 for CBCT. CONCLUSIONS: When conventional CT cannot be performed in patients with clinically suspected orbital floor fracture and no severe or complex head and face injuries, CBCT could be used in detecting fractures as a reliable surrogate. Because of a lower sensitivity of ultrasonography, however, its use is limited in this regard.
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Affiliation(s)
- Masoumeh Johari
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Mohammad Ali Ghavimi
- 2 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Hediyeh Mahmoudian
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Reza Javadrashid
- 3 Department of Radiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Simin Mirakhor Samani
- 4 Department of Pathology, Qazvin University of Medical Sciences, Qazvin, Islamic Republic of Iran
| | - Daniel F Fouladi
- 5 Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
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Welman T, Shanmugarajah K, Sabah S, Bryan J, Hachach-Haram N, Segaren N, Collier J. Assessment of Emergency Department Eye Examinations in Patients Presenting with Mid-Face Injury. J Emerg Med 2015; 50:422-6. [PMID: 26443644 DOI: 10.1016/j.jemermed.2015.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/21/2015] [Accepted: 07/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND One-fifth of patients with severe facial trauma suffer ophthalmic injury. Currently, patients presenting with mid-face injury to the emergency department (ED) undergo visual examination and then further assessment by ophthalmologists and with computed tomography (CT) scanning. The utility of the initial visual examination in the ED, performed by nonophthalmologists, remains unclear. OBJECTIVE We aimed to objectively identify whether a more thorough initial visual assessment, performed by nonophthalmologists in the ED, was associated with improved ophthalmic outcomes. METHODS Patients (n = 100) were retrospectively recruited from a tertiary craniomaxillofacial center. Visual examinations performed in the ED were scored objectively and measured against defined management and prognostic outcomes. RESULTS There was no significant difference between more thorough initial visual examination and reduced time to ophthalmology assessment or reduced visual complications. There was no correlation between more comprehensive examination and incidence of CT scanning. CONCLUSIONS We identified no significant difference between a comprehensive visual examination performed by nonophthalmologists in the ED, and improved ophthalmic outcomes. Physicians assessing patients with mid-face trauma in the ED should rule out eye emergencies, including retrobulbar hemorrhage and penetrating globe injury, and initiate expeditious CT scan and assessment by specialist ophthalmologists.
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Affiliation(s)
- Ted Welman
- Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK
| | - Kumaran Shanmugarajah
- Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK
| | - Shiraz Sabah
- Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK
| | - James Bryan
- Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK
| | - Nadine Hachach-Haram
- Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK
| | - Nicholas Segaren
- Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK
| | - Jonathan Collier
- Department of Craniomaxillofacial Surgery, Chelsea and Westminster Hospital, London, UK
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GIARDA M, TAVOLACCINI A, ARCURI F, BRUCOLI M, BENECH A. Surgical approach to isolated bilateral orbital floor fractures. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2015; 35:362-4. [PMID: 26824920 PMCID: PMC4720928 DOI: 10.14639/0392-100x-90612] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 10/05/2012] [Indexed: 11/29/2022]
Abstract
Isolated bilateral orbital floor fractures are uncommon and are rarely described in the scientific literature. They are usually seen in association with naso-ethmoidal fractures, zygomatic fractures, or fractures of the middle third. We report our experience in the management of a patient presenting bilateral isolated orbital floor fracture. The difficulties in management of these fractures are due to the lack of an uninjured contralateral side for intraoperative comparison.
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Affiliation(s)
- M. GIARDA
- Resident Department of Maxillo-Facial Surgery, Azienda Ospedaliera Maggiore della Carità, University of Piemonte Orientale "Amedeo Avogadro", Novara, Italy
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Vaibhav N, Keerthi R, Nanjappa M, Ashwin DP, Reyazulla MA, Gopinath AL, Ghosh A. Comparison of 'sutureless' Transconjunctival and Subciliary Approach for Treatment of Infraorbital Rim Fractures: a Clinical Study. J Maxillofac Oral Surg 2015; 15:355-362. [PMID: 27752207 DOI: 10.1007/s12663-015-0835-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 07/30/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The aim of the study is to compare subciliary incision and 'sutureless' transconjunctival incision in the treatment of infraorbital rim fractures. MATERIALS AND METHOD In this prospective study, 40 patients with fractures of the infraorbital rim were selected and divided into 2 groups using random sampling technique. Group A patients were treated using 'sutureless' transconjunctival technique and group B patients were treated using subciliary approach. The following parameters were compared a) time taken, intraoperative ease of access, exposure achieved; b) clinical outcome and postoperative complications; c) Aesthetic outcome at intervals of 15 days, 1 month and 3 months. RESULTS Total time taken for completion of surgery was lesser in group A patients. The presence of subconjunctival ecchymosis (at 1 month interval) and neurological deficit was found to be statistically significant (P<0.05) in the 'subciliary' group of patients. The transconjunctival approach showed better esthetic results and fewer post-operative complications. CONCLUSION The subciliary approach gives good exposure of the infra-orbital rim and is better suited to reduce extensively displaced fractures of the infra-orbital rim. The transconjunctival approach is comparatively faster, gives better esthetic results and fewer post-operative complications but is technique sensitive and requires an additional lateral canthotomy in cases where more exposure is needed.
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Affiliation(s)
- N Vaibhav
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, K R Road, V V Puram, Bangalore, India ; No. 165, IV Cross, II Main, Chamarajpet, Bangalore, 560018 India
| | - R Keerthi
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, K R Road, V V Puram, Bangalore, India
| | - Madan Nanjappa
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, K R Road, V V Puram, Bangalore, India
| | - D P Ashwin
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, K R Road, V V Puram, Bangalore, India
| | - M A Reyazulla
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, K R Road, V V Puram, Bangalore, India
| | - A L Gopinath
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, K R Road, V V Puram, Bangalore, India
| | - Abhishek Ghosh
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, K R Road, V V Puram, Bangalore, India
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Beck-Broichsitter BE, Acar C, Kandzia C, Jochens A, Wiltfang J, Becker ST. Reconstruction of the orbital floor with polydioxanone: a long-term clinical survey of up to 12 years. Br J Oral Maxillofac Surg 2015; 53:736-40. [PMID: 26051867 DOI: 10.1016/j.bjoms.2015.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 05/13/2015] [Indexed: 11/19/2022]
Abstract
Fractures of the orbital floor are common in injured patients, who often require operation to prevent complications and, among other materials, polydioxanone is widely used. The aim of this study was to evaluate the long-term outcomes of fractures of the orbital floor that had been reconstructed with polydioxanone foil. A total of 101 patients (73 men and 28 women) who had reconstruction of the orbital floor for defects of 2cm(2) or smaller with polydioxanone implants, over a mean (SD) time period of 8 (2) years were evaluated. Sensitivity of the infraorbital nerve, ocular motility, and diplopia were evaluated and correlated with perioperative values. Persistent hyperaesthesia was found in 15 patients, whereas in another 15 the hyperaesthesia recovered completely over time. Three patients had double vision during follow-up. Twenty patients with preoperative diplopia had no persistent double vision postoperatively, and 15 patients with disturbed ocular motility recovered completely. Two patients had persistently disturbed motility, and one patient had enophthalmos. There was a significant association between hyperaesthesia preoperatively and postoperatively (p= 0.005). In most patients reconstruction of the orbital floor with polydioxanone was successful. Long-term complications such as diplopia, compromised bulbar motility, and hyperaesthesia of the cheek were seen in a few cases, but might not have been solely related to the use of polydioxanone.
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Affiliation(s)
| | - Carolin Acar
- Schleswig-Holstein University Hospital, Department of Oral and Maxillofacial Surgery, Arnold-Heller-Straße 3, Haus 26, 24105 Kiel, Germany.
| | - Christian Kandzia
- Schleswig-Holstein University Hospital, Department of Ophthalmology, Arnold-Heller-Straße 3, Haus 25, 24105 Kiel, Germany.
| | - Arne Jochens
- Schleswig-Holstein University Hospital, Institute of Medical Informatics and Statistics, Brunswiker Straße 10, 24105 Kiel, Germany.
| | - Jörg Wiltfang
- University Professor and Head of the Department, Schleswig-Holstein University Hospital, Department of Oral and Maxillofacial Surgery, Arnold-Heller-Straße 3, Haus 26, 24105 Kiel, Germany
| | - Stephan T Becker
- Schleswig-Holstein University Hospital, Department of Oral and Maxillofacial Surgery, Arnold-Heller-Straße 3, Haus 26, 24105 Kiel, Germany.
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Nagaraj V, Ghosh A, Nanjappa M, Ramesh K. 'Sutureless' transconjunctival approach for infraorbital rim fractures. Contemp Clin Dent 2015; 6:S56-8. [PMID: 25821377 PMCID: PMC4374321 DOI: 10.4103/0976-237x.152939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To analyze the ease and surgical outcome of using sutureless transconjunctival approach for repair of infra-orbital fractures. DESIGN Prospective clinical case series. MATERIALS AND METHODS Totally 5 patients with infra-orbital rim or orbital floor fractures were selected and the fractures were accessed through a pre-septal transconjunctival incision. After reduction and fixation, the conjunctiva was just re-approximated and re-draped into position. Incidence of post-operative complications such as diplopia, lid retraction, eyelid dystopia, foreign body granuloma and poor conjunctival healing was assessed at intervals of 1 week, 15 days and a month post-operatively. RESULTS No complications were observed in any of the 5 patients. Healing was satisfactory in all patients. CONCLUSION The sutureless technique appears to be a time saving and technically simpler viable alternative to multilayered suturing in orbital trauma with minimal post-operative complications.
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Affiliation(s)
- Vaibhav Nagaraj
- Department of Oral and Maxillofacial Surgery, V. S. Dental College and Hospital, Bengaluru, Karnataka, India
| | - Abhishek Ghosh
- Department of Oral and Maxillofacial Surgery, V. S. Dental College and Hospital, Bengaluru, Karnataka, India
| | - Madan Nanjappa
- Department of Oral and Maxillofacial Surgery, V. S. Dental College and Hospital, Bengaluru, Karnataka, India
| | - Keerthi Ramesh
- Department of Oral and Maxillofacial Surgery, V. S. Dental College and Hospital, Bengaluru, Karnataka, India
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Garg V, Giraddi GB, Roy S. Comparison of efficacy of mandible and iliac bone as autogenous bone graft for orbital floor reconstruction. J Maxillofac Oral Surg 2014; 14:291-8. [PMID: 26028849 DOI: 10.1007/s12663-014-0654-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 06/23/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE This study evaluated and compared the efficacy of mandible and iliac bone as autogenous bone graft for correction of orbital floor fractures. PATIENTS AND METHODS Twenty patients who suffered orbital floor fractures took part in the study. The subjects enrolled in the study sustained both isolated orbital floor fracture and orbital floor fracture associated with fracture of zygomatico-maxillary complex. Each inferior orbital wall was reconstructed using either a mandible bone graft or an iliac graft. Mandibular symphysis was opted as a donor site for graft harvest from mandible and anterior iliac crest for the iliac group. CT scans were taken before the operation. Inclusion criteria consisted of at least 2 months postsurgical follow-up, pre- and post-surgical photographic documentation, and complete medical records regarding inpatient and outpatient data. To describe the distribution of complications and facilitate statistical analysis, we categorized our findings into diplopia, enophthalmos, and restriction of ocular movements before and after treatment. We also considered the time required for the harvest of the grafts and the donor site complications. A comparative study was carried out using Chi square test and student t test. We considered P value <0.05 to be statistically significant. RESULTS Ten iliac crest grafts and ten mandible bone grafts were placed. The mean age of the patients was 33.1 years. 80 % of the patients were males. The most common complication of orbital floor fracture was diplopia, followed by enophthalmos and restriction of ocular movements. The post operative results were compared after 2 months of the surgery. In iliac crest group, diplopia got corrected in six out of seven patients (85 %), enophthalmos in four out of five patients (80 %) and restricted ocular movement showed 100 % correction. While in mandible group, diplopia and ocular movement showed 100 % correction and enophthalmos got corrected in five out of six patients (83 %). No statistically significant differences were found between the two groups on comparing these variables. On the other hand the mean time required for the harvest of iliac graft and mandible graft was 30.2 ± 3.52 min and 16.8 ± 1.75 min respectively. The difference was statistically significant. CONCLUSION There is no difference in the ability of mandible and anterior iliac crest bone grafts to correct post-traumatic diplopia, enophthalmos and restricted ocular movements. But the time and ease of harvest of the graft from mandible was comparatively less and easy especially when the treating doctor was an oral and maxillofacial surgeon. Secondly the post-operative morbidity was low and the quality and contour of the bone graft was very adaptable for the reconstruction of the orbital floor.
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Affiliation(s)
- Vipul Garg
- Department of Oral and Maxillofacial Surgery, Himachal Institute of Dental Sciences (HIDS), Paonta Sahib, Himachal Pradesh India
| | - Girish B Giraddi
- Department of Oral and Maxillofacial Surgery, Government Dental College and Research Institute, Bangalore Fort, Karnataka India
| | - Swati Roy
- Department of Oral and Maxillofacial Pathology, Himachal Institute of Dental Sciences (HIDS), Paonta Sahib, Himachal Pradesh India
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Abstract
Orbital floor injuries, alone or combination with other facial fractures, are one of the most commonly encountered midface fractures. Techniques for orbital reconstruction have migrated away from autogenous bone grafts to well-tolerated alloplasts, such as titanium and Medpor. Material for reconstructing the orbit can then be selected based on requirements of the defect matched to the mechanical properties of the material. Material selection is largely and ultimately dependent upon surgeon preference.
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Forouzanfar T, Salentijn E, Peng G, van den Bergh B. A 10-year analysis of the "Amsterdam" protocol in the treatment of zygomatic complex fractures. J Craniomaxillofac Surg 2013; 41:616-22. [PMID: 23375533 DOI: 10.1016/j.jcms.2012.12.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 12/10/2012] [Accepted: 12/11/2012] [Indexed: 11/30/2022] Open
Abstract
Despite many publications on the epidemiology, incidence and aetiology of zygomatic complex (ZC) fractures there is still a lack of information about a consensus in its treatment. The aim of the present study is to investigate retrospectively the Amsterdam protocol for surgical treatment of ZC fractures. The 10 years results and complications are presented. The study population consisted of 236 patients (170 males, 66 females, 210 ZC fractures, 26 solitary zygomatic arch fractures) with a mean age of 39.3 (SD: ±15.6) years (range 4-87 years). The mean cause of injury was traffic accident followed by violence and fall. A total of 225 plates and 943 screws were used. Twenty-eight patients presented with complications, including wound infection (9 patients) and transient paralysis of the facial nerve (one patient). Seven patients (2.8%) needed surgical retreatment of whom four patients needed secondary orbital floor reconstruction as these patients developed enophthalmos and diplopia. In conclusion this report provides important data for reaching a consensus for the treatment of these types of fractures.
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Affiliation(s)
- Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology (Head: Tymour Forouzanfar), VU University Medical Center, Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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Yang R, Zhang C, Liu Y, Li Z, Li Z. Why Should We Start From Mandibular Fractures in the Treatment of Panfacial Fractures? J Oral Maxillofac Surg 2012; 70:1386-92. [DOI: 10.1016/j.joms.2011.11.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 11/03/2011] [Accepted: 11/03/2011] [Indexed: 12/01/2022]
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Abstract
Orbital injuries are often missed out when they occur concomitantly with other facial bone fractures. Clinical examination and plain radiographic findings alone may prove inadequate in the detection of orbital floor fractures. Refined imaging techniques like CT scans and MRI are immensely helpful in the diagnosis of orbital blowout fractures. A case of 'impure' orbital blowout fracture which went undetected at the time of initial examination and its secondary surgical reconstruction is reported here. This case report emphasizes the importance of careful clinical and radiologic evaluation in orbital injuries.
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Affiliation(s)
- K P Manoj Kumar
- Department of Oral and Maxillofacial Surgery KMCT Dental College, Kerala, India.
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Luo W, Wang L, Jing W, Zheng X, Long J, Tian W, Liu L. A new coronal scalp technique to treat craniofacial fracture: the supratemporalis approach. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:177-82. [PMID: 22677733 DOI: 10.1016/j.tripleo.2011.01.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 01/15/2011] [Accepted: 01/27/2011] [Indexed: 02/07/2023]
Abstract
OBJECTIVE A new coronal scalp approach, denoted as the supratemporalis approach, was designed to address facial nerve injury induced by the traditional coronal scalp approach. STUDY DESIGN First, the complication rate among 38 cases operated upon with the traditional coronal scalp approach was analyzed retrospectively. Then 40 cases were operated upon using the supratemporalis approach. The rate of complications was recorded. The follow-up periods were 3-17 months. RESULTS The facial contours and functions recovered well after the operation in all 78 cases. Seven cases of facial nerve injury, 1 of which was permanent, were observed in the group treated with the traditional coronal scalp approach. No case of facial nerve injury was observed in the group treated with the supratemporalis approach. CONCLUSIONS The supratemporalis approach prevented facial nerve injury and did not increase the frequency of other complications. It is therefore worthy of application in the clinical setting.
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Affiliation(s)
- Wen Luo
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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24
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Biomaterials and implants for orbital floor repair. Acta Biomater 2011; 7:3248-66. [PMID: 21651997 DOI: 10.1016/j.actbio.2011.05.016] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 04/19/2011] [Accepted: 05/16/2011] [Indexed: 11/23/2022]
Abstract
Treatment of orbital floor fractures and defects is often a complex issue. Repair of these injuries essentially aims to restore the continuity of the orbital floor and to provide an adequate support to the orbital content. Several materials and implants have been proposed over the years for orbital floor reconstruction, in the hope of achieving the best clinical outcome for the patient. Autografts have been traditionally considered as the "gold standard" choice due to the absence of an adverse immunological response, but they are available in limited amounts and carry the need for extra surgery. In order to overcome the drawbacks related to autografts, researchers' and surgeons' attention has been progressively attracted by alloplastic materials, which can be commercially produced and easily tailored to fit a wide range of specific clinical needs. In this review the advantages and limitations of the various biomaterials proposed and tested for orbital floor repair are critically examined and discussed. Criteria and guidelines for optimal material/implant choice, as well as future research directions, are also presented, in an attempt to understand whether an ideal biomaterial already exists or a truly functional implant will eventually materialise in the next few years.
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Poeschl PW, Baumann A, Dorner G, Russmueller G, Seemann R, Fabian F, Ewers R. Functional outcome after surgical treatment of orbital floor fractures. Clin Oral Investig 2011; 16:1297-303. [PMID: 21858424 DOI: 10.1007/s00784-011-0609-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
Abstract
In the present article, the authors want to present the results of a retrospectively evaluated consecutive series of patients with surgically treated isolated orbital floor fractures (OFF; "blow-out fractures") concerning the functional outcome after OFF and give detailed recommendations based on the clinical and radiological findings. A series of 60 patients with isolated OFF over a 5-year period needing surgically repair at the same institution were evaluated. Patient data were analysed in terms of preoperative and postoperative clinical parameters and radiological findings. The analysed parameters were type of fracture, diplopia, gaze restriction, enophthalmos, materials used for repair, surgical approach and timing of the surgical intervention. Burst type fractures were more often found than punched-out fractures. The most frequently used surgical approach was a preseptal transconjunctival approach. An overall decrease of gaze restriction (93%), diplopia (89%) and enophthalmos (86%) was observed. According to the fracture size, we used Ethisorb patches in smaller fractures and resorbable or titanium meshes or autologous bone in larger fractures in most cases. Patients who underwent surgery more than 7 days after the trauma showed better results with regard to an improvement of diplopia and motility disturbances than patients who were treated immediately. In indicated cases, the surgical repair of OFF leads to very good results if the anatomical and functional properties of the orbit and its contents are respected. The applied strategy and means presented in our study proved of value and can therefore be recommended.
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Affiliation(s)
- Paul W Poeschl
- University Hospital for Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria.
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Comparison of the Outcomes of Blowout Fracture Repair According to the Orbital Implant. J Craniofac Surg 2011; 22:1422-5. [DOI: 10.1097/scs.0b013e31821cc2b5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
The aim of this research was to analyze the surgical approaches and methods of rigid fixation used to treat zygomatic complex (ZC) fractures over a 10-year period. One hundred fifty-three patients who underwent surgery to treat ZC fractures between 1999 and 2008 were retrospectively evaluated. Demographic information, signs, and symptoms of the fractures, classification, surgical approaches, and methods of internal fixation were obtained from the medical records. The data were analyzed using statistical descriptive analysis and chi test (P < 0.05). The mean age of the sample was 31 years, and males were predominant (82.3%). In 60.1% of the patients, one surgical approach was used to treat the ZC fractures, whereas 2 surgical approaches were used in 24.8% of the patients. The zygomaticomaxillary buttress was fixed in 86.9% of the patients, followed by infraorbital rim fixation and zygomaticofrontal. There was a statistical significance between fracture displacement and surgical approach for the infraorbital rim (P < 0.0001) and zygomaticofrontal suture (P < 0.0001). Considering that adequate reduction and fixation should be performed and that we try to minimize the amount of scarring, the intraoral zygomaticomaxillary buttress approach is the first choice to treat ZC fractures. In cases of displacement bigger than 5 mm, approaches to 3 of 4 points of the ZC are mandatory to reduce the fractures. The infraorbital rim and zygomaticofrontal suture approaches are indicated to treat displaced fractures.
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Treatment of orbital fractures: evaluation of surgical techniques and materials for reconstruction. J Craniofac Surg 2011; 21:1033-7. [PMID: 20613564 DOI: 10.1097/scs.0b013e3181e4345d] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Reconstruction of the fractured orbit serves to prevent functional and aesthetic posttraumatic sequels. In 2004, the surgical protocol at our unit was modified with respect to techniques for surgical access, types, and materials for reconstruction. The modifications were as follows: (a) introduction of medial orbital wall reconstructions through a bicoronal approach, (b) transconjunctival approach instead of the subciliary approach, and (c) porous polyethylene or porous polyethylene-titanium instead of autologous bone grafts. To evaluate the different surgical techniques and materials used, orbital reconstructions performed at our unit from 2000 to 2007 were retrospectively studied. In total, 177 primary or first-time secondary reconstructions were performed in 176 patients. The overall rate of early complications requiring medical or surgical intervention was 6.4%, and the reoperation rate was 3.4%. There were no statistically significant differences in the frequency of cicatricial eyelid complications between the subciliary and the transconjunctival approaches. There was a reduction in operative time with the use of implants compared with the use of bone. The overall rate of infections was 2%; however, there were no infections in the group treated with implants. Seven patients had secondary surgery for persistent enophthalmos, 4 of them due to defects in the medial orbital wall that had not been corrected at the time of primary reconstruction of the orbital floor. In conclusion, porous polyethylene/porous polyethylene-titanium is a safe material for orbital reconstructions. Reconstruction of the medial orbital wall is important to prevent posttraumatic enophthalmos, particularly in combined medial wall-orbital floor fractures.
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Saxena R, Phuljhele S, Lohiya P, Sharma P, Menon V. Management of disinserted inferior rectus muscle by fixation of globe to the inferior orbital margin. J Pediatr Ophthalmol Strabismus 2011; 48 Online:e1-4. [PMID: 20210274 DOI: 10.3928/01913913-20100218-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Accepted: 09/02/2009] [Indexed: 11/20/2022]
Abstract
Trauma to the orbital floor is often associated with trauma to the inferior rectus muscle. The currently available options yield inconsistent postoperative results. The authors describe a new technique in which the globe was fixed to the inferior orbital margin with the help of a silicone band and titanium orbital plate.
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Ho SYM, Nallanthamby V, Wong MTC. Accelerated osteomesh resorption: a case report. Craniomaxillofac Trauma Reconstr 2010; 3:115-7. [PMID: 22110825 DOI: 10.1055/s-0030-1254379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Facial fractures occur commonly as a result of blunt trauma from road traffic accidents, assaults, and sporting injuries. Orbital floor fractures form a significant proportion of these and when large enough, the defect often requires surgical reconstruction of the floor to prevent orbital content herniation. Here, we present a case of a 28-year-old gentleman, who sustained an orbital floor fracture from a soccer-related injury. The resulting floor defect was surgically repaired using an osteomesh that was hand-cut to size. He developed delayed enophthalmos and entrapment of the inferior rectus muscle due to early resorption of the osteomesh, requiring revision surgery.
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Affiliation(s)
- Samuel Y M Ho
- Section of Plastic, Reconstructive, and Aesthetic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Prowse SJ, Hold PM, Gilmour RF, Pratap U, Mah E, Kimble FW. Orbital floor reconstruction: A case for silicone. A 12 year experience. J Plast Reconstr Aesthet Surg 2010; 63:1105-9. [DOI: 10.1016/j.bjps.2009.05.057] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
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Gosau M, Schöneich M, Draenert FG, Ettl T, Driemel O, Reichert TE. Retrospective analysis of orbital floor fractures--complications, outcome, and review of literature. Clin Oral Investig 2010; 15:305-13. [PMID: 20165966 DOI: 10.1007/s00784-010-0385-y] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 01/20/2010] [Indexed: 01/03/2023]
Abstract
This retrospective study aimed at investigating indications, surgical approaches, and the materials used for orbital floor reconstructions, as well as the clinical follow-up, particularly with regard to postoperative complications. This study comprised 189 patients who underwent surgery for fractures of the orbital floor between 2003 and 2007. Diagnosis and treatment were based on both physical examination and computed tomography scan of the orbit. Patients were retrospectively analyzed for data, such as mechanism of injury, classification of fracture, and complications. The most common cause of injury was physical assault followed by traffic accidents. Surgery was conducted with a mean delay of 2.9 days after the incident. Mid lower eyelid incision was the most common surgical approach to the orbital floor. For orbital floor reconstruction, polydioxanone sheets (70.5%) were mainly used, followed by Ethisorb Dura (23.3%) and titanium mesh (6.2%). There were 19.0% of patients who showed postoperative complications: 5.8% suffered from persisting motility impairment, 3.7% from enophthalmos, 3.2% from consistent diplopia, 2.6% from ectropion, and 0.5% from orbital infection. Intraorbital hematoma (3.2%) represented the most severe complications, one patient suffered lasting impairment of sight and another one, complete blindness of the affected eye. If postoperative impairment of vision becomes evident, immediate surgical intervention is mandatory. Retrobulbar hematoma is more likely to occur in heavily traumatized patients with comminuted fractures and also in patients taking anticoagulative medication. The subciliary approach to the orbit and repeated operations by the same approach are associated with a higher risk of developing ectropion.
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Affiliation(s)
- Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042 Regensburg, Germany.
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Shetty P, Senthil Kumar G, Baliga M, Uppal N. Options in orbital floor reconstruction in blowout fractures: a review of ten cases. J Maxillofac Oral Surg 2009; 8:137-40. [PMID: 23139492 DOI: 10.1007/s12663-009-0034-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 05/20/2009] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The purpose of this case series was to assess the aesthetic and functional outcome of orbital floor reconstruction performed with calvarial bone graft, titanium mesh or prolene mesh. METHODS Ten cases of orbital blowout fractures treated at our centre from October 2006 to July 2008 were considered for this study. Clinical examination, patient satisfaction and radiographic investigations were used to assess repaired fractures. RESULTS Prolene mesh was used in four cases, titanium mesh was used in four cases and calvarial graft used in two cases. Nine patients had significant improvement in their esthetic appearance. Symmetry was restored in all cases. All ten cases had a noticeable improvement in the function. Of total ten cases six had diplopia, three recovered completely during the six months after the surgery. Three cases showed improvement later. All ten cases with enopthalmos recovered completely. Of the nine patients with infraorbital numbness, all recovered completely during the six months following surgery. One patient where the reconstruction was done with calvarial bone graft showed mild discrepancy in the ocular level. CONCLUSION For small, linear defects measuring less than 2cm with enopthalmos and restricted ocular movements, prolene mesh (four cases) was used. For larger defects and impure blowout fractures involving the infraorbital rim, calvarial graft (two cases) or titanium mesh (four cases) was used. The outcome of surgery with all three materials was satisfactory. No postoperative complications were seen except for mild hypoglobus in a case reconstructed with calvarial graft. All three materials, calvarial graft, titanium mesh, prolene mesh, have the potential to be useful reconstructive materials in orbital floor blowout fractures.
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Affiliation(s)
- Premalatha Shetty
- Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, India
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Jia-jie X, Li T, Xiao-lei J, Ying J, Jian-jian L, Bo Z. Porous Polyethylene Implants in Orbital Blow-Out Fractures and Enophthalmos Reconstruction. J Craniofac Surg 2009; 20:918-20. [PMID: 19480046 DOI: 10.1097/scs.0b013e3181a2d728] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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