Radiographic Optic Nerve Findings and Their Clinical Implications in the Setting of Craniomaxillofacial Trauma

FACE ◽  
2021 ◽  
pp. 273250162110369
Author(s):  
Alexandra L. Alving-Trinh ◽  
Matthew E. Pontell ◽  
Nolan Jaeger ◽  
Stéphane A. Braün ◽  
Kevin J. Kelly ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Clinical Findings ◽  
Facial Trauma ◽  
Orbital Fracture ◽  
Orbital Fractures ◽  
Increased Risk ◽  
Open Globe ◽  
Craniomaxillofacial Trauma ◽  
Abnormal Visual

Purpose: Computed tomography (CT) scans obtained in the setting of facial trauma often report aberrations in neural anatomy, such as optic nerve stretching. While these findings have not yet been correlated with clinical findings, they raise concern for traumatic optic neuropathy (TON). This study aims to correlate radiographic optic nerve abnormalities with clinical findings in the setting of craniomaxillofacial trauma. Methods: Patient charts were queried based on ICD-9 codes for the presence of an orbital fracture. Patients were included if the CT report mentioned an anatomic abnormality of the optic nerve. Patients who expired within 24 hours of arrival, had an open globe injury, or who were not able to participate in a visual exam were excluded. An additional matched cohort of patients with orbital fractures and without optic nerve abnormalities was selected. The primary endpoint was a clinical diagnosis of TON, and secondary endpoints included the need for ophthalmologic intervention and the presence of abnormal visual acuity. Results: One-hundred and eight patients were included in the study (54 per group). Radiographic optic nerve stretching was not associated with an increased risk of TON (OR: 2.22, 95% CI: 0.71-7.02); however, it was associated with increased risk for abnormal visual acuity (OR: 2.24, 95% CI: 1.01-4.99). There was no increased need for any ophthalmologic intervention (OR: 1.93, 95% CI: 0.86-4.31). Conclusions: Alterations in orbital anatomy on CT are common after orbital fracture and may inappropriately raise concern for TON. This in turn may prompt interfacility transfer and/or emergent ophthalmology consultation. This study demonstrates that radiographic stretching of the optic nerve does not increase the odds for TON in the setting of orbital fractures. While patients with abnormal optic nerve findings did have a higher rate of abnormal visual acuity, this is a common, multifactorial finding in this setting.

Risk Factors for Post–Open-Globe Injury Endophthalmitis

2020 ◽  
Vol 4 (5) ◽  
pp. 353-359
Author(s):  
Aditya Uppuluri ◽  
Marco A. Zarbin ◽  
Neelakshi Bhagat
Keyword(s):  
Risk Factors ◽  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Clinical Findings ◽  
National Inpatient Sample ◽  
Open Globe Injury ◽  
Adult Group ◽  
Cross Sectional ◽  
Increased Risk ◽  
Open Globe

Purpose: The objective of our project is to use the National Inpatient Sample Database to identify risk factors for endophthalmitis in cases of open-globe injury (OGI). Methods: This is a cross-sectional observational study of 48 627 cases of OGI from the National Inpatient Sample Database. We performed regression analysis using IBM SPSS Statistics 23. Codes from the International Classification of Disease, Ninth Revision were used to identify ocular findings and conditions. Variables with P values less than .05 on univariate analysis were included in the multivariable regression model; Bonferroni correction was applied to these results. Results: Of the 48 627 cases of OGI, 37 440 (77.0%) occurred in the adult group (21 years and older). Overall, 1018 (2.1%) cases developed posttraumatic endophthalmitis, with 74.5% cases in the adult group. Endophthalmitis developed in 293 (4.5%) eyes with an intraocular foreign body (IOFB). Results of binary logistic regression showed the clinical findings of traumatic cataracts, hypopyon, vitreous inflammation, corneal ulcers, or IOFBs were associated with an increased risk of developing endophthalmitis after OGI. Conversely, orbital fractures, rupture-type injuries, and intraocular tissue prolapse were associated with a decreased likelihood of being diagnosed with endophthalmitis. Conclusions: Endophthalmitis developed in 2.4% of pediatric OGIs and 2.0% of adult OGIs. Traumatic cataract, hypopyon, vitreous inflammation, corneal ulcer, keratitis, retinal detachment, IOFB, and diabetes increased the risk of post-open-globe endophthalmitis.

Orbital Fractures

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.

Endoscopic-Assisted Orbital Floor Reconstruction: the First Two Cases in Vietnam

2018 ◽  
Vol 8 (3) ◽  
Author(s):  
Trung Trực Vũ ◽  
Mai Anh Bui
Keyword(s):  
Endoscopic Surgery ◽  
University Hospital ◽  
Orbital Floor ◽  
Facial Trauma ◽  
Orbital Fracture ◽  
Viet Nam ◽  
Orbital Fractures ◽  
Surgical Indications ◽  
Orbital Floor Reconstruction

Tóm tắt Vỡ xương ổ mắt là một bệnh cảnh phối hợp trong chấn thương hàm mặt và chấn thương sọ mặt. Các biến chứng thường gặp nhất là lõm ổ mắt, song thị và kẹt cơ vận nhãn để lại ảnh hưởng nặng nề cả về chức năng và tâm lý. Điều trị có thể được thực hiện bởi nhiều chuyên khoa, tuy nhiên kỹ thuật và chỉ định vẫn còn nhiều bàn cãi. Tác giả thông báo hai trường hợp đầu tiên ở Việt Nam được tạo hình sàn ổ mắt sau chấn thương với nội soi hỗ trợ tại Bệnh viện Hữu nghị Việt Đức năm 2016. Abstract Orbital fractures are a combination of facial jaw injuries and face skull injuries. The most common complications are enophthalmos, diplopia and muscle entrapment that leave a bad effect on both funtion and psychology. Treatment can be done by various specialists, howeverthe technique and surgical indications are still controversial. The authors report the first two cases in Vietnam which were reconstructed of the orbital floor with endoscopic-assisted at VietDuc University Hospital in 2016. Keyword: Orbital fracture, facial trauma, enophthalmos, orbital floor reconstruction, endoscopic surgery.

scholarly journals Paediatric Orbital Fractures: The Importance of Regular Thorough Eye Assessment and Appropriate Referral

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Karim Kassam ◽  
Ishrat Rahim ◽  
Caroline Mills
Keyword(s):  
Emergency Department ◽  
Visual Acuity ◽  
Short Paper ◽  
Orbital Fracture ◽  
Orbital Fractures ◽  
Red Flags ◽  
Traumatic Optic Neuropathy ◽  
Pupillary Reaction ◽  
Bony Fragment ◽  
Bicycle Injury

The paediatric orbital fracture should always raise alarm bells to all clinicians working in an emergency department. A delay or failure in diagnosis and appropriate referral can result in rapidly developing and profound complications. We present a boy of childhood age who sustained trauma to his eye during a bicycle injury. Acceptance of the referral was based on no eye signs; however, on examination in our unit the eye had reduction in visual acuity, no pupillary reaction, and ophthalmoplegia. CT scan suggested bone impinging on the globe and the child was rushed to theatre for removal of the bony fragment. Postoperatively no improvement was noted and a diagnosis of traumatic optic neuropathy was made. An overview of factors complicating paediatric orbital injuries, their associated “red flags”, and appropriate referral are discussed in this short paper.

scholarly journals Management of a type II nasoethmoid orbital fracture and near-penetration of the intracranial cavity with transnasal canthopexy

2007 ◽  
Vol 86 (6) ◽  
pp. 344-360 ◽  
Author(s):  
Philip A. Young ◽  
Dale H. Rice
Keyword(s):  
Tendon Repair ◽  
Suture Line ◽  
Orbital Fracture ◽  
Type Ii ◽  
Orbital Fractures ◽  
Medial Canthus ◽  
Craniomaxillofacial Trauma ◽  
Anterior Ethmoid Artery ◽  
Medial Canthal Tendon

Nasoethmoid orbital fractures are perhaps the most complicated aspect of craniomaxillofacial trauma. Involvement of the medial canthal tendon markedly increases the complexity of the repair. We report a case of type II nasoethmoid orbital fracture in a 32-year-old man that was managed without formal medial canthal tendon repair; instead, we used open reduction and internal fixation of the central fragment and the nasoethmoid complex. However, during the immediate postoperative period, we noted anterior and inferior displacement of the medial canthus. We took the patient back to the operating room to address the detachment. Revision surgery was successful, and at the 6-month follow-up, his medial canthi were completely symmetrical in all dimensions. We describe our intraoperative technique and measures to prevent complications that can help the surgeon intraoperatively. We also discuss an important point that has not been adequately addressed in the literature to date—that is, the fact that the use of the frontoethmoid suture line and the anterior ethmoid artery as a guide to the skull base can be inaccurate. Problems associated with this inaccuracy can be avoided by carefully reviewing preoperative computed tomography, which can help keep the surgeon from entering the intracranial cavity while fixing the medial canthal tendon during transnasal canthal repair.

scholarly journals Optic Neuritis and its several etiologies

2021 ◽  
Author(s):  
Anna Carlinda Arantes de Almeida Braga ◽  
Patryk Marques da Silva Rosa ◽  
Luiza Monteiro dos Santos ◽  
Igor Yury Silva ◽  
Ana Elisa Choucair Hosken Arão ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Neuritis ◽  
Vitamin B12 Deficiency ◽  
Clinical Findings ◽  
Hereditary Neuropathy ◽  
Ophthalmological Examination ◽  
Scientific Publications ◽  
Increased Risk ◽  
Demyelinating Lesions ◽  
Common Etiology

Introduction: Optic neuritis (ON) is characterized by a condition of the optic nerve´s demyelinating inflammation, unilateral or bilateral involvement, which can lead to painful visual loss, color blindness, and other neurological and systemic impairments. Because it has several etiologies, ON is underdiagnosed and the studies seek an integrative review to identify the causes and differential diagnoses for the proper management. Methods: An analysis of scientific publications in the Pubmed and ScienceDirect databases was realized using the descriptors Optic Neuritis and diagnosis. Results: The diagnosis of ON is made by clinical findings associating neuroimage tests. About 60% of diagnosed patients have an alternative diagnosis; as optic neuropathies of anterior ischemic causes, Leber’s hereditary neuropathy and compressive neuropathies; infiltrative; toxic-metabolic or vitamin B12 deficiency. ON has different etiologies, such as infectious, paraneoplastic, autoimmune and demyelinating, so a directed anamnesis and ophthalmological examination is essential for professional´s orientation. The investigation of infectious, parainfectious and inflammatory causes must include the research of diseases such as syphilis, ricketsiosis, toxoplasmosis, mycobacteriosis, HIV and herpes zoster, and the recent vaccination. It is necessary to investigate autoimmune diseases, due to the increased risk of the coexistence of autoantibodies that attack structures of the optic nerve. Within the spectrum of demyelinating lesions, Multiple Sclerosis is the most common etiology, although Neuromyelitis Optica, Schilder Disease and Encephalitis Periaxilis Concentric should be remembered. Conclusion: When considering the various causes, it is necessary for professionals to make the diagnosis with effective clinical evaluation, with complementary tests, essential for the proper patient´s management.

Sudden Blindness following Facial Trauma

1981 ◽  
Vol 89 (6) ◽  
pp. 941-948 ◽  
Author(s):  
William R. Panje ◽  
Cordell E. Gross ◽  
Richard L. Anderson
Keyword(s):  
Optic Nerve ◽  
Head Trauma ◽  
Patient Population ◽  
Clinical Findings ◽  
Facial Trauma ◽  
Early Administration ◽  
Nerve Decompression ◽  
Select Patient ◽  
A Minor ◽  
Sudden Blindness

Blindness following facial trauma may occur with what appears to be a minor insult to the periorbital area. This report deals with our experience in treating five patients who had sudden blindness following frontal head trauma. Unselected optic nerve decompression was in general unrewarding in reversing blindness. However, the early administration of pharmacologic doses of corticosteroids does appear effective in reversing blindness in this select patient population and may indicate which patient is a good candidate for decompression. Examination of holographic experiments performed on dried skulls, in addition to clinical findings, appears to suggest that the cause of blindness associated with frontal head trauma may be related to stretching of the optic nerve and not necessarily to compression.

Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy

2021 ◽  
pp. 112067212110006
Author(s):  
Xin Liu ◽  
Lufei Wang ◽  
Fengjuan Yang ◽  
Jia’nan Xie ◽  
Jinsong Zhao ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Management ◽  
Pediatric Patients ◽  
Vitreous Hemorrhage ◽  
Visual Outcome ◽  
Poor Visual Outcome ◽  
Early Vitrectomy ◽  
Open Globe ◽  
Time From Injury ◽  
Ocular Sign

Purpose: To describe surgical management and establish visual outcomes of open globe injury (OGI) in pediatric patients requiring vitrectomy. Methods: Forty-eight eyes of 48 pediatric patients underwent vitrectomy for OGI with secondary vitreoretinal complications in the eye center of Jilin University were included. Characteristics of patients, details of ocular examination and operation, presenting and final visual acuity were recorded. Results: Presenting visual acuity less than 20/400 was found in 44 eyes (91.7%), which included no light perception (NLP) in four eyes. At last visit, there was no eyes with visual acuity of NLP, and 19 eyes (39.6%) had a vision recovery to 20/400 or better. Mechanisms of injury, intraocular contents prolapse, presence of hyphema, intraocular foreign body, vitreous hemorrhage, retinal detachment, and total time from injury to PPV > 2 weeks were significant predictors of visual prognosis. Logistic regression analysis showed that hyphema was a significant predictive factor for poor visual outcome. Conclusion: Visual acuity was improved in most of the patients with OGI in this study. Hyphema is an important presenting ocular sign in estimating the post-vitrectomy visual outcome for OGI in children. Proper timing of vitrectomy is suggested, and in this study patients may benefit more with early vitrectomy as less proliferative vitreoretinopathy (PVR) was found together with a better visual acuity.

scholarly journals The Relationship between Inflammatory Cytokines and Coagulopathy in Patients with COVID-19

2021 ◽  
Vol 10 (9) ◽  
pp. 2020
Author(s):  
Fariba Rad ◽  
Ali Dabbagh ◽  
Akbar Dorgalaleh ◽  
Arijit Biswas
Keyword(s):  
Inflammatory Cytokines ◽  
Interleukin 1 ◽  
Clinical Findings ◽  
Laboratory Findings ◽  
Necrosis Factor Alpha ◽  
Coagulation Parameters ◽  
Increased Risk ◽  
Cytokine Levels ◽  
Α Level ◽  
High Level

Coronavirus disease 2019 (COVID-19), with a broad range of clinical and laboratory findings, is currently the most prevalent medical challenge worldwide. In this disease, hypercoagulability and hyperinflammation, two common features, are accompanied by a higher rate of morbidity and mortality. We assessed the association between baseline inflammatory cytokine levels and coagulopathy and disease outcome in COVID-19. One hundred and thirty-seven consecutive patients hospitalized with COVID-19 were selected for the study. Baseline interleukin-1 (IL-1), IL-6, and tumor necrosis factor alpha (TNF-α) level were measured at time of admission. At the same time, baseline coagulation parameters were also assessed during the patient’s hospitalization. Clinical findings, including development of thrombosis and clinical outcome, were recorded prospectively. Out of 136 patients, 87 (~64%) had increased cytokine levels (one or more cytokines) or abnormal coagulation parameters. Among them, 58 (~67%) had only increased inflammatory cytokines, 12 (~14%) had only coagulation abnormalities, and 17 (19.5%) had concomitant abnormalities in both systems. It seems that a high level of inflammatory cytokines at admission points to an increased risk of developing coagulopathy, thrombotic events, even death, over the course of COVID-19. Early measurement of these cytokines, and timely co-administration of anti-inflammatories with anticoagulants could decrease thrombotic events and related fatal consequences.

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