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Yi Y, He X, Wu Y, Wang D. Global, regional, and national burden of incidence, prevalence, and years lived with disability for facial fractures from 1990 to 2019: a systematic analysis for the Global Burden of Disease study 2019. BMC Oral Health 2024; 24:435. [PMID: 38600477 PMCID: PMC11005257 DOI: 10.1186/s12903-024-04206-9] [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: 12/28/2023] [Accepted: 03/29/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Facial fractures are common injuries causing cosmetic, functional, and psychological damage. The purpose of this study was to assess the incidence, prevalence, and years lived with disability (YLDs) of facial fractures from 1990 to 2019 using the Global Burden of Disease (GBD). METHODS Detailed data for the disease burden of facial fractures were obtained from online available public data (Global Health Data Exchange) derived from the GBD study. The incidence, prevalence, and YLDs of facial fractures from 1990 to 2019 were analyzed by country, region, age, gender, sociodemographic index (SDI), and cause. The age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized YLDs rate (ASYR), and estimated annual percentage change (EAPC) were calculated to evaluate the disease burden and quantify the trends over time. The main causes of facial fractures in different years and ages were assessed. RESULTS Globally, there were 8.9 million incident cases, 1.5 million cases prevalent cases, and 98.1 thousand years YLDs in 2019. Compared with 1990, the number of incident cases, prevalent cases, and YLDs increased, while ASIR (EAPC, - 0.47; 95% uncertainty interval [UI], - 0.57 to - 0.37), ASPR (EAPC, - 0.39; 95% UI, - 0.46 to - 0.31), ASYR (EAPC, - 0.39; 95% UI, - 0.47 to - 0.32) showed a downward trend. The high SDI region held the highest ASIR, ASPR, and ASYR both in 1990 and 2019, such as New Zealand, Slovenia, and Australia. The burden was higher in men than in women from 1990 to 2019, while the ASRs in women exceeded that of men in the elderly. The ASIR peaked in the young adult group, however, the ASPR and ASYR increased with age. Falls and road injuries were the leading causes of facial fractures. CONCLUSIONS Facial fractures continue to cause a heavy burden on public health worldwide. More targeted strategies need to be established to control the burden of facial fractures.
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Affiliation(s)
- Yi Yi
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China
| | - Xiao He
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Yiping Wu
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China
| | - Dawei Wang
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China.
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Comparison of Postoperative Enophthalmos Between Fresh and Delayed Unilateral Orbital Fractures After Orbital Reconstruction With Titanium Mesh Using Computer-Assisted Navigation. J Craniofac Surg 2023; 34:663-668. [PMID: 36166498 DOI: 10.1097/scs.0000000000009029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/20/2022] [Indexed: 11/26/2022] Open
Abstract
This study compares postoperative enophthalmos between fresh and delayed unilateral orbital fractures after orbital reconstruction with titanium mesh using computer-assisted navigation. The sample was composed of 45 patients with post-traumatic unilateral enophthalmos who were divided into the fresh fracture group and the delayed fracture group. They underwent orbital reconstruction with standard preformed orbital implants and computer-assisted navigation system. The following parameters were measured with computed tomography images: the degree of enophthalmos, orbital volume, and fracture defect area. Patients were reviewed preoperatively (T0), 1 week postoperatively (T1), and 6 months postoperatively (T2). Computed tomography measurements showed that in both groups, the degree of enophthalmos decreased after surgery but increased significantly from T1 to T2 ( P <0.05). ΔE (difference in the degree of enophthalmos between T1 and T2) was similar in patients with fresh and delayed fractures. There was a significant difference in the degree of ΔE between patients with single-wall orbital fractures and those with two-wall orbital fractures. The findings indicate that postoperative enophthalmos is common in both the groups and is closely related to the degree of preoperative enophthalmos. Furthermore, the recurrence of enophthalmos is similar between the 2 groups, but it is higher in patients with orbital fractures involving 2 walls.
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Hihara M, Kihara M, Fukui M, Mitsui T, Kakudo N. Reduction and fixation of comminuted fractures of the midface by using a Hoffman-type external fixator: A case report. JPRAS Open 2022; 34:252-256. [DOI: 10.1016/j.jpra.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/14/2022] [Indexed: 11/27/2022] Open
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Al-Qattan YM, Al-Qattan MM. The use of interosseous dental wires and sutures for internal fixation in a patient with multiple comminuted middle facial fractures and facial nerve injury: A demonstrative case report. Int J Surg Case Rep 2021; 79:188-192. [PMID: 33482446 PMCID: PMC7819820 DOI: 10.1016/j.ijscr.2021.01.026] [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: 12/10/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 11/21/2022] Open
Abstract
We report on a case of multiple comminuted middle facial fractures. There was concurrent facial nerve injury. Fracture fixation was done with wires which is considered obsolete. Wire fixation was preferred to protect the facial nerve repair. The outcome was satisfactory.
Introduction The use of plates and screws for facial fractures is considered the gold standard; providing accurate reduction and rigid fixation. Case report We report on a case with multiple comminuted middle facial fractures and concurrent facial nerve injury. The fractures were fixed with a combination of interosseous dental wires and polypropylene sutures with a satisfactory outcome. Discussion We aim to demonstrate two main advantages of wire/suture fixation in such cases when compared to plates and screws. Wire/suture fixation does not require periosteal dissection for fixation; and hence there is more preservation of the blood supply of the bony fragments. Furthermore, in the setting of concurrent facial nerve repair, the use of plates may risk re-injury of the repaired nerve during the late removal of the hardware. Interosseous wires/sutures do not require late removal and this is another advantage in these cases. Conclusion Interosseous dental wires and polypropylene sutures may be considered for fixation of multiple comminuted middle facial fractures and concurrent facial nerve injury.
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Affiliation(s)
| | - Mohammad M Al-Qattan
- Department of Surgery, Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia.
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5
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Anthropometric changes in the morphology of the lower eyelid after using three different approaches in patients with orbital fractures. J Craniomaxillofac Surg 2020; 48:985-993. [DOI: 10.1016/j.jcms.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/20/2020] [Accepted: 08/09/2020] [Indexed: 11/16/2022] Open
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Evolution of Full Facial Feminization Surgery: Creating the Gendered Face With an All-in-one Procedure. J Craniofac Surg 2019; 30:1419-1424. [PMID: 31299735 DOI: 10.1097/scs.0000000000005221] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Facial feminization surgery (FFS) has recently gained popularity to enhance the female facial profile and promote a real transformation of the male to female face in transgender patients. The term involves overlapping of the surgical procedures devoted to feminization and represents a dual and reversible procedure unique in plastic and reconstructive surgery. Indeed, FFS envisages modifications of the hard and soft tissues and is both reductive and augmentative. For these reasons, full FFS (F-FFS) is used by surgeons with special expertise in FFS. This study describes a novel approach to F-FFS performed in a single surgery and thus renamed, de facto, all-in-one and representing its most recent evolution. Forty-nine consecutive nonrandomized patients underwent FFS at a private clinical practice (Face Surgery Center, Parma, Italy) between January 2003 and December 2017. Following a retrospective review according to specific inclusion criteria, the authors identified 9 patients aged 19 to 33 years (mean age, 21 years) who underwent all-in-one F-FFS. Patients were discharged the day after surgery with written postoperative care instructions. No reports of wound infection/dehiscence or nerve/vessel damage were recorded. Patients typically returned to work within 30 days following surgery. The mean operative time was 281 minutes (range, 245-305 minutes). The evolved all-in-one F-FFS provides a further step technically (overlapping several procedures) in terms of surgical outcome (higher satisfaction rate) and reduced overall costs and low morbidity.
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Goswami D, Sardar A, Baidya DK, Yadav R, Bhutia O, Roychoudhury A. Comparative Evaluation of Two Doses of Etoricoxib (90 mg and 120 mg) as Pre-Emptive Analgesic for Post-Operative Pain Relief in Mandibular Fracture Surgery Under General Anaesthesia: A Prospective, Randomised, Double-Blinded, Placebo-Controlled Trial. Turk J Anaesthesiol Reanim 2019; 48:24-30. [PMID: 32076676 PMCID: PMC7001814 DOI: 10.5152/tjar.2019.54614] [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: 12/17/2018] [Accepted: 02/28/2019] [Indexed: 11/25/2022] Open
Abstract
Objective This trial investigated the post operative analgesic efficacy of oarl etoricoxib 90 mg and 120 mg and a placebo in mandibular fracture pain model. Methods A total of 63 adult patients with mandibular fractures who were scheduled to undergo maxillofacial surgery were randomly allocated to receive etoricoxib 90 mg, etoricoxib 120 mg and a placebo 1 hour before the surgery. Patients were followed-up till 24 hours after the surgery. Duration of analgesia, intra-operative and post-operative analgesic requirement, pain score, post-operative patient satisfaction and adverse effects were measured. Results The baseline demographic parameters were similar in all the groups. Duration of analgesia was longer in both the E120 (6.00±0.816 hours) and E90 (4.37±1.008 hours) groups (p<0.05) as compared to the placebo group (2.60±0.821 hours). Mean difference of duration of analgesia between E120 and E90 was 1.62 (95% confidence interval: 0.234–3.484; p>0.05). Post-operative pain intensity was significantly lower in both the E120 and E90 groups as compared to the C group. Both the etoricoxib groups required less intra-operative (p=0.002) and post-operative (p=0.001) analgesic supplementation as compared to the placebo group. The patient satisfaction score and rate of occurrence of significant adverse effects were similar among all the three groups. Conclusion Etoricoxib 90 mg is equally efficacious to etoricoxib120 mg with a similar side effect profile in a severely acute setting.
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Affiliation(s)
- Devalina Goswami
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Arijit Sardar
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim Kumar Baidya
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Yadav
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Sanjaya IGPH, Hamid ARRH, Adnyana IMS, Purwanthi IGAP, Magdalena P, Mardhika PE. Risk of Lower Eyelids Malposition in Subciliary Compared to Transconjunctival Approach in Maxillofacial Fractures Management: A Systematic Review and Meta-Analysis. Open Access Maced J Med Sci 2019; 7:2953-2957. [PMID: 31844463 PMCID: PMC6901874 DOI: 10.3889/oamjms.2019.726] [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: 05/31/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Both subciliary and transconjunctival approaches have been used for decades to visualise the site of the maxillofacial fracture. The most common complication following those procedures is lower eyelids malposition. AIM: This meta-analysis will analyse which approach (subciliary and transconjunctival approaches) is more favourable to decrease lower eyelids malposition incidence. METHOD: This meta-analysis was conducted based on PRISMA guidelines. The electronic search was conducted using keywords (“Lower Eyelids Malposition” OR “Complications” OR “Ectropion” OR “Entropion”) AND (Transconjunctival) AND (Subciliary) AND (Maxillofacial Fractures) in PubMed, The Cochrane Library, and Directory of Open Access Journal (DOAJ). This review included full-text studies (observational and randomised controlled trials) in English comparing subciliary and transconjunctival approach in patients with maxillofacial fractures in the last 10 years. The data collected were the type of fractures and approaches, ectropion and entropion incidence as well as follow-up duration. The risk of bias was assessed using Joanna Briggs Institute critical appraisal checklist. Statistical analysis was done using Review Manager 5.3 (Cochrane, Denmark). RESULT: This study included 3 cohort studies and 2 Randomized Controlled Trial (RCT) studies from 2012 to 2017 with a total of 574 samples. Subciliary approach had a significant higher ectropion incidence when compared to transconjunctival approach (RR = 4.64, 95% CI: 1.68-12.81, p = 0.003). There was also a significant reduction of entropion incidence in patients with subciliary approach compared to transconjunctival approach (RR = 0.16, 95% CI: 0.04 – 0.69, p = 0.01). CONCLUSION: There was no superiority between one procedure toward another since each procedure related to different lower eyelids malpositions.
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Affiliation(s)
- I Gusti Putu Hendra Sanjaya
- Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Agus Roy Rusly Hariantana Hamid
- Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - I Made Suka Adnyana
- Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - I Gusti Ayu Putri Purwanthi
- Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Paulina Magdalena
- Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Putu Eka Mardhika
- Department of Neurosurgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
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Stathopoulos P, Igoumenakis D, Mezitis M, Rallis G. Blindness after facial trauma: epidemiology, incidence and risk factors: a 27-year cohort study of 5708 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:129-133. [PMID: 29673800 DOI: 10.1016/j.oooo.2018.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This was a 27-year study of a cohort of 5708 patients who had sustained maxillofacial fractures. Our purpose was to present the etiology, mechanism of trauma, site, and concomitant injuries that led to visual loss. We hypothesize that fractures caused by high-energy impact of the midface may be associated with blindness. A discussion of the treatment approaches is also included. STUDY DESIGN The study included 5708 patients who had sustained a maxillofacial fracture during the years 1985-2012. Patients' records were reviewed for gender, age, fracture site, etiology of trauma, concomitant injuries, method of treatment, length of hospital stay, and cause of blindness. The relationship of the above variables to blindness was investigated. RESULTS The incidence of loss of vision was 0.34%. A very strong association between firearm injuries and blindness was observed (P < .001). These patients spent much longer time in hospital (P < .01) and suffered serious concomitant injuries involving the brain. CONCLUSIONS Retrobullbar hemorrhage should be treated with lateral canthotomy, whereas in traumatic optic neuropathy, observation seems to be the safest thing to do. In patients with penetrating injuries of the globe, the immediate involvement of an ophthalmic surgeon is of paramount importance.
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Affiliation(s)
- Panagiotis Stathopoulos
- Dublin Dental University Hospital, Consultant Oral and Maxillofacial Surgeon St James and Mater Hospital, Dublin, Ireland.
| | | | - Michalis Mezitis
- Consultant Oral and Maxillofacial Surgeon, KAT General Hospital of Athens, Athens, Greece
| | - George Rallis
- Consultant Oral and Maxillofacial Surgeon, KAT General Hospital of Athens, Athens, Greece
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Abstract
Facial fractures are a common source of emergency department consultations for the plastic surgeon. A working understanding of evaluation, assessment, management, and prevention of further injury when dealing with these fractures is vital. This two-part series detailing the management of midface fractures serves as a guide for the appropriate workup and management of the wide variety of fracture patterns that are commonly encountered.
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Affiliation(s)
- Matthew Louis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Nikhil Agrawal
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Matthew Kaufman
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Tuan A Truong
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Halsey JN, Hoppe IC, Granick MS, Lee ES. A Single-Center Review of Radiologically Diagnosed Maxillofacial Fractures: Etiology and Distribution. Craniomaxillofac Trauma Reconstr 2017; 10:44-47. [PMID: 28210407 PMCID: PMC5305313 DOI: 10.1055/s-0036-1597582] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/17/2016] [Indexed: 10/20/2022] Open
Abstract
The etiology of fractures of the maxillofacial skeleton varies among studies, with motor vehicle accidents and assaults oftentimes the most common. The number of males outnumbers females throughout most studies. Fractures of the zygoma, orbit, and mandible are usually cited as most common fracture types. This study examines a single center's experience with regards to etiology and distribution of fractures. A retrospective review of all radiologically confirmed facial fractures in a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Patient demographics, etiology of injury, and location of fractures were collected. During this time period, 2,998 patients were identified as having sustained a fracture of the facial skeleton. The average age was 36.9 years, with a strong male predominance (81.5%). The most common etiologies of injury were assault (44.9%) and motor vehicle accidents (14.9%). Throughout the study period, the number of fractures as a result of assault remained relatively constant, whereas the number as a result of motor vehicle accidents decreased slightly. The most common fracture observed was of the orbit, followed by mandible, nasal bones, zygoma, and frontal sinus. Patients sustaining a fracture as a result of assault were more likely to have a mandible fracture. Patients in motor vehicle accidents were more likely to suffer fractures of the maxilla, orbit, and frontal sinus. Mandible fractures are more common in cases of assault. Motor vehicle accidents convey a large force, which, when directed at the craniofacial skeleton, can cause a variety of fracture patterns. The decreasing number of fractures as a result of motor vehicle accidents may represent improved safety devices such as airbags.
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Affiliation(s)
- Jordan N. Halsey
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ian C. Hoppe
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Mark S. Granick
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Edward S. Lee
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Plastic Surgery, VA New Jersey Health Care System, East Orange, New Jersey
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12
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Abstract
BACKGROUND Traumatic optic neuropathy is characterized by sudden loss of vision following facial trauma leading to variable visual deficits. The purpose of this study was to evaluate recent institutional trends in the treatment of traumatic optic neuropathy, evaluate the outcomes of different treatment strategies, and identify factors associated with improved vision. METHODS Institutional review board approval was obtained to retrospectively review patients diagnosed with traumatic optic neuropathy at a high-volume trauma center from 2004 to 2012. Pretreatment and posttreatment visual acuity was compared using quantitative analysis of standard ophthalmologic conversion. RESULTS A total of 109 patients met inclusion criteria (74.3 percent male patients), with a mean age of 38.0 ± 17.5 years (range, 8 to 82 years). Management of traumatic optic neuropathy involved intravenous corticosteroids alone in 8.3 percent of patients (n = 9), 56.9 percent (n = 62) underwent observation, 28.4 percent (n = 31) had surgical intervention, and 6.4 percent (n = 7) underwent surgery and corticosteroid administration. Only 19.3 percent of patients returned for follow-up. Vision improved in 47.6 percent of patients, with a mean follow-up of 12.9 weeks. Patients younger than 50 years had a trend toward higher rates of visual improvement, 60 percent versus 16.7 percent (p = 0.15). CONCLUSIONS The majority of traumatic optic neuropathy patients are unlikely to return for a follow-up examination. Optic nerve decompression has fallen out of favor in the authors' institution, and observation is the most common management strategy. Outcomes following corticosteroid administration and observation are comparable. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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González-Vargas I, García-Pérez M, Castro-Govea Y, Franco-Vazquez C, Juárez-López de Nava A, Fonseca-Sada J. Management of firearm facial fractures at the “Dr. José Eleuterio González”: University Hospital Case Report. MEDICINA UNIVERSITARIA 2016. [DOI: 10.1016/j.rmu.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Raschke G, Djedovic G, Peisker A, Wohlrath R, Rieger U, Guentsch A, Gomez-Dammeier M, Schultze-Mosgau S. The isolated orbital floor fracture from a transconjunctival or subciliary perspective-A standardized anthropometric evaluation. Med Oral Patol Oral Cir Bucal 2016; 21:e111-7. [PMID: 26595833 PMCID: PMC4765746 DOI: 10.4317/medoral.20818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 09/09/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The influence of orbital fractures and their repair on the rate of deformities of the lower eyelid is an ongoing source of discussion in the literature. Most of the present studies include isolated blow-out as well as combined orbital fractures. MATERIAL AND METHODS We present a retrospective evaluation of a series of 100 patients after isolated blow-out fracture repair using reference anthropometric data on standardized photographs. Analysis included eye fissure width and height, lid sulcus height, upper lid height, upper and lower iris coverage, position of cornea to palpebra inferior, canthal tilt, scleral show, ectropion and entropion. It was clearly distinguished between operated and contralateral eyelid, whether a transconjunctival or a subciliary approach was performed and amount of fracture. Our main interests were changes of the aforementioned parameters with regards to eyelid deformities. RESULTS Surgery per se did not significantly influence eyelid deformities. However, the surgical approach selected significantly affected eye fissure index, lower iris coverage and rate of scleral show, indicating retraction of the lower eyelid. CONCLUSIONS The standardized measurements described here are accurate and objective to evaluate postoperative results. The subciliary approach included the highest risk of lower lid retraction as compared to transconjunctival approaches.
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Affiliation(s)
- Gregor Raschke
- Department of Cranio-Maxillofacial, Plastic Surgery, Friedrich Schiller University Jena, Universitätsklinikum Jena, D-07747 Jena ,Germany,
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Butts SC, Floyd E, Lai E, Rosenfeld RM, Doerr T. Reporting of Postoperative Pain Management Protocols in Randomized Clinical Trials of Mandibular Fracture Repair: A Systematic Review. JAMA FACIAL PLAST SU 2015; 17:440-8. [PMID: 26335408 DOI: 10.1001/jamafacial.2015.1011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The control of pain associated with mandibular fractures is an important treatment outcome that affects function, adherence to treatment regimens, and patient comfort and satisfaction. OBJECTIVE To explore the pain management protocols reported in studies of mandibular fractures, including the reporting of quality-of-life measures. EVIDENCE REVIEW PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, and clinicaltrials.gov were searched for randomized clinical trials published from 1970 to July 2014. We followed PRISMA reporting standards to assess study eligibility and extract data. Studies of patients older than 16 years who underwent operative mandibular fracture management were included. The primary data collected included the type of analgesic prescribed, associated adverse effects of the analgesic, method of pain assessment, and use of quality-of-life measures. A pain attentiveness score was assigned to studies based on the comprehensiveness of the information reported. Several variables were reviewed to determine the factors that predict reporting of pain-related data. Assessments of risk for bias were performed using the Cochrane Collaboration's domain-based evaluation method. FINDINGS The initial search identified 111 articles, of which 38 met inclusion criteria. Among the 38 reviewed articles, there were 38 trials and 1808 unique patients represented. Among the 38 articles, the procedures reported included maxillomandibular fixation only in 6 (16%), open reduction with internal fixation only in 20 (53%), and both in 12 (32%). Specific analgesics prescribed were reported in only 5 of the 38 studies (13%), and 3 of these used a combination of nonsteroidal anti-inflammatory drugs and acetaminophen (paracetamol). Thirteen studies (34%) reported pain assessments and 5 (13%) included quality-of-life measures. Geographic region was the only variable that predicted pain attentiveness, with studies from Europe (3 of 11 studies [27%]) and Asia (6 of 16 studies [38%]) most likely to have a high pain attentiveness score. A low rating was least common in the United States (2 of 5 studies [40%]) (P = .047, Fisher exact test). Most of the studies had unclear (n = 27) or high (n = 6) risks for bias in the key domains assessed. CONCLUSIONS AND RELEVANCE Pain management is a neglected outcome in randomized clinical trials of mandibular trauma; most studies did not describe the specific analgesics used. Many randomized clinical trials (13 [34%]) assessed pain levels among patients without providing information about the agents prescribed. The incorporation of validated pain measures and quality-of-life scores in future studies of mandibular trauma would focus attention on this key outcome measure.
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Affiliation(s)
- Sydney C Butts
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, State University of New York Downstate Medical Center, College of Medicine, Brooklyn
| | - Elizabeth Floyd
- Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn
| | - Erica Lai
- School of Public Health, State University of New York Downstate Medical Center, Brooklyn
| | - Richard M Rosenfeld
- Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn
| | - Timothy Doerr
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
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DeAngelis AF, Barrowman RA, Harrod R, Nastri AL. Review article: Maxillofacial emergencies: Maxillofacial trauma. Emerg Med Australas 2014; 26:530-7. [PMID: 25292416 DOI: 10.1111/1742-6723.12308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2014] [Indexed: 11/27/2022]
Abstract
Fractures of the facial skeleton are a common reason for patients to present to EDs and general medical practice in Australia. Trauma to the maxillofacial region can lead to airway obstruction, intracranial injuries, loss of vision or long term cosmetic and functional deficits. This article focuses on the emergency assessment, triage and non-specialist management of traumatic injuries of the orbit and facial skeleton.
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Affiliation(s)
- Adrian F DeAngelis
- Maxillofacial Surgery Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Trends in Facial Fracture Treatment Using the American College of Surgeons National Surgical Quality Improvement Program Database. Plast Reconstr Surg 2014; 133:627-638. [DOI: 10.1097/01.prs.0000438457.83345.e9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Orbital trauma is one of the most common reasons for ophthalmology specialty consultation in the emergency department setting. We survey the literature from 1990 to present to describe the role of computed tomography (CT), magnetic resonance imaging (MRI) and their associated angiography in some of the most commonly encountered orbital trauma conditions. CT orbit can often detect certain types of foreign bodies, lens dislocation, ruptured globe, choroidal or retinal detachments, or cavernous sinus thrombosis and thus complement a bedside ophthalmic exam that can sometimes be limited in the setting of trauma. CT remains the workhorse for acute orbital trauma owing to its rapidity and ability to delineate bony abnormalities; however MRI remains an important modality in special circumstances such as soft tissue assessment or with organic foreign bodies.
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Affiliation(s)
- Ken Y Lin
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA 92697, USA
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Raschke GF, Rieger UM, Bader RD, Schaefer O, Guentsch A, Hagemeister C, Schultze-Mosgau S. The zygomaticomaxillary complex fracture – An anthropometric appraisal of surgical outcomes. J Craniomaxillofac Surg 2013; 41:331-7. [DOI: 10.1016/j.jcms.2012.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 10/16/2012] [Accepted: 10/18/2012] [Indexed: 11/27/2022] Open
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Outcomes analysis of eyelid deformities using photograph-assisted standardized anthropometry in 311 patients after orbital fracture treatment. J Trauma Acute Care Surg 2013; 73:1319-25. [PMID: 23064604 DOI: 10.1097/ta.0b013e318265cc92] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Before undergoing repair of orbital fractures, most patients are worried about their postoperative appearance. Furthermore, there is an ongoing discussion in the literature about the influence of trauma and surgical approach to the inferior orbita on eyelid deformities. METHODS In this retrospective comparative study, we present an evaluation of a series of 311 postoperative results of orbital fractures on standardized photographs based on reference anthropometric data. Analysis included eye fissure width and height, lid sulcus height, upper lid height, upper and lower iris coverage, position of cornea to inferior palpebra, canthal tilt, scleral show, ectropion, and entropion. It was clearly differentiated between operated and contralateral eyelid type of fracture of the midface and whether a transconjunctival or a subciliary approach was used. RESULTS Surgery and the chosen approach presented significant effects on eye fissure index, lower iris coverage, scleral show, and ectropion. Different types of fractures affecting the orbita showed no influence on the investigated values. CONCLUSION Not surprisingly, an association between surgery and lower lid retraction was found. The underlying osseous trauma did not show a significant influence on the presented measurements. Subciliary approaches increased the risk of lower lid retraction. The standard measurements described here are accurate and objective to evaluate postoperative results. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III.
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Fulton A. Diagnostic imaging in veterinary dental practice. Maxillofacial trauma. J Am Vet Med Assoc 2013; 242:161-3. [PMID: 23276089 DOI: 10.2460/javma.242.2.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Amy Fulton
- Dentistry and Oral Surgery Service, William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA.
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Chandran VSR, Candamourty R, Thangavelu A. The versatility of lower eyelid blepharoplasty incision: In open reduction and fixation of zygomatic complex injuries. J Nat Sci Biol Med 2012; 3:161-7. [PMID: 23225979 PMCID: PMC3510911 DOI: 10.4103/0976-9668.101900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A ZYGOMATIC COMPLEX FRACTURE INCLUDES DISRUPTION OF THE FOUR ARTICULATING SUTURES: zygomaticofrontal, zygomaticotemporal, zygomaticomaxillary and zygomaticosphenoidal sutures. All zygomatic complex fractures involve the orbital floor and therefore an understanding of orbital anatomic features is essential for those treating these injuries. AIMS AND OBJECTIVES To analyze the efficacy and shortcomings of this approach. To evaluate the adequacy, role of tarsorrhaphy, difficulties, role of steroid in postoperative edema control in lower lid blepharoplasty approach. MATERIALS AND METHODS A total number of six patients were included in this study and all the patients were treated surgically under general anesthesia. All the patients were approached through lower eyelid blepharoplasty incision. The first skin crease in the lower eyelid region is selected for this incision. RESULTS All patients were administered with steroid injection. Frost sutures were placed in four cases and tarsorrhaphy was done in two patients. Three cases encountered immediate mild edema and immediate scar formation. Late scar was present only in two patients with a follow up of three months. CONCLUSION Lower eyelid blepharoplasty incision is an excellent, non complicated, simple procedure in the management of fractures in the infraorbital region, orbital floor, which occurs as a part of zygomatic complex fractures.
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Affiliation(s)
- V S R Chandran
- Department of Oral and Maxillofacial Surgery, Best Dental College, Madurai, India
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Raschke GF, Rieger UM, Bader RD, Schaefer O, Guentsch A, Schultze-Mosgau S. Transconjunctival versus subciliary approach for orbital fracture repair—an anthropometric evaluation of 221 cases. Clin Oral Investig 2012; 17:933-42. [DOI: 10.1007/s00784-012-0776-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
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[Maxillofacial fractures: midface and internal orbit : Part 1: classification and diagnosis]. Unfallchirurg 2011; 114:1007-17. [PMID: 22116545 DOI: 10.1007/s00113-011-2091-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Fractures of the midface and internal orbit occur isolated or in combination with other injuries. Frequently, the patients are first seen in emergency rooms responsible for the coordination of initial diagnostic procedures, followed by the transfer to specialties for further treatment. It is, therefore, important for all colleagues in traumatology to understand the basic principles of injuries to the midface. Thus, the aim of this article is the description of the anatomy and the current classification systems in use, the related clinical symptoms, and the essential diagnostic measures to obtain precise information about the injury pattern. Issues for treatment will be illustrated and discussed in "Part 2" of this article.
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