Patterns of Orbital Fractures Needing Surgical Reconstruction in a Large Tertiary Hospital in Northern India

Study Design: This is a prospective study for 3 year duration. Objective: The aim of this study was to observe the incidence and patterns of orbital fractures and discuss their treatment options. Methods: A total 29604 trauma patients visited our emergency department within May 2017 to Oct 2019, where 1230 (4.15%) patients presented with orbital fractures, of which only 44 (3.6% of orbital fracture) patients required surgical reconstruction, and were enrolled in our study and evaluated for their fracture patterns, size of bone defect, clinical presentation, timing of surgery, reconstruction, and complications. Results: The incidence of orbital fracture was 4.15%, of which only 20.5% were pure blow out. Associated fractures included 72.7% zygomatic complex, 50% LeFort, 31.8% mandible and 20.5% pan facial fractures. The most common pattern was the 1 wall orbital defect in 38.6%, 2 wall in 27.3%, 3 wall in 29.5% and 4 wall in 4.5%. The orbital floor fracture was seen in 100%, medial wall in 27.3%, lateral wall in 61.4%, roof in 15.9%. Different reconstruction options used included calvarial bone (2.3%), ear cartilage (2.3%), medpore (36.4%), polycaprolactone sheet (6.8%), titanium mesh (52.3%), patient specific implant (6.8%) and navigation (4.5%). Conclusion: Orbital fractures are mostly impure fractures, associated with zygomatic complex fractures, hence lateral wall fractures are seen more commonly. Patient specific implants, navigation guided reconstruction, autologous calvarial bone graft and preformed titanium mesh show better results, and fulfill the objectives of orbital reconstruction by restoring the normal anatomy and volume of the orbit.

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Functional and Cosmetic Outcome after Reconstruction of Isolated, Unilateral Orbital Floor Fractures (Blow-Out Fractures) with and without the Support of 3D-Printed Orbital Anatomical Models

Journal of Clinical Medicine ◽

10.3390/jcm10163509 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3509

Author(s):

Guido R. Sigron ◽

Marina Barba ◽

Frédérique Chammartin ◽

Bilal Msallem ◽

Britt-Isabelle Berg ◽

...

Keyword(s):

Titanium Implant ◽

Cosmetic Outcome ◽

Orbital Floor ◽

Surgical Reconstruction ◽

Patient Specific ◽

Ocular Motility ◽

Titanium Mesh ◽

Anatomical Models ◽

Orbital Floor Fractures ◽

3D Printed

The present study aimed to analyze if a preformed “hybrid” patient-specific orbital mesh provides a more accurate reconstruction of the orbital floor and a better functional outcome than a standardized, intraoperatively adapted titanium implant. Thirty patients who had undergone surgical reconstruction for isolated, unilateral orbital floor fractures between May 2016 and November 2018 were included in this study. Of these patients, 13 were treated conventionally by intraoperative adjustment of a standardized titanium mesh based on assessing the fracture’s shape and extent. For the other 17 patients, an individual three-dimensional (3D) anatomical model of the orbit was fabricated with an in-house 3D-printer. This model was used as a template to create a so-called “hybrid” patient-specific titanium implant by preforming the titanium mesh before surgery. The functional and cosmetic outcome in terms of diplopia, enophthalmos, ocular motility, and sensory disturbance trended better when “hybrid” patient-specific titanium meshes were used but with statistically non-significant differences. The 3D-printed anatomical models mirroring the unaffected orbit did not delay the surgery’s timepoint. Nonetheless, it significantly reduced the surgery duration compared to the traditional method (58.9 (SD: 20.1) min versus 94.8 (SD: 33.0) min, p-value = 0.003). This study shows that using 3D-printed anatomical models as a supporting tool allows precise and less time-consuming orbital reconstructions with clinical benefits.

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Orbital Fractures

Seminars in Plastic Surgery ◽

10.1055/s-0041-1735815 ◽

2021 ◽

Vol 35 (04) ◽

pp. 269-273

Author(s):

Peiran Zhou ◽

Christopher B. Chambers

Keyword(s):

Clinical Evaluation ◽

Treatment Options ◽

Diagnostic Evaluation ◽

Surgical Approaches ◽

Facial Trauma ◽

Orbital Fracture ◽

Acute Management ◽

Indications For Surgery ◽

Orbital Fractures ◽

Appropriate Treatment

AbstractOrbital fractures are common in facial trauma and can be a challenge to treat. Understanding anatomy of the orbit, the clinical evaluation, indications for surgery, surgical approaches, complications, and postoperative are essential in providing appropriate treatment for patients who have sustained orbital fractures. In this article, the authors review the diagnostic evaluation, acute management, treatment options, and common complications of orbital fractures, as well as recent advancements in orbital fracture repairs.

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Spheno-Orbital Meningioma Resection and Reconstruction: The Role of Piezosurgery and Premolded Titanium Mesh

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0031-1286113 ◽

2011 ◽

Vol 4 (4) ◽

pp. 193-200 ◽

Cited By ~ 14

Author(s):

Susana Heredero Jung ◽

Alicia Dean Ferrer ◽

Juan Solivera Vela ◽

Francisco Alamillos Granados

Keyword(s):

Soft Tissues ◽

Treatment Options ◽

Titanium Mesh ◽

Calvarial Bone ◽

Easy Method ◽

Orbital Reconstruction ◽

Skull Model ◽

Orbital Wall ◽

Orbitozygomatic Approach ◽

Orbital Meningioma

We present the clinical case of a patient with a spheno-orbital meningioma. Literature review of the treatment options, including the application of piezoelectric or ultrasound surgery and orbital reconstruction after meningioma resection, is also presented. Complete resection was performed by means of a frontotemporal craniotomy and an orbitozygomatic approach. Piezoelectric osteotomy was used around the optic nerve canal and the superior orbital fissure to minimize the damage to soft tissues. Orbital wall reconstruction was done using a titanium mesh previously premolded using a skull model. The superior orbital rim was reconstructed with calvarial bone grafts, and the sphenotemporal bone defect was covered with a titanium mesh cranioplasty. Ultrasonic vibrations to perform osteotomies in craniofacial surgery provide an interesting tool to reduce damage to surrounding soft tissues. Reconstruction of the roof and lateral orbital wall with premolded titanium meshes with a skull model is a safe and easy method to achieve a good orbital reconstruction and to avoid secondary sequelae.

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Orbital Fracture Leading to Severe Multifascial Space Infection Including the Parapharyngeal Space: A Report of a Case and Review of the Literature

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0034-1371974 ◽

2014 ◽

Vol 7 (3) ◽

pp. 237-244 ◽

Cited By ~ 1

Author(s):

Chan Park ◽

Erica Marchiori ◽

Jacob Barber ◽

Curtis Cardon

Keyword(s):

Parapharyngeal Space ◽

Orbital Fracture ◽

Trauma Patients ◽

Orbital Fractures ◽

Review Of The Literature ◽

Orbital Trauma ◽

Incision And Drainage ◽

Clinical Resolution ◽

Space Infection

Orbital trauma can result in periorbital and orbital infections. Orbital infections have been classified by Chandler et al in 1970 to their anatomic location and boundaries. This case report describes a patient who developed a severe orbital infection following orbital fractures. The infection progressed to the parapharyngeal space. The patient required multiple incision and drainage surgeries and tissue debridements to have clinical resolution. To our knowledge, there has not been a case described in the literature of an orbital infection progressing to the parapharyngeal space. A literature review of orbital trauma leading to infection discusses the pathogenesis of the infections. This case demonstrates that close clinical follow-up and appropriate medical management of comorbidities that put a patient at higher risk of developing an infection is of the utmost importance in the treatment of maxillofacial trauma patients.

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QOLP-37. QUALITATIVE RESEARCH IN LOWER GRADE GLIOMA: UNDERSTANDING SIGNS, SYMPTOMS, AND DISEASE IMPACTS DURING EXPECTANT MANAGEMENT

Neuro-Oncology ◽

10.1093/neuonc/noz175.857 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi206-vi206

Author(s):

Audra Boscoe ◽

Ted Wells ◽

Christina Graham ◽

Caitlin Pohl ◽

Brooke Witherspoon ◽

...

Keyword(s):

Treatment Options ◽

Expectant Management ◽

Signs And Symptoms ◽

Molecular Therapy ◽

Patient Specific ◽

Lower Grade ◽

Concept Elicitation ◽

Post Surgery ◽

Lower Grade Glioma ◽

Isocitrate Dehydrogenase Mutation

Abstract BACKGROUND Patients with lower grade glioma (LGG) (i.e., grade II or III) have limited treatment options. After surgical resection of their tumor, patients will undergo either a period of expectant management (watch and wait) or treatment with adjuvant chemotherapy and/or radiotherapy. Approximately 80% of patients with LGG have an isocitrate dehydrogenase mutation, which is a viable target for molecular therapy. This offers a therapeutic intervention that could potentially delay the need for chemotherapy and/or radiotherapy in select patients. Several prognostic and patient-specific factors contribute to the decision to recommend expectant management, including concerns about the side effects of chemotherapy and radiotherapy. The aim of this project was to understand patients’ signs and symptoms during the expectant management period and how LGG impacts their lives. METHODS Concept elicitation interviews were conducted in the US with patients with LGG as well as key opinion leaders (KOLs) with experience treating patients with LGG. Interview data were analyzed using Atlas.ti, and patient data were reviewed against KOL data. RESULTS Seven patients with ≥ 3 months of expectant management experience and three KOLs were interviewed. During their expectant management periods, patients reported 12 signs/symptoms, mostly related to deficits in cognition. Patients reported 16 impacts across four categories, with a substantial proportion of the impacts identified as negatively affecting emotional function. The signs/symptoms and impacts reported by patients were generally also reported by KOLs. During expectant management, patients typically resume their original quality of life post-surgery, but may also experience anxiety. Patients and KOLs indicated a preference for expectant management and delaying chemotherapy or radiotherapy. CONCLUSIONS Patient and KOL interviews characterized the LGG experience and indicated a preference for expectant management, which may be supported by therapies that delay the initiation of chemotherapy and/or radiotherapy.

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Comparison of titanium mesh versus polycaprolactone-tricalcium phosphate implant in orbital fracture reconstruction

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2017.02.295 ◽

2017 ◽

Vol 46 ◽

pp. 82

Author(s):

J. Hung ◽

A.C. Han ◽

E. Cai ◽

L.T. Chye

Keyword(s):

Tricalcium Phosphate ◽

Orbital Fracture ◽

Titanium Mesh

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State of the Art Reviews: Nonpharmacologic Approaches for the Treatment of Insomnia

American Journal of Lifestyle Medicine ◽

10.1177/1559827607301397. ◽

2007 ◽

Vol 1 (4) ◽

pp. 274-282 ◽

Cited By ~ 3

Author(s):

Ann M. Lynch ◽

Courtney I. Jarvis ◽

Ronald J. DeBellis ◽

Anna K. Morin

Keyword(s):

Behavioral Therapy ◽

Treatment Options ◽

Sleep Onset ◽

Treatment Strategies ◽

Economic Consequences ◽

Patient Specific ◽

Sleep Onset Latency ◽

Medline Search ◽

Wake Time ◽

Nonpharmacologic Treatment

Insomnia is a common condition resulting in significant clinical and economic consequences. This review discusses the efficacy of nonpharmacologic treatment options commonly recommended for sleep onset and sleep maintenance insomnia. In addition, the efficacy of these approaches as part of a multifaceted intervention and in comparison to that of pharmacologic options is reviewed. The primary literature and review articles on the nonpharmacologic treatment of insomnia were identified through a MEDLINE search between 1966 and August 2006. Articles on the nonpharmacologic treatment of primary insomnia, including clinical trials on the efficacy of individual and combination treatment options, were reviewed. The nonpharmacologic treatment options for insomnia include stimulus control, sleep hygiene educations, sleep restriction, paradoxical intention, relaxation therapy, biofeedback, and cognitive-behavioral therapy. These treatment strategies produce significant changes in several sleep parameters of chronic insomniacs, including sleep-onset latency, wake time after sleep onset, sleep duration, and sleep quality. Many therapeutic options are available to treat insomnia, including nonpharmacologic strategies. Treatment recommendations, both pharmacologic and nonpharmacologic, should be made based on patient-specific insomnia symptoms, treatment history, and medical history.

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Individually preformed titanium mesh implants for a true-to-original repair of orbital fractures

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2006.06.018 ◽

2006 ◽

Vol 35 (11) ◽

pp. 990-995 ◽

Cited By ~ 67

Author(s):

R. Schön ◽

M.C. Metzger ◽

C. Zizelmann ◽

N. Weyer ◽

R. Schmelzeisen

Keyword(s):

Orbital Fractures ◽

Titanium Mesh

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Transoral digital reduction of complete anterior odontoid dislocation followed by fiducial-based navigated transcondylar screw fixation: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21576 ◽

2022 ◽

Vol 3 (3) ◽

Keyword(s):

Spinal Fusion ◽

Screw Fixation ◽

Treatment Options ◽

Pedicle Screws ◽

Craniocervical Junction ◽

Atlantoaxial Instability ◽

Illustrative Case ◽

Trauma Patients ◽

Lateral Mass ◽

Craniocervical Instability

BACKGROUND Posterior atlantoaxial dislocations (i.e., complete anterior odontoid dislocation) without C1 arch fractures are a rare hyperextension injury most often found in high-velocity trauma patients. Treatment options include either closed or open reduction and optional spinal fusion to address atlantoaxial instability due to ligamentous injury. OBSERVATIONS A 60-year-old male was struck while on his bicycle by a truck and sustained an odontoid dislocation without C1 arch fracture. Imaging findings additionally delineated a high suspicion for craniocervical instability. The patient had neurological issues due to both a head injury and ischemia secondary to an injured vertebral artery. He was stabilized and transferred to our facility for definitive neurosurgical care. LESSONS The patient underwent a successful transoral digital closed reduction and posterior occipital spinal fusion via a fiducial-based transcondylar, C1 lateral mass, C2 pedicle, and C3 lateral mass construct. This unique reduction technique has not been recorded in the literature before and avoided potential complications of overdistraction and the need for odontoidectomy. Furthermore, the use of bone fiducials for navigated screw fixation at the craniocervical junction is a novel technique and recommended particularly for placement of technically demanding transcondylar screws and C2 pedicle screws where pars anatomy is potentially unfavorable.

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Fractures Involving the Orbit

Surgery of the Eyelid, Lacrimal System, and Orbit ◽

10.1093/oso/9780195340211.003.0023 ◽

2011 ◽

Author(s):

Don O. Kikkawa ◽

Christine C. Annunziata

Keyword(s):

Lateral Wall ◽

Medial Wall ◽

Orbital Floor ◽

Trauma Patients ◽

Posterior Aspect ◽

Orbital Roof ◽

Life Threatening ◽

Interior Walls ◽

Anterior Support ◽

Orbital Rim

Orbital and periorbital injury can occur with localized trauma to the eye or in the setting of multiple trauma associated with injury to other vital organs. A reported 16% of major trauma patients have ocular or orbital injury, and 55% of patients with facial injury have associated ocular or orbital injury. In general, the amount of ocular, soft tissue, and bony damage is related to the amount, duration, and direction of force applied to the orbit and face. Nevertheless, orbital injury is common and can be a subtle finding in the context of other facial or life-threatening injuries. Geometrically, the bony orbit most closely resembles a four-sided pyramid consisting of an apex, a base, and four sides: roof, floor, medial wall, and lateral wall. The absence of the orbital floor posteriorly and the inclination of the lateral wall toward the medial wall changes the geometric shape from a four-sided pyramid to a three-sided pyramid at the orbital apex. The bony margin circumscribes the orbital entrance and provides anterior support for the thin bones of the interior walls of the orbit. Rounding of the orbital walls blends demarcation of the superior, medial, inferior, and lateral walls. The entrance measures 40 mm horizontally and 32 mm vertically. The widest portion of the orbital margin lies about 1 cm behind the anterior orbital rim. In adults, the depth from orbital rim to apex varies from 40 to 45 mm. Safe subperiosteal dissection may be accomplished along the lateral wall and orbital floor for 22 mm and along the medial wall and orbital roof for 30 mm. The volume of the orbit is approximately 30 cc. The triangular floor of the orbit serves as the roof of the maxillary sinus. Several areas of thin bone create weak points in the orbital floor that are susceptible to fracture. The thinnest portion is medial to the infraorbital groove and canal, particularly posteriorly, where the medial wall has no bony support. In the posterior aspect of the floor, the infraorbital fissure extends as the infraorbital canal.

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