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Zhao Z, Guo Z, Hu W, Long J. Assessment of the Correlation Between Types of Orbital Fractures and Ocular Symptoms, and the Effect of Manual Preformed and Patient-Specific Mesh Implants: A Retrospective Study. J Craniofac Surg 2024:00001665-990000000-01947. [PMID: 39287427 DOI: 10.1097/scs.0000000000010656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 08/13/2024] [Indexed: 09/19/2024] Open
Abstract
OBJECTIVE Although certain orbital fractures are associated with specific clinical symptoms, these relationships should be reviewed comprehensively. The optimal choice between manual preformed mesh implants (MPIs) and patient-specific mesh implants (PSIs) for orbital reconstruction remains undetermined due to inconclusive evidence regarding their effectiveness. METHODS This retrospective study investigated 280 patients with unilateral orbital fractures to explore the correlation between clinical ocular symptoms, including diplopia, enophthalmos, limitation of ocular movement, blindness, and the specific type of orbital fracture. The effects on orbital volume (OV) and orbital volume ratio (OVR) of MPI and PSI with and without the use of navigation were also evaluated in this study. Patients were categorized into 4 groups: MPI, PSI, navigation-assisted MPI, and navigation-assisted PSI. After this categorization, alterations in OV and OVR were analyzed before and after surgical intervention. RESULTS Significant correlations were observed between the orbital fracture type and diplopia, enophthalmos, and limitation of ocular movement (P < 0.05). Patients in the MPI group exhibited a notable difference in the postoperative OV between the injured and normal sides (P < 0.05), but no statistically significant difference was found in the postoperative OV between the injured and normal sides among the patients in the other 3 groups (P > 0.05). Moreover, the MPI group demonstrated significantly higher postoperative OVR than the other groups (P < 0.05). Notably, PSI remained effective with or without navigation, MPI combined with navigation technology achieved a reconstruction quality similar to that of PSI by rectifying positioning errors during surgery. CONCLUSION The authors found significant correlations (P < 0.05) between orbital fracture type and diplopia, enophthalmos, and limitations of ocular movement. Patient-specific mesh implant plays an important role in orbital reconstruction. It is also a good method for reconstructing orbital fractures using MPI assisted by navigation technology.
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Affiliation(s)
- Zhihao Zhao
- State Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Hughes D, McQuillan J, Holmes S. Quantitative analysis of diplopia following orbital fracture repair. Br J Oral Maxillofac Surg 2023; 61:202-208. [PMID: 36805788 DOI: 10.1016/j.bjoms.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
Orbital fractures can result in devastating functional complications to sight and well-being, yet our understanding of functional sequelae post reconstruction is not well understood in the literature. This research retrospectively analysed the activity of a specialist orbital surgeon over five years to evaluate the incidence of, and risk factors for, debilitating complications such as diplopia and restriction of extraocular movement. Orbital fracture cases repaired between 1 January 2015 and 31 December 2019 were retrospectively analysed. Demographics, orthoptic assessment, injury classification, timing, operative details, outcomes, and complications were recorded. Preoperative and postoperative binocular single vision scores (BSV) were recorded to calculate the effect of orbital repair on residual diplopia. Of 582 patients undergoing orbital access, 472 cases of orbital wall reconstruction satisfied the inclusion criteria, of which 162 (34%) were Jaquiéry 4 or 5. Overall, 10.6% had complications, 4.9% had diplopia, and 5.7% were returned to theatre. All those with residual diplopia had had it preoperatively, and had evidence of an improvement in BSV score. Time to surgery, material, and pure orbital fractures had a significant impact on the incidence of diplopia. Defect size did not. Whilst complication rates were low we conclude that strict adherence to a defined surgical protocol, postoperative imaging, and objective assessment of postoperative function are central to maintaining these standards. Objective orthoptic analysis of patients before and after orbital repair is critical to our understanding of this pathology. Whilst preoperative prediction of the persistence of long-term diplopia currently eludes us, further research should target it.
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Affiliation(s)
- Declan Hughes
- Oral and Maxillofacial surgery department, Royal London Hospital, Whitechapel, London E1 1FR, United Kingdom.
| | - Joe McQuillan
- Oral and Maxillofacial surgery department, Royal London Hospital, Whitechapel, London E1 1FR, United Kingdom
| | - Simon Holmes
- Oral and Maxillofacial surgery department, Royal London Hospital, Whitechapel, London E1 1FR, United Kingdom
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Committeri U, Arena A, Carraturo E, Austoni M, Germano C, Salzano G, De Riu G, Giovacchini F, Maglitto F, Abbate V, Bonavolontà P, Califano L, Piombino P. Incidence of Orbital Side Effects in Zygomaticomaxillary Complex and Isolated Orbital Walls Fractures: A Retrospective Study in South Italy and a Brief Review of the Literature. J Clin Med 2023; 12:845. [PMID: 36769492 PMCID: PMC9918000 DOI: 10.3390/jcm12030845] [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: 12/05/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
Zygomaticomaxillary complex and isolated orbital walls fractures are one of the most common fractures of the midface, often presenting orbital symptoms and complications. Our study was born with the aim of understanding the trend in the incidence of orbital presurgical symptoms, specifically diplopia, enophthalmos and exophthalmos, in the Campania Region in southern Italy. We conducted a retrospective, monocentric observational study at the Maxillofacial Surgery Unit of the Federico II University Hospital of Naples, enrolling 402 patients who reported a fracture of the zygomaticomaxillary complex and orbital floor region from 15 June 2021 to 15 June 2022. Patients were evaluated by age, gender, etiology, type of fracture, preoperative orbital side effects and symptoms. Pre-surgical side effects were studied, and 16% of patients (n = 66) developed diplopia. Diplopia was most common in patients previously operated on for orbital wall fractures (100%), and least common in patients who reported trauma after interpersonal violence (15%) and road traffic accidents (11%). Exophthalmos appeared only in 1% (six cases); whereas it did not appear in 99% (396 cases). Enophthalmos was present in 4% (sixteen cases), most commonly in interpersonal violence cases (two cases). The frequency of orbital complications in patients with zygomaticomaxillary complex and isolated orbital walls fractures suggests how diplopia remains the most common pre-surgical orbital side effect.
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Affiliation(s)
- Umberto Committeri
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Antonio Arena
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Emanuele Carraturo
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Martina Austoni
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Cristiana Germano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Giovanni Salzano
- Otolaryngology and Maxillo-Facial Surgery Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, 07100 Sassari, Italy
| | - Francesco Giovacchini
- Maxillofacial Surgery Unit, Santa Maria Della Misericordia Hospital, San Sisto, 06121 Perugia, Italy
| | - Fabio Maglitto
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Paola Bonavolontà
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Pasquale Piombino
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
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Crozet A, Lebranchu P, Vabre B, Paillé C, Bourry M, Corre P, Bertin H. Management of orbital floor fractures in France: Results of a national online survey. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101389. [PMID: 36669743 DOI: 10.1016/j.jormas.2023.101389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Orbital floor fractures (OFF) are common facial trauma injuries, and there are no official guidelines for their medical and surgical management. The aim of this study was to provide an overview of the management of OFF in France. MATERIALS AND METHODS An online questionnaire was sent to 144 surgeons at the 88 French centers involved in the management of OFF (2019 data from the National Health Insurance Body). The questions related to the preoperative clinical and radiographic examinations, the criteria for surgical indication, the materials used, and the elements of the postoperative period. RESULTS Ultimately, 42 questionnaires were analyzed (32 from oral and maxillofacial surgeons (OMFS), 8 from ophthalmologists, and 2 from ENT or plastic surgeons). For 69% of the surgeons, a systematic ophthalmological examination was carried out, 3-7 days after the trauma, and based on a Lancaster test or visual acuity (97.6% and 83.3% of the responders, respectively). The most important criteria for the therapeutic decision were diplopia or oculomotor disorder that persisted for more than 7 days (76.2%), clinical enophthalmos (54.8%), a large fracture (52.4%), and ptosis of the orbital content on CT scan (38.1%). The mean surgical delay was 7-15 days for 54.8% of the responders. Resorbing sheets were the preferred materials to repair small fractures, while larger fractures required alloplastic implants (titanium mesh). CONCLUSION This survey confirms the diversity of practices in France regarding the management of OFF. Further studies are needed before guidelines can be developed.
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Affiliation(s)
- Audrey Crozet
- Service d'ophtalmologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France
| | - Pierre Lebranchu
- Service d'ophtalmologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France; Laboratoire des Sciences du Numérique de Nantes (UMR 6004), Faculté des Sciences et des Techniques, 2 rue de la Houssinière Cedex 03, 44322 Nantes, France.
| | - Bertrand Vabre
- Service d'ophtalmologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France.
| | - Cécile Paillé
- Unité Evaluation et Risques Cliniques (ERiC), service d'Evaluation Médicale et d'Epidémiologie (SEME), Hôpital Saint-Jacques, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France.
| | - Mae Bourry
- Service de chirurgie maxillo-faciale et stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France.
| | - Pierre Corre
- Service de chirurgie maxillo-faciale et stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France; Regenerative medicine and skeleton (RMeS), Faculté de Chirurgie Dentaire, 1 Place Alexis Ricordeau, 44042 Nantes, France.
| | - Hélios Bertin
- Service de chirurgie maxillo-faciale et stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France; Centre de recherche en cancérologie et immunologie intégrée Nantes Angers (CRCI(2)NA), équipe 9 (CHILD), faculté de médecine, 1 rue Gaston Veil, 44035 Nantes, France.
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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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Kooger TJA, Joosse MV, van Minderhout EM, Hergaarden K, Khouw YL. Epidemiology of Orbital Fractures in a Large Hospital in the Netherlands: Results of Implementation of a Multidisciplinary Orbital Trauma Team. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
This study aims to describe the epidemiology, aetiology and therapy of orbital fractures in a large municipal hospital in The Hague, the Netherlands, and to demonstrate the effectiveness of an integrated approach of orbital trauma care with a team consisting of an ophthalmologist, an orthoptist and an oral and maxillofacial (OMF) surgeon.
Methods:
We obtained data from patients with an orbital fracture between June 2015 until July 2018. Primary outcomes were the classification of orbital fractures and treatment (conservative or surgical).
Results:
182 patients were included in this study. The most common type of orbital fracture was an isolated orbital floor fracture (n=56, 30.8%). In most cases, therapy was conservative (69.2%). When surgical repair was indicated, a polydioxanone (PDS) plate was most commonly used (11.5%). The main cause of an orbital fracture was a fall accident (38.5%), followed by assault (32.4%). 32.4% of the patients were intoxicated with alcohol.
Conclusion:
In our study population, almost 70% (69.2%) of the patients were treated conservatively in our study. Compared to the international literature, this percentage is considerably higher than in other studies. In our opinion, our integrated approach to orbital trauma has led to a justifiable reduction of the proportion of cases receiving surgical intervention in orbital fractures. We would like to advocate the implementation of a similar team in other hospitals to improve the quality and cost-effectiveness of treatment in patients with orbital fractures.
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Three-Dimensional Computer-Aided Analysis of 293 Isolated Blowout Fractures - Which Radiological Findings Guide Treatment Decision? J Oral Maxillofac Surg 2021; 79:2306-2318. [PMID: 34339620 DOI: 10.1016/j.joms.2021.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Our study purpose was to clarify the extent of isolated unilateral orbital blowout fracture in relation to surgical treatment and other factors behind the treatment decision. The specific aim was to determine which computer-aided measurements based on radiological images associate with treatment choice. METHODS A retrospective cohort study was implemented on patients with an isolated unilateral orbital blowout fracture. Computer-aided measurement of fracture extent was performed. The study variables included treatment as primary outcome (surgical vs nonsurgical), post-traumatic orbital volume difference (mL) compared to contralateral orbit, fracture area (mm2), fracture depth (mm) as predictor variables, and age, sex, injury mechanism, side and site of orbital fracture and positions of recti muscles as explanatory variables. Postoperative outcomes were reported. Logistic regression analysis was used to determine the risk factors for surgery. The statistical significance level was set at P < .05. RESULTS Of 293 patients, 28.0% received surgical and 72.0% nonsurgical treatment. Volume difference, fracture area and fracture depth predicted surgical outcome (P < .001). In adjusted univariate regression analyses, fractures with moderate and severe displacement of recti muscles were more likely to receive surgical treatment than fractures with mild or no displacement (OR 6.15 and 30.75, respectively, P < .001). Isolated medial wall fractures were significantly less often (OR 0.05, P = .006) and patients with older age (OR 0.97, P = .013) slightly less often treated with surgery. Patients with preoperative symptoms had more often persisting postoperative symptoms than patients without preoperative symptoms. CONCLUSIONS Positions of the recti muscles are an independent radiological factor guiding orbital blowout fracture treatment decision. The bony fracture extent is a combination of volume difference, fracture area and fracture depth which are strongly correlated to each other. A computer-aided method significantly facilitates the systematic evaluation of bone fragments, and the extent of orbital fractures.
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Bourry M, Hardouin JB, Fauvel F, Corre P, Lebranchu P, Bertin H. Clinical evaluation of the efficacy of materials used for primary reconstruction of orbital floor defects: Meta-analysis. Head Neck 2020; 43:679-690. [PMID: 33145908 DOI: 10.1002/hed.26518] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/12/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aim of this network meta-analysis (NMA) was to compare the clinical results obtained after primary reconstruction of orbital floor fractures (OFF) using different materials. METHODS PubMed, Cochrane, and Google Scholar databases were screened from 1989 to 2019. For a study to be eligible, it had to evaluate two or more materials and report the following clinical parameters: diplopia and/or enophthalmos and/or other complications. RESULTS Nine studies involving 946 patients presenting with an OFF were included. After the surgical procedure, 105 patients (11%) had diplopia, while 43 patients (4.5%) suffered from enophthalmos. The NMA revealed that less postoperative diplopia and enophthalmos were obtained either by using polydioxanone (PDS), or a polymer of l-lactic acid and dl-lactic acid (P[L/DL]LA), or porous polyethylene, or titanium mesh compared with the use of autologous bone grafts. CONCLUSION P(L/DL)LA and PDS seem to be the best options for small and intermediate defects, whereas the association of porous polyethylene and titanium should be preferred for larger defects.
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Affiliation(s)
- Maeva Bourry
- Department of Maxillofacial Surgery, Nantes University Hospital, Nantes Cedex 1, France
| | | | - Fabien Fauvel
- Department of Maxillofacial Surgery, Saint-Nazaire Hospital, Saint-Nazaire, France
| | - Pierre Corre
- Department of Maxillofacial Surgery, Nantes University Hospital, Nantes Cedex 1, France.,Regenerative Medicine and Skeleton (RMeS), Faculty of Dental Sciences, Nantes, France
| | - Pierre Lebranchu
- Department of Ophthalmology, Nantes University Hospital, Nantes, France.,UMR 6597 CNRS, Image and Video Communication Team, Polytech-Nantes, Nantes, France
| | - Hélios Bertin
- Department of Maxillofacial Surgery, Nantes University Hospital, Nantes Cedex 1, France.,Bone sarcoma and remodeling of calcified tissues (PhyOs, UMR 1238), Faculty of Medicine, Nantes Cedex, France
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Steinmassl O, Laimer J, Offermanns V, Wildauer M, Steinmassl PA, Grams AE, Kofler F, Rasse M, Bruckmoser E. Clinical Outcome Following Surgical Repair of Small Versus Large Orbital Floor Fractures Using Polyglactin 910/Polydioxanone (Ethisorb ®). MATERIALS (BASEL, SWITZERLAND) 2020; 13:E206. [PMID: 31947782 PMCID: PMC6982172 DOI: 10.3390/ma13010206] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 11/16/2022]
Abstract
The aim of this retrospective study was to evaluate the clinical outcome of surgical management of small versus large, isolated orbital floor fractures (OFFs) using polyglactin 910/polydioxanone (Ethisorb®). Covering a four-year period (2010-2013), all records concerning midfacial fractures with involvement of the orbit were screened. Isolated fractures of the orbital floor as well as combined injuries of the orbital floor and medial wall that had been treated surgically using polyglactin 910/polydioxanone (Ethisorb®) were included. Patients underwent a preoperative, a postoperative, and a late ophthalmologic assessment. The clinical outcomes of surgically managed small OFFs up to 2 cm2 were statistically analyzed and compared to clinical results in larger defects. The final sample included 61 patients (25 women, 36 men). Fractures up to 2 cm2 were found in 33 patients (54.1%), whereas 28 patients (45.9%) suffered from OFFs larger than 2 cm2. The clinical outcomes did not significantly differ between both sample categories, and statistical analysis showed a power of 0.91 to detect a potentially existing difference. On final examination, 52 patients were free of any clinical symptoms, whereas minor issues were found in seven subjects, and two patients suffered from severe impairment. In conclusion, polyglactin 910/polydioxanone (Ethisorb®) seems to be a suitable material for surgical repair of both small and large OFFs.
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Affiliation(s)
- Otto Steinmassl
- University Hospital for Cranio-Maxillofacial and Oral Surgery, A-6020 Innsbruck, Austria
| | - Johannes Laimer
- University Hospital for Cranio-Maxillofacial and Oral Surgery, A-6020 Innsbruck, Austria
| | - Vincent Offermanns
- University Hospital for Cranio-Maxillofacial and Oral Surgery, A-6020 Innsbruck, Austria
| | - Matthias Wildauer
- University Hospital for Radiology, Medical University of Innsbruck, A-6020 Innsbruck, Austria
| | | | - Astrid E. Grams
- University Hospital for Neuroradiology, A-6020 Innsbruck, Austria
| | - Ferdinand Kofler
- University Hospital for Cranio-Maxillofacial and Oral Surgery, A-6020 Innsbruck, Austria
| | - Michael Rasse
- University Hospital for Cranio-Maxillofacial and Oral Surgery, A-6020 Innsbruck, Austria
| | - Emanuel Bruckmoser
- Private Practice for Oral and Maxillofacial Surgery, A-5020 Salzburg, Austria
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Anatomic Factors Predicting Postoperative Strabismus in Orbital Wall Fracture Repair. Sci Rep 2019; 9:14785. [PMID: 31616002 PMCID: PMC6794272 DOI: 10.1038/s41598-019-51127-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 09/25/2019] [Indexed: 11/25/2022] Open
Abstract
This study is aimed to determine the relationship between orbital fracture sites in each CT scan view and postoperative diplopia. Data for 141 patients of orbital wall fracture were analyzed retrospectively. One group of examiners reviewed sagittal, coronal and axial CT scans. Descriptive statistical analysis was used to assess each fracture area and its potential relationship with the occurrence of postoperative diplopia. Among the three anatomical views, sagittal sections were significantly associated with post-operative diplopia (PD) (p = 0.044). For orbital wall fractures in a single location, C1 (p = 0.015), A1 (p = 0.004) and S3 (p = 0.006) fractures were significantly related to PD. Orbital wall fractures found in more than one location resulted in a higher probability of PD in all sections:, C1 + C2 group (p = 0.010), C1 + C2 + C3 group (p = 0.005), A1 + A2 group (p = 0.034), A3 + A1 group (p = 0.005), S1 + S2 group (p < 0.001), S2 + S3 group (p = 0.006) and S1 + S2 + S3 group (p < 0.001). For combinations of two or three sections, we found that only fractures involving both coronal and sagittal sections led to a significantly increased risk of PD (p = 0.031). PD is the main posttreatment complication of orbital bone fracture reduction. In addition to the known myogenic cause (failure to relieve entrapment) of diplopia, both trauma and surgical manipulation can compromise ocular motor nerve function and possibly result in the development of neurogenic causes of diplopia. Careful assessment of patient symptoms (whether preoperative diplopia is present), and the location of orbital fractures (and the influence of related musculature, fat, and nerves) on CT scans are strongly related to surgical success.
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Brucoli M, Boccafoschi F, Boffano P, Broccardo E, Benech A. The Anatomage Table and the placement of titanium mesh for the management of orbital floor fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:317-321. [DOI: 10.1016/j.oooo.2018.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/19/2018] [Accepted: 04/29/2018] [Indexed: 10/17/2022]
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12
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Kennedy TA, Corey AS, Policeni B, Agarwal V, Burns J, Harvey HB, Hoang J, Hunt CH, Juliano AF, Mack W, Moonis G, Murad GJ, Pannell JS, Parsons MS, Powers WJ, Schroeder JW, Setzen G, Whitehead MT, Bykowski J. ACR Appropriateness Criteria® Orbits Vision and Visual Loss. J Am Coll Radiol 2018; 15:S116-S131. [PMID: 29724415 DOI: 10.1016/j.jacr.2018.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 01/22/2023]
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13
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Can Clinical Findings Predict Orbital Fractures and Treatment Decisions in Patients With Orbital Trauma? Derivation of a Simple Clinical Model. J Craniofac Surg 2017; 28:e661-e667. [DOI: 10.1097/scs.0000000000003823] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kim YJ, Ahn S, Seo DW, Sohn CH, Lee HJ, Park IJ, Yang DJ, Ryoo SM, Kim WY, Lim KS. Patterns and injuries associated with orbital wall fractures in elderly patients who visited the emergency room: a retrospective case-control study. BMJ Open 2016; 6:e011110. [PMID: 27645553 PMCID: PMC5030573 DOI: 10.1136/bmjopen-2016-011110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aimed to determine orbital wall fracture (OWF) patterns and associated facial injuries in elderly patients and compare them with those in their younger adult counterparts. DESIGN A retrospective case-control study. SETTING An emergency department of a university-affiliated hospital located in an urban area. PARTICIPANTS A total of 1378 adult patients with OWF diagnosed by CT from 1 January 2004 through 31 March 2014 were enrolled. Patients were categorised into elderly (≥65 years) and non-elderly (<65 years) groups. RESULTS The elderly group (n=146) had a mean age of 74.0 years compared with 37.5 years in the non-elderly group (n=1232). Slipping was the most common cause of OWF in the elderly group (43.8%, p<0.001), whereas violence was the most common cause in the non-elderly group (37.3%, p<0.001). The lateral orbital wall was the more common site of fracture in the elderly group, and their injuries were more often associated with concurrent facial bone fractures, including the mandible, maxilla and zygoma, compared with the non-elderly group. After adjusting for sex and the mechanism of injury, inclusion in the elderly group was a significant risk factor for fracture of the lateral wall (OR 1.658; 95% CI 1.074 to 2.560) and concomitant facial bone fractures of the maxilla (OR 1.625; 95% CI 1.111 to 2.377) and zygoma (OR 1.670; 95% CI 1.126 to 2.475). CONCLUSIONS Elderly patients were vulnerable to facial trauma, and concurrent facial bone fracture associated with OWF was more commonly observed in this age group. Therefore, a high index of suspicion and thorough investigation, including CT, for OWF-associated facial bone fractures are important.
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Affiliation(s)
- Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Shin Ahn
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong-Woo Seo
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyung-Joo Lee
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - In-June Park
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong-Jin Yang
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung Soo Lim
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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15
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Mishra GS, Bhatt SH. Eye Inside Out: Endonasal Endoscopic Reposition of Eye from Nose with Complete Vision Regainment. Craniomaxillofac Trauma Reconstr 2016; 10:84-88. [PMID: 28210414 DOI: 10.1055/s-0036-1584401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 12/27/2015] [Indexed: 10/21/2022] Open
Abstract
Faciomaxillary and ocular trauma is a common entity in most emergency and trauma units. We came across a 68-year-old female patient with a history of bull horn injury over the right eye. Examination revealed an empty orbital socket with unreliable perception of light present. Imaging showed that the eye had displaced posteroinferomedially to be lying in the ethmoid air cells in the nasal cavity. Under nasal endoscopic guidance, the eye was reposited back into the orbital socket and conjunctival sutures were taken to stabilize the position. The patient had vision of counting fingers at 1.5 m on the first postoperative day which improved to 6/24 on last follow-up. Such is the rarity that never before has such a case been described in literature where traumatic displacement of eyeball into the nose has been successfully repositioned by an endonasal endoscope with appreciable regaining of vision. It also further promotes endonasal endoscopic approach in the management of orbital blow out injuries.
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Affiliation(s)
- Girish S Mishra
- Department of Otorhinolaryngology, Head and Neck Surgery, Pramukh Swami Medical College and Shri Krishna Hospital, Anand, Gujarat, India
| | - Sushen Harish Bhatt
- Department of Otorhinolaryngology, Head and Neck Surgery, Pramukh Swami Medical College and Shri Krishna Hospital, Anand, Gujarat, India
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16
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Maxillofacial fractures associated with motor vehicle accidents: A review of the current literature. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2015.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:385-91. [DOI: 10.1016/j.oooo.2014.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 11/15/2014] [Accepted: 12/02/2014] [Indexed: 11/23/2022]
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18
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Righi S, Boffano P, Guglielmi V, Rossi P, Martorina M. Diagnosis and imaging of orbital roof fractures: a review of the current literature. Oral Maxillofac Surg 2015; 19:1-4. [PMID: 25582115 DOI: 10.1007/s10006-015-0482-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 01/05/2015] [Indexed: 06/04/2023]
Abstract
Isolated adult orbital roof fractures are uncommon, and the majority of them are typically associated with extensive craniofacial, ophthalmologic, and other body injuries. It is crucial to make an appropriate diagnosis of orbital roof fracture if present. Therefore, the aim of this article was to review the current literature about diagnosis and imaging of orbital roof fracture to obtain current indications. A systematic review of articles published between January 1990 and August 2013 was performed. Early diagnosis of orbital roof fractures can reduce the incidences of intracranial and ocular complications. CT scan still plays a major role in the assessment of acute orbital trauma. Careful assessment and reporting of the CT scan findings are important. In fact, the clinicians managing the patient with acute head and facial trauma should be familiar with the common findings of CT scan in case of an orbital roof fracture.
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Affiliation(s)
- Stefano Righi
- Division of Otolaryngology, Maxillofacial Surgery and Dentistry, Aosta Hospital, Aosta, Italy
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19
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Boffano P, Roccia F, Zavattero E, Dediol E, Uglešić V, Kovačič Ž, Vesnaver A, Konstantinović VS, Petrović M, Stephens J, Kanzaria A, Bhatti N, Holmes S, Pechalova PF, Bakardjiev AG, Malanchuk VA, Kopchak AV, Galteland P, Mjøen E, Skjelbred P, Koudougou C, Mouallem G, Corre P, Løes S, Lekven N, Laverick S, Gordon P, Tamme T, Akermann S, Karagozoglu KH, Kommers SC, Forouzanfar T. European Maxillofacial Trauma (EURMAT) project: A multicentre and prospective study. J Craniomaxillofac Surg 2015; 43:62-70. [DOI: 10.1016/j.jcms.2014.10.011] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/15/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022] Open
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20
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Boffano P, Roccia F, Zavattero E, Dediol E, Uglešić V, Kovačič Ž, Vesnaver A, Konstantinović VS, Petrović M, Stephens J, Kanzaria A, Bhatti N, Holmes S, Pechalova PF, Bakardjiev AG, Malanchuk VA, Kopchak AV, Galteland P, Mjøen E, Skjelbred P, Grimaud F, Fauvel F, Longis J, Corre P, Løes S, Lekven N, Laverick S, Gordon P, Tamme T, Akermann S, Karagozoglu KH, Kommers SC, Meijer B, Forouzanfar T. European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:499-504. [PMID: 25660086 DOI: 10.1016/j.oooo.2014.12.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/01/2014] [Accepted: 12/12/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year. STUDY DESIGN The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years. RESULTS The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures. CONCLUSIONS Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.
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Affiliation(s)
- Paolo Boffano
- Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
| | - Fabio Roccia
- Department of Maxillofacial Surgery, University of Turin, Turin, Italy
| | | | - Emil Dediol
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Vedran Uglešić
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Žiga Kovačič
- Maxillofacial Department, UKC Ljubljana, Ljubljana, Slovenia
| | - Aleš Vesnaver
- Maxillofacial Department, UKC Ljubljana, Ljubljana, Slovenia
| | | | - Milan Petrović
- Clinic of Maxillofacial Surgery, School of Dentistry, University of Belgrade, Belgrade, Serbia
| | - Jonny Stephens
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, Barts Health NHS, London, UK
| | - Amar Kanzaria
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, Barts Health NHS, London, UK
| | - Nabeel Bhatti
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, Barts Health NHS, London, UK
| | - Simon Holmes
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, Barts Health NHS, London, UK
| | - Petia F Pechalova
- Department of Maxillofacial Surgery, Medical University, Plovdiv, Bulgaria
| | - Angel G Bakardjiev
- Department of Maxillofacial Surgery, Medical University, Plovdiv, Bulgaria
| | - Vladislav A Malanchuk
- Department for Oral and Maxillofacial Surgery, Bogomolets National Medical University, Kiev, Ukraine
| | - Andrey V Kopchak
- Department for Oral and Maxillofacial Surgery, Bogomolets National Medical University, Kiev, Ukraine
| | - Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway
| | - Even Mjøen
- Department of Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway
| | - Per Skjelbred
- Department of Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway
| | - Fanny Grimaud
- Service de Stomatologie et Chirurgie Maxillo-faciale, Chu de Nantes, France
| | - Fabien Fauvel
- Service de Stomatologie et Chirurgie Maxillo-faciale, Chu de Nantes, France
| | - Julie Longis
- Service de Stomatologie et Chirurgie Maxillo-faciale, Chu de Nantes, France
| | - Pierre Corre
- Service de Stomatologie et Chirurgie Maxillo-faciale, Chu de Nantes, France
| | - Sigbjørn Løes
- Department of Maxillofacial Surgery, University of Bergen, Bergen, Norway
| | - Njål Lekven
- Department of Maxillofacial Surgery, University of Bergen, Bergen, Norway
| | - Sean Laverick
- Department of Oral and Maxillofacial Surgery, NHS Tayside, University of Dundee, Dundee, UK
| | - Peter Gordon
- Department of Oral and Maxillofacial Surgery, NHS Tayside, University of Dundee, Dundee, UK
| | - Tiia Tamme
- Department of Maxillofacial surgery, Stomatology Clinic, Tartu University, Tartu, Estonia
| | - Stephanie Akermann
- Department of Maxillofacial surgery, Stomatology Clinic, Tartu University, Tartu, Estonia
| | - K Hakki Karagozoglu
- Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Sofie C Kommers
- Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Brigitte Meijer
- Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
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21
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Righi S, Boffano P, Guglielmi V, Rossi P, Martorina M. Diplopia and driving: a problematic issue. J Craniomaxillofac Surg 2014; 42:1329-33. [PMID: 24794892 DOI: 10.1016/j.jcms.2014.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/05/2014] [Accepted: 03/21/2014] [Indexed: 11/18/2022] Open
Abstract
The aim of this article was to review the literature regarding diplopia and driving license and to review the West European legislations about this topic, in order to obtain appropriate indications for hospitals specialists and patients. A systematic review of articles published about diplopia and driving was performed. In addition a review of West European national legislations about driving license regulations for medical illnesses was performed, in addition to the European Union Directive on driving licenses. In the literature, the presence of diplopia has not been considered a reliable predictor of the safety of driving behavior, or it has not appeared to be a contraindication for driving according to some authors who were unable to demonstrate significant differences on driving simulator performance between subjects with chronic stable diplopia and control subjects. Nevertheless, in all western European legislations, acute diplopia constitutes an important limitation for driving, thus making the knowledge of current regulations fundamental for specialists involved in managing patients with diplopia. Ophthalmologists and maxillofacial/head and neck surgeons, may advise patients before hospital discharge about current legislations in their respective countries.
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Affiliation(s)
- Stefano Righi
- Division of Otolaryngology, Maxillofacial Surgery and Dentistry, Aosta Hospital, Aosta, Italy
| | - Paolo Boffano
- Division of Otolaryngology, Maxillofacial Surgery and Dentistry, Aosta Hospital, Aosta, Italy.
| | | | - Paolo Rossi
- Division of Otolaryngology, Maxillofacial Surgery and Dentistry, Aosta Hospital, Aosta, Italy
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