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Starck E, Lusila N, Suojanen J, Kormi E. Are Age and Trauma Mechanism Associated with Volume Change in the Fractures of the Bony Orbit? J Clin Med 2024; 13:3618. [PMID: 38930147 PMCID: PMC11204536 DOI: 10.3390/jcm13123618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Blowout fractures are common midfacial fractures in which one or several of the bones of orbital vault break. This is usually caused by a direct trauma to the eye with a blunt object such as a fist. Fracturing of the fragile orbital bones can lead to changes in the orbital volume, which may cause enophthalmos, diplopia, and impaired facial aesthetics. Objectives: The aim of this study is to investigate whether there is an association between volume change of the bony orbit and age, gender, or trauma mechanism. Methods: A retrospective study of patients with unilateral blowout or blow-in fractures treated and examined in Päijät-Häme Central Hospital, Lahti, Finland was conducted. Altogether, 127 patients met the inclusion criteria. Their computed tomographs (CT) were measured with an orbit-specific automated segmentation-based volume measurement tool, and the relative orbital volume change between fractured and intact orbital vault was calculated. Thereafter, a statistical analysis was performed. A p-value less than 0.05 was considered significant. Results: We found that relative increase in orbital volume and age have a statistically significant association (p = 0.022). Trauma mechanism and gender showed no significant role. Conclusions: Patient's age is associated with increased volume change in fractures of the bony orbit.
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Affiliation(s)
- Ella Starck
- Clinicum, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Niilo Lusila
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Radiology, Päijät-Häme Central Hospital, 15850 Lahti, Finland
| | - Juho Suojanen
- Clinicum, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Päijät-Häme Central Hospital, 15850 Lahti, Finland
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Eeva Kormi
- Clinicum, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Päijät-Häme Central Hospital, 15850 Lahti, Finland
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Humphrey JG, Laguerre W, Sarpong C, Means O, Komorowska-Timek E. Use of Fibrin Sealant in Pediatric Orbital Fracture Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5911. [PMID: 38881958 PMCID: PMC11177824 DOI: 10.1097/gox.0000000000005911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/04/2024] [Indexed: 06/18/2024]
Affiliation(s)
| | - Wheddy Laguerre
- From the Loma Linda University School of Medicine, Loma Linda, Calif
| | - Claudy Sarpong
- From the Loma Linda University School of Medicine, Loma Linda, Calif
| | - Olivia Means
- Integrated Plastic Surgery Residency, Corewell Health/Michigan State University, Grand Rapids, Mich
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3
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Voss JO, Ziegenrücker P, Doll C, Maier C, Steffen C, Heiland M, Hofmann E, Koerdt S. Diagnostic pitfalls in pediatric orbital entrapment fractures. J Craniomaxillofac Surg 2024; 52:228-233. [PMID: 38142169 DOI: 10.1016/j.jcms.2023.12.006] [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: 06/12/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023] Open
Abstract
Prompt diagnosis and management of orbital entrapment fractures in the pediatric patient have been advocated. This retrospective study analyzed a cohort of orbital entrapment fractures in pediatric patients with regard to diagnostic pitfalls, treatment and outcomes in a Level I trauma center in Germany. Based on medical records and radiological imaging, patients under the age of 18 years who presented with orbital fractures during 2009-2021 were analyzed. Overall, 125 patients presented with orbital fractures, of whom 29 patients (23.2%) had orbital entrapment fractures. The majority of patients presented with monocle hematoma (n = 23), diplopia (n = 20), and/or restricted extraocular eye movement (n = 14). While all patients with orbital entrapment fractures underwent three-dimensional imaging, 10 radiological reports (34.5%) did not include findings on orbital entrapment fractures. All patients underwent surgical exploration in less than 24 h. In 12 patients, clinical symptoms such as diplopia and restricted ocular elevation were documented upon postoperative evaluation before discharge. Considering the significant proportion of orbital entrapment fractures that are not noted on radiological imaging, prompt clinical examination should be initiated in pediatric patients at risk for orbital fractures. Urgent surgical intervention should be recommended in entrapment fractures.
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Affiliation(s)
- Jan Oliver Voss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Paula Ziegenrücker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Christian Doll
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Christoph Maier
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Radiology, Augustenburger Platz 1, 13353, Berlin, Germany; New York University School of Medicine, Dept. of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), 650 1st Avenue, New York, 10016, NY, USA.
| | - Claudius Steffen
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Max Heiland
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Elena Hofmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Steffen Koerdt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
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4
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Bressler S, Morris L. Pediatric Head and Neck Trauma. Otolaryngol Clin North Am 2023; 56:1169-1182. [PMID: 37460373 DOI: 10.1016/j.otc.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
The pediatric patient population has unique anatomic characteristics that bring challenges and increased risk to management. The purpose of this article is to guide the head and neck trauma surgeon in decision making for the treatment of pediatric head and neck trauma with an emphasis on facial fracture management.
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Affiliation(s)
- Sara Bressler
- Louisiana State University Health Sciences Center-New Orleans, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA
| | - Lisa Morris
- Louisiana State University Health Sciences Center-New Orleans, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA.
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5
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Capote R, Preston K, Kapadia H. Craniofacial Growth and Development: A Primer for the Facial Trauma Surgeon. Oral Maxillofac Surg Clin North Am 2023; 35:501-513. [PMID: 37302949 DOI: 10.1016/j.coms.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Understanding craniofacial growth and development is important in the management of facial trauma in the growing pediatric patient. This manuscript is a review of craniofacial growth and development and clinical implications of pediatric facial fractures.
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Affiliation(s)
- Raquel Capote
- Department of Oral and Maxillofacial Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Cleft and Craniofacial Program, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
| | - Kathryn Preston
- Center for Cleft and Craniofacial Care, Phoenix Children's Hospital, Phoenix, AZ, USA; Department of Orthodontics, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA
| | - Hitesh Kapadia
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA; Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA; Department of Orthodontics, School of Dentistry, University of Washington, Seattle, WA, USA
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Hassan B, Liang F, Grant MP. Pediatric Orbital Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:585-596. [PMID: 37302946 DOI: 10.1016/j.coms.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The unique anatomy and physiology of the growing craniofacial skeleton predispose children to different fracture patterns as compared to adults. Diagnosis and treatment of pediatric orbital fractures can be challenging. A thorough history and physical examination are essential for the diagnosis of pediatric orbital fractures. Physicians should be aware of symptoms and signs suggestive of trapdoor fractures with soft tissue entrapment including symptomatic diplopia with positive forced ductions, restricted ocular motility (regardless of conjunctival abnormalities), nausea/vomiting, bradycardia, vertical orbital dystopia, enophthalmos, and hypoglobus. Equivocal radiologic evidence of soft tissue entrapment should not withhold surgery. A multidisciplinary approach is recommended for the accurate diagnosis and proper management of pediatric orbital fractures.
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Affiliation(s)
- Bashar Hassan
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 South Paca Street, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, USA
| | - Fan Liang
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 South Paca Street, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, USA
| | - Michael P Grant
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 South Paca Street, Baltimore, MD, USA.
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7
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Bataineh AB. The pattern of orbital walls fractures in north of Jordan. J Clin Exp Dent 2023; 15:e850-e854. [PMID: 37933392 PMCID: PMC10625680 DOI: 10.4317/jced.60894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/03/2023] [Indexed: 11/08/2023] Open
Abstract
Background The aim of this study was to examine the incidence and demographic characteristics of patients with orbital walls fractures who were treated in the department of oral and maxillofacial surgery of a tertiary hospital in Jordan. Material and Methods A retrospective cohort study of patients with a diagnosis of with selected orbital walls fracture was designed and implemented, during a two-year period between January 2020 and December 2021. Information on patients treated for orbital walls fractures were retrieved and analyzed regarding age, sex, etiology, anatomical site, and treatment modality. Descriptive data presented as simple frequencies and percentages. Results A total of 76 patients with 100 orbital wall fractures, age range was 4-68 years old with a mean age 28 (SD±12), of whom were 53 (69.7%) were male and 23(30.3%) were female, with male:female ratio was 2:1. The most common etiology of all orbital walls fractures was RTA in 47 patients (61.8%; P ≤0.021), followed by violence in male patients. The most prevalent age-group was 21-30 years old with 16 patients (21.05%; P ≤0.235), and single orbital wall fractures 56 (56%) were more common than combined orbital wall fractures. Conclusions In conclusion, this study will contribute to identifying the best clinical therapy and protective techniques for individuals with orbital fractures. Key words:Orbital fracture, Etiology, Orbital trauma, Road traffic accidents, Trauma.
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Affiliation(s)
- Anwar B Bataineh
- BDS, MScD, MDSc, CSOS. Professor of Oral & Maxillofacial Surgery, Faculty of Dentistry, Jordan University of Science & Technology
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8
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Pediatric Orbital Fractures: Outcomes in Relation to Time of Surgery. J Craniofac Surg 2023; 34:976-978. [PMID: 36728445 DOI: 10.1097/scs.0000000000009163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 10/02/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Orbital trapdoor fractures in children and adolescents can cause persistent problems with vision and appearance. Early surgery is recommended, although, because of the rarity of these fractures, there is a lack of evidence regarding the optimal timing of surgery.The objective of this study was to examine the effect of the time from trauma to surgery on the recovery time and severity of diplopia in children and adolescents with orbital trapdoor fractures. MATERIALS AND METHODS A retrospective cohort study was performed of all orbital fractures in children and adolescents aged 0 to 20 years, treated at a tertiary referral center in 2005-2017. Data relating to demographics, cause of injury, surgery, time of follow-up, and final outcomes were extracted. The cases of trapdoor fracture were specifically examined with regard to the time from trauma to surgery and diplopia at last follow-up, which was the primary outcome. RESULTS One hundred thirty-five patients, aged 2.4 to 20 years (mean 17.0), were treated for orbital fractures during the period; 37 (27%) had an isolated orbital floor fracture and 12 (9%) had a trapdoor fracture. All patients with trapdoor fractures underwent surgery; the mean time to surgery was 11.9 days in 2007-2011 and 1.1 days in 2012-2017. Although statistical significance cannot be proven in this small and retrospective study, a shorter time from trauma to surgery seems to lead to fewer problems with diplopia and 2 patient cases that highlight this are presented. CONCLUSIONS Delayed surgical intervention in pediatric orbital trapdoor fractures increases the risk of delayed recovery and persistent diplopia. Other factors, such as the degree of muscle incarceration and necrosis and the surgeon's experience and skill, may, however, also influence the outcomes.
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9
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Muacevic A, Adler JR, Bhola ND, Vishnani R. Pediatric Orbital Floor Reconstruction Using a Nonresorbable Polypropylene-Based Hernia Mesh: A Case Report. Cureus 2023; 15:e34326. [PMID: 36865976 PMCID: PMC9974009 DOI: 10.7759/cureus.34326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/24/2023] [Indexed: 01/30/2023] Open
Abstract
Orbital floor fracture is the most common type of orbit-related injury seen in pediatric age groups. It is also called a white-eyed blowout fracture when the usual signs of orbital fracture-periorbital edema, ecchymosis, and subconjunctival hemorrhage are absent. Several materials are used for orbital defect reconstruction. The most popular and widely used material is titanium mesh. We present a case of a 10-year-old boy with a white-eyed blowout fracture of the floor of the orbit of the left side. The patient had a history of trauma, after which he developed diplopia in the left eye. On examination, his upward gaze was restricted in the left eye, which was suggestive of inferior rectus muscle entrapment. The orbital floor reconstruction was done using a hernia mesh made up of nonresorbable polypropylene material. This case demonstrates the utility of nonresorbable materials in orbital defect reconstruction in pediatric patients. Further studies are needed to better understand the scope of polypropylene-based materials in the floor of orbit reconstruction and their benefits and shortcomings in the long run.
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Affiliation(s)
- Alexander Muacevic
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - John R Adler
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Katrolia R, Mohammad S, Mehrotra D, Singh G, Jain D, Ezhilarasi, Khan MH, Sowmya M. The outcome of conventional open reduction approach vs endoscopic approach for orbital floor repair. J Oral Biol Craniofac Res 2022; 12:589-592. [PMID: 35968038 PMCID: PMC9364092 DOI: 10.1016/j.jobcr.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/16/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Blunt trauma to the orbital rim is a frequent cause of both orbital fractures and damage to the surrounding facial bones and soft tissues. The inception of endoscopy and minimal invasive intervention has revolutionized the surgical treatment of blow out fracture of orbital walls. Thus, the present study was conducted to compare the outcome of conventional open reduction approach with endoscopic approach for orbital floor repair. Materials and method The study included 10 patients with clinical and radiographic evidence of orbital floor fracture, divided randomly into two groups: Group I-operated using endoscopic approach; and Group II- operated using conventional external approach. All the patients were evaluated clinically preoperatively, immediate post-operative and after 1 month for Diplopia, Extrinsic ocular motility, Enophthalmos and Hypoglobus. Results The study consisted of 40% females and 60% males, with mean age of Endoscopic and Conventional group being 27.20 ± 6.14 years and 27.60 ± 7.23 years respectively. In relation to diplopia, an insignificant difference was observed statistically. The mean change in enophthalmos and hypoglobus in endoscopic and conventional group showed a significant difference statistically (p < 0.001). Unrestricted ocular motility was present only in one case of each group and significantly increased to 5 cases in both the groups (p = 0.048). The mean duration of surgery in endoscopic and conventional group showed a significant difference statistically. Conclusion Diplopia, hypoglobus and Enophthalmos correction was better achieved in endoscopic group as compared to conventional group. But duration of surgery was more in endoscopic group as compared to conventional group.
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Affiliation(s)
- Ravi Katrolia
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, India
| | - Shadab Mohammad
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, India
| | - Divya Mehrotra
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, India
| | - Geeta Singh
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, India
| | - Deepika Jain
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, India
| | - Ezhilarasi
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, India
| | - M Haaris Khan
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, India
| | - M.V. Sowmya
- Department of Oral and Maxillofacial Surgery, King George Medical University, Lucknow, India
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11
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Orbital fracture with involvement of the lacrimal sac in a child. J Fr Ophtalmol 2022; 45:e423-e425. [DOI: 10.1016/j.jfo.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 11/19/2022]
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12
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Pushker N. Born with a luxated globe: An ocular emergency. World J Emerg Med 2022; 13:158-159. [DOI: 10.5847/wjem.j.1920-8642.2022.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022] Open
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Sandhu PS, Bucur S, Good C, Cutler M, Rajak S. The Management of Orbital Roof Fractures and Defects: A Review. Ophthalmic Plast Reconstr Surg 2022; 38:8-16. [PMID: 34293784 DOI: 10.1097/iop.0000000000002025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the anatomy, etiopathogenesis, diagnosis and classification, current evidence on intervention and the surgical management of orbital roof fractures and defects (ORFD) for oculoplastic surgeons presented with such cases. METHODS A review of the current literature through the MEDLINE database using the following search terms: "orbital roof fracture (+treatment/management)," "orbital roof defect (+treatment/management)," "orbital roof erosion (+treatment/management)," "orbital roof repair," "orbital roof," "orbital fracture," "pediatric orbital roof (defect/fracture/erosion)," "orbital anatomy," and "orbital roof anatomy" was conducted. As relatively little has been published on this topic, inclusion criteria were broad and peer-reviewed articles judged to be of clinical importance, relevant to the aims of this review, were included. Non-English abstracts were also included if relevant. Year of publication was not a strict exclusion criterion, and older articles were judged for their suitability based on clinical importance and relevance to current practice. Additional references were obtained from citations in key articles and recommendations from the coauthors based on their areas of expertise. RESULTS The etiopathogenesis of ORFD varies. Classification systems have been formulated to guide management decisions and can range from conservative management to complex neurosurgery. Eyelid approaches have also been described. This review provides a summary of the evidence for each and a management framework oculoplastic surgeons can use when presented with ORFD. CONCLUSION Oculoplastic surgeons can be involved, either alone or as part of a multidisciplinary team, in the management of ORFD, and for some, conduct orbital approach reconstructive surgery.
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Affiliation(s)
| | | | - Catriona Good
- Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Mark Cutler
- Department of Head & Neck Prosthetics, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| | - Saul Rajak
- Orbital and Oculoplastics Department, Sussex Eye Hospital
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Mehmood N, Hasan A. Oculocardiac Reflex: An Underrecognized But Important Association With Orbital Trap Door Fractures. Pediatr Emerg Care 2021; 37:e1731-e1732. [PMID: 31389903 DOI: 10.1097/pec.0000000000001884] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Blowout fractures of the floor of the orbit can serve as a "trap door" for extraocular muscles. Presentation of inferior orbital muscle entrapment classically involves an upward gaze restriction. Diplopia and exophthalmos can also be present. Rarely, orbital fractures can result in an oculocardiac reflex, which is a triad of bradycardia, syncope, and nausea. The purpose of this study was to describe a patient who had orbital floor fracture with symptoms highly suggestive for oculocardiac reflex after a traumatic injury. Although entrapment of extraocular muscles does require early intervention to prevent ischemia and tissue necrosis, the presence of oculocardiac reflex warrants emergent evaluation and management by an ophthalmologist due to the risk of developing arrhythmias. Frequently, there may be none or very subtle clinical findings present, and abnormal motility may be the only apparent clinical sign, which can be difficult to assess in very young and uncooperative children; therefore, a high index of suspicion must be maintained for early identification and management as well as a reduction of complications.
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Affiliation(s)
- Noormah Mehmood
- From the GY-3 Driscoll Children's Hospital, Corpus Christi, Texas
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15
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Abstract
The bony orbit is commonly involved in athletic injuries. Evaluation should include a comprehensive history and ocular examination. Computed tomography imaging is the gold standard for diagnostic testing. Urgent surgical intervention for orbital floor fractures should occur after "white eye" trapdoor fractures or if oculocardiac response occurs. Most orbital fractures do not require urgent intervention and repair can be completed within 2 weeks of injury. There are many approaches to repair orbital fractures, and consideration of techniques depends on the unique fracture pattern. Intraoperative computed tomography has become frequently used and can lead to increased identification of plate malpositioning intraoperatively.
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Affiliation(s)
- John Flynn
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3010, Kansas City, KS 66160, USA.
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Blowout Fracture Assessment Based on Computed Tomography and Endoscopy: The Effectiveness of Endoscopy for Fracture Repair. J Craniofac Surg 2021; 33:1008-1012. [PMID: 34629380 DOI: 10.1097/scs.0000000000008170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The purpose of this study was to compare the configuration of blowout fracture observed through orbital computed tomography (CT) and endoscopy, then present the effectiveness of using an endoscope in reconstruction surgery of blowout fracture. We retrospectively reviewed the clinical records of 337 patients who underwent reconstruction surgery of blowout fracture between January 2017 and December 2020 in the Department of Ophthalmology at Korea University Guro Hospital. The patients were categorized into 3 groups based on preoperative CT findings as follows: combined orbital medial and floor wall fractures, trapdoor fractures, and large blowout fractures. The images obtained through CT and endoscopy were compared among the 3 groups. Endoscopy helped identify herniated soft tissue and posterior fracture margins, and it also provides better magnification and a brighter view of the posterior aspects of the fracture site. Furthermore, endoscopy can also provide educational opportunities to visualize the fracture site and help trainees understand the surgical procedure approach or orbital anatomy. Based on our results, we suggest using an endoscope during blowout fracture surgery as an effective approach to reduce postoperative complications due to endoscopy's advantages in clear visualization of the fracture site during operation.
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Halsey J, Argüello-Angarita M, Carrasquillo OY, Hoppe IC, Lee ES, Granick MS. Periorbital and Globe Injuries in Pediatric Orbital Fractures: A Retrospective Review of 116 Patients at a Level 1 Trauma Center. Craniomaxillofac Trauma Reconstr 2021; 14:183-188. [PMID: 34471473 DOI: 10.1177/1943387520933697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design Retrospective chart review of pediatric and globe injuries associated with orbital fractures. Objective Our study seeks to examine these injuries and their association with orbital fractures at our trauma center to gain a better understanding of how to approach pediatric patients with orbital fractures. Methods A retrospective review of all facial fractures in pediatric patients at an urban level 1 trauma center was performed for the years 2002 to 2014. Patient demographics were collected, as well as orbital fracture location, mechanism of injury, concomitant injuries, ophthalmologic documentation, imaging, and perioperative records. Results One hundred sixteen pediatric patients over a 12-year period sustained an orbital fracture. The orbital floor was the most commonly fractured orbital bone in our series (60%). Thirty-four (30%) of the pediatric patients with orbital fractures had documented periorbital and/or globe injuries at the time of presentation. The most common periorbital injury was entrapment related to orbital floor fractures. Significant eyelid lacerations were present in seven patients, with five of these patients had canalicular injuries and two had canthal malposition. Five pediatric patients presented with traumatic optic neuropathy. Two patients had ruptured globes requiring enucleation. Conclusions Periorbital soft tissue and globe injuries associated with orbital fractures occurs in a substantial number of pediatric patients. There are no guidelines for treatment of these type of injuries in the pediatric population. Further research should be performed to better understand the appropriate management of periorbital injuries in conjunction with surgical management of the orbital fractures.
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Affiliation(s)
- Jordan Halsey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marvin Argüello-Angarita
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Osward Y Carrasquillo
- Department of Dermatology, University of Puerto Rico School of Medicine, Puerto Rico
| | - Ian C Hoppe
- Department of Plastic Surgery, University of Mississippi College of Medicine, Jackson, MS, USA
| | - Edward S Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mark S Granick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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Kooger TJA, Joosse MV, van Minderhout EM, Hergaarden K, Khouw YL. Epidemiology of Orbital Fractures in a Large Hospital in the Netherlands: Results of Implementation of a Multidisciplinary Orbital Trauma Team. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
This study aims to describe the epidemiology, aetiology and therapy of orbital fractures in a large municipal hospital in The Hague, the Netherlands, and to demonstrate the effectiveness of an integrated approach of orbital trauma care with a team consisting of an ophthalmologist, an orthoptist and an oral and maxillofacial (OMF) surgeon.
Methods:
We obtained data from patients with an orbital fracture between June 2015 until July 2018. Primary outcomes were the classification of orbital fractures and treatment (conservative or surgical).
Results:
182 patients were included in this study. The most common type of orbital fracture was an isolated orbital floor fracture (n=56, 30.8%). In most cases, therapy was conservative (69.2%). When surgical repair was indicated, a polydioxanone (PDS) plate was most commonly used (11.5%). The main cause of an orbital fracture was a fall accident (38.5%), followed by assault (32.4%). 32.4% of the patients were intoxicated with alcohol.
Conclusion:
In our study population, almost 70% (69.2%) of the patients were treated conservatively in our study. Compared to the international literature, this percentage is considerably higher than in other studies. In our opinion, our integrated approach to orbital trauma has led to a justifiable reduction of the proportion of cases receiving surgical intervention in orbital fractures. We would like to advocate the implementation of a similar team in other hospitals to improve the quality and cost-effectiveness of treatment in patients with orbital fractures.
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Abstract
INTRODUCTION Despite its popularity, there have been no reports outlining adult craniofacial trauma in the setting of golf injuries. Our main objective was to identify and describe trends in head and neck injuries incurred while participating in golf including injury type, anatomic location, and patient disposition. METHODS A retrospective cohort analysis of the National Electronic Injury Surveillance System (NEISS) was conducted from 2009-2018. Population characteristics of golf-related injuries were recorded, including, age, sex, and race distributions. Distribution of injury anatomic location, injury type, distribution of fracture location, patient disposition was further analyzed. A one way ANOVA was utilized to obtain the mean ages for all injuries and compare them for any statistical difference. To identify statistical significance, a Fisher exact test with a Monte Carlo simulation was performed. RESULTS A total of 509 golf-related injuries (national estimate 24,425 cases) were recorded over the study period. Lacerations were the most common injury overall (54.2%), while contusions and abrasions were the next most common injuries (27.3%). The most common fracture subtype observed was midface (40.43%), followed by nasal bone (27.66%), mandible (12.77%), skull (12.77%), and cervical spine (6.38%). The highest proportion of patients admitted for further treatment were individuals >70 years of age. Fractures had the highest rate of admission (29.8%). CONCLUSIONS A better understanding of golf injuries can allow for rapid detection and appropriate treatment when encountered. This knowledge can also help to develop safety precautions by potentially reforming rules and regulations as well as protective equipment.
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Glassman GE, Jackson K, Pontell ME, Golinko M, Drolet BC. Pediatric Orbital Entrapment: Radiographic Findings and Their Predictive Values. Ann Plast Surg 2021; 86:S606-S609. [PMID: 34100821 DOI: 10.1097/sap.0000000000002883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although orbital fractures are less common in children than adults, the literature suggests that orbital entrapment occurs more frequently in the pediatric population. Orbital entrapment is an emergency, and early diagnosis and prompt management are critical. Specific radiographic manifestations such as herniation of extraocular muscles (EOMs) through orbital fractures have led to increased suspicion and overdiagnosis of orbital entrapment. This study evaluated the value of specific radiographic findings in predicting clinical findings after pediatric orbital floor fractures. METHODS A retrospective review at a pediatric level 1 trauma center was performed. ICD-9 and ICD-10, codes identified patients with orbital fractures. Computed tomography (CT) reports were queried for the following terms: "herniation," "herniated," "entrapped," and "entrapment." Patients 16 years and older were excluded, as were all patients who were unable to undergo EOM evaluation on presentation. Electronic medical records were reviewed for fracture type, mechanism of injury, clinical and radiographic findings, surgical interventions, and demographic information. Medical diagnosis tests, including positive and negative predictive values, sensitivity, as well as specificity, were calculated to identify the relationship between radiographic findings and specific symptomology. RESULTS One hundred fifty-three patients with 265 orbital fractures were included. "Entrapment" was mentioned in 34.6% of CT reports, whereas the incidence of clinical entrapment was 12.4% (19/153). Radiographic fat herniation, EOM herniation, and EOM irregularity had positive predictive values of 25%, 31%, and 10%, respectively, for clinical entrapment diagnosis at the initial examination. Overall, 32.7% (50/153) of patients with orbital fractures required surgery. CONCLUSIONS Although the radiographic description of soft tissue herniation has become interchangeable with entrapment, these CT findings alone are poorly predictive. Orbital entrapment should be diagnosed preoperatively by physical examination, with radiographs as an adjunct only. Radiographic statements without clinical correlation may lead to the improper management of pediatric facial trauma patients.
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Affiliation(s)
| | - Kianna Jackson
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew E Pontell
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
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21
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Management of Pediatric Orbital Fractures. J Craniofac Surg 2021; 32:224-227. [PMID: 33273204 DOI: 10.1097/scs.0000000000006915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Although uncommon in children, orbital fractures can be devastating to both vision and appearance. Due to the scarce information in the literature, the authors here present our experience and management with all pediatric orbital fracture patients. MATERIAL AND METHODS A 6-years retrospective study was conducted on pediatric patients presented with orbital wall fracture (OFx). All patients (n = 43) were grouped for comparison based on the treatment method. The cohorts were analyzed for demographics data, location of fracture, type of material used for reconstruction, complication rate and follow up length. Data was analyzed utilizing SPSS for χ2 test. RESULTS The majority of patients were male (86%) and the mean age of patients was 12.09 ± 4 years. Mean follow-up time was 237 ± 72 days. Most of Patients 31 (72%) underwent surgical intervention. A higher rate of complications was observed in the surgically treated group (32%) compared to the conservative group (8%) regardless to the defect size. Subgroup analysis of the surgery treated group revealed that large size defect had inferior outcome compared to small size defect. CONCLUSION The consequences of treatment on long-term growth and development must be a cornerstone when choosing the optimal therapeutic method. Conservative management should be considered first in the absence of significant clinical pathologies. In addition, when surgery is indicated the least invasive procedure should be applied. The use of autogenous bone graft is preferable over alloplastic materials, however, when there is insufficient bone quantity the use of alloplastic materials is not contraindicated for reconstruction.
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22
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Manisha S, Sunita M, Sanjeev M, Ravi K, Aarzoo J, Ajai A. Anatomical and Clinical Characteristics of Paediatric and Adult Eyes. NATIONAL JOURNAL OF CLINICAL ANATOMY 2021. [DOI: 10.4103/njca.njca_16_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Kim SH, Choi JH, Hwang JH, Kim KS, Lee SY. Surgical indication analysis according to bony defect size in pediatric orbital wall fractures. Arch Craniofac Surg 2020; 21:276-282. [PMID: 33143394 PMCID: PMC7644352 DOI: 10.7181/acfs.2020.00409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/12/2020] [Indexed: 11/11/2022] Open
Abstract
Background Orbital fractures are the most common pediatric facial fractures. Treatment is conservative due to the anatomical differences that make children more resilient to severe displacement or orbital volume change than adults. Although rarely, extensive fractures may result in enophthalmos, causing cosmetic problems. We aimed to establish criteria for extensive fractures that may result in enophthalmos. Methods We retrospectively reviewed the charts of patients aged 0–15 years diagnosed with orbital fractures in our hospital from January 2010 to February 2019. Computed tomography images were used to classify the fractures into linear, trapdoor, and open-door types, and to estimate the defect size. Data on enophthalmos severity (Hertel exophthalmometry results) and fracture pattern and size at the time of injury were obtained from patients who did not undergo surgery during the follow-up and were used to identify the surgical indications for pediatric orbital fractures. Results A total of 305 pediatric patients with pure orbital fractures were included–257 males (84.3%), 48 females (15.7%); mean age, 12.01± 2.99 years. The defect size (p= 0.002) and fracture type (p= 0.017) were identified as the variables affecting the enophthalmometric difference between the eyes of non-operated patients. In the linear regression analysis, the variable affecting the fracture size was open-door type fracture (p< 0.001). Pearson’s correlation analysis demonstrated a positive correlation between the enophthalmometric difference and the bony defect size (p= 0.003). Using receiver operating characteristic curve analysis, a cutoff value of 1.81 cm2 was obtained (sensitivity, 0.543; specificity, 0.724; p= 0.002). Conclusion The incidence of enophthalmos in pediatric pure orbital fractures was found to increase with fracture size, with an even higher incidence when open-door type fracture was a cofactor. In clinical settings, pediatric orbital fractures larger than 1.81 cm2 may be considered as extensive fractures that can result in enophthalmos and consequent cosmetic problems.
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Affiliation(s)
- Seung Hyun Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jun Ho Choi
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Ha Hwang
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Kwang Seog Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sam Yong Lee
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
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24
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Mendonca TM, K S, Rodrigues GR, Pai SG. An Uncommon Case of Isolated Superior Rectus Palsy. J Neurosci Rural Pract 2020; 11:484-486. [PMID: 32753818 PMCID: PMC7394612 DOI: 10.1055/s-0040-1709367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Head injury associated with orbital trauma is commonly encountered in day-to-day practice. We report a rare case of orbital trauma resulting in isolated orbital "roof blow" in fracture in a 14-year-old child. The patient presented to us with diplopia and limitation of elevation of right eye after orbital trauma. Computed tomography of the orbits (2 mm sections) did not reveal fracture of the orbital floor. However, there was orbital roof "blow in" fracture with fracture fragment impingement on the superior rectus muscle. Patient was treated conservatively and spontaneous recovery of ocular motility was noted after a month.
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Affiliation(s)
- Teena Mariet Mendonca
- Department of Ophthalmology, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, India
| | - Suprasanna K
- Manipal Academy of Higher Education, Manipal, India.,Department of Radiology, Kasturba Medical College, Mangalore, India
| | - Gladys R Rodrigues
- Department of Ophthalmology, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, India
| | - Shobha G Pai
- Department of Ophthalmology, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, India
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Pediatric Pedestrian Facial Fracture Patterns and Management Following Motor Vehicle Collisions. J Craniofac Surg 2020; 31:265-268. [PMID: 31821213 DOI: 10.1097/scs.0000000000006034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Pedestrian trauma due to motor vehicle crashes can be especially destructive to the pediatric population as the facial skeleton is immature and developing. Almost half of crashes resulting in pedestrian death involved alcohol consumption, and children are often victims of irresponsible driving. The objective of this study was to examine the prevalence of facial fractures in this patient population in order to analyze management strategies that optimize functional recovery. METHODS A retrospective chart review was performed for all facial fractures resulting from motor vehicle collisions with pedestrians in the pediatric population at a level 1 trauma center in an urban environment (University Hospital in Newark, NJ). Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies. RESULTS During the time period examined, 55 patients were identified as 18 years of age or younger and having sustained a facial fracture as the result of being struck by a motor vehicle. The mean age was 11.3 (range 1-18) years, with a male predominance of 69.0%. There were a total of 125 fractures identified on radiologic imaging via CT or X-ray. The most common fractures were those of the orbit (20.0%), mandible (19.2%), and nasal bone (10.4%). The mean Glasgow Coma Scale on arrival was 12.1 (range 4-15). Fifteen patients were intubated on, or prior to, arrival to the trauma bay. The most common concomitant injuries were intracranial hemorrhage, long bone fractures, and cervical spine fractures. The mean operative time was 216.9 (range 63-515) minutes. Surgery was required in 36 patients, with most undergoing open reduction and internal fixation with titanium plates and screws. Two patients required resorbable plates, and one required Medpor implants. The mean hospital length of stay was 9.9 (range 1-59) days. Two patients expired. CONCLUSIONS There is currently a dearth of literature regarding the management and patterns of injury for pediatric pedestrian injuries due to motor vehicle collisions. The impact of these injuries can be devastating with concomitant life-threatening complications, and may influence the future development of the facial skeleton after healing of the bone and soft tissue. The authors hope this study can provide insight and further investigation regarding prevention and management.
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Valente L, Tieghi R, Elia G, Galiè M. Orbital Fractures in Childhood. Ann Maxillofac Surg 2020; 9:403-406. [PMID: 31909024 PMCID: PMC6933969 DOI: 10.4103/ams.ams_185_19] [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: 11/04/2022] Open
Abstract
Pediatric orbital floor fractures exhibit distinctive features that distinguish them from orbital injuries seen in the adult population. This is mainly due to different anatomy and mechanical properties of the orbital bones in children. The management of pediatric orbital floor fractures requires consideration of these factors, including the age of the patient and therefore child's growth potential, using, if possible, a minimally invasive surgical approach. The aim of this paper is to report a case of a 1-year-old male child with a surgically treated blowout fracture of the orbital floor. To enable early diagnosis and treatment, accurate physical examination is mandatory, but a computed tomographic examination is important, especially in younger patients because of their inability to fully express their symptoms and poor compliance. We discuss the specific presentation and diagnostics of orbital floor fractures in early childhood and the related surgical planning and treatment.
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Affiliation(s)
- Luisa Valente
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, St. Anna Hospital and University, Ferrara, Italy
| | - Riccado Tieghi
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, St. Anna Hospital and University, Ferrara, Italy
| | - Giovanni Elia
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, St. Anna Hospital and University, Ferrara, Italy
| | - Manlio Galiè
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, St. Anna Hospital and University, Ferrara, Italy
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Sarfraz M, Mustansir F, Khan N, Darbar A. Acute Orbital Pseudomeningocele Due to Traumatic Fracture in an Infant. Neuroophthalmology 2019; 44:339-343. [PMID: 33012925 DOI: 10.1080/01658107.2019.1611881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Paediatric orbital trauma is uncommon, but it can be associated with significant morbidity. Traumatic pseudomeningocele is an infrequent complication of orbital trauma; it occurs due to an extradural collection of cerebrospinal fluid (CSF) that develops after a dural tear. Herein, we report a case of a seven-month-old male child who presented with eye swelling and suspicion of orbital cellulitis, along with a history of a road traffic accident. He was later diagnosed with traumatic orbital pseudomeningocele and underwent a left frontal craniotomy and duroplasty along with repair of medial orbital pseudomeningocele. Postoperatively, the child remained stable and resolution of proptosis was observed.
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Affiliation(s)
- Maryam Sarfraz
- Department of Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Fatima Mustansir
- Department of Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Natasha Khan
- Department of Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Aneela Darbar
- Department of Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
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28
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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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Kulenkamp JE, Farooq AV, Abbasian J, Shah H. Trapdoor orbital floor fracture and inferior rectus entrapment with minimal infraduction deficit and hypertropia. Can J Ophthalmol 2018; 53:e252-e254. [PMID: 30503008 DOI: 10.1016/j.jcjo.2018.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 10/17/2022]
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30
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Christian CW, Levin AV, Flaherty EG, Sirotnak AP, Budzak AE, Gavril AR, Haney SB, Idzerda SM, Laskey A, Legano LA, Messner SA, Moles RL, Palusci VJ, Karr DJ, Bradford GE, Nischal K, Roarty JD, Rubin SE, Suh DW. The Eye Examination in the Evaluation of Child Abuse. Pediatrics 2018; 142:peds.2018-1411. [PMID: 30037976 DOI: 10.1542/peds.2018-1411] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Child abuse can cause injury to any part of the eye. The most common manifestations are retinal hemorrhages (RHs) in infants and young children with abusive head trauma (AHT). Although RHs are an important indicator of possible AHT, they are also found in other conditions. Distinguishing the number, type, location, and pattern of RHs is important in evaluating a differential diagnosis. Eye trauma can be seen in cases of physical abuse or AHT and may prompt referral for ophthalmologic assessment. Physicians have a responsibility to consider abuse in the differential diagnosis of pediatric eye trauma. Identification and documentation of inflicted ocular trauma requires a thorough examination by an ophthalmologist, including indirect ophthalmoscopy, most optimally through a dilated pupil, especially for the evaluation of possible RHs. An eye examination is helpful in detecting abnormalities that can help identify a medical or traumatic etiology for previously well young children who experience unexpected and unexplained mental status changes with no obvious cause, children with head trauma that results in significant intracranial hemorrhage and brain injury, and children with unexplained death.
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Affiliation(s)
- Cindy W. Christian
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Alex V. Levin
- Departments of Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital and Departments of Ophthalmology and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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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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Heitz C, Louzada GP, Conci RA, Rodrigues RL, Fritscher GG. Primary Repair of a Complex Panfacial Fracture by Dog Bite. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1719. [PMID: 29876169 PMCID: PMC5977943 DOI: 10.1097/gox.0000000000001719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/23/2018] [Indexed: 11/27/2022]
Abstract
Facial fractures due to dog attacks have an unknown incidence rate. To date, only 41 cases of canine bite trauma in a pediatric patient, associated with facial fracture, have been reported in the literature. As major species of involving dogs are the American pitbull terrier and rottweiler. Due to the intense kinematics of this trauma, the treatment becomes complex. Thus, attention to the primary repair of such complex lesions ensures satisfactory results, which is the focus of this discussion. The purpose of this review was to analyze how different ways to approach this type of trauma in children for clarification or correct management. In addition, we address the treatment plan of a complex case of panfacial fracture by a canine bite in a 4-year-old patient. According to a review addressed, the main involved are orbit, nasal, and zygomatic. Antibiotic therapy is indicated for infected bite wounds and wounded considerations at risk of infection, with high complexity and when involving important structures such as bones, vessels, and joints. The state of tetanus immunization and the risk of rabies infection should be routinely addressed in the management of the bite wound.
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Affiliation(s)
- Cláiton Heitz
- From the Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Guilherme Pivatto Louzada
- Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Ricardo Augusto Conci
- Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil
| | | | - Guilherme Genehr Fritscher
- From the Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
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Abstract
OBJECTIVES Data regarding clinical predictors of orbital fractures in children are limited. We sought to describe the epidemiology of pediatric orbital fractures and identify the signs and symptoms of orbital fractures in children. METHODS We performed a retrospective cohort study of children younger than 22 years who underwent a facial or orbital computed tomography (CT) scan to evaluate for orbital fracture. We included patients presenting to an emergency department of a tertiary care children's hospital between January 2009 and May 2013. The presence of an orbital fracture was assessed using the final interpretation of the CT by an attending radiologist in the electronic medical record. RESULTS Among 326 children who underwent facial or orbital CT during the study period, 133 (41%) had an orbital fracture. The presence of nausea or vomiting, orbital tenderness, swelling, or ecchymosis and limitation of extraocular movement were each associated with the presence of an orbital fracture (P < 0.05 for each). Twenty-two children (6.7% of cohort and 16.5% of children with orbital fractures) underwent surgical repair for an orbital fracture. In the absence of orbital tenderness, swelling, or ecchymosis, there was 1 child with an orbital fracture who underwent operative intervention. CONCLUSIONS Fewer than half of children undergoing CT have an orbital fracture identified, and fewer than 7% have a fracture that requires operative intervention. In the absence of orbital tenderness, swelling, or ecchymosis, only 1 child had an orbital fracture requiring surgical repair.
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Pediatric Orbital Floor Fractures: Clinical and Radiological Predictors of Tissue Entrapment and the Effect of Operative Timing on Ocular Outcomes. J Craniofac Surg 2017; 28:1966-1971. [PMID: 28953154 DOI: 10.1097/scs.0000000000004017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Orbital floor fractures can produce acute constitutional symptoms and poor ocular outcomes. This study aims to determine the clinical and radiological predictors of tissue entrapment in pediatric orbital floor fractures and to explore the effect of operative timing on ocular outcomes. The authors reviewed medical records from pediatric patients with orbital floor fractures from 2007 to 2015. One hundred fifty-two patients with 159 orbital floor fractures were included. One hundred twenty-two (80.3%) patients were male, and the mean age was 12.2 years. Twelve patients sustained orbital floor fractures with tissue entrapment. At presentation extraocular movement (EOM) restriction, diplopia, nausea, and vomiting were all associated with tissue entrapment (P < 0.001). Among patients with trapdoor fractures (determined by facial computed tomography), the presence of nausea and/or vomiting was predictive of tissue entrapment: positive predictive value 80%, negative predictive value 100%. For all the patients, regardless of fracture configuration, the presence of nausea and/or vomiting was valuable in ruling out tissue entrapment: sensitivity 83.3%, negative predictive value 98.1%. In tissue entrapment patients, poorer ocular outcomes (EOM restriction and diplopia) were associated with the length of operation (P = 0.007), but not the time interval to operation (P = 0.146). The authors conclude that nausea and vomiting are valuable predictors of tissues entrapment, particularly when EOM restriction and diplopia are equivocal. In the authors' study, radiological findings were also predictive of entrapment, but inconsistent language in this area limits the external validity of these results. The authors' study draws attention to the relationship between operation length and poorer ocular outcomes, suggesting that case severity/complexity and surgeon technique/experience may influence outcomes.
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Wei N, Bi H, Zhang B, Li X, Sun F, Qian X. Biphasic growth of orbital volume in Chinese children. Br J Ophthalmol 2017; 101:1162-1167. [PMID: 28258076 PMCID: PMC5574409 DOI: 10.1136/bjophthalmol-2016-309848] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/31/2017] [Accepted: 02/06/2017] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to map out the developmental curve of the orbital volume of Chinese children aged 1–15 years. Methods CT scanning was performed on 109 children and the orbital volume, interlateral orbital rim distance (IORD), and extent of exophthalmos were measured on the CT images and plotted against age. Results The development of the orbit structure followed a biphasic pattern. The first growth phase was before 3 years and the second growth phase was between 7 years and 12 years of age. The growth speed in the first phase was about 3 times that of the second one (first vs second phase: 2.28 cm3/year vs 0.67 cm3/year for orbital volume, 5.01 mm/year vs 1.57 mm/year for IORD, 1.29 mm/year vs 0.42 mm/year for the exophthalmos). During development, there was no significant difference between the left and right orbits. There was no significant difference between boys and girls before 12 years of age. However, after 12 years of age, boys had significantly larger orbital volumes (22.16±2.28 cm3/year vs 18.57±1.16 cm3/year, p<0.001) and a greater IORD (96.29±3.18 mm/year vs 91.00±4.54 mm/year, p<0.001) than girls. Conclusions In Chinese children, the development of orbital volume follows a biphasic pattern and a sex difference becomes significant after the age of 12 years.
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Affiliation(s)
- Nan Wei
- Department of Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Hua Bi
- College of Optometry, Nova Southeastern University, Davie, Florida, USA
| | - Bin Zhang
- College of Optometry, Nova Southeastern University, Davie, Florida, USA
| | - Xue Li
- Department of Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Fengyuan Sun
- Department of Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xuehan Qian
- Department of Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
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[Bone cement implant as an alternative for orbital floor reconstruction: A case report]. CIR CIR 2017; 85 Suppl 1:13-18. [PMID: 28038736 DOI: 10.1016/j.circir.2016.10.034] [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: 03/03/2016] [Accepted: 10/17/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The management of orbitary fractures is one of the most challenging in facial trauma; the variety of reconstruction materials for its treatment is broad and is constantly improving, but despite this there is no consensus for its use or literature that sustains it. OBJECTIVE To present the use and design of a preformed bone implant as an alternative for the reconstruction of orbital floor fractures in the pediatric age group. CLINICAL CASE A 7-year old male who suffered a right hemifacial contusion trauma with clinical and tomographic diagnosis of right pure blowout type orbital floor fracture with inferior rectus muscle entrapment and right post-traumatic palpebral ptosis. Successful surgical reconstruction was performed 7 days later with a pre-constructed bone cement implant. Eight weeks after surgery the patient presented with mild residual palpebral ptosis, no ocular movement limitations and no diplopia. CONCLUSIONS The use of a bone cement implant can be considered appropriate for the reconstruction of these fractures, as another alternative to be used by the ophthalmologist among the variety of all the other materials used for this purpose. We consider that our optimism based on the results obtained in this case obligates us to increase the number of patients treated in order to gather more evidence and do larger follow up.
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Li Y, Song X, Li L, Fan X, Lin M. Forced duction training: A potential key point for recovery in pediatric patients with trapdoor fracture. Medicine (Baltimore) 2016; 95:e5121. [PMID: 27858844 PMCID: PMC5591092 DOI: 10.1097/md.0000000000005121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Trapdoor fracture is a type of orbital fracture frequently observed in pediatric patients after facial trauma. The treatment options and surgical outcomes associated with this fracture are controversial.This study investigated the surgery principles and strategies as well as the functional training for the recovery and prognosis of pediatric patients with trapdoor fracture.A retrospective study was conducted on 21 pediatric patients with orbital trapdoor fracture who received the transconjunctival approach for orbital defect reconstruction surgery between 2009 and 2014 at the Department of Ophthalmology, Shanghai Ninth People's Hospital. The minimum follow-up period was 1 year, and the average follow-up time was 2.5 years. These data included surgery principles and strategies, functional training for recovery, and patient prognosis.Of all the numerical variables, interval to surgery was the only parameter that affected the recovery of ocular movement and diplopia grades [ΔLEMSG (6 m:pre) = -2.689 + 0.015 • interval to surgery, P = 0.018; ΔLEMSG (last:pre) = -3.171 + 0.026 • interval to surgery, P = 0.033; Δdiplopia (6 m:pre) = -3.266 + 0.026 • interval to surgery, P = 0.047; Δdiplopia (last:pre) = -2.518 + 0.019 • interval to surgery, P = 0.031], whereas recovery was not affected by age or preoperative ocular movement or diplopia grades (P > 0.05). According to the categorical variable analysis, patient prognosis grouped by coordination to forced duction training varied across the different groups (P < 0.05); however, male and female patients did not differ with regard to prognosis (P > 0.05).To judge the prognosis of pediatric patients with trapdoor fracture, cooperation to forced duction training and interval to surgery are most likely key points. Correct surgical approaches and functional training are of great importance for faster recovery.
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Affiliation(s)
| | | | | | | | - Ming Lin
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai, China
- Correspondence: Ming Lin and Xianqun Fan, Department of Ophthalmology, Shanghai Ninth People's Hospital, Zhizaoju Rd 639, Shanghai 200011, China (e-mail: ; )
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Abstract
OBJECTIVES Absorbable plates are sometimes grafted for treating orbital fractures. These plates cannot be readily processed to fit the shape of the fracture site, particularly when the fracture encompasses a broad area from the medial toward the inferior wall. Preparing the plates in a standard shape beforehand will be useful. Thus, in this study, the authors measured the orbital wall distance in healthy orbits to determine the mean orbital size with the ultimate goal of developing and clinically applying a standard plate for orbital fracture. METHODS Measurements were performed for the left eye orbit on computed tomography images using a three-dimensional medical image processing workstation. The authors measured the orbital wall distances and angle of healthy orbits in 40 males and 40 females to determine the mean size of the orbit. RESULTS In healthy orbits, no significant difference was noticeable in the angle between medial wall and inferior wall between males and females. The medial, inferior, and medial + inferior wall distances were markedly longer in males than in females (P < 0.05). DISCUSSIONS The orbital shapes had the same pattern in males and females. The standard plate would be adaptable to all cases if it were produced with the medial wall + inferior wall distance greater than the maximum value in males and trimmed to fit the orbit form of the patient. CONCLUSIONS The results would be the basis of creating a standard plate and using it after appropriate adjustments.
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Boyette JR, Pemberton JD, Bonilla-Velez J. Management of orbital fractures: challenges and solutions. Clin Ophthalmol 2015; 9:2127-37. [PMID: 26604678 PMCID: PMC4655944 DOI: 10.2147/opth.s80463] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Many specialists encounter and treat orbital fractures. The management of these fractures is often challenging due to the impact that they can have on vision. Acute treatment involves a thorough clinical examination and management of concomitant ocular injuries. The clinical and radiographic findings for each individual patient must then be analyzed for the need for surgical intervention. Deformity and vision impairment can occur from these injuries, and while surgery is intended to prevent these problems, it can also create them. Therefore, surgical approach and implant selection should be carefully considered. Accurate anatomic reconstruction requires complete assessment of fracture margins and proper implant contouring and positioning. The implementation of new technologies for implant shaping and intraoperative assessment of reconstruction will hopefully lead to improved patient outcomes.
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Affiliation(s)
- Jennings R Boyette
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - John D Pemberton
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Juliana Bonilla-Velez
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Abstract
There are few reports of blowout fractures of the orbital floor in children younger than 5 years of age; in a search of the literature, we found only six reported cases which revealed the exact age, correct diagnosis, and treatment. We herein report the case of a 3-year-old boy with a blowout fracture of the orbital floor. Computed tomography showed a pure blowout fracture of the left orbital floor with a slight dislocation of the orbital contents. The patient was treated conservatively due to the absence of abnormal limitation of eye movement or enophthalmos. The patient did not develop any complications that necessitated later surgical intervention. Computed tomography at 6 months after the injury showed the regeneration of the orbital floor in the area of the fracture and no abnormalities in the left maxillary sinus. We herein present our case and the details of six other cases reported in the literature, and discuss their etiology, diagnosis, and treatment methods.
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Affiliation(s)
- Akira Sugamata
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Naoki Yoshizawa
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
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Model-based segmentation in orbital volume measurement with cone beam computed tomography and evaluation against current concepts. Int J Comput Assist Radiol Surg 2015; 11:1-9. [DOI: 10.1007/s11548-015-1228-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
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Lee J, Lee HK, Lee H, Chang M, Park M, Baek S. Epidemiology of Oculoplastic and Reconstructive Surgeries Performed by a Single Specialist With 15 Years’ Experience at a Tertiary Center. J Craniofac Surg 2015; 26:e308-11. [DOI: 10.1097/scs.0000000000001699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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