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Takabayashi K, Maeda Y, Kataoka N. An innovative reconstruction procedure for fractures extending to the posterior orbital floor: utilizing the inferior margin of the greater wing of the sphenoid bone for reconstruction. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08808-5. [PMID: 39085473 DOI: 10.1007/s00405-024-08808-5] [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: 04/16/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE No definitive procedures have been proposed for orbital floor fractures extending to the slope of the posterior end, which is a challenging problem. This study demonstrates the effectiveness of an orbital reconstruction procedure based on anatomical landmarks that we developed, called the three landmarks procedure (TLP). METHODS This study is a single-center retrospective cohort study conducted by the Department of Otorhinolaryngology, Japanese Red Cross Asahikawa Hospital. Data were collected from April 2000 to December 2023. The effect of TLP and the balloon procedure (BP) on ocular movement was compared. The prevalence of postoperative enophthalmos after TLP was examined. RESULTS The study included 17 patients who underwent TLP and 25 patients who underwent BP. Postoperative mean Hess area ratio (HAR%) was 98.3 (95% confidence interval (CI), 97.0-99.6) in the TLP group and 88.6 (95% CI 83.2-94.0) in the BP group. Among study patients with fractures extending to the posterior slope, 14 underwent TLP and 16 underwent BP. Postoperative mean HAR% was 98.5 (95% CI 97.3-99.7) in the TLP group and 89.2 (95% CI 82.4-95.8) in the BP group. Among all patients who underwent TLP, mean postoperative enophthalmos was 0.06 mm (95% CI - 0.32 to 0.44). It was 0.14 mm (95% CI - 0.31 to 0.59) among patients with fractures extending to the posterior slope. CONCLUSION TLP resulted in better postoperative ocular movements than BP. Furthermore, TLP is an effective technique for treating fractures extending to the posterior slope, which are challenging to reconstruct.
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Affiliation(s)
- Kosuke Takabayashi
- Department of Otorhinolaryngology, Japanese Red Cross Asahikawa Hospital, Asahikawa City, Hokkaido, Japan
- Department of Otorhinolaryngology, Sapporo Medical University School of Medicine, Sapporo City, Hokkaido, Japan
| | - Yohei Maeda
- Department of Otorhinolaryngology, Japan Community Health Care Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka City, Osaka, 553-0003, Japan.
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan.
| | - Nobuya Kataoka
- Department of Ophthalmology, Japanese Red Cross Asahikawa Hospital, Asahikawa City , Hokkaido, Japan
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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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Thomas AB, Pawar SS. Approaches to the Maxillofacial Skeleton: Application of Standard and Minimally Invasive Techniques. Otolaryngol Clin North Am 2023; 56:1079-1088. [PMID: 37353367 DOI: 10.1016/j.otc.2023.05.003] [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: 06/25/2023]
Abstract
Management of maxillofacial trauma is complex and challenging and requires a clear understanding of facial anatomy and function. There are multiple approaches that can be used to access each anatomical region, each with specific indications and complication profiles. Open, "invasive" approaches are being replaced or augmented with minimally invasive and endoscopic approaches when possible. Thorough knowledge of indications, surgical techniques, and potential complications allows surgeons to make appropriate decisions for access and repair of fractures. This article is a comprehensive review of standard and minimally invasive approaches, with description of techniques and pros and cons for their use.
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Affiliation(s)
- Abigail B Thomas
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Sachin S Pawar
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Orbital Soft Tissue Displacement After Blow-Out Fracture Repair Using Poly (L-Lactide-Co-Glycolide) Polymer Plates Based on Image Fusion Technique. J Craniofac Surg 2023; 34:e149-e153. [PMID: 35968947 PMCID: PMC9944747 DOI: 10.1097/scs.0000000000008891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To analyze the displacement of orbital soft tissue after blow-out fracture (BOF) repair with poly (L-lactide-co-glycolide) plates. MATERIALS AND METHODS In this retrospective study, all patients who had undergone repair operations for orbital BOF from 2017 to 2021 were evaluated. Poly (L-lactide-co-glycolide) plates were used as repair materials. Preoperative and postoperative computed tomography images were integrated into the same coordinate system applying image fusion technique and were compared to determine the maximum displacement of orbital tissue after surgical repair. RESULTS A total of 15 patients were included. Five were male, and 10 were female. Mean age was 33±16 years. Median waiting period was 18 (12-23) days. Six cases were medial wall fractures, 5 were floor fractures, and 4 were combined fractures. Maxillo-ethmoidal strut was involved in 4. Mean defect area was 176.52±108.48 mm 2 . Median interval between postoperative imaging examinations was 292 (223-600) days. Mean orbital tissue displacement was 2.6±1.8 mm. Using simple and multivariable linear regression analysis, the fracture defect area ( P =0.001) and maxillo-ethmoidal strut involvement ( P =0.013) were found to be significantly associated with orbital tissue displacement. Median orbital volume change was 0.804 (0.647-1.010) cm 3 . Average proptosis variation was 1.2±0.8 mm. CONCLUSIONS Poly (L-lactide-co-glycolide) plates were more suitable for orbital BOF with small defect size. Those with large defect or maxillo-ethmoidal strut involved might have greater tissue displacements due to decline of supporting strength of poly (L-lactide-co-glycolide) plates.
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Salli MI, Nikunen M, Snäll J. Primary reconstruction of extensive orbital fractures using two-piece patient-specific implants: the Helsinki protocol. Oral Maxillofac Surg 2022:10.1007/s10006-022-01065-y. [PMID: 35585440 DOI: 10.1007/s10006-022-01065-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: 08/01/2021] [Accepted: 04/13/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE We present our experience of titanium-milled two-piece patient-specific implants (PSIs) for primary reconstructions of extensive orbital floor and medial wall fractures (EOFMFs) and evaluate their postoperative functional and aesthetic outcomes in relation to commercially available implants. METHODS We included all patients with primary reconstructions (< 22 days from injury) of EOFMFs treated in our department between January 2011 and October 2020. Extensive orbital floor and medial wall fracture was defined as involvement of orbital floor, medial wall and maxilloethmoidal junction; a fracture defect 5 mm or more; defect size more than a third of both inferior and medial walls; and Jaquiéry classification III or more. Patient characteristics, details of fracture defects and surgeries, postoperative outcomes and implant positions were retrospectively evaluated and compared between study groups. RESULTS Nineteen patients were included: 5 with two-piece PSIs and 14 with commercial implants. Implant position was good in 4/5 patients with two-piece PSIs and 2/14 with commercial implants. Revision surgery, globe malposition (GMP) > 2 mm, significant diplopia and poor implant position were more frequent in patients with commercial implants than two-piece PSIs. None of the patients with a good overall implant position had any significant postoperative symptoms. CONCLUSION Extensive orbital fracture reconstructions are somewhat rare, and surgical treatment is associated with a high rate of complications and postoperative symptoms. Titanium-milled two-piece PSIs are well suited for primary reconstructions of EOFMFs, as they lead to more precise reconstructions and fewer postoperative symptoms than commercially available implants.
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Affiliation(s)
- Malla I Salli
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4E, 00029 HUS, Helsinki, Finland.
| | - Matti Nikunen
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4E, 00029 HUS, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4E, 00029 HUS, Helsinki, Finland
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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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Vasile VA, Istrate S, Iancu RC, Piticescu RM, Cursaru LM, Schmetterer L, Garhöfer G, Cherecheanu AP. Biocompatible Materials for Orbital Wall Reconstruction-An Overview. MATERIALS (BASEL, SWITZERLAND) 2022; 15:2183. [PMID: 35329635 PMCID: PMC8954765 DOI: 10.3390/ma15062183] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/27/2022] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
The reconstruction of an orbit after complex craniofacial fractures can be extremely demanding. For satisfactory functional and aesthetic results, it is necessary to restore the orbital walls and the craniofacial skeleton using various types of materials. The reconstruction materials can be divided into autografts (bone or cartilage tissue) or allografts (metals, ceramics, or plastic materials, and combinations of these materials). Over time, different types of materials have been used, considering characteristics such as their stability, biocompatibility, cost, safety, and intraoperative flexibility. Although the ideal material for orbital reconstruction could not be unanimously identified, much progress has been achieved in recent years. In this article, we summarise the advantages and disadvantages of each category of reconstruction materials. We also provide an update on improvements in material properties through various modern processing techniques. Good results in reconstructive surgery of the orbit require both material and technological innovations.
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Affiliation(s)
- Victor A Vasile
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, District 5, 020021 Bucharest, Romania
| | - Sinziana Istrate
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, District 5, 020021 Bucharest, Romania
- Department of Ophthalmology, University Emergency Hospital, 020021 Bucharest, Romania
| | - Raluca C Iancu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, District 5, 020021 Bucharest, Romania
- Department of Ophthalmology, University Emergency Hospital, 020021 Bucharest, Romania
| | - Roxana M Piticescu
- Nanostructured Materials Laboratory, National R&D Institute for Nonferrous and Rare Metals, 077145 Pantelimon, Romania
| | - Laura M Cursaru
- Nanostructured Materials Laboratory, National R&D Institute for Nonferrous and Rare Metals, 077145 Pantelimon, Romania
| | - Leopold Schmetterer
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- School of Chemical and Biological Engineering, Nanyang Technological University, Singapore 637459, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, 1090 Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, 1090 Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, 4056 Basel, Switzerland
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, 1090 Vienna, Austria
| | - Alina Popa Cherecheanu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, District 5, 020021 Bucharest, Romania
- Department of Ophthalmology, University Emergency Hospital, 020021 Bucharest, Romania
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Khandelwal P, Zimmerman CE, Xie L, Lee H, Song HK, Yushkevich PA, Vossough A, Bartlett SP, Wehrli FW. Automatic Segmentation of Bone Selective MR Images for Visualization and Craniometry of the Cranial Vault. Acad Radiol 2022; 29 Suppl 3:S98-S106. [PMID: 33903011 PMCID: PMC8536795 DOI: 10.1016/j.acra.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES Solid-state MRI has been shown to provide a radiation-free alternative imaging strategy to CT. However, manual image segmentation to produce bone-selective MR-based 3D renderings is time and labor intensive, thereby acting as a bottleneck in clinical practice. The objective of this study was to evaluate an automatic multi-atlas segmentation pipeline for use on cranial vault images entirely circumventing prior manual intervention, and to assess concordance of craniometric measurements between pipeline produced MRI and CT-based 3D skull renderings. MATERIALS AND METHODS Dual-RF, dual-echo, 3D UTE pulse sequence MR data were obtained at 3T on 30 healthy subjects along with low-dose CT images between December 2018 to January 2020 for this prospective study. The four-point MRI datasets (two RF pulse widths and two echo times) were combined to produce bone-specific images. CT images were thresholded and manually corrected to segment the cranial vault. CT images were then rigidly registered to MRI using mutual information. The corresponding cranial vault segmentations were then transformed to MRI. The "ground truth" segmentations served as reference for the MR images. Subsequently, an automated multi-atlas pipeline was used to segment the bone-selective images. To compare manually and automatically segmented MR images, the Dice similarity coefficient (DSC) and Hausdorff distance (HD) were computed, and craniometric measurements between CT and automated-pipeline MRI-based segmentations were examined via Lin's concordance coefficient (LCC). RESULTS Automated segmentation reduced the need for an expert to obtain segmentation. Average DSC was 90.86 ± 1.94%, and average 95th percentile HD was 1.65 ± 0.44 mm between ground truth and automated segmentations. MR-based measurements differed from CT-based measurements by 0.73-1.2 mm on key craniometric measurements. LCC for distances between CT and MR-based landmarks were vertex-basion: 0.906, left-right frontozygomatic suture: 0.780, and glabella-opisthocranium: 0.956 for the three measurements. CONCLUSION Good agreement between CT and automated MR-based 3D cranial vault renderings has been achieved, thereby eliminating the laborious manual segmentation process. Target applications comprise craniofacial surgery as well as imaging of traumatic injuries and masses involving both bone and soft tissue.
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Affiliation(s)
- Pulkit Khandelwal
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA,Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie E. Zimmerman
- Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Long Xie
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hyunyeol Lee
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hee Kwon Song
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A. Yushkevich
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Arastoo Vossough
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Children’s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA, USA
| | - Scott P. Bartlett
- Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Surgery, University of Pennsylvania, Philadelphia, PA USA
| | - Felix W. Wehrli
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Corresponding Author: University of Pennsylvania, Department of Radiology, MRI Education Center, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104-4283,
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Timkovic J, Stransky J, Janurova K, Handlos P, Stembirek J. Role of orthoptics and scoring system for orbital floor blowout fracture: surgical or conservative treatment. Int J Ophthalmol 2021; 14:1928-1934. [PMID: 34926210 DOI: 10.18240/ijo.2021.12.18] [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: 11/27/2020] [Accepted: 04/22/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the role of orthoptics in referring patients with orbital floor blowout fracture (OFBF) for conservative or surgical treatment and based on the results, to propose a scoring system for such decision making. METHODS A retrospective analysis of 69 patients with OFBF was performed (35 treated conservatively, 34 surgically). The role of orthoptics in referring to surgery or conservative treatment was retrospectively evaluated, the factors with the highest significance for decision making were identified, and a scoring system proposed using Logistic regression. RESULTS According to defined criteria, the treatment was unsuccessful in 2 (6%) surgically treated and only in one (3%) conservatively treated patient. The proposed scoring system includes the defect size and several values resulting from the orthoptic examination, the elevation of the eyebulb measured on Lancaster screen being the most significant. CONCLUSION The study demonstrates the benefits of orthoptic examination when making decisions on conservative or surgical treatment and for diagnosing ocular motility disorder (with or without binocular diplopia) in OFBF patients. The proposed scoring system could, following verification in a prospective study, become a valuable adjunctive tool.
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Affiliation(s)
- Juraj Timkovic
- Clinic of Ophthalmology, University Hospital Ostrava, 17. Listopadu 1790/5, Ostrava 708 52, Czech Republic.,Department of Craniofacial Surgery, Faculty of Medicine, Ostrava University, Syllabova 19, Ostrava 703 00, Czech Republic
| | - Jiri Stransky
- Clinic of Oral and Maxillofacial Surgery, University Hospital Ostrava, 17. Listopadu 1790/5, Ostrava 708 52, Czech Republic
| | - Katerina Janurova
- IT4Innovations, VSB-Technical University of Ostrava, Studentská 6231, Ostrava 708 33, Czech Republic
| | - Petr Handlos
- Department of Forensic Medicine, University Hospital Ostrava, 17. Listopadu 1790/5, Ostrava 708 52, Czech Republic
| | - Jan Stembirek
- Clinic of Oral and Maxillofacial Surgery, University Hospital Ostrava, 17. Listopadu 1790/5, Ostrava 708 52, Czech Republic.,Laboratory of Molecular Morphogenesis, Institute of Animal Physiology and Genetics CAS, Veveří 97, Brno 602 00, Czech Republic
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El-Hadad C, Deschênes J, Arthurs B. Fractures du plancher de l’orbite. CMAJ 2021; 193:E705. [PMID: 33972229 PMCID: PMC8158004 DOI: 10.1503/cmaj.200657-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Christian El-Hadad
- Département d'ophtalmologie et des sciences de la vision, Faculté de médecine et des sciences de la santé, Université McGill, Montréal, Qc.
| | - Jean Deschênes
- Département d'ophtalmologie et des sciences de la vision, Faculté de médecine et des sciences de la santé, Université McGill, Montréal, Qc
| | - Bryan Arthurs
- Département d'ophtalmologie et des sciences de la vision, Faculté de médecine et des sciences de la santé, Université McGill, Montréal, Qc
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Blessing NW, Rong AJ, Tse BC, Erickson BP, Lee BW, Johnson TE. Orbital Bony Reconstruction With Presized and Precontoured Porous Polyethylene-Titanium Implants. Ophthalmic Plast Reconstr Surg 2021; 37:284-289. [PMID: 32976336 PMCID: PMC7982351 DOI: 10.1097/iop.0000000000001829] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Complex bony orbital defects are reconstructively challenging due to loss of intraoperative anatomical landmarks and adjacent support. Presized and precontoured porous polyethylene-titanium implants (Medpor Titan 3D Orbital Floor Implant) are designed to reestablish normal orbital floor and medial wall anatomy and are modeled after anatomically averaged orbits. This is the first study to report clinical outcomes with this implant. METHODS This retrospective case series reviewed clinical data and outcomes for patients undergoing orbital reconstruction with a presized and precontoured porous polyethylene-titanium orbital implant from January 2016 to June 2018. RESULTS A total of 34 orbits of 33 patients were identified (mean age: 43 ± 16 years, 70% men). Most bony defects were a result of trauma and included large orbital floor deformities (100%), medial wall defects (74%), disrupted inferomedial struts (68%), and broken posterior ledges (82%). Symptomatic diplopia (73%) and enophthalmos (89%, mean: 3.7 ± 2.1 mm) were common preoperatively. Many cases were revisions (44%). Mean follow up was 7.8 ± 6.7 months. All patients had improved globe positioning, enophthalmos, and hypoglobus. Seven patients had persistent postoperative diplopia: 6 responded to prism therapy and 1 required strabismus surgery. One patient required retrobulbar hematoma drainage and 1 patient required implant explantation due to chronic infection. CONCLUSIONS Commercially available presized and precon toured porous polyethylene-titanium implants are useful for complex orbital bony defects and can achieve functional improve ments in diplopia, enophthalmos, and extraocular motility with a low incidence of postoperative complications or revisional surgery.
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Affiliation(s)
- Nathan W. Blessing
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
- Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Andrew J. Rong
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Brian C. Tse
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Benjamin P. Erickson
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
- Byers Eye Institute, Stanford University School of Medicine, Stanford, California
| | - Bradford W. Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas E. Johnson
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Migliorini R, Comberiati AM, Pacella F, Longo AR, Messineo D, Trovato Battagliola E, Malvasi M, Pacella E, Arrico L. Utility of Ocular Motility Tests in Orbital Floor Fractures with Muscle Entrapment That is Not Detected on Computed Tomography. Clin Ophthalmol 2021; 15:1677-1683. [PMID: 33935485 PMCID: PMC8079357 DOI: 10.2147/opth.s292097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/08/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Determine the usefulness of ocular motility testing to detect the presence of muscle entrapment. Materials and Methods Cross-sectional study of patients with symptoms of diplopia secondary to facial trauma. Inclusion criteria: age between 20 and 80 years; symptoms of diplopia following facial trauma; presence of orbital floor fracture confirmed radiologically; presence of muscle entrapment confirmed at the time of surgery; best-corrected visual acuity of 0.6 or more. Exclusion criteria: muscle entrapment visible on computed tomography; candidate for immediate surgical correction; prior history of strabismus surgery. Outcome measures: Abnormal Head Position (AHP), Hirschberg Corneal Reflexes (CR), Cover/Uncover and Alternating Cover Test, Hertel exophthalmometry, Near Point of Convergence (NPC), Kestenbaum Limbus test, Red Filter test, and Hess screen test. Results Forty-six subjects (38 males, 8 females, mean age 27 ± 3.3 SD years). Pre-operative assessment: forty-six (100%) reported diplopia on the Red Filter test and showed some degree of abnormality on the Hess Screen test. Forty-two (91%) showed AHP. Forty-one (89%) had exophthalmometry values that differed 2 mm or more between the two eyes and insufficient NPC. Thirty-two (69.6%) showed deficits of 3 mm or more on the Kestenbaum Limbus test. Sixteen (35%) had abnormal Hirschberg corneal reflexes. Eleven (24%) demonstrated constant or intermittent strabismus. Conclusion Ocular motility testing can differentiate non-invasively, pre-operatively, and cost-effectively the presence of muscle entrapment even when this is not visible on computed tomography.
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Affiliation(s)
| | | | | | - Anna Rosy Longo
- Department of Sense Organs, University Sapienza, Rome, Italy
| | - Daniela Messineo
- Department of Radiology, Oncology, and Anatomopathological, University Sapienza, Rome, Italy
| | | | | | - Elena Pacella
- Department of Sense Organs, University Sapienza, Rome, Italy
| | - Loredana Arrico
- Department of Sense Organs, University Sapienza, Rome, Italy
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Affiliation(s)
- Christian El-Hadad
- Ophthalmology & Visual Sciences, Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.
| | - Jean Deschênes
- Ophthalmology & Visual Sciences, Faculty of Medicine and Health Sciences, McGill University, Montréal, Que
| | - Bryan Arthurs
- Ophthalmology & Visual Sciences, Faculty of Medicine and Health Sciences, McGill University, Montréal, Que
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Gu RD, Xiao F, Wang L, Sun KJ, Chen LL. Biocompatibility of polyetheretherketone for the treatment of orbital bone defects. Int J Ophthalmol 2020; 13:725-730. [PMID: 32420218 DOI: 10.18240/ijo.2020.05.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022] Open
Abstract
AIM To investigate the biocompatibility and therapeutic effects of polyetheretherketone (PEEK) on recovery of a rabbit orbital defect. METHODS Totally 16 New Zealand rabbits were used to establish an orbital bone defect model and then randomly divided into two groups. PEEK was implanted in the experimental group. The control group was blank, and no substance was implanted. The model rabbits were sacrificed at 4 and 8wk, and examined by general observations, histology, electron microscopy, Western blotting, and real-time polymerase chain reaction. RESULTS No infection or rejection occurred after PEEK implantation, and biocompatibility was good. The relative expression of vascular endothelial growth factor (VEGF) protein in the experimental group was significantly higher than that in the control group postoperatively (P<0.05). Bone defect repair in the experimental group was significantly better than that in the control group in the same period and some osteogenesis was observed. CONCLUSION PEEK has good biocompatibility and efficacy for the treatment of orbital bone defects in a rabbit model.
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Affiliation(s)
- Rui-Dong Gu
- Department of Ophthalmology, the Fourth People's Hospital of Shenyang, Shenyang 110031, Liaoning Province, China
| | - Fan Xiao
- Department of Ophthalmology, the Fourth People's Hospital of Shenyang, Shenyang 110031, Liaoning Province, China
| | - Lin Wang
- Department of Ophthalmology, the Fourth People's Hospital of Shenyang, Shenyang 110031, Liaoning Province, China
| | - Kai-Jian Sun
- Department of Ophthalmology, the Fourth People's Hospital of Shenyang, Shenyang 110031, Liaoning Province, China
| | - Lin-Lin Chen
- Department of Ophthalmology, the Fourth People's Hospital of Shenyang, Shenyang 110031, Liaoning Province, China
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