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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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2
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Fu Y, He Y, Xie H, Sun K, Dai H. Closed head injury combined with orbital blowout fracture and displacement of the eyeball into the maxillary sinus in a 14-year-old boy: a case report. BMC Ophthalmol 2024; 24:146. [PMID: 38566099 PMCID: PMC10988962 DOI: 10.1186/s12886-024-03421-w] [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: 01/31/2024] [Accepted: 03/30/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Trauma-induced orbital blowout fracture (OBF) with eyeball displacement into the maxillary sinus is rare. CASE PRESENTATION We present the case of a 14-year-old with a closed head injury, OBF, and displacement of the eyeball into the maxillary sinus following a car accident. A prompt transconjunctival access surgery was performed for eyeball repositioning and orbital reconstruction in a single session, mitigating anaesthesia-related risks associated with multiple surgeries. At the 12-month follow-up, his visual acuity was 20/200. Despite limited eye movement and optic nerve atrophy, overall satisfaction with the ocular appearance was achieved. CONCLUSIONS This report offers novel insights into the mechanisms of OBF occurrence and the development of postoperative complications.
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Affiliation(s)
- Yue Fu
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying He
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huixuan Xie
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kongliang Sun
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Hanjun Dai
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Takabayashi K, Maeda Y, Kataoka N, Kagokawa H, Nagamine M, Ota I, Fujita T. Algorithm for pediatric orbital blowout fractures: a 20-year retrospective cohort study. Braz J Otorhinolaryngol 2023; 89:447-455. [PMID: 36754674 PMCID: PMC10164772 DOI: 10.1016/j.bjorl.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/02/2022] [Accepted: 01/19/2023] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Pediatric orbital blowout fractures can include pathologies that seem mild but require urgent release; serious sequelae can occur with standby surgery or conservative treatment. We sought to validate an algorithm for the treatment of pediatric orbital blowout fractures. METHODS This retrospective cohort study included 61 pediatric patients, aged 18 years or younger, treated for pure orbital blowout fractures according to the algorithm from April 1, 2000, to August 31, 2020, at the Japanese Red Cross Asahikawa Hospital. RESULTS There were 52 males (85%). Median age was 14 years (range, 5-18 years). There were 9 patients categorized as needing urgent release, 16 as needing repair, and 36 as needing conservative treatment. Mean follow-up ocular movement was 98.0 (95% Confidence Interval [95% CI], 96.8-99.2). Postoperative diplopia was not observed in 96% (79.6%-99.9%) of patients, better than in previous studies. A higher proportion of patients aged 0-12 years needed urgent repair than those aged 13-18 years (Odds Ratio [OR] = 14.2; 95% CI 1.6-683.4; p = 0.0046). There were no differences in Hess area ratio by age group. CONCLUSION Clinical results with the algorithm were satisfactory. The algorithm is suitable for treatment of pediatric orbital blowout fractures. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Kosuke Takabayashi
- Japanese Red Cross Asahikawa Hospital, Department of Otorhinolaryngology, Asahikawa City, Hokkaido, Japan
| | - Yohei Maeda
- Osaka University Graduate School of Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Suita City, Osaka, Japan; Japan Community Health Care Organization Osaka Hospital, Department of Otorhinolaryngology, Osaka City, Osaka, Japan.
| | - Nobuya Kataoka
- Japanese Red Cross Asahikawa Hospital, Department of Ophthalmology, Asahikawa City, Hokkaido, Japan
| | - Hiroyuki Kagokawa
- Japanese Red Cross Asahikawa Hospital, Department of Otorhinolaryngology, Asahikawa City, Hokkaido, Japan
| | - Masayoshi Nagamine
- Japanese Red Cross Asahikawa Hospital, Department of Ophthalmology, Asahikawa City, Hokkaido, Japan
| | - Isao Ota
- Japanese Red Cross Asahikawa Hospital, Department of Otorhinolaryngology, Asahikawa City, Hokkaido, Japan
| | - Taketoshi Fujita
- Japanese Red Cross Asahikawa Hospital, Department of Otorhinolaryngology, Asahikawa City, Hokkaido, Japan
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4
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Is Surgery Needed for Diplopia after Blowout Fractures? A Clarified Algorithm to Assist Decision-making. Plast Reconstr Surg Glob Open 2022; 10:e4308. [PMID: 35558136 PMCID: PMC9084434 DOI: 10.1097/gox.0000000000004308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
Diplopia is a common symptom after blowout fractures, with an incidence of 43.6%–83%. Although there is some consensus toward surgical correction, diplopia is not always resolved by surgery. Thus, there is a clinical dilemma for surgeons with regard to performing surgery at a specific time. This review aimed to create an algorithm to support accurate and effective decision-making.
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Does Early Treatment of Paediatric Orbital Fracture Offer Any Advantage in Terms of Post-Operative Clinical Outcomes. J Maxillofac Oral Surg 2022; 21:25-33. [PMID: 35400913 PMCID: PMC8934817 DOI: 10.1007/s12663-021-01543-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/24/2021] [Indexed: 10/21/2022] Open
Abstract
Background Trapdoor fractures commonly occur in children below 6 years of age. The high resiliency of bone, pneumatisation of sinuses and other factors lead to entrapment of muscle and/or soft tissue which undergoes ischaemic changes leading to residual diplopia. The timing of intervention in children ranges from 24 h to greater than 2 weeks. Early surgical intervention is particularly indicated in cases of Oculocardiac reflex. Methods A Prisma guided systematic review of literature was conducted with no filters on language till September 2020. Studies on paediatric orbital fractures with data on timing of intervention and clinical outcomes were considered eligible for the review. The Oxford Level Of Evidence was used to assess the strength of individual studies. Results A total of 19 studies (18 English, 1 French) were selected; except for one study all were retrospective series. The timing of intervention ranged from 24 h to more than 1 month. Most of the studies agreed that orbital fractures in children should receive early intervention preferably within 2 weeks. In case of white-eyed blowout fracture, oculocardiac reflex and trapdoor fractures with muscle entrapment surgical intervention should be carried out within 24-48 h. Discussion Children presenting with facial injuries should be thoroughly examined for signs of muscle entrapment, diplopia, nausea, vomiting and bradycardia. If present these should receive early intervention. In cases with no signs of oculocardiac reflex and muscle entrapment a treatment within 2 weeks is recommended. If diplopia is mild or resolving with minimal hypoglobus and enophthalmos a wait and watch policy should be carried out.
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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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7
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Effects of orthoptic training for residual diplopia after surgical repair of blowout fractures. Graefes Arch Clin Exp Ophthalmol 2021; 260:1395-1404. [PMID: 34536119 DOI: 10.1007/s00417-021-05414-7] [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: 06/09/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To investigate the effects of orthoptic training for residual diplopia after blowout fracture (BOF) surgery. METHODS We retrospectively reviewed the medical records of 14 (average age, 22.9 ± 13.1 years) patients with residual diplopia, who had undergone orthoptic training after BOF surgery at the Department of Ophthalmology, Kindai University Hospital, between August 2013 and September 2019. The orthoptic training included exercises for eye movement, convergence, and fusional area expansion. We assessed the training effects by scoring patients' Hess screen (Hess) test results and fields of binocular single vision (BSV). The scores obtained before/after surgery and after training were compared. We also investigated the factors that influenced patients' BSV scores after training. p < 0.05 was considered statistically significant. RESULTS The respective pre- and postoperative and after-training average scores were 7.0 ± 5.3, 5.4 ± 4.3, and 2.5 ± 3.2 points for Hess and 50.0 ± 41.3, 48.2 ± 35.9, and 89.4 ± 14.0 points for BSV. Neither Hess nor BSV score showed a significant difference before and after surgery (p > 0.05, the Steel-Dwass test). Compared to the postoperative (i.e., before training) scores, both Hess and BSV scores significantly improved after training (p < 0.05 for Hess, p < 0.01 for BSV; the Steel-Dwass test). CONCLUSION Orthoptic training appeared effective in resolving residual diplopia after BOF surgery by improving patients' ocular motility and expanding the BSV field.
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Yamanaka Y, Watanabe A, Rajak SN, Nakayama T, Sotozono C. The trend of recovery period on postoperative eye movement in orbital blowout fractures. J Craniomaxillofac Surg 2021; 49:688-693. [PMID: 33608201 DOI: 10.1016/j.jcms.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/09/2020] [Accepted: 02/07/2021] [Indexed: 11/25/2022] Open
Abstract
To investigate the trend of restoration of postoperative eye movements after orbital blowout fractures by analyzing the percentage of Hess area ratio (HAR%). This was a retrospective study of patients who underwent orbital blow out reconstruction surgery within 28-days post injury. Eye movements were measured preoperatively and 3, 6, and 12 months post operatively by Hess chart. Orbital fractures were classified into three shapes: trap-door fracture with muscle entrapment, trap-door fracture with incarcerated tissue, and depressed fracture. Correlations between fracture shapes, regions, reconstruction implant, age and HAR% were analyzed. This study involved 125 eyes (64 right eyes and 61 left eyes) of 125 isolated orbital fracture cases (95 males, 30 females, mean age: 27.2, range 4-85 years old). Of the total 125 cases, 96 patients had orbital floor fractures, 18 had orbital medial wall fractures, and 11 had combined orbital medial wall and floor fractures. Three had trap-door fractures with muscle entrapment, 42 had trap-door fractures with incarcerated tissue, and 80 had orbital depressed fractures. The overall mean HAR% improved significantly from 76.0 pre-operatively to 95.5 post-12 months (P < 0.01). The mean HAR% in orbital floor fracture improved significantly from 76.7 pre-operatively to 92.9 and 94.7 at 3, 6 months respectively. There was a non-significant improvement in the HAR% in medial wall fractures from 83.2 pre-operatively to 89.5 at 3 months and a significant improvement to 93.2 at 6 months (p < 0.05). Orbital fractures were reconstructed with either Unsintered hydroxyapatite particles/poly l-lactide composite sheet (u-HA/PLLA composite sheet) (91 patients), a silicone silastic sheet (20 patients) a combination of sheets (7 patients) or without an implant (7 patients). There was no significant difference in the HAR% improvement between the different implants. The HAR% improvement was significantly greater in patients <18 years old than in those aged 18 or over. The HAR% is an effective method of the objective assessment of recovery after orbital fracture. Patients and surgeons should be aware that the recovery after medial wall fractures is slower than after floor fractures and continues after three months post-surgery and that a longer period of observation without further intervention may be required for medial wall fractures, whilst floor fractures are likely to have achieved their maximal recovery by three months.
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Affiliation(s)
- Yukito Yamanaka
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan; Department of Ophthalmology, Meiji University of Integrative Medicine, Kyoto, Japan
| | - Akihide Watanabe
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan.
| | - Saul N Rajak
- The Sussex Eye Hospital, Brighton and Sussex University Hospital, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK
| | - Tomomichi Nakayama
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan
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9
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Koryczan P, Zapała J, Gontarz M, Wyszyńska-Pawelec G. Surgical treatment of enophthalmos in children and adolescents with pure orbital blowout fracture. J Oral Sci 2020; 63:129-132. [PMID: 33390460 DOI: 10.2334/josnusd.20-0371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE This study evaluated outcomes of surgical treatment for enophthalmos after pediatric orbital blowout fracture. Associations of fracture type, fracture site, time from injury to treatment, and type of surgical procedure with treatment outcomes were assessed. METHODS The medical records of 200 children and adolescents (38 girls and 162 boys) with orbital fractures treated in the authors' department from 1975 to 2015 were reviewed retrospectively. The main causes of injury were accidental blows to the orbit and sports injuries. This study included only patients with fracture of the floor and/or medial wall of the orbit, which is referred to in the English literature as pure, or internal, blowout fracture. Patients with fracture of the orbital rim, lateral wall, or roof were excluded. Surgical treatment was performed for 178 patients; the other 22 children were treated conservatively. RESULTS In the surgically treated group, treatment outcomes did not differ in relation to the severity of post-traumatic enophthalmos. The setting of the eyeball improved in 83% of patients. CONCLUSION The severity of post-traumatic enophthalmos was not associated with surgical outcome in children.
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Affiliation(s)
- Piotr Koryczan
- Department of Cranio-Maxillofacial, Oncological and Recontructive Surgery, Jagiellonian University Medical College, University Hospital in Cracow
| | - Jan Zapała
- Department of Cranio-Maxillofacial, Oncological and Recontructive Surgery, Jagiellonian University Medical College, University Hospital in Cracow
| | - Michał Gontarz
- Department of Cranio-Maxillofacial, Oncological and Recontructive Surgery, Jagiellonian University Medical College, University Hospital in Cracow
| | - Grażyna Wyszyńska-Pawelec
- Department of Cranio-Maxillofacial, Oncological and Recontructive Surgery, Jagiellonian University Medical College, University Hospital in Cracow
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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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Zeng C, Fan C, Liu J, Xiao Q, Zhu Y, Song X, Chen H. Gradual oculomotor training in blow-out orbital fracture reconstruction recovery. J Int Med Res 2019; 48:300060519893846. [PMID: 31885341 PMCID: PMC7607529 DOI: 10.1177/0300060519893846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study compared the impact of gradual oculomotor training (GOT) in
blow-out orbital fracture (BOF) reconstruction recovery with the impact of
high-intensity trainings. Methods In total, 120 patients with BOF requiring orbital reconstruction surgery were
randomly divided into four groups; all groups performed postoperative
oculomotor training four times per day. Patients in Groups 1, 2, 3, and 4
performed 10, 20, 30, and 50 sets of all-direction movement per training on
the first 3 days, respectively; they performed 10 additional sets per
training on the following 4 days. Patients in all groups performed 50 sets
per training from 8 days to 3 months postoperatively. Incision healing,
pain, and satisfaction rate, as well as degree of diplopia, were recorded
during follow-up. Results At 7 days postoperatively, more patients in Group 1 had no/mild swelling and
no/mild pain, compared with patients in Group 4. Patients in Groups 1 and 2
had higher satisfaction rates than patients in Group 4. The degree of
diplopia did not significantly differ among the groups. Conclusions For patients with BOF, GOT after reconstruction surgery was more beneficial
for wound healing, pain relief, and satisfaction; the degree of diplopia did
not significantly differ, compared with high-intensity trainings.
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Affiliation(s)
- Changjuan Zeng
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Chengjing Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jinlin Liu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Qiong Xiao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yiwen Zhu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xuefei Song
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Huifang Chen
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Reich W, Aust O, Eckert A. Prospective analysis of mid-facial fractures in a single-center pediatric-adolescent cohort. Int J Pediatr Otorhinolaryngol 2019; 119:151-160. [PMID: 30708183 DOI: 10.1016/j.ijporl.2019.01.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/19/2019] [Accepted: 01/19/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The complex architecture of the midface renders diagnosing and treating fractures challenging, especially for young patients who present the additional risk of suffering growth and development deficiencies, which is to be avoided at all costs. OBJECTIVES This study sought to characterize pediatric mid-facial fractures considering the possible complications. METHODS Between September 2008 and September 2018, data was collected on inpatients aged <18 years, treated for mid-facial fractures at the Halle University Hospital. Evaluated parameters were age, gender, cause and type of fracture, associated injuries, treatment, and complications. RESULTS In total, 31 patients were examined; 20 were boys. The most common cause of injury was road traffic accident (41.9%). Orbital floor fracture was the most common type of injury (58.1%). In 54.8% of cases, surgery was performed. CONCLUSION The incidence of complications associated with mid-facial fractures was low (n = 7), requiring treatment in only three cases (orthodontic, ophthalmological).
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Affiliation(s)
- Waldemar Reich
- Department of Oral and Plastic Maxillofacial Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, D-06120, Halle (Saale), Germany.
| | - Oliver Aust
- Dental Practice, Waldkerbelstraße 12, D-04329, Leipzig, Germany.
| | - Alexander Eckert
- Department of Oral and Plastic Maxillofacial Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, D-06120, Halle (Saale), Germany.
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13
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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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Barh A, Swaminathan M, Mukherjee B. Orbital fractures in children: clinical features and management outcomes. J AAPOS 2018; 22:415.e1-415.e7. [PMID: 30366051 DOI: 10.1016/j.jaapos.2018.07.353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/02/2018] [Accepted: 07/07/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To report the clinical characteristics and management outcomes of orbital fractures in children. METHODS The medical records of pediatric patients (<18 years of age) who presented with orbital fractures over a 15-year period (January 2001-December 2015) were reviewed retrospectively. The cause of injury, imaging findings, clinical features, management, and outcomes were noted. RESULTS A total of 52 patients (39 males) were included. Mean age at presentation was 10.9 years (range, 2-18). Road traffic accidents (18/52 [35%]) were the most common cause, with the orbital floor (42/52 [81%]) being the most common fracture site. The most common complaint was double vision (52%). Thirty-eight patients underwent surgical intervention, and extraocular muscle entrapment (56%) was the most common indication for surgery. Early surgical intervention within 15 days of injury resulted in complete resolution of diplopia. CONCLUSION In our study cohort, orbital floor fracture was most common. The trapdoor type of fracture was seen in almost half of the patients, with diplopia being the most common presenting complaint. Early surgical intervention was associated with complete resolution of ocular motility limitation and diplopia.s.
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Affiliation(s)
- Atanu Barh
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetics, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Meenakshi Swaminathan
- Department of Pediatric Ophthalmology & Strabismus, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Bipasha Mukherjee
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetics, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India.
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Yoo YJ, Yang HK, Kim N, Hwang JM. Pediatric orbital wall fractures: Prognostic factors of diplopia and ocular motility limitation. PLoS One 2017; 12:e0184945. [PMID: 29095826 PMCID: PMC5667750 DOI: 10.1371/journal.pone.0184945] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/02/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate the factors affecting recovery of diplopia and limited ocular motility in pediatric patients who underwent surgery for orbital wall fracture. DESIGN Retrospective observational case series. METHODS In this retrospective observational case series, 150 pediatric patients (1-18 years old) who were diagnosed with orbital medial wall or floor fracture and underwent corrective surgery between 2004 and 2016 at Seoul National University Bundang Hospital were included. The medical records of patients with orbital medial wall or floor fracture were reviewed, including sex, age, diplopia, ocular motility, preoperative computed tomographic finding, and surgical outcomes. Factors affecting recovery of diplopia and ocular motility limitation were analyzed. RESULTS Of the 150 patients (134 boys; mean age, 14.4 years) who underwent corrective surgery for orbital wall fracture, preoperative binocular diplopia was found in 76 (50.7%) patients and limited ocular motility in 81 (54.0%). Presence of muscle incarceration or severe supraduction limitation delayed the recovery of diplopia. In case of ocular motility limitation, presence of muscle incarceration and retrobulbar hemorrhage were related with the delayed resolution. Multivariate analysis revealed supraduction limitation (Hazard ratio [HR] = 1.74, 95% confidence interval [CI] = 1.19-2.55), larger horizontal orbital floor defects (HR = 1.22, 95% CI = 1.07-1.38), and shorter time interval to first visit (HR = 0.73) as negative prognostic factors for the recovery of diplopia. In addition, muscle incarceration (HR = 3.53, 95% CI = 1.54-8.07) and retrobulbar hemorrhage (HR = 3.77, 95% CI = 1.45-9.82) were found as negative prognostic factors for the recovery of motility limitation. CONCLUSIONS Presence of muscle incarceration and retrobulbar hemorrhage, horizontal length of floor fracture, supraduction limitation, and time interval from trauma to first visit were correlated with the surgical outcomes in pediatric orbital wall fracture patients. These results strengthen that the soft tissue damage associated with bony fracture affects the orbital functional unit. When managing children with orbital wall fracture, meticulous physical examination and thorough preoperative computed tomography based evaluation will help physicians to identify damage of orbital functional unit.
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Affiliation(s)
- Yung Ju Yoo
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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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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Su Y, Shen Q, Lin M, Fan X. Predictive factors for residual diplopia after surgical repair in pediatric patients with orbital blowout fracture. J Craniomaxillofac Surg 2016; 44:1463-8. [DOI: 10.1016/j.jcms.2016.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/16/2016] [Accepted: 06/13/2016] [Indexed: 11/28/2022] Open
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