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Lin JAJ, Li PH, Liao CH, Hsieh CH, Kuo YC, Hsu TA, Chu YY, Fu CY. Evaluation of Concomitant Facial Fracture in Traumatic Brain Injury Patients-Simplification and External Validation of a Prediction Model. Ann Plast Surg 2024; 92:S27-S32. [PMID: 38285992 DOI: 10.1097/sap.0000000000003774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND Patients with traumatic brain injuries (TBIs) often experience concurrent facial bone fractures. In 2021, a prediction model with 10 variables was published and precisely predicted concomitant facial fractures in TBI patients. Herein, external validation and simplification of this model was performed. METHODS Traumatic brain injury patients treated at a major referral trauma center were retrospectively reviewed for 1 year. The original prediction model (published in 2021), which was developed from a rural level II trauma center, was applied for external validation. A new and simplified model from our level I trauma center was developed and backwardly validated by rural level II trauma center data. RESULTS In total, 313 TBI patients were enrolled; 101 (32.3%) had concomitant facial fractures. When the previous prediction model was applied to the validation cohort, it achieved acceptable discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.713 and good precision, with a Brier score of 0.083. A new and simplified model with 6 variables (age, tooth rupture, epistaxis, facial lesion, eye injury, and intracranial hemorrhage) was created with excellent discrimination (AUC = 0.836) and good precision (Brier score of 0.055). The backward validation of this new model also showed excellent discrimination in the cohort used to develop the original model (AUC = 0.875). CONCLUSION The original model provides an acceptable and reproducible prediction of concomitant facial fractures among TBI patients. A simplified model with fewer variables and the same accuracy could be applied in the emergency department and at higher- and lower-level trauma centers.
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Affiliation(s)
| | - Pei-Hua Li
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chi Kuo
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ting-An Hsu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ying Chu
- From the Department of Plastic and Reconstructive Surgery
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Shakir S, Ettinger RE, Susarla SM, Birgfeld CB. Pediatric Panfacial Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:607-617. [PMID: 37280142 DOI: 10.1016/j.coms.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pediatric panfacial trauma is a rare occurrence with poorly understood implications for the growing child. Treatment algorithms largely mirror adult panfacial protocols with notable exceptions including augmented healing and remodeling capacities that favor nonoperative management, limited exposure to avoid disruption of osseous suture and synchondroses growth centers, and creative fracture fixation techniques in the setting of an immature craniomaxillofacial skeleton. The following article provides a review of our institutional philosophy in the management of these challenges injuries with important anatomic, epidemiologic, examination, sequencing, and postoperative considerations.
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Affiliation(s)
- Sameer Shakir
- Division of Plastic Surgery, Children's Wisconsin, Milwaukee, WI, USA.
| | - Russell E Ettinger
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
| | - Srinivas M Susarla
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
| | - Craig B Birgfeld
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
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Accuracy of linear-probe ultrasonography in diagnosis of infraorbital rim fractures. Ultrasound J 2023; 15:9. [PMID: 36763227 PMCID: PMC9918656 DOI: 10.1186/s13089-022-00298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/27/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Maxillofacial fractures are a common cause of visits to emergency department, accounting for more than 400,000 annual visits in the United States. Gold standard diagnostic tool is conventional computerized tomography (CT) or 3DCT reconstruction. However, the disadvantages of CT are radiation exposure, unavailable in some hospital and expensiveness. Whereas the bony structures overlap is a problem in diagnostic when using plain film X-ray. The objective of this study is to show the accuracy of a linear-probe ultrasound compared to computed tomography and plain film X-ray in diagnosis of infraorbital rim fracture. METHODS Patients clinically suspected of an inferior orbital rim fracture underwent linear-probe ultrasonographic investigation, plain film X-ray and CT. CT was used as gold standard in this diagnostic study. A radiologist and senior resident of plastic surgery were the examiner and interobserver for comparison. RESULT A total of 34 patients with suspected infraorbital rim fractures were investigated. Sensitivity of the linear-probe ultrasonography versus CT in the detection of infraorbital rim fracture was 92.9% (95% CI 66.1-99.8), specificity was 90.0% (95% CI 68.3-98.8), positive predictive value was 86.7% (95% CI 59.5-98.3), negative predictive value was 94.7% ( 95% CI 74.0-99.9), accuracy 91%. CONCLUSION Linear probe ultrasonography is a good diagnostic tool and has better reliability than the plain film X-ray and can be used as alternative to CT in inferior orbital rim fracture.
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Fawzy HH, Saber AF, Nassar AT, Eid KA, Ghareeb FM. Technical considerations of computer-aided planning in severe orbital trauma: A retrospective study. J Craniomaxillofac Surg 2022; 50:873-883. [PMID: 36681615 DOI: 10.1016/j.jcms.2023.01.002] [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: 01/22/2022] [Revised: 11/11/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
The aim of this study was to evaluate the clinical outcomes of linear and orbital volume measurements in severe orbital trauma. Patients with severe orbital trauma that involved more than two walls and entailed a marked degree of comminution were included in this retrospective analysis. However, patients with incomplete clinical records and a simple blowout or zygmatico-orbital fractures were excluded. All the cases underwent surgical correction guided by virtual surgical planning and 3D-printed templates. The measurement protocol depended on assessing orbital dimensions, orbital volumetry, and the zygomatic bone's position in the three-dimensional planes. All patients' preoperative 3D CT scans were obtained, and DICOM files were imported into a three-dimensional image processing software. Data were then converted for 3D reconstruction in the axial, coronal, and sagittal views. A total of 18 patients with a mean age was 39.28 ± 6.28 were included in this study. The results revealed a significant difference between the pre and postoperative differences in distances in relation to the FHP (Frankfurt Horizontal Plane) (P = 0.0014) and sagittal planes (P < 0.0001). The orbital width and height of the traumatized orbit were significantly decreased from 45.26 ± 6.72 mm and 45.30 ± 2.89 mm to 39.74 ± 3.91 mm (P = 0.0022), and 40.34 ± 0.86 mm (P < 0.0001), respectively. Clinically, there was a satisfactory degree of symmetry regarding the zygomatic bones' position and orbital dimensions postoperatively. Moreover, the mean orbital volume on the traumatized side decreased significantly from 23.16 ± 1.91 cm3 preoperatively to 20.7 ± 1.96 cm3 postoperatively (P < 0.0001). These findings were associated with a low incidence of complications. Within the limitations of the study it seems that the described methodology is a relevant addition to clinical treatment options. It incorporates all the latest technology to plan virtual reconstruction surgery in the treatment of complex orbital trauma and should be adapted accordingly in cases of severe displacement and comminution.
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Affiliation(s)
- Hossam Hassan Fawzy
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
| | - Ahmed Fergany Saber
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Tharwat Nassar
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - Fouad Mohamed Ghareeb
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Abstract
Panfacial trauma refers to high-energy mechanism injuries involving two or more areas of the craniofacial skeleton, the frontal bone, the midface, and the occlusal unit. These can be distracting injuries in an unstable patient and, as in any trauma, Advanced Trauma Life Support (ATLS) protocols should be followed. The airway should be secured, bleeding controlled, and sequential examinations should take place to avoid overlooking injuries. When indicated, neurosurgery and ophthalmology should be consulted as preservation of brain, vision, and hearing function should be prioritized. Once the patient is stabilized, reconstruction aims to reduce panfacial fractures, restore the horizontal and vertical facial buttresses, and resuspend the soft tissue to avoid the appearance of premature aging. Lost or comminuted bone can be replaced with bone grafts, although adequate reduction should be ensured prior to any grafting. Operative sequencing can be performed from top-down and outside-in or from bottom-up and inside-out depending on patient presentation. All protocols can successfully manage panfacial injuries, and the emphasis should be placed on a systematic approach that works from known areas to unknown areas.
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Affiliation(s)
- Benjamin B Massenburg
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - Melanie S Lang
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, Washington
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Wang TH, Yu WC, Chen ZH, Tien YH, Chen WM, Chiu FY, Wang SJ. The symmetry indices of malar mounds for zygomatic bone fracture management based on a computed tomographic model. J Chin Med Assoc 2021; 84:709-712. [PMID: 34050106 DOI: 10.1097/jcma.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To date, plastic surgeons do not have an objective method of measuring facial symmetry for zygomatic bone fracture management. Based on clinical practice, the authors utilized a 3-dimensional (3D) model to propose the symmetry index from the anterior view (SIAV) and the symmetry index from inferior view (SIIV). This study aimed to assess the application of these 2 indices. METHODS The SIAV is defined as the distance between the superior and lower orbital rims (DSLOR) of the defective side divided by that of the healthy side in the anterior view. The SIIV is defined as the area within the region of interest (AROI) of the defective side divided by that of the healthy side in the inferior view. We retrospectively reviewed 95 patients who underwent zygomatic fracture surgery at our medical center from January 2017 to September 2020. The Patients who had bilateral zygomatic fractures and did not have both pre- and postoperative computed tomography (CT) images were excluded. RESULTS Five out of the 95 patients were enrolled in this study. The difference between pre- and postoperative mean AROI and DSLOR on the healthy side was not significant. The insignificant difference indicates the repeatability of the measurement of the 3D skull model and different CT machines would not affect the calculation of AROI and DSLOR. The mean values of postoperative SIAV (1.06 ± 0.07) and SIIV (1.02 ± 0.08) were closer to 1 than the preoperative values (0.97 ± 0.09 and 1.10 ± 0.12). Although the difference was not statistically significant, the SIIV and SIAV would numerically present the changes in malar bone fracture postoperatively. CONCLUSION The SIAV and SIIV based on clinical practice could numerically assess the symmetry of the malar mound.
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Affiliation(s)
- Tien-Hsiang Wang
- Division of Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Mechanical Engineering, National Central University, Taoyuan, Taiwan, ROC
| | - Wen-Chan Yu
- Rehabilitation and Technical Aids Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Zih-Hua Chen
- Rehabilitation and Technical Aids Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yao-Hsuan Tien
- Division of Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei Taiwan, ROC
| | - Wei-Ming Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fang-Yau Chiu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Rehabilitation and Technical Aids Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shyh-Jen Wang
- Rehabilitation and Technical Aids Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Experimental Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei Taiwan, ROC
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei Taiwan, ROC
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Fifteen-Year Review of the American Board of Plastic Surgery Maintenance of Certification Tracer Data: Clinical Practice Patterns and Evidence-Based Medicine in Zygomatico-Orbital Fractures. Plast Reconstr Surg 2021; 147:967e-975e. [PMID: 34019507 DOI: 10.1097/prs.0000000000007955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND From 2005 to 2020, the American Board of Plastic Surgery collected data on 20 common plastic surgery operations as part of the Maintenance of Certification process. These data allow the authors to examine national trends in zygomatico-orbital fracture repair over a 15-year period. METHODS Tracer data for zygomatico-orbital fracture repair were reviewed in cohorts from 2005 to 2013 and 2014 to 2020. Results were categorized based on their presence in evidence-based medicine articles published during this period. Differences between years were assessed using the t test or chi-square test as appropriate. RESULTS Four hundred thirty patients were included as of March of 2020. Average age was 37 years (range, 6 to 85 years), and 76 percent were male. Operations took place on average 10 days from injury. There were significant decreases in the use of subciliary (31.9 percent versus 10.0 percent; p < 0.001), gingival buccal (84.3 percent versus 56.4 percent; p < 0.001), and lateral brow (45.2 percent versus 22.3 percent; p < 0.001) incisions, with an increase in lower lid external incisions (15.2 percent versus 30.9 percent; p < 0.001); 2.7 percent of patients had a complication requiring readmission and 4.5 percent required reoperation. The incidence of postoperative diplopia was 7.7 percent, and the infection rate was 1.7 percent. CONCLUSIONS This article reviews the American Board of Plastic Surgery tracer data for zygomatico-orbital fracture repair. The Maintenance of Certification tracer data provide a national database with longer follow-up and more specific information than comparable databases. Analysis of these data over time enables the authors to describe practice trends and gives surgeons the opportunity to compare their outcomes to national norms.
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Al-Shami H, Alnemare AK, Mahfoz TB, Salah AM. Traumatic Frontal Sinus Fractures Management: Experience from High-Trauma Centre. Korean J Neurotrauma 2021; 17:15-24. [PMID: 33981639 PMCID: PMC8093022 DOI: 10.13004/kjnt.2021.17.e3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/10/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022] Open
Abstract
Objective Analysis of our traumatic brain injury data, reviewing current literatures and assessing planning valuable decision making in frontal sinus fracture for young neurosurgeons. Methods Hospital data base for head trauma was retrieved after board permission for retrospective analysis of cases admitted from 2010-2020. Patients with frontal sinus fractures and head trauma were identified according to a flow chart. Variables of the study included patients' demographics, mechanism of injury, incidence of cerebrospinal fluid (CSF) leakage, types of associated injuries, imaging findings and operative techniques. Results Three-hundred eighty two patients were eligible to be screened in our study and represented the sample size under investigations in the following sections, 206 (53.9%) of patients were treated conservatively while 176 patients (46.1%) were identified as having an indication for surgical intervention. Eighty-four percent of patients were males. The mean age was 36.2±9.4 years (14-86 years). Depressed skull fracture was commonly associated injury (17.61%). Leakage of CSF was found in 32.95% of patients. Conclusion Frontal sinus fracture is not an easy scenario. It harbors many proportions and deliver many varieties in which, deep understanding of anatomy, naso-frontal outflow tract status, CSF leakage and neurological injury are of important points in decision. Our institutional algorithm provide rapid, accessible and applicable treatment protocol for resident and young neurosurgeons which minimizes consultations of other specialties.
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Affiliation(s)
- Hieder Al-Shami
- Department of Neurosurgery, Al-Ahly Bank Hospital, Cairo, Egypt
| | - Ahmad K. Alnemare
- Department of Otolaryngology, College of Medicine, Majmaah University, Majmaah, Saudi Arabia
| | - Turki Bin Mahfoz
- Department of Otolaryngology, Faculty of Medicine, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Ahmed M. Salah
- Department of Neurosurgery, Faculty of Medicine, Kasr Al-Ainy Medical College, Cairo, Egypt
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Seventy-Fifth Anniversary of Plastic and Reconstructive Surgery: How Evidence-Based Medicine Has Transformed Plastic Surgery. Plast Reconstr Surg 2021; 147:1235-1241. [PMID: 33890912 DOI: 10.1097/prs.0000000000007913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bin LR, Garbin EÁ, Magro-Érnica N, Griza GL, Conci RA, Nadal L. The Role of Computed Tomography in Zygomatic Bone Fracture - A Case Report. Ann Maxillofac Surg 2020; 10:491-494. [PMID: 33708603 PMCID: PMC7944019 DOI: 10.4103/ams.ams_9_20] [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: 01/08/2020] [Revised: 08/09/2020] [Accepted: 08/19/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction The zygomatic complex is integral to the facial contour, protection of the eye and other facial structures, and dental occlusion. Its importance in facial function and aesthetics requires high quality outcomes of the treatment. Case presentation This paper reports the case of a 46-year-old man who had an occupational accident resulting in extensive facial trauma and zygomatic fractures. The patient presented with hyposphagma, palpable step in the area of the infraorbital rim, paresthesia of the right infraorbital nerve, flattening of zygomatic prominence, abrasion of the chin and nose, a 7-cm laceration in the midface region, ecchymosis in the palate, and alteration in the dental occlusion without limitation of mouth opening. Computed tomography (CT) confirmed the zygomatic complex fractures. The treatment was reduction and fixation with plates and screws. CT was used throughout the treatment period as an essential diagnostic tool for accurate fracture assessment and classification, formulation of the surgical plan, and postoperative evaluation. Conclusion This case study illustrated the correct use of CT for improved and efficient treatment of traumatic injury of the zygoma, an anatomical area where restoration of function and aesthetics is challenging. The patient signed a written informed consent statement for publication.
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Affiliation(s)
- Luiza Roberta Bin
- Department of Oral and Maxillofacial Surgery in Biology and Health Science Department, Western Parana State University, Cascavel, Brazil
| | - Eleonor Álvaro Garbin
- Department of Oral and Maxillofacial Surgery in Biology and Health Science Department, Western Parana State University, Cascavel, Brazil
| | - Natasha Magro-Érnica
- Department of Oral and Maxillofacial Surgery in Biology and Health Science Department, Western Parana State University, Cascavel, Brazil
| | - Geraldo Luiz Griza
- Department of Oral and Maxillofacial Surgery in Biology and Health Science Department, Western Parana State University, Cascavel, Brazil
| | - Ricardo Augusto Conci
- Department of Oral and Maxillofacial Surgery in Biology and Health Science Department, Western Parana State University, Cascavel, Brazil
| | - Letícia Nadal
- Department of Oral and Maxillofacial Surgery in Biology and Health Science Department, Western Parana State University, Cascavel, Brazil
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Andrades P, Maripangui M, Jara R, Troncoso E, Rodriguez D, Ríos M, Minassian M, Borel C. Intraoperative Fluoroscopy Reduces Complication and Reoperation Rate in Facial Fractures. Facial Plast Surg Aesthet Med 2020; 23:278-282. [PMID: 32898440 DOI: 10.1089/fpsam.2020.0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate surgical outcomes of facial fractures after the introduction of intraoperative radiology. Methods: An historic cohort of patients without intraoperative fluoroscopy (IOF) was compared with a prospective cohort of patients with IOF. Main outcomes were postoperative complications and reoperation rate. Results: There were 51 in the non-IOF group and 49 in the IOF group. In the group with IOF 10 patients required intraoperative revisions (20.46%). Overall postoperative complication rate was higher in the non-IOF group (25.49% vs. 6.12%) due to the significantly higher bone-related complication rate (15.69% vs. 2.04%). Reoperation rate was also higher in the non-IOF group (11.76% vs. 0%). Conclusion: This study demonstrates that IOF reduces bone-related complication and reoperation rate by allowing correction of surgical errors immediately during surgery.
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Affiliation(s)
- Patricio Andrades
- Division of Maxillofacial Surgery, Hospital del Trabajador, Santiago, Chile.,Division of Plastic Surgery, Department of Surgery, University of Chile Clinical Hospital, Santiago, Chile
| | - Maritza Maripangui
- Division of Plastic Surgery, Department of Surgery, University of Chile Clinical Hospital, Santiago, Chile
| | - Rocío Jara
- Division of Plastic Surgery, Department of Surgery, University of Chile Clinical Hospital, Santiago, Chile
| | - Ekaterina Troncoso
- Division of Plastic Surgery, Department of Surgery, University of Chile Clinical Hospital, Santiago, Chile
| | - Diego Rodriguez
- Division of Maxillofacial Surgery, Hospital del Trabajador, Santiago, Chile
| | - Marcos Ríos
- Division of Maxillofacial Surgery, Hospital del Trabajador, Santiago, Chile
| | - Matías Minassian
- Division of Maxillofacial Surgery, Hospital del Trabajador, Santiago, Chile
| | - Claudio Borel
- Division of Maxillofacial Surgery, Hospital del Trabajador, Santiago, Chile
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Griffin MJ, Sims JR, Spaulding SL, Baik FM, Elahi E, Urken ML. Management of orbital complications in palatomaxillary reconstruction: A review of preemptive and corrective measures. Head Neck 2019; 42:556-568. [PMID: 31837075 DOI: 10.1002/hed.26015] [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: 05/31/2019] [Revised: 09/20/2019] [Accepted: 10/30/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Reconstruction of orbit-sparing palatomaxillary defects requires consideration of globe dystopia, orbital volume, eyelid position and function, and the nasolacrimal system to preserve and optimize vision, globe protection, and appearance. We describe the fundamentals of orbital and eyelid anatomy, common orbital complications related to palatomaxillary reconstruction, and preemptive and corrective surgical techniques to be utilized during and after globe-sparing palatomaxillary reconstruction. METHODS We present a review of the literature supplemented by clinical case examples. RESULTS We advocate for the use of preemptive and corrective techniques to ensure optimal aesthetic and functional outcomes for patients with orbital defects. CONCLUSIONS Recognition and anticipation of problems in patients undergoing midface ablative and reconstructive procedures are vital to the implementation of corrective measures. Incision choice, orbital volume restoration, appropriate orbital floor reconstruction, and permanent or temporary lower eyelid suspension during the primary surgery can all significantly impact the development of long-term orbital complications.
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Affiliation(s)
- Martha J Griffin
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - John R Sims
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
| | - Sarah L Spaulding
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Fred M Baik
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
| | - Ebrahim Elahi
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark L Urken
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York.,Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
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