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Er S, Hassan B, Yoon J, Resnick E, Yusuf C, Lagziel T, Liang F, Ptak T, Redett R, Yang R, Grant M. Orbital Fracture Characteristics and Outcomes in Baltimore. J Craniofac Surg 2024:00001665-990000000-01420. [PMID: 38534184 DOI: 10.1097/scs.0000000000010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/11/2024] [Indexed: 03/28/2024] Open
Abstract
Fracture characteristics and postoperative outcomes of patients presenting with orbital fractures in Baltimore remain poorly investigated. The purpose of our study was to determine the fracture patterns, etiologies, and postoperative outcomes of patients treated for orbital fractures at 2 level I trauma centers in Baltimore. A retrospective cohort study was conducted on patients who underwent orbital fracture repair at the R Adams Cowley Shock Trauma Center and the Johns Hopkins Hospital from January 2015 to December 2019. Of 374 patients, 179 (47.9%) had orbital fractures due to violent trauma, 252 (67.4%) had moderate to near-total orbital fractures, 345 (92.2%) had orbital floor involvement, and 338 (90.4%) had concomitant neurological symptoms/signs. Almost half of the patients had at least one postoperative ocular symptom/sign [n = 163/333 (48.9%)]. Patients who had orbital fractures due to violent trauma were more likely to develop postoperative ocular symptoms/signs compared with those who had orbital fractures due to nonviolent trauma [n = 88/154 (57.1%), n = 75/179 (41.9%); P = 0.006]. After controlling for factors pertaining to injury severity, there was no significant difference in patient throughput or incidence of any postoperative ocular symptom/sign after repair between the two centers. Timely management of patients with orbital fractures due to violent trauma is crucial to mitigate the risk of postoperative ocular symptoms/signs.
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Affiliation(s)
- Seray Er
- School of Medicine, University of Maryland
| | - Bashar Hassan
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Joshua Yoon
- Department of Surgery, George Washington University, Washington, DC
| | | | - Cynthia Yusuf
- School of Medicine, University of Maryland
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Tomer Lagziel
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Fan Liang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Thomas Ptak
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD
| | - Richard Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Michael Grant
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center
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Terenzi V, Dal Cortivo F, Dell'Aquila A, Pompucci A, Sepe M, Ciarlo S, Gallo A, Valentini V. Multidisciplinary Management of Complex Ophthalmic Craniofacial Trauma During Coronavirus Disease 2019 Pandemic: Considerations for Treatment. J Craniofac Surg 2023; 34:2234-2235. [PMID: 37276339 DOI: 10.1097/scs.0000000000009452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/11/2023] [Indexed: 06/07/2023] Open
Affiliation(s)
- Valentina Terenzi
- Department of Odontostomatological and Maxillo-Facial Sciences, 'Sapienza' University of Rome
- Otolaryngology University Unit, 'S.M. Goretti Hospital', Latina, Italy
| | - Fiorenza Dal Cortivo
- Department of Odontostomatological and Maxillo-Facial Sciences, 'Sapienza' University of Rome
| | - Alberto Dell'Aquila
- Department of Odontostomatological and Maxillo-Facial Sciences, 'Sapienza' University of Rome
| | - Angelo Pompucci
- Department of Neurosurgery, 'S.M.Goretti Hospital', Latina, Italy
| | | | - Silvia Ciarlo
- Department of Neurosurgery, 'S.M.Goretti Hospital', Latina, Italy
- Department of Neurosurgery, UOC Neurosurgery, Department of Biomedical and Dental Sciences and Morphological and Functional Images, University of Messina, Messina
| | - Andrea Gallo
- Otolaryngology University Unit, 'S.M. Goretti Hospital', Latina, Italy
- Department of Sense Organs, ENT Section, 'Sapienza' University of Rome, Italy
| | - Valentino Valentini
- Department of Odontostomatological and Maxillo-Facial Sciences, 'Sapienza' University of Rome
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Dave TV, Chheda PP, Das AV, Dave VP. Open Globe Injuries with Concurrent Orbital Fractures - Clinical Settings and Factors Predicting Outcomes. Semin Ophthalmol 2023:1-7. [PMID: 36683272 DOI: 10.1080/08820538.2023.2169582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIM We describe the clinical settings and the factors predicting outcomes in open globe injuries with concurrent orbital fractures. METHODS Retrospective, consecutive, non-comparative study. All eyes from January 2014 to January 2021 with concurrent open globe injuries with orbital fractures that underwent management were included. The clinical data of each patient who underwent a comprehensive ophthalmic examination was entered into a browser-based electronic medical records system (eyeSmart EMR) by uniformly trained ophthalmic personnel and supervised by an ophthalmologist using a standardized template. Favorable functional outcome was defined as the final best corrected visual acuity of >20/200 as per the World Health Organization (WHO) definitions of severe visual impairment and blindness. A favorable anatomic outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit. Multivariate logistic regression analysis was done to assess the effect of various demographic and clinical factors and the type of orbital fracture on the final anatomic and functional outcome. RESULTS Ninety-one eyes of 91 patients were included in the study. Females accounted for 74/91 (81.3%) of the eyes. Modes of trauma was rupture in 67%, perforating in 5.5% and penetrating in 27.5% of the cases. Orbital rim involvement was seen in 79.1%. The most common isolated fracture seen was a medial wall (19.78%), which was followed by the orbital floor (15.38%). Favorable functional outcome was seen in 10 eyes (11%), while a favorable anatomic outcome was achieved in 45 (49.5%). Odds of a favorable functional outcome were 6.12 (95% CI 1.22 to 30.71), p = .02 for an open globe injury with orbital fracture in the absence of a concurrent retinal detachment. Odds of a favorable anatomic outcome were 55.55 (95% CI 2.43 to 1250), p = .01 when the injury did not involve zone 3, 9.94 (95% CI 2.05 to 48), p = .004 when concurrent retinal detachment was absent, 16.3 (95% CI 1.42 to 187.19), p = .02 when the orbital rim was intact and 7.83 (95% CI 1.09 to 56.19), p = .04 when only one orbital wall was involved. CONCLUSIONS Open globe injuries with concurrent orbital fractures result in a very poor functional outcome. Concurrent retinal detachment is a negative predictive factor. Associated fractures involving the orbital rim increase the risk of eyeball loss.
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Affiliation(s)
- Tarjani Vivek Dave
- Hariram Motumal Nasta & Renu Hariram Nasta Ophthalmic Plastic Surgery Centre, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Prapti Praful Chheda
- Academy for Eye Care Education, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Anthony Vipin Das
- Department of eyeSmart EMR & AEye, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Vivek Pravin Dave
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
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Placide J, Ip CS, Le BHA, Ali SF, Ghergherehchi LM. An Update on the Management of Traumatic Pediatric Open Globe Repair: Prognostication and Complication Management. Int Ophthalmol Clin 2022; 62:203-218. [PMID: 34965235 DOI: 10.1097/iio.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Valencia MR, Miyazaki H, Ito M, Nishimura K, Kakizaki H, Takahashi Y. Radiological findings of orbital blowout fractures: a review. Orbit 2021; 40:98-109. [PMID: 32212885 DOI: 10.1080/01676830.2020.1744670] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/11/2020] [Indexed: 06/10/2023]
Abstract
Purpose: To summarize the radiological findings in patients with orbital blowout fractures. Methods: We reviewed the published literature on radiological findings of orbital blowout fractures that were searched on PubMed and included our own radiologic findings on patients with orbital blowout fractures that were seen at our hospital. Results: Radiologic examination reveals a variety of findings in each case. However, common radiological findings of orbital blowout fractures include comminuted/unhinged, hinged, and linear fractures. These fractures are usually located in the orbital floor medial to the infraorbital nerve and in the medial orbital wall. Orbital fat is frequently herniated in the paranasal sinus or incarcerated at the fracture site. Orbital emphysema and haematoma sometimes occur as complications. Conclusions: This review will provide surgeons with a better understanding of various radiological findings, which could be helpful in the management of patients with orbital blowout fracture.
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Affiliation(s)
- Ma ReginaPaula Valencia
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital , Aichi, Japan
- Section of Orbital Surgery and Section of Oculoplastic and Lacrimal Surgery, The Medical City Eye and Vision Institute , Metro Manila, Philippines
| | - Hidetaka Miyazaki
- Department of Oral and Maxillofacial Surgery, Graduate School Tokyo Medical and Dental University , Tokyo, Japan
| | - Makoto Ito
- Departments of Radiology, Aichi Medical University , Aichi, Japan
| | | | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital , Aichi, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital , Aichi, Japan
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Uppuluri A, Bhagat N, Langer PD. Orbital Floor Fractures Concurrent with Acute Open-Globe Injuries. Ophthalmology 2020; 128:626-628. [PMID: 32735905 DOI: 10.1016/j.ophtha.2020.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/24/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Aditya Uppuluri
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Neelakshi Bhagat
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Paul D Langer
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey.
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Uppuluri A, Zarbin MA, Bhagat N. Risk Factors for Post–Open-Globe Injury Endophthalmitis. JOURNAL OF VITREORETINAL DISEASES 2020; 4:353-359. [PMID: 37008290 PMCID: PMC9979028 DOI: 10.1177/2474126420932322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: The objective of our project is to use the National Inpatient Sample Database to identify risk factors for endophthalmitis in cases of open-globe injury (OGI). Methods: This is a cross-sectional observational study of 48 627 cases of OGI from the National Inpatient Sample Database. We performed regression analysis using IBM SPSS Statistics 23. Codes from the International Classification of Disease, Ninth Revision were used to identify ocular findings and conditions. Variables with P values less than .05 on univariate analysis were included in the multivariable regression model; Bonferroni correction was applied to these results. Results: Of the 48 627 cases of OGI, 37 440 (77.0%) occurred in the adult group (21 years and older). Overall, 1018 (2.1%) cases developed posttraumatic endophthalmitis, with 74.5% cases in the adult group. Endophthalmitis developed in 293 (4.5%) eyes with an intraocular foreign body (IOFB). Results of binary logistic regression showed the clinical findings of traumatic cataracts, hypopyon, vitreous inflammation, corneal ulcers, or IOFBs were associated with an increased risk of developing endophthalmitis after OGI. Conversely, orbital fractures, rupture-type injuries, and intraocular tissue prolapse were associated with a decreased likelihood of being diagnosed with endophthalmitis. Conclusions: Endophthalmitis developed in 2.4% of pediatric OGIs and 2.0% of adult OGIs. Traumatic cataract, hypopyon, vitreous inflammation, corneal ulcer, keratitis, retinal detachment, IOFB, and diabetes increased the risk of post-open-globe endophthalmitis.
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Affiliation(s)
| | - Marco A. Zarbin
- Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
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Huckhagel T, Regelsberger J, Westphal M, Nüchtern J, Lefering R. Damage to the eye and optic nerve in seriously traumatized patients with concomitant head injury: analysis of 84,627 cases from the TraumaRegister DGU® between 2002 and 2015. Scand J Trauma Resusc Emerg Med 2020; 28:15. [PMID: 32122368 PMCID: PMC7052966 DOI: 10.1186/s13049-020-0712-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the prevalence and characteristics of prechiasmatic visual system injuries (VSI) among seriously injured patients with concomitant head trauma in Europe by means of a multinational trauma registry. METHODS The TraumaRegister DGU® was searched for patients suffering from serious trauma with a Maximum Abbreviated Injury Scale (AIS) ≥ 3 between 2002 and 2015 in Europe. After excluding cases without significant head injury defined by an AIS ≥ 2, groups were built regarding the existence of a concomitant damage to the prechiasmatic optic system comprising globe and optic nerve. Group comparisons were performed with respect to demographic, etiological, clinical and outcome characteristics. RESULTS 2.2% (1901/84,627) of seriously injured patients with concomitant head trauma presented with additional VSI. These subjects tended to be younger (mean age 44.7 versus 50.9 years) and were more likely of male gender (74.8% versus 70.0%) compared to their counterparts without VSI. The most frequent trauma etiologies were car accidents in VSI patients (28.5%) and falls in the control group (43.2%). VSI cases were prone to additional soft tissue trauma of the head, skull and orbit fractures as well as pneumocephalus. Primary treatment duration was significantly longer in the VSI cohort (mean 23.3 versus 20.5 days) along with higher treatment costs and a larger proportion of patients with moderate or severe impairment at hospital discharge despite there being a similar average injury severity at admission in both groups. CONCLUSIONS A substantial proportion of patients with head injury suffers from additional VSI. The correlation between VSI and prolonged hospitalization, increased direct treatment expenditures, and having a higher probability of posttraumatic impairment demonstrates the substantial socioeconomic relevance of these types of injuries.
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Affiliation(s)
- Torge Huckhagel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Regelsberger
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Nüchtern
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
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Gaier ED, Tarabishy S, Bayers C, Wolkow N, Gardiner M, Lefebvre DR, Grob S. Poor prognoses of open globe injuries with concomitant orbital fractures. Orbit 2019; 39:241-250. [PMID: 31658857 DOI: 10.1080/01676830.2019.1663881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Orbital trauma, particularly with open globe injury, can have a wide range of visual outcomes, which can be difficult to predict at presentation. Clinical features on presentation may provide insight into visual prognosis. We hypothesized that patients with open globe injuries and concomitant orbital fractures have poorer visual outcomes than patients without orbital fractures. METHODS We reviewed the charts of 77 patients with isolated open globe injuries (OG) and 76 patients with open globe injuries and concomitant orbital fractures (OGOF). Multivariate regression analysis was performed to assess the relative influence of individual presenting historical and clinical features on visual outcome. RESULTS OGOF patients were more likely to have sustained blunt trauma than a sharp, penetrating injury compared to OG patients. Ocular wound locations were more posterior and likely to involve multiple zones in OGOF compared to OG patients. Among OGOF patients, orbital floor fractures were the most common and roof fractures were the least common, but the latter was associated with presenting NLP vision and multiple zone involvement. The presence of an orbital fracture independently increased the odds of subsequent evisceration/enucleation (OR: 4.6, 95% CI 1.3-20.1, p = .0246) and NLP vision (OR: 6.81, 95% CI 2.42-21.85, p = .0005) when controlling for zone, mechanism of injury, uveal prolapse and demographic variables. CONCLUSIONS The presence of an orbital fracture independently confers a worse visual and ocular prognosis in patients with open globe injuries. Patients with open globe injuries in this category should be appropriately counseled.
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Affiliation(s)
- Eric D Gaier
- Department of Ophthalmology, Boston Children's Hospital , Boston, MA, USA.,Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology , Cambridge, MA, USA.,Department of Surgery, Medical University of South Carolina , Charleston, SC, USA.,Foundation Medicine , Cambridge, MA, USA
| | - Sami Tarabishy
- Department of Surgery, Medical University of South Carolina , Charleston, SC, USA
| | | | - Natalie Wolkow
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Boston, MA, USA.,Harvard Medical School , Boston, MA, USA
| | - Matthew Gardiner
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Boston, MA, USA.,Harvard Medical School , Boston, MA, USA
| | - Daniel R Lefebvre
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Boston, MA, USA.,Harvard Medical School , Boston, MA, USA
| | - Seanna Grob
- Department of Ophthalmology, University of California , San Francisco, CA, USA
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Orbital roof fractures as an indicator for concomitant ocular injury. Graefes Arch Clin Exp Ophthalmol 2019; 257:2541-2545. [DOI: 10.1007/s00417-019-04455-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022] Open
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