Pediatric Orbital Roof Fractures: A Ratio of Orbital Dimensions Correlated to Prevalence of Fracture

2020 ◽  
Author(s):  
Stephen C. Dryden ◽  
Andrew G. Meador ◽  
Andrew B. Johnston ◽  
Adrianna E. Eder ◽  
James C. Fleming ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Pediatric Population ◽  
Relative Length ◽  
Orbital Floor ◽  
Orbital Fracture ◽  
Orbital Roof ◽  
Fracture Patterns ◽  
Gender And Age ◽  
The Mean ◽  
Orbital Roof Fractures

Abstract Objective Orbital roof fractures are more likely to occur in younger children, specifically younger than 7 years. Cranium to face ratio decreases with age; however, there is no definition for measurement of the neurocranium or face. We propose using the length of the orbital roof as a measurement of the neurocranium and length of the orbital floor as a tool to estimate midface size. The purpose of this study is to test this measurement as a correlation rate of orbital roof fractures within the pediatric population. Design This is a retrospective study. Setting This study was done at the LeBonheur Children's Hospital. Participants Sixty-six patients with orbital roof fractures were identified and stratified by gender and age, specifically younger than 7 years and 7 years or older. Main Outcome Measures The main outcome measures were orbital roof length, floor length, and ratio thereof. Results Mean orbital roof length was 43.4 ± 3.06 and 45.1 ± 3.94 mm for patients <7 and ≥7 years, respectively (p = 0.02). Mean orbital floor length was 41.3 ± 2.99 and 47.7 ± 4.19 for patients <7 and ≥7 years, respectively (p < 0.00001). The mean roof to floor ratio (RTFR) for patients <7 years was 1.051 ± 0.039 and for patients ≥ 7 years was 0.947 ± 0.031 (p < 0.00001). Conclusion As children age, the relative length of the orbital roof decreases when compared with the orbital floor. The RTFR was more than 1.0 in children younger than 7 years. These differences were statistically significant when compared with children 7 years and older. This measurement shift follows the differences noted in orbital fracture patterns during childhood.

Orbital Roof Fractures in the Pediatric Population

1989 ◽  
Vol 84 (2) ◽  
pp. 213-216 ◽  
Author(s):  
Alan Messinger ◽  
Mary Ann Radkowski ◽  
Mark J. Greenwald ◽  
Jay M. Pensler
Keyword(s):  
Pediatric Population ◽  
Orbital Roof ◽  
Orbital Roof Fractures

Orbital Roof Fractures in the Pediatric Population

1989 ◽  
Vol 84 (2) ◽  
pp. 217-218 ◽  
Author(s):  
Alan Messinger ◽  
Mary Ann Radkowski ◽  
Mark J. Greenwald ◽  
Jay M. Pensler ◽  
Joseph S. Gruss ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Orbital Roof ◽  
Orbital Roof Fractures

Orbital Roof Fractures in the Pediatric Population

1991 ◽  
Vol 7 (1) ◽  
pp. 75
Author(s):  
Alan Messinger ◽  
Mary Ann Radkowski ◽  
Mark J. Greenwald ◽  
Jay M. Pensler
Keyword(s):  
Pediatric Population ◽  
Orbital Roof ◽  
Orbital Roof Fractures

scholarly journals Impact of surgical timing of postoperative ocular motility in orbital blowout fractures

2017 ◽  
Vol 102 (3) ◽  
pp. 398-403 ◽  
Author(s):  
Yukito Yamanaka ◽  
Akihide Watanabe ◽  
Chie Sotozono ◽  
Shigeru Kinoshita
Keyword(s):  
Surgical Repair ◽  
Orbital Floor ◽  
Orbital Fracture ◽  
Ocular Motility ◽  
Surgical Timing ◽  
Trap Door ◽  
The Mean ◽  
Orbital Blowout Fractures ◽  
Better Than

PurposeTo investigate the surgical timing postinjury in regard to ocular motility in patients with orbital-floor blowout fractures.MethodsThis study involved 197 eyes (92 right eyes and 105 left eyes) of 197 patients (154 males and 43 females, mean age: 29.0 years, range: 7–85 years) with pure orbital blowout fractures. All patients underwent surgical repair within 30 days postinjury and were followed up for 3 months or more postoperative (mean follow-up period: 8.4 months, range: 3–59 months). Orbital blowout fractures were classified into one of three shapes: (1) trap-door fracture with muscle entrapment, (2) trap-door fracture with incarcerated tissue and (3) depressed fragment fracture. Ocular motility was estimated by percentage of Hess area ratio (HAR%) on the Hess chart at the final follow-up examination. In addition, correlations between postinjury surgical timing and HAR% were analysed.ResultsThe mean postinjury surgical timing was 10.7±7.8 days (range: 0–30 days). The mean postoperative HAR% (92.9%±10.5%) was significantly improved compared with preoperative HAR% (73.5%±21.7%) (p<0.01). The mean postoperative HAR% (98.3%±4.4%) of the orbital-floor trap-door fracture patients with incarcerated tissue who underwent surgical repair within 8 days postinjury was significantly better than that of the patients who underwent surgical repair after 8 days (94.2%±5.8%) (p<0.01).ConclusionsPatients with orbital-floor trap-door blowout fractures with incarcerated tissue that were repaired within 8 days postinjury had better outcomes than those repaired after 8 days, and HAR% is a useful method to record orbital fracture surgical outcomes.

scholarly journals Facial Fracture Patterns Associated with Traumatic Optic Neuropathy

2019 ◽  
Vol 12 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Shahrooz S. Kelishadi ◽  
Matthew R. Zeiderman ◽  
Karan Chopra ◽  
Joseph A. Kelamis ◽  
Gerhard S. Mundinger ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Optic Neuropathy ◽  
Orbital Floor ◽  
Orbital Fractures ◽  
Traumatic Optic Neuropathy ◽  
Nasal Bones ◽  
Orbital Roof ◽  
Fracture Patterns ◽  
Orbital Wall ◽  
Study Population

Traumatic optic neuropathy (TON) is rare. The heterogeneity of injury patterns and patient condition on presentation makes diagnosis difficult. Fracture patterns associated with TON have never been evaluated. Retrospective review of 42 patients diagnosed with TON at the R. Adams Cowley Shock Trauma Center from May 1998 to August 2010 was performed. Thirty-three patients met criteria for study inclusion of fracture patterns. Additional variables measured included patient demographics and mechanism. Cluster analysis was used to form homogenous groups of patients based on different fracture patterns. Fracture frequency was analyzed by group and study population. Visual depiction of fracture patterns was created for each group. Cluster analysis of fracture patterns yielded five common “groups” or fracture patterns among the study population. Group 1 ( n = 3, 9%) revealed contralateral lateral orbital wall (100%), zygoma (67%), and nasal bone (67%) fractures. Group 2 ( n = 7, 21%) demonstrated fractures of the frontal bone (86%), nasal bones (71%), and ipsilateral orbital roof (57%). Group 3 ( n = 14, 43%) involved fractures of the ipsilateral zygoma (100%), lateral orbital wall (29%), as well as frontal and nasal bones (21% each). Group 4 ( n = 5, 15%) consisted of mid- and upper-face fractures; 100% fractured the ipsilateral orbital floor, medial and lateral walls, maxilla, and zygoma; 80% fractured the orbital roof and bilateral zygoma. Group 5 ( n = 4, 12%) was characterized by fractures of the ipsilateral orbital floor, medial and lateral orbital walls (75% each), and orbital roof (50%). A notably high 15 of 33 patients (45%) sustained penetrating trauma. Our study demonstrates five fracture pattern groups associated with TON. Zygomatic, frontal, nasal, and orbital fractures were the most common. Fractures with a combination of frontal, nasal, and orbital fractures are particularly concerning and warrant close attention to the eye.

Periorbital and Globe Injuries in Pediatric Orbital Fractures: A Retrospective Review of 116 Patients at a Level 1 Trauma Center

2020 ◽  
pp. 194338752093369
Author(s):  
Jordan Halsey ◽  
Marvin Argüello-Angarita ◽  
Osward Y. Carrasquillo ◽  
Ian C. Hoppe ◽  
Edward S. Lee ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Trauma Center ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Orbital Floor ◽  
Orbital Fracture ◽  
Orbital Fractures ◽  
Orbital Floor Fractures ◽  
Level 1 ◽  
Level 1 Trauma Center

Study Design: Retrospective chart review of pediatric and globe injuries associated with orbital fractures.ObjectiveOur study seeks to examine these injuries and their association with orbital fractures at our trauma center to gain a better understanding of how to approach pediatric patients with orbital fractures. Methods: A retrospective review of all facial fractures in pediatric patients at an urban level 1 trauma center was performed for the years 2002 to 2014. Patient demographics were collected, as well as orbital fracture location, mechanism of injury, concomitant injuries, ophthalmologic documentation, imaging, and perioperative records. Results: One hundred sixteen pediatric patients over a 12-year period sustained an orbital fracture. The orbital floor was the most commonly fractured orbital bone in our series (60%). Thirty-four (30%) of the pediatric patients with orbital fractures had documented periorbital and/or globe injuries at the time of presentation. The most common periorbital injury was entrapment related to orbital floor fractures. Significant eyelid lacerations were present in seven patients, with five of these patients had canalicular injuries and two had canthal malposition. Five pediatric patients presented with traumatic optic neuropathy. Two patients had ruptured globes requiring enucleation. Conclusions: Periorbital soft tissue and globe injuries associated with orbital fractures occurs in a substantial number of pediatric patients. There are no guidelines for treatment of these type of injuries in the pediatric population. Further research should be performed to better understand the appropriate management of periorbital injuries in conjunction with surgical management of the orbital fractures

scholarly journals In Situ Splitting of a Rib Bone Graft for Reconstruction of Orbital Floor and Medial Wall

2017 ◽  
Vol 10 (2) ◽  
pp. 123-129 ◽  
Author(s):  
Tetsuji Uemura ◽  
Tetsu Yanai ◽  
Masato Yasuta ◽  
Yoshimi Harada ◽  
Aya Morikawa ◽  
...  
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Donor Site ◽  
Medial Wall ◽  
Orbital Floor ◽  
Orbital Fracture ◽  
Safe Procedure ◽  
Mean Width ◽  
The Mean

In situ splitting of rib bone graft was conducted in 22 patients for the repair of orbital fracture with no other complicating fractures. A bone graft was harvested from the sixth or seventh rib in the right side. The repair of the orbital floor and medial wall was successful in all the cases. Ten patients had bone grafting to the orbital floor, eight had it done onto medial wall, and 4 onto both floor and wall after reduction. The mean length of in situ rib bone graft was 40.9 mm (range, 20–70 mm), the mean width of these was 14.9 mm (range, 8–20 mm). The bone grafting was done by one leaf for 15 cases and two leafs for 7 cases in size of defects. The technique of in situ splitting of a rib bone graft for the repair of the orbital floor and medial wall is a simple and safe procedure, easily taking out the in situ splitting of a rib, and less pain in donor site. It has proved to be an optimal choice in craniofacial reconstruction, especially the defects of orbital floor and medial wall.

scholarly journals Reconstruction of a Combined Frontal Bone and Orbital Roof Defect With Associated Meningoencephalocele Using 3D Modeling and 3D Navigation

2021 ◽  
Vol 6 ◽  
pp. 247275122110233
Author(s):  
Rory C. O’Connor ◽  
Sead Abazi ◽  
Jehuda Soleman ◽  
Florian M. Thieringer
Keyword(s):  
3D Modeling ◽  
Road Traffic ◽  
Treatment Algorithm ◽  
Visual Disturbance ◽  
High Energy ◽  
Frontal Bone ◽  
3D Navigation ◽  
Orbital Roof ◽  
Close Observation ◽  
Orbital Roof Fractures

Introduction: Orbital roof fractures are uncommon and normally associated with high energy trauma in which multiple other injuries are present. Most can be managed non-operatively with close observation. However, in a small proportion the defect is such that it permits the development of a meningoencephalocele, which can cause exophthalmos, a reduction in visual acuity and pain, all of which are unlikely to improve without surgical treatment. In light of their scarcity and the potential of serious risks with surgery that includes meningitis and visual disturbance (or even loss), thorough planning is required so that the meningoencephalocele can be reduced safely and the orbital roof adequately reconstructed. Methods: We report a case of a patient with a frontal bone defect, orbital roof fracture and associated meningoencephalocele that presented years after being involved in a road traffic accident in another country, who complained of a significant headache and orbital pain. The use of 3D modeling to help plan the surgery, and intraoperative 3D navigation to help negotiate the anterior skull base are described along with the reconstruction of the frontal bone and orbital roof using titanium mesh contoured on the 3D model. Conclusions: Although conservative management of orbital roof fractures predominates; those that are symptomatic, have associated neurologic symptoms or pose a risk to the eyesight warrant a surgical approach. The methods of repair, which center around separating the intracranial and intraorbital contents, are described in the context of this patient and previous cases, and a treatment algorithm is proposed.

scholarly journals Comparison of the costs of HPV testing through community health campaigns versus home-based testing in rural Western Kenya: a microcosting study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e033979
Author(s):  
Easter Elizabeth Olwanda ◽  
James G Kahn ◽  
Yujung Choi ◽  
Jessica Yasmine Islam ◽  
Megan Huchko
Keyword(s):  
Community Health ◽  
Outcome Measures ◽  
Health Campaigns ◽  
Capital Goods ◽  
Western Kenya ◽  
Home Based ◽  
Registration Number ◽  
The Mean ◽  
The Cost ◽  
Mean Cost

ObjectivesTo estimate the cost of human papillomavirus (HPV)-based screening through community health campaigns (CHCs) and home-based testing.SettingCHCs and home-based testing in six communities in rural Western Kenya.ParticipantsCHCs and home-based screening reached 2297 and 1002 women aged 25–65 years, respectively.Outcome measuresOutcome measures were overall cost per woman screened achieved through the CHCs and home-based testing and the cost per woman for each activity comprising the screening intervention.ResultsThe mean cost per woman screened through CHCs and home-based testing were similar, at $37.7 (range $26.4–$52.0) and $37.1 (range $27.6–$54.0), respectively. For CHCs, personnel represented 49% of overall cost, supplies 25%, services 5% and capital goods 23%. For home-based testing, these were: personnel 73%, supplies 25%, services 1% and capital goods 2%. A greater number of participants was associated with a lower cost per participant.ConclusionsThe mean cost per woman screened is comparable for CHC and home-based testing, with differences in type of input. The CHCs generally reached more eligible women in the six communities, whereas home-based strategies more efficiently reached populations with low screening rates.Trial registration numberNCT02124252.

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