Altered Brain Network Centrality in Patients With Orbital Fracture: A Resting-State fMRI Study. Running Head: DC Alterations in OF Patients

Objective: We aimed to identify potential functional network brain-activity abnormalities in patients with orbital fractures (OFs) by using the voxel-wise degree centrality (DC) method.Methods:We selected 20 patients with OFs (12 men and 8 women) and 20 healthy controls (HCs; 12 men and 8 women) matched by gender, age, and education level for this study. Resting-state functional magnetic resonance imaging (fMRI) has been widely used in various disciplines. We calculated receiver operating characteristic (ROC) curves to differentiate characteristics between patients with orbital fractures and HCs; in addition, we applied correlation analyses between behavioral performance and average DC values in different areas. The DC method served to evaluate spontaneous brain activity.Results:The DC values of patients with OFs were higher in the right cerebellum 9 area (Cerebelum_9_R) and left cerebellar peduncle 2 area (Cerebelum_Crus2_L) than those in HCs. The area under the curve (AUC) values for Cerebelum_9_R and Cerebelum_Crus2_L were 0.983 and 1, respectively. The accuracy of our ROC curve analysis result was reliable. Conclusion:Many brain regions seem to show abnormal brain network characteristics in patients with orbital fractures, suggesting potential neuropathic mechanisms.

Displaced Orbital Fractures with Concurrent Orbital Compartment Syndrome: A Case-Based Systematic Review

Orbital compartment syndrome (OCS) is an emergency that complicates intra-orbital, retrobulbar hemorrhage in most cases. Bony orbital decompression is an effective treatment for OCS, and displaced orbital fractures are protective. Nevertheless, in rare cases, OCS occurs despite a displaced orbital fracture. The aim of the current review is to present its pathophysiology and management based on what is published in the medical literature, and our center's experience. A systematic review of literature was conducted through PubMed, Medline, Embase, and Cochrane from inception through February 2021. The following search query was used: “orbital fracture” and “trauma” and “orbital compartment syndrome.” Studies tackling the pathophysiology and management of concurrent displaced orbital fracture with OCS were included and a cohort of patients was constituted. A cohort of 18 cases reported in the literature were included (49.3 ± 30.6 years, 50% M). Given that OCS occurs with or without orbital fracture, pathophysiology of OCS is mostly explained by the division of the orbital fat into many compartments, due to the presence of Koorneef's fibrous septa. Management of OCS in such circumstances consisted of inferior-lateral canthotomy and cantholysis in 50% of cases, subperiosteal drainage with myringotomy in 22.2% of cases, subperiosteal drainage in 16.7% of cases, and complete lateral cantholysis in 16.7% of cases. Two cases who presented to our tertiary care center were also added to this review. Physicians should be aware that OCS can occur even with displaced fractures of the orbital cavity. When clinical suspicion is present, an emergent management is needed.

Orbital Fractures

Orbital 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.

Changing trends in ocular trauma during the COVID-19 pandemic in the USA

Background/aimsThe COVID-19 pandemic has been associated with a decline in emergency department (ED) presentations for trauma. The purpose of this study is to compare the estimated number and characteristics of eye injuries in 2020, the year of the COVID-19 pandemic, to those in 2011–2019.MethodsA stratified probability sample of US ED-treated eye injuries was used to calculate the estimated annual number and incidence of these injuries in 2020, the year of the pandemic, and 2011–2019 (prepandemic years). Two-sample t-tests and Pearson χ2 were used to assess differences in demographics and injury characteristics. For multiple comparisons, Bonferroni correction was applied.ResultsThe estimated number of ED-treated eye injuries per year was 152 957 (95% CI 132 637 to 176 153) in 2020 and 194 142 (95% CI 191 566 to 196 401) in 2011–2019. The annual incidence of ED-treated eye injuries was lower in 2020, at 46 per 100 000 population than in 2011–2019, at 62 per 100 000 per year (p<0.001). In 2020 vs 2011–2019, there was a higher incidence of ruptured globes (0.5 per 100 000 vs 0.3 per 100 000 per year, p<0.001), hyphemas (0.6 per 100 000 vs 0.4 per 100 000 per year, p<0.001), lacerations (1.0 per 100 000 in 2020 vs 0.8 per 100 000 per year, p<0.001) and orbital fractures (0.3 per 100 000 vs 0.03).ConclusionThe estimated incidence of eye injuries presenting to the ED was significantly lower in 2020 than in 2011–2019, but there was a higher estimated incidence of severe eye injuries. Changes in living and work environments due to the COVID-19 pandemic were likely associated with the differences in ocular trauma presentations observed in this study.

Epidemiology of Orbital Fractures in a Large Hospital in the Netherlands: Results of Implementation of a Multidisciplinary Orbital Trauma Team

Introduction: This study aims to describe the epidemiology, aetiology and therapy of orbital fractures in a large municipal hospital in The Hague, the Netherlands, and to demonstrate the effectiveness of an integrated approach of orbital trauma care with a team consisting of an ophthalmologist, an orthoptist and an oral and maxillofacial (OMF) surgeon. Methods: We obtained data from patients with an orbital fracture between June 2015 until July 2018. Primary outcomes were the classification of orbital fractures and treatment (conservative or surgical). Results: 182 patients were included in this study. The most common type of orbital fracture was an isolated orbital floor fracture (n=56, 30.8%). In most cases, therapy was conservative (69.2%). When surgical repair was indicated, a polydioxanone (PDS) plate was most commonly used (11.5%). The main cause of an orbital fracture was a fall accident (38.5%), followed by assault (32.4%). 32.4% of the patients were intoxicated with alcohol. Conclusion: In our study population, almost 70% (69.2%) of the patients were treated conservatively in our study. Compared to the international literature, this percentage is considerably higher than in other studies. In our opinion, our integrated approach to orbital trauma has led to a justifiable reduction of the proportion of cases receiving surgical intervention in orbital fractures. We would like to advocate the implementation of a similar team in other hospitals to improve the quality and cost-effectiveness of treatment in patients with orbital fractures.

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

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.