scholarly journals A Functional Radiological and Soft Tissue Classification to Predict Outcomes in Orbital Fracture Surgery in a Multidisciplinary “Real-World” Setting

2021 ◽  
Vol 8 ◽  
Author(s):  
Elizabeth Yang ◽  
Shu-Yi Claire Chan ◽  
Yara Al-Omari ◽  
Louise Ward ◽  
Timothy E. Yap ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Clinical Severity ◽  
Successful Outcome ◽  
Time Interval ◽  
Orbital Fracture ◽  
Ocular Motility ◽  
Orbital Fractures ◽  
Fracture Geometry ◽  
Presenting Symptoms ◽  
Bony Landmarks

Purpose: The decision for open reduction and internal fixation (ORIF) of orbital fractures is usually based on clinical severity and soft tissue and bony findings. This study aimed to identify prognostic factors for a successful surgical outcome.Materials and Methods: We included all orbital fractures treated by ORIF referred to the Ophthalmology clinic for assessment over a 12-year period. A successful outcome was defined as (i) a single operation, (ii) improved diplopia and globe position at 6 months, (iii) no surgical complications, and (iv) patient satisfaction. Data was collected on presenting symptoms, orthoptic measurements, time interval from injury to surgery, fracture geometry and involvement of internal, and external bony landmarks. Univariate and multivariate regression was used to identify predictive factors for success.Results: There were 143 cases with median age 35.4 years and 81.8% (117/143) male. 51% (73/143) were complex fractures involving multiple orbital walls. 63.6% (91/143) achieved significant improvement in both enophthalmos and diplopia at 6 months. 15.3% (22/143) had significant preoperative soft tissue or neurogenic injury. 11.8% (17/143) required orbital plate repositioning or removal. 1.4% (2/143) developed orbital haematoma and 4.2% (6/143) had cicatricial entropion. Pre-operative nerve or muscle damage (OR 0.05, p = 0.01) and infraorbital fissure fracture (OR 0.38, p = 0.04) were associated with poor outcomes, whereas an intact posterior ledge was associated with successful outcomes (OR 3.03, p = 0.02).Conclusion: Careful ocular motility evaluation to ascertain neurogenic injury and muscle compartment syndrome, and radiological analysis of the integrity of the posterior ledge and the inferior orbital fissure can facilitate management and expectations of ORIF surgery.

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.

A Study Assessing Surgical Management of Traumatic Orbital Fractures with Delayed Presentation at Tertiary Care Institutions: An Experience of 1 Year

2017 ◽  
Vol 14 (02/03) ◽  
pp. 065-069
Author(s):  
Sourabh Dixit ◽  
Manpreet Banga ◽  
Suniti Saha ◽  
Kaushik Roy ◽  
Partha Ghosh ◽  
...  
Keyword(s):  
Traffic Accidents ◽  
Surgical Repair ◽  
Road Traffic ◽  
Bone Fractures ◽  
Tertiary Care ◽  
Orbital Fracture ◽  
Ocular Motility ◽  
Delayed Presentation ◽  
Orbital Fractures ◽  
Fracture Stabilization

Abstract Background Orbital and periorbital injuries are significant contributors to traumatic facial injuries. Orbital fractures can occur either alone or in conjugation with other facial bone fractures and cranial and maxillofacial injuries. Objectives The study aims to find out the incidence of various types of fractures occurring in patients, mode of trauma, clinical presentation, and results of delayed surgical repair in cases of orbital fractures. Materials and Methods This is a “prospective observational study” including 12 patients. Surgical repair of orbital fractures was considered for suspected muscle entrapment in fractures, restricted ocular motility, symptomatic diplopia not improving for over 2-week period, or if enophthalmos greater than 2 mm was present. Results Regarding age incidence, the maximum number of cases, that is 41.66%, were aged between 21and 30 years. The main modes of trauma in most cases, that is, 50%, were due to road traffic accidents followed by fall from height, that is, 25%. The majority of cases presented to us with complex fractures involved one or more orbital bones, that is 33.33%. Postsurgery outcomes were good and fair in 75% and 25% patients, respectively. Conclusion Proper orbital fracture stabilization is crucial to bring out good cosmetic as well as ocular outcome.

scholarly journals Salvage Secondary Reconstruction of the Mandible with Vascularized Fibula Flap

2019 ◽  
Vol 12 (4) ◽  
pp. 274-283
Author(s):  
Dinesh Kadam
Keyword(s):  
Soft Tissue ◽  
Tissue Loss ◽  
Successful Outcome ◽  
Primary Reconstruction ◽  
Reconstruction Plate ◽  
Secondary Reconstruction ◽  
Fibula Flap ◽  
Skeletal Defects ◽  
Vascularized Fibula ◽  
Free Fibula

Primary restoration of the mandibular continuity remains the standard of care for defects, and yet several constraints preclude this objective. Interim reconstructions with plate and nonvascular bone grafts have high failure rates. The secondary reconstruction, when becomes inevitable, remains a formidable task. This retrospective study evaluates various issues to address secondary reconstruction. Twenty-one patients following mandibulectomy presented with various complications between 2012 and 2016 were included in the study. The profile of primary reconstruction includes reconstruction plate ( n = 9), reconstruction plate with rib graft ( n = 3), soft tissue only reconstruction ( n = 4), free fibula ( n = 2), inadequate growth of reconstructed free fibula during adolescence ( n = 1), nonvascular bone graft alone ( n = 1), and no reconstruction ( n = 1). All had problems or complications related to unsatisfactory primary reconstruction such as plate fracture, recurrent infection, plate exposure, deformity, malocclusion, and failed fibula reconstruction. All were reconstructed with osteocutaneous free fibula flap with repair of soft-tissue loss. All flaps survived and had satisfactory outcome functionally and aesthetically. Dental rehabilitation was done in four patients. One flap was reexplored for thrombosis and salvaged. The challenges in secondary reconstruction include difficulty in recreating true defects, extensive fibrosis and loss of planes, unanticipated soft-tissue and skeletal defects, reestablishing the contour and occlusion, insufficient bone strength, dearth of suitable recipient vessels, nonpliable skin, tissue contraction to accommodate new mandible, need of additional flap for defect closure, and postirradiation effects. Notwithstanding them, the reasonable successful outcome can be attainable.

scholarly journals Surgical intervention in ectopic pregnancies

2019 ◽  
Vol 26 (06) ◽  
Author(s):  
Fouzia Rasool Memon ◽  
Mini Poothavelil ◽  
Samreen Memon
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
Surgical Intervention ◽  
University Hospital ◽  
Time Interval ◽  
Presenting Symptoms ◽  
Beta Hcg ◽  
Ultrasound Findings ◽  
Ectopic Pregnancies ◽  
Study Setting

Objectives: To find out the negative laparoscopy rate for suspected ectopic pregnancy. Study Design: Retrospective cohort study. Setting: Electronic medical record databases in North Cumbria University Hospital, Carlisle, United Kingdom. Period: August 2014 to August 2018. Material and Methods: The data of total 150 laparoscopies performed for ectopic pregnancy management was collected for gestational age at presentation, symptoms, serial beta human chorionic gonadotrophic hormone (HCG) levels, ultrasound findings, time interval for diagnosis, time to surgery and histology. Results: One hundred and fifty patients (52 under 5 weeks and 98 over 5 weeks’ gestation) were incorporated into this study. The primary presenting symptoms were pain and vaginal bleeding. Suboptimal rise in serial beta HCG (performed 48 hours apart) was seen in 69 patients (46%) while other 81 patients (54%) had confirmed ectopic on USS and were offered surgical management after the scan. One hundred forty for women (96%) went for surgical management and one patient had conservative management as she was asymptomatic with low HCG(less than 1000IU) at the first visit and rapid drop in serial BHG results. Fifty three women (35%) had surgery on the same day when they had ectopic pregnancies seen on USS, 63 (42%) went to theatre for surgery between 0-6 days, while 34 patients (23%) had surgery between 7-14 days of USS. All women were operated through laparoscopic route and tubal ectopic pregnancies were confirmed at laparoscopy. There was no negative laparoscopy in our study period. Conclusion: Judicious and timely surgical intervention made it possible to treat every case through laparoscopic route with zero negative laparoscopy rate.

scholarly journals Superior Mesenteric Artery Syndrome: A Worldwide Descriptive Study with Literature Review

2016 ◽  
Vol 4 (2) ◽  
pp. 50-54
Author(s):  
Ruhidayati Awaludin ◽  
Hazimah Ab Rahim ◽  
Dg. Syazana Arivai ◽  
Mostafa Refaie Elkeleny
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Rare Condition ◽  
Superior Mesenteric Artery Syndrome ◽  
Time Interval ◽  
Presenting Symptoms ◽  
Clinical Presentations ◽  
Choice Of Treatment ◽  
Long Term Follow Up ◽  
Microsoft Office

Background: Superior mesenteric artery syndrome is best described as compression of the third part of duodenum by the superior mesenteric artery, resulting in obstruction. This rare condition has been studied for decades yet remains obscure. This study aimed to analyze different clinical presentations, diagnostic modalities, treatment approaches and outcomes of this condition. Methods: Thirty-five superior mesenteric artery syndrome cases were collected retrospectively from a Facebook group called “Superior Mesenteric Artery Syndrome Awareness & Support”. A questionnaire was designed using Google Forms to obtain the demographics, presenting symptoms, risk factors and co-morbidities, investigations, means of treatment and the outcomes. Data was entered into Microsoft Office Excel for statistical analysis. Results: The median age at diagnosis was 22 years. The median body mass index was 20.8 kg/m2. The median time interval from symptom onset to initial diagnosis was 22 months. The major presenting symptoms were abdominal pain (82.9%), nausea (77.1%), and vomiting (65.7%). Abdominal computed tomography scan with contrast (82.9%) was commonly used for confirmation of diagnosis. Thirteen cases (37.1%) were congenital. Thirty patients (85.7%) had received treatment. The overall management success was only 13.3%. Surgical management (34.3%) was the most commonly used regimen. Conclusion: Diagnosis of superior mesenteric artery syndrome is established after a thorough assessment of the clinical presentations and confirmed with suitable imaging modalities. The choice of treatment should be dependent on the causes and severity as different patients respond differently to therapy. Recurrence is possible in all patients, and a long-term follow up is thus required.

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 Systematic Approach to the Application of Soft Tissue Histopathology in Paleopathology

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Christina Grove ◽  
Oliver Peschel ◽  
Andreas G. Nerlich
Keyword(s):  
Soft Tissue ◽  
Connective Tissue ◽  
Time Interval ◽  
Tissue Preservation ◽  
Fat Tissue ◽  
Short Term ◽  
Internal Organs ◽  
Time Intervals ◽  
Pathological Conditions ◽  
Desert Areas

The application of histology to soft tissue remains offers an important technique to obtain diagnostically important information on various physiological and pathological conditions in paleopathology. In a series of 29 cases with mummified tissue ranging between 16 months and c. 5.200 years of postmortem time interval, we systematically investigated paleohistology and the preservation of various tissues. We established a reproducible histological ranking system for the evaluation of mummified tissue preservation. The application of this scheme to the series showed good tissue preservation of tissues with high connective tissue content but also fat tissue and connective tissue rich organs, such as lung tissue, while most other internal organs were less well preserved despite highly different postmortem time intervals. There are some organs with only poor conservation even in short term periods such as the kidneys and CNS. Artificial mummification does not provide better conservation than naturally mummified tissues; “cold” mummies may be much better conserved than those from desert areas. The identification of specific pathologies underlines the potential power of paleohistology.

scholarly journals Estimating intervention dose of the multilevel multisite children’s healthy living program intervention

2019 ◽  
Vol 10 (4) ◽  
pp. 989-997
Author(s):  
Jean Butel ◽  
Kathryn L Braun ◽  
Claudio R Nigg ◽  
Rachael Leon Guerrero ◽  
Travis Fleming ◽  
...  
Keyword(s):  
Civic Engagement ◽  
Collective Efficacy ◽  
Screen Time ◽  
Common Good ◽  
Low Dose ◽  
Building Blocks ◽  
Successful Outcome ◽  
High Dose ◽  
Time Interval ◽  
Healthy Living

Abstract Increased community collective efficacy (CE), defined as social cohesion among neighbors and their willingness to intervene for common good, is associated with improved community health outcomes. However, processes to increase CE and estimate its dose within an intervention are not well understood. The 2 year Children’s Healthy Living (CHL) intervention aimed to improve child behaviors known to affect obesity. We used data from CHL to estimate CE dose and examine its association with a successful outcome from CHL—reduction in children’s recreational screen time. Monthly reports from nine intervention communities were quantified, and CE dose was calculated for each community overall, at 4 time intervals (6, 12, 18, and 24 months), and for each CE building block—social bonding, social bridging, social leveraging, empowerment, and civic engagement. CE dose at each time interval and change in screen time was correlated using Spearman’s rho. Next, communities were categorized as having a high CE dose or a low CE dose, and differences between four high-dose and five low-dose communities were compared using a two-tailed t-test. The correlation between change in screen time and CE dose was significant (rs = 0.83, p = .003). Significantly more activities facilitating empowerment and civic engagement were conducted in high-dose communities, which were more likely to show improvements in screen time, than in low-dose communities. This method of estimating an intervention’s CE dose and examining change over time and effect of CE and its building blocks on intervention outcomes shows promise.

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