scholarly journals Posttraumatic Orbital Emphysema: A Numerical Model

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Andrzej Skorek ◽  
Paweł Kłosowski ◽  
Łukasz Plichta ◽  
Dorota Raczyńska ◽  
Marcin Zmuda Trzebiatowski ◽  
...  
Keyword(s):  
Elevated Pressure ◽  
Orbital Fracture ◽  
Common Symptom ◽  
Inferior Wall ◽  
Finite Model ◽  
Upper Airways ◽  
Numeric Model ◽  
Orbital Emphysema ◽  
Orbital Wall ◽  
Resilience Modulus

Orbital emphysema is a common symptom accompanying orbital fracture. The pathomechanism is still not recognized and the usually assumed cause, elevated pressure in the upper airways connected with sneezing or coughing, does not always contribute to the occurrence of this type of fracture. Observations based on the finite model (simulating blowout type fracture) of the deformations of the inferior orbital wall after a strike in its lower rim. Authors created a computer numeric model of the orbit with specified features—thickness and resilience modulus. During simulation an evenly spread 14400 N force was applied to the nodular points in the inferior rim (the maximal value not causing cracking of the outer rim, but only ruptures in the inferior wall). The observation was made from1·10-3to1·10-2second after a strike. Right after a strike dislocations of the inferior orbital wall toward the maxillary sinus were observed. Afterwards a retrograde wave of the dislocation of the inferior wall toward the orbit was noticed. Overall dislocation amplitude reached about 6 mm. Based on a numeric model of the orbit submitted to a strike in the inferior wall an existence of a retrograde shock wave causing orbital emphysema has been found.

Resources: Internet Resources for the Independent Medical Evaluator – 2007

2007 ◽  
Vol 12 (4) ◽  
pp. 4-7
Author(s):  
Christopher R. Brigham ◽  
Jenny Walker
Keyword(s):  
Head Trauma ◽  
Clonic Seizure ◽  
Acute Subdural Hematoma ◽  
Orbital Fracture ◽  
Orbital Wall ◽  
First Occurrence ◽  
One Year ◽  
The One ◽  
Neurological Injuries ◽  
Medial Orbital Wall

Abstract Rating patients with head trauma and multiple neurological injuries can be challenging. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, Section 13.2, Criteria for Rating Impairment Due to Central Nervous System Disorders, outlines the process to rate impairment due to head trauma. This article summarizes the case of a 57-year-old male security guard who presents with headache, decreased sensation on the left cheek, loss of sense of smell, and problems with memory, among other symptoms. One year ago the patient was assaulted while on the job: his Glasgow Coma Score was 14; he had left periorbital ecchymosis and a 2.5 cm laceration over the left eyelid; a small right temporoparietal acute subdural hematoma; left inferior and medial orbital wall fractures; and, four hours after admission to the hospital, he experienced a generalized tonic-clonic seizure. This patient's impairment must include the following components: single seizure, orbital fracture, infraorbital neuropathy, anosmia, headache, and memory complaints. The article shows how the ratable impairments are combined using the Combining Impairment Ratings section. Because this patient has not experienced any seizures since the first occurrence, according to the AMA Guides he is not experiencing the “episodic neurological impairments” required for disability. Complex cases such as the one presented here highlight the need to use the criteria and estimates that are located in several sections of the AMA Guides.

scholarly journals Clinical profile of patients with inferolateral myocardial infarction: a comparison study

2020 ◽  
Vol 8 (12) ◽  
pp. 4320
Author(s):  
Sibaram Panda ◽  
Sunil Kumar Jena ◽  
Uttam Kumar Pattanaik
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Lateral Wall ◽  
Clinical Profile ◽  
Common Symptom ◽  
Inferior Wall ◽  
Ecg Changes ◽  
Killip Class ◽  
Number Of Patients ◽  
Group A

Background: Patient with lateral wall changes in inferior wall myocardial infarction (MI) usually ignored most often. However above lateral MI changes in the clinical setting of inferior wall MI usually impact on final clinical outcome and prognosis of the patients. Our aim of the study is observe diversity in clinical profile of inferolateral MI in comparison to patient with inferior wall without any lateral wall MI changes.Methods: Current study enrolled 405 patients admitted to cardiology emergency with inferior wall MI. Patients divided into three groups on the basis of ECG changes, inferolateral (group A), isolated inferior wall MI (group B) and inferior wall MI with RVMI (group C). Patients with RVMI (group C) excluded from the group. Clinical profile and outcomes compared between group A and B.Results: Around 33.8% pts with inferior wall STEMI have ECG changes of lateral wall AMI. STEMI equivalent in lead V1, V2 which is the most common ECG presentation, seen in 65% inferolateral patients. 45.7% of population of inferolateral MI are above age group of 60 years. 66.2 % of the patients with inferolateral MI having two or more risk factors. Dyspnoea is one of common symptom seen in 29.9% patients. Statistically significant number of patients in inferlateral MI have clinical picture of LVF (crepitation, S3), higher Killip class as compared to inferior wall MI. Incidence of complications like LVF, MR, VT, death is significantly higher in this group.Conclusions: Around 1/3rd patient with lateral MI changes seen in inferior wall MI patients. STEMI equivalent changes in anterior precordial leads are most common ECG presentation. More no patients are older and with multiple risk factors. Complication and death are higher in this group. So meticulous attention should be given to patients with lateral wall MI changes in inferior wall MI. 

scholarly journals Patterns and prognosis of commotio retinae in orbital wall fractures

2019 ◽  
Vol 11 ◽  
pp. 251584141986213
Author(s):  
Halward M.J. Blegen ◽  
Joseph A. Santamaria ◽  
Aditya Mehta ◽  
Donovan S. Reed ◽  
Paul M. Drayna ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Fracture Pattern ◽  
Posterior Segment ◽  
Ocular Injury ◽  
Inferior Wall ◽  
Retinal Pathology ◽  
Orbital Wall ◽  
High Index Of Suspicion ◽  
Commotio Retinae

Purpose: Orbital wall fractures are a significant cause of ocular injury in trauma and are associated with posterior segment pathology. This study aims to characterize patterns and prognosis of commotio retinae following orbital wall fracture. Methods: This study is a retrospective analysis of 294 orbital wall fractures diagnosed by computed tomography imaging from August 2015 to October 2016 at a Level 1 trauma center. Dilated funduscopic exams were assessed for acute posterior segment pathology, focusing specifically on commotio retinae ( N = 38). These were compared with patients with no traumatic retinal findings ( N = 253) to indicate statistically significant differences in the mechanism of injury, fracture pattern, subjective symptoms, radiologic and exam findings, and acute interventions. Results: Commotio was most commonly associated with assault (60.5%, p = 0.004) in a younger patient population, whereas normal retinal exams were more likely after falls from standing (24.1%, p = 0.022). Half of all commotio was found inferiorly and most commonly occurred in medial or inferior wall fracture. Patients with commotio were more likely to have motility deficits (29.7%, p = 0.049) with clinical evidence of entrapment (13.2%, p < 0.001), requiring acute operative repair (15.8%, p = 0.005). Inferior wall fracture was associated with 19.4% surgical intervention in commotio as compared with those with normal funduscopic exams (6.1%, p = 0.012). All patients with follow-up had resolution of commotio and best-corrected visual acuity of 20/25 or better. Conclusion: Retinal pathology is not infrequent in orbital wall fractures. Inferior wall fracture was associated with 19.4% surgical intervention in commotio as compared to those with normal funduscopic exams (6.1%, p = 0.012). A high index of suspicion and thorough investigation is warranted in evaluating these patients.

scholarly journals Predictors and Significance of Orbital Fracture in Traumatic Brain Injury

2020 ◽  
Vol 2 (1) ◽  
pp. 18-22
Author(s):  
Karuna Tamrakar Karki ◽  
Pankaj Raj Nepal
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Visual Loss ◽  
Orbital Fracture ◽  
Subconjunctival Hemorrhage ◽  
Number Of Patients ◽  
Orbital Wall ◽  
Ct Head ◽  
Time Of Presentation

Background and purpose: Orbital manifestation in traumatic brain injury though uncommon, is one of the major complications of traumatic brain injury that has to be addressed judiciously to prevent permanent visual loss. Material and Methods: 211 patients who underwent CT for traumatic brain injury in between September to December 2019 were prospectively examined for the orbital manifestation. Patients who had undergone CT head including orbit with 3D face RECON were only included in our study to remove the bias between fracture line and suture in plain CT scan. CT imaging was evaluated to identify and subtype the orbital fracture.  Results: Total number of patients was 28, with mean age of 33.82 (SD 17.15) years. Majority of the patients were male which accounted 79% of sample size. There was 78% mild head injury followed by 18% and 4% moderate and severe head injury respectively. The most common type involved among all were blow out fracture and lateral orbital wall fracture. Clinically vision was abnormally around 21% of the cases, abnormal papillary reaction was seen in 25% of the cases around 93% of the cases had raccoon eye at the time of presentation. There was proptosis in around 14% of the patients and subconjunctival hemorrhage was seen in around 93% of the cases. Around 79% of the patients had intact vision at the time of presentation and 3.6% of the patients improved their vision during the course of treatment. Complete globe disruption who required evisceration of the eyeball was 10.7% and those who had abnormal vision at the time of presentation, 7.1% that did not improve their vision. Conclusions: orbital manifestations with either type of orbital fracture in traumatic brain injury are useful for the prediction of severity of orbital injury and its clinical outcome. This helps to identify patients in high risk and start early treatment to prevent permanent visual loss.

Retrobulbar Orbital Emphysema Associated With Medial Orbital Wall Fracture

2019 ◽  
Vol 30 (5) ◽  
pp. 1549-1551 ◽  
Author(s):  
Quang Ngoc Dong ◽  
Taichi Ide ◽  
Masaaki Karino ◽  
Satoe Okuma ◽  
Takashi Koike ◽  
...  
Keyword(s):  
Orbital Emphysema ◽  
Orbital Wall ◽  
Medial Orbital Wall

scholarly journals Snoring Sound Intensity and Formant Frequencies by Sleep Position in Patients with Positional Obstructive Sleep Apnea

2020 ◽  
Vol 63 (7) ◽  
pp. 308-313
Author(s):  
Tae Kyung Koh ◽  
Soon Bok Kwon ◽  
Soo Kweon Koo ◽  
Ho Byung Lee ◽  
Chang Lok Ji ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sound Intensity ◽  
Sleep Position ◽  
Apnea Hypopnea Index ◽  
Common Symptom ◽  
Upper Airways ◽  
Formant Frequencies ◽  
Obstructive Sleep ◽  
Sleep Posture

Background and Objectives Snoring is the most common symptom of obstructive sleep apnea (OSA) and is caused by turbulent airflow due to narrowing of the upper airways. In patients with positional OSA, a change in sleep posture from supine to lateral is known to reduce snoring and sleep apnea. This study was performed to compare changes in snoring sound intensity and formant frequencies according to sleep position.Subjects and Method A total of 19 patients (male: 18; female: 1) diagnosed with positional OSA by polysomnography (PSG) were enrolled in this study. The snoring sounds recorded during PSG were analyzed acoustically and compared according to sleep position (i.e., supine vs. lateral).Results Snoring disappeared on changing sleep position in five patients, all of whom had Apnea-Hypopnea Index (AHI) <15. In other patients, the snoring sounds tended to decrease with posture change, and the degree of decrease was inversely proportional to AHI (p=0.015) and respiratory disturbance index (RDI) (p=0.013). Formant frequencies 1, 3, and 4 (F1, F3, and F4, respectively) decreased when sleeping in the lateral position (p=0.02, 0.03, and 0.01, respectively).Conclusion In patients with positional OSA, a change in sleep posture from supine to lateral during sleep reduced the intensity and frequency of snoring sound.

scholarly journals Proper Imaging Modality in Medial Orbital Wall and Blowout Fracture

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Yunia Irawati ◽  
Carennia Paramita ◽  
Dian Farikha
Keyword(s):  
Ct Scan ◽  
Imaging Modality ◽  
Orbital Fracture ◽  
Movement Restriction ◽  
Eyelid Margin ◽  
X Ray ◽  
Blowout Fracture ◽  
Orbital Wall ◽  
Ocular Movement ◽  
The Right

A 27-year-old man was first seen 4 weeks after his right eye being accidently hit by branches of tree. He complained of diplopia which was significant on the right gaze. There were partial thickness superior and inferior eyelid rupture and full thickness superior eyelid margin laceration (which got repaired), hematoma, and swelling of the right eye. Orbital x-ray demonstrated no abnormality. However, orbital CT Scan was eventually obtained and it showed medial wall and orbital floor fracture of the right eye, hence, we planned to do the reconstruction of orbital fracture. We concluded that patient with severe soft tissue swelling, unclear ocular movement restriction and diplopia with normal orbital X-ray should undergo orbital CT scan, as it is the best radiologic imaging in establishing an orbital wall fracture. This case report will discuss the importance on determining a proper imaging modality in blowout fracture.

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