scholarly journals The Importance of Accurate, Early Bony Reconstruction in Orbital Injuries with Globe Loss

2011 ◽  
Vol 4 (3) ◽  
pp. 121-128 ◽  
Author(s):  
Craig Birgfeld ◽  
Joseph Gruss
Keyword(s):  
Bone Grafts ◽  
Visual Disturbance ◽  
Orbital Fracture ◽  
Ocular Injury ◽  
Fracture Treatment ◽  
Orbital Fractures ◽  
Facial Fractures ◽  
Prosthetic Rehabilitation ◽  
Orbital Reconstruction ◽  
Anophthalmic Orbit

Patients who sustain facial fractures frequently suffer from visual disturbance. Additionally, orbital fractures often involve ocular injury, which, not infrequently, may require enucleation. Yet an anophthalmic orbit does not obviate the need for aggressive orbital fracture treatment. In fact, treatment of the sequelae of the anophthalmic orbit can be difficult and require multiple surgeries. Intraoperative use of a conformer after accurate bony reduction and orbital reconstruction with bone grafts or orbital implants are essential steps to allow for prosthetic rehabilitation of the anophthalmic orbit.

scholarly journals Bioresorbable Material in Secondary Orbital Reconstruction Surgery

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Hui Pan ◽  
Zhenzhen Zhang ◽  
Weiwei Tang ◽  
Zhengkang Li ◽  
Yuan Deng
Keyword(s):  
Retrospective Chart Review ◽  
Fracture Repair ◽  
Orbital Fracture ◽  
Ocular Motility ◽  
Orbital Fractures ◽  
Orbital Reconstruction ◽  
Primary Surgery ◽  
Ocular Movement ◽  
Bioresorbable Material ◽  
Secondary Orbital Reconstruction

Purpose. To validate the potential of bioresorbable implantation in secondary revisional reconstruction after inadequate primary orbital fracture repair, with assessment of pre- and postoperative clinical characteristics and computed tomography image findings. Methods. A retrospective chart review was conducted on 16 consecutive patients treated for orbital fractures at Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, with inadequate prior surgeries between July 2010 and June 2017; patients who had suffered orbital blowout fractures had undergone primary surgeries elsewhere. Secondary repair of orbital fractures used bioresorbable material following unsatisfactory primary orbital repair. Patients’ demographics, degree of enophthalmos, ocular motility, diplopia test results, primary implants, and surgical complications were reviewed. Results. All 16 patients had primary orbital implants consisting of Medpor, titanium mesh, hydroxyapatite, or poly-L-lactide. Of the 16 cases, 14 had malpositioned implants posteriorly and two had implant infections. Findings following primary surgery included enophthalmos (12/16), diplopia (9/16), intraorbital abscess (2/16), and ocular movement pain (1/16). Mean preoperative enophthalmos was 3.8 ± 0.8 mm. Secondary reconstruction resulted in a mean reduction of enophthalmos by 3.1 ± 0.9 mm (P<0.01). Nine in ten patients experienced improvements in postoperative ocular motility and diplopia following secondary surgery. Intraorbital abscesses and eyeball movement-associated pain were cured. Conclusions. This study demonstrates that secondary orbital reconstruction of previously repaired orbital fractures using bioresorbable material can achieve excellent functional and aesthetic results with minimal complications. Bioresorbable material should be considered in secondary orbital reconstruction when clinically indicated.

scholarly journals Factors Associated with Significant Ocular Injury in Conservatively Treated Orbital Fractures

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Christopher J. Layton
Keyword(s):  
Visual Acuity ◽  
Ocular Injury ◽  
Orbital Fractures ◽  
Facial Fractures ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Fracture Characteristics ◽  
Factors Associated ◽  
Blowout Fracture ◽  
Highly Sensitive

Purpose.To determine factors associated with the presence of significant ocular injury in subjects with orbital fractures.Subjects.A consecutive prospective cohort of 161 patients presenting to a general tertiary referral hospital with orbital fractures and undergoing initial conservative treatment was identified. Subjects were assessed at time of injury for the need for emergency surgery, and those initially treated conservatively were subsequently followed up by the Ophthalmology Department to assess for ocular injury requiring ophthalmic management at 1–7 days after injury. Associations between ocular injury and age, sex, visual acuity, presence of blowout fracture, extent of orbital involvement, and presence of distant facial fractures were assessed.Results.142 male (average age of 32 [95% CI 30–35]) and 19 female (average age of 49 [95% CI 39–59]) subjects were identified. 17 subjects were diagnosed with significant ocular injury. Ocular injury was significantly associated with LogMAR VA worse than 0.2 (OR 49 [95% CI 11–217,P<0.0001]), but no relationship was noted for age, sex, presence of blowout fracture, extent of fractures, or presence of distal facial fractures. LogMAR visual acuity worse than or equal to 0.2 had a 98% negative predictive value for ocular injury in the setting of orbital fractures.Conclusions.Demographic and nonophthalmic fracture characteristics were not useful predictors of ocular injury in orbital fractures. LogMAR visual acuity worse than or equal to 0.2 is a highly sensitive and useful guide of the need for ophthalmic referral in subjects with orbital fractures.

Incidence of Ocular Injury in Visually Asymptomatic Orbital Fractures

2009 ◽  
Vol 25 (4) ◽  
pp. 306-308 ◽  
Author(s):  
Peter A. Mellema ◽  
Mohit A. Dewan ◽  
Michael S. Lee ◽  
Scott D. Smith ◽  
Andrew R. Harrison
Keyword(s):  
Ocular Injury ◽  
Orbital Fractures

Ocular injury in orbital fractures at a level I trauma center

2017 ◽  
Vol 52 (5) ◽  
pp. 499-502 ◽  
Author(s):  
Michael Ross ◽  
Christian El-Haddad ◽  
Jean Deschênes
Keyword(s):  
Trauma Center ◽  
Ocular Injury ◽  
Orbital Fractures ◽  
Level I

“AN ANALYSIS OF OPHTHALMIC INJURIES IN PATIENTS WITH MAXILLOFACIAL TRAUMA”

2021 ◽  
pp. 81-83
Author(s):  
Sharmila. S ◽  
Abhilash Balakrishnan ◽  
Saji Nair .A ◽  
Ajith Kumar.K
Keyword(s):  
Maxillofacial Surgery ◽  
Maxillofacial Trauma ◽  
Facial Trauma ◽  
Oral And Maxillofacial Surgery ◽  
Ocular Injury ◽  
Age Group ◽  
Facial Fractures ◽  
Periorbital Oedema ◽  
Maxillofacial Fractures ◽  
Ocular Injuries

PURPOSE OFTHE STUDY: To estimate the proportion and types of ophthalmic injuries in patients with maxillofacial fractures PATIENTS AND METHODS: All patients with maxillofacial trauma, who came to the Department of Oral and Maxillofacial surgery Government Dental college Thiruvananthapuram from November 2020 to June 2021were included in this study. The information and data collected included age, sex, mechanism of injury, type of maxillofacial fracture and type of ophthalmic injury. RESULTS: Ocular injury was sustained by 209 patients out of which 180 (86.1%) were males and 29(13.9%)were females. The largest age group of patients associated with ophthalmic injuries were 30-39 years. The etiology of facial fractures or ocular injuries showed that road trafc accidents more frequently resulted in ocular injuries 66.5% followed by assault 18.7% and self fall 14.8%. Ophthalmic injuries occurred mostly in association with orbital fractures 33.5% followed by Zygomatico maxillary complex fracture 26.8%and Maxillary sinus fractures 24.4%. Periorbital oedema was the most common ophthalmic injury accounting for 46.4%of cases followed by Periorbital ecchymosis 35.4% and Subconjuntival haemorrhage 17.2%. CONCLUSION: Mid facial trauma commonly causes ophthalmic injuries of varying degrees. Prompt ophthalmic examination of all patients with mid facial trauma is mandatory to prevent any blinding complications

scholarly journals Antibiotic Prophylaxis in Orbital Fractures

2017 ◽  
Vol 11 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Benjamin Reiss ◽  
Lamise Rajjoub ◽  
Tamer Mansour ◽  
Tony Chen ◽  
Aisha Mumtaz
Keyword(s):  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
University Hospital ◽  
Orbital Fracture ◽  
Number Needed To Treat ◽  
Orbital Fractures ◽  
Oral Antibiotics ◽  
George Washington ◽  
Amoxicillin Clavulanate ◽  
Trauma Teams

Purpose: To determine whether prophylactic antibiotic use in patients with orbital fracture prevent orbital infection. Design: Retrospective cohort study. Participants: All patients diagnosed with orbital fracture between January 1, 2008 and March 1, 2014 at The George Washington University Hospital and Clinics. Main Outcome Measures: Development of orbital infection. Results: One hundred seventy-two patients with orbital fracture met our inclusion and exclusion criteria. No orbital infections were documented. Twenty subjects (12%) received no prophylactic antibiotic, and two (1%) received only one dose of antibiotics pre-operatively for surgery. For primary antibiotic, 136 subjects (79%) received oral antibiotics, and 14 (8%) received intravenous (IV) antibiotics (excluding cefazolin). Cephalexin and amoxicillin-clavulanate were the most prescribed oral antibiotics that are equally effective. Five-to-seven day courses of antibiotics had no increased infections compared to ten-to-fourteen day courses. Calculated boundaries for effectiveness of prophylactic antibiotics ranged from a Number Needed to Treat (NNT) of 75 to a Number Needed to Harm (NNH) of 198. Conclusion: Antibiotics for prevention of orbital infection in patients with orbital fractures have become widely used. Coordination between trauma teams and specialists is needed to prevent patient overmedication and antibiotic resistance. Should antibiotics be used, shorter courses and avoidance of broad spectrum agents are recommended. Additional studies are needed.

scholarly journals A Protocol to Reduce Interobserver Variability in the Computed Tomography Measurement of Orbital Floor Fractures

2015 ◽  
Vol 8 (4) ◽  
pp. 289-298 ◽  
Author(s):  
ChuanHan Ang ◽  
JinRong Low ◽  
JiaYi Shen ◽  
Elijah Zheng Yang Cai ◽  
Eileen Chor Hoong Hing ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Surface Area ◽  
Interobserver Variability ◽  
Intraclass Correlation ◽  
Orbital Floor ◽  
Orbital Fracture ◽  
Orbital Fractures ◽  
Fracture Detection ◽  
Orbital Floor Fractures

Orbital fracture detection and size determination from computed tomography (CT) scans affect the decision to operate, the type of surgical implant used, and postoperative outcomes. However, the lack of standardization of radiological signs often leads to the false-positive detection of orbital fractures, while nonstandardized landmarks lead to inaccurate defect measurements. We aim to design a novel protocol for CT measurement of orbital floor fractures and evaluate the interobserver variability on CT scan images. Qualitative aspects of this protocol include identifying direct and indirect signs of orbital fractures on CT scan images. Quantitative aspects of this protocol include measuring the surface area of pure orbital floor fractures using computer software. In this study, 15 independent observers without clinical experience in orbital fracture detection and measurement measured the orbital floor fractures of three randomly selected patients following the protocol. The time required for each measurement was recorded. The intraclass correlation coefficient of the surface area measurements is 0.999 (0.997–1.000) with p-value < 0.001. This suggests that any observer measuring the surface area will obtain a similar estimation of the fractured surface area. The maximum error limit was 0.901 cm2 which is less than the margin of error of 1 cm2 in mesh trimming for orbital reconstruction. The average duration required for each measurement was 3 minutes 19 seconds (ranging from 1 minute 35 seconds to 5 minutes). Measurements performed with our novel protocol resulted in minimal interobserver variability. This protocol is effective and generated reproducible results, is easy to teach and utilize, and its findings can be interpreted easily.

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