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Surgical Timing and Fracture Type on the Outcome of Diplopia After Orbital Fracture Repair

Yu DY, Chen CH, Tsay PK, Leow AM, Pan CH, Chen CT

Ann Plast Surg, 2016 Mar;76 Suppl 1:S91-5.
PMID: 26808744 DOI: 10.1097/SAP.0000000000000726

Orbital fractures and the concomitant soft tissue injuries within the bony orbit result in well-recognized complications such as diplopia and enophthalmos. Guidelines for timing and indications for surgery for achieving an optimal outcome remain elusive. This study examined the effects of timing and fracture type on the outcome of orbital fracture repair.

Matched MeSH terms: Orbital Fractures
White-eyed blowout fracture: Diagnostic pitfalls and review of literature

Yew CC, Shaari R, Rahman SA, Alam MK

Injury, 2015 Sep;46(9):1856-9.
PMID: 25986667 DOI: 10.1016/j.injury.2015.04.025

White-eyed blowout fracture was first termed by Jordan et al. in individuals sustaining a blow to the periocular area and presenting with ocular symptoms, although with minimal soft tissue signs of trauma. It is often found in pure orbital floor blowout fractures among paediatric patients, and it could manifest as a linear or hinge-like trapdoor deformity. Unlike the more common open orbital blowout fractures with distinct diagnostic clinical signs, white-eyed blowout fractures are rarer and their diagnoses can be easily missed, subsequently costing an optimal time window for surgical intervention. This is critical as better outcomes are found with earlier release of entrapments. This report describes a case of a white-eyed blowout fracture in a 10-year-old child faced with its diagnostic challenges. The current literature review discusses the types of fracture pattern, signs and symptoms, mechanism of action, as well as timing of surgery. In view of the common complication of persistent diplopia, clinical pitfalls in achieving this diagnosis are emphasized to prevent any delay of treatment. Current literature evidences are weighted towards urgent surgical intervention, as positive outcomes are found to correlate with earlier release of entrapments.

Matched MeSH terms: Orbital Fractures
Subperiosteal Dissection in Orbital Blowout Fracture: Technical Tips Including the Use of Modified Periosteal Elevator

Nazimi AJ, Rajaran JR, Nordin R

J Craniofac Surg, 2019 Oct;30(7):e609-e611.
PMID: 31503125 DOI: 10.1097/SCS.0000000000005617

Orbital blowout fractures are common. The same goes for its surgical complications when the efficiency of the dissection of entrapped or herniated intraorbital contents into the fracture could not be completely and safely dissected out. The authors describe a modification of the commonly used Howarth periosteal elevator for dissection of intraorbital content displacement or herniation on orbital blowout fracture. The instrument was modified by marking out the instrument from the tip into 10, 20, 25, 30, and 40 mm on both of its concave and convex surfaces to allow safe orbital soft tissue dissection and distance control. From the authors' experience, these simple modifications from its original instrument design allow better intraoperative control and appreciation of any intact important intraorbital anatomical structures such as inferomedial strut and posterior ledge. At the same time of importantly getting complete orbital fracture dissection and visualization, it causes less trauma to surrounding soft tissue with the markings ensuring unnecessary orbital exploration or visualization. Dissection can be kept for optimum maneuverability at the required or intended location based on the preoperative scan or dimension of anatomical orbital implant.

Matched MeSH terms: Orbital Fractures
Intraoperative Computed Tomography Scan for Orbital Fracture Reconstruction

Nazimi AJ, Khoo SC, Nabil S, Nordin R, Lan TH, Rajandram RK, et al.

J Craniofac Surg, 2019 Oct;30(7):2159-2162.
PMID: 31232997 DOI: 10.1097/SCS.0000000000005667

Orbital fractures pose specific challenge in its surgical management. One of the greatest challenges is to obtain satisfactory reconstruction by correct positioning of orbital implant. Intraoperative computed tomography (CT) scan may facilitate this procedure. The aim of this study was to describe the early use of intraoperative CT in orbital fractures repair in our center. The authors assessed the revision types and rates that have occurred with this technique. With the use of pre-surgical planning, optical intraoperative navigation, and intraoperative CT, the impact of intraoperative CT on the management of 5 cases involving a total number of 14 orbital wall fractures were described. There were 6 pure orbital blowout wall fractures reconstructed, involving both medial and inferior wall of the orbit fracturing the transition zone and 8 impure orbital wall fractures in orbitozygomaticomaxillary complex fracture. 4 patients underwent primary and 1 had delayed orbital reconstruction. Intraoperative CT resulted in intraoperative orbital implant revision, following final navigation planning position, in 40% (2/5) of patients or 14% (2/14) of the fractures. In revised cases, both implant repositioning was conducted at posterior ledge of orbit. Intraoperative CT confirmed true to original reconstruction of medial wall, inferior wall and transition zone of the orbit. Two selected cases were illustrated. In conclusion, intraoperative CT allows real-time assessment of fracture reduction and immediate orbital implant revision, especially at posterior ledge. As a result, no postoperative imaging was indicated in any of the patients. Long-term follow-ups for orbital fracture patients managed with intraoperative CT is suggested.

Matched MeSH terms: Orbital Fractures/surgery
Fulltext Predictors of enophthalmos among adult patients with pure orbital blowout fractures

Ahmad Nasir S, Ramli R, Abd Jabar N

PLoS One, 2018;13(10):e0204946.
PMID: 30289909 DOI: 10.1371/journal.pone.0204946

The aim of this study was to determine the predictors of post-traumatic enophthalmos (PE) in relation to the internal orbital changes following pure orbital blowout fractures. The design was a 10-year retrospective cross-sectional study analysing 629 medical records and computed tomography (CT) data of patients with orbital fractures from January 2008 to January 2017. Demographic, etiology, co-morbidity and clinical characteristics were obtained from the medical records. Assessment of the PE, fracture site and size, intraorbital structures and muscle change were performed using the Digital Imaging and Communications in Medicine (DICOM) viewer software, OsiriX v5.8.2. Of the 629 patients with orbital fractures, 87 were pure orbital blowout fractures. Demographic pattern showed that males outnumbered females in the series, with male: female ratio of 5.7:1. The mean age was 37.2 ± 14.7 and the main etiology was motor vehicle accident. Orbital floor fracture was the most common fracture location (67.8%). The involvement of the posterior ledge and inferior orbital fissure showed statistical significant difference with PE (Fisher's exact test, p = 0.03). Binary logistic regression showed that after controlling for age, patients with fracture size of more than 150 mm2 had three times the odds of sustaining a PE, (adjusted odds ratio (AOR) = 3.01 (95% CI 1.17-7.92). Fracture size larger than 150 mm2 was a radiological predictor of PE. Additional research investigating further on the role of concurrent fracture of the posterior ledge and inferior orbital fissure is advocated.

Matched MeSH terms: Orbital Fractures/complications*
Hospital Universiti Sains Malaysia experience in orbital floor reconstruction: autogenous graft versus Medpor

Wajih WA, Shaharuddin B, Razak NH

J Oral Maxillofac Surg, 2011 Jun;69(6):1740-4.
PMID: 21272979 DOI: 10.1016/j.joms.2010.07.053

A normally restored orbital structure after reconstructive surgery would accelerate the return of orbital function. The aim of the present study was to compare the outcomes of 2 orbital implants: autogenous grafts and porous polyethylene (Medpor).

Matched MeSH terms: Orbital Fractures/complications; Orbital Fractures/diagnosis; Orbital Fractures/surgery*
Biomaterials for repair of orbital floor blowout fractures: a systematic review

Gunarajah DR, Samman N

J Oral Maxillofac Surg, 2013 Mar;71(3):550-70.
PMID: 23422151 DOI: 10.1016/j.joms.2012.10.029

To evaluate the reported use and outcomes of implant materials used for the restoration of post-traumatic orbital floor defects in adults.

Matched MeSH terms: Orbital Fractures/complications; Orbital Fractures/surgery*
Fulltext Management Of Zygomatico-Orbital Fractures Using Rigid Internal Fixation With Cosmetic Surgical Considerations - Case Report

Ong, A.H.M.

Ann Dent, 1996;3(1):-.
MyJurnal

The current standard of managing facial bone fractures is the use of rigid internal fixation. This method provides good stabilization and repair for mid-face fractures such as the zygomatico-orbitalfracture. Nowadays, for the young and old, patients want not only rapid bone healing, but also good facial aesthetics after surgical treatment following maxillofacial trauma. Therefore, osteosynthesis of fractures and inconspicuous post-operative scars are considered essential. The lower eyelid approach or modified blepharoplasty provides rapid access to the infraorbital rim as well as the orbital floor, while the lateral eyebrow incision gives direct access for fixation at the fronto-zygomatic suture. Combining the Gillies' approach and a single form of rigid internal fixation, good cosmetic results and function can be achieved. Cases using the micro-plate-system for thin infraorbital bones and the miniplate- system for thicker facial bones involving zygomatico-orbital fractures are described.

Matched MeSH terms: Orbital Fractures
Fulltext A Case of Medialized Lateral Maxillary Sinus Wall: A Pillar of Support

Othman IA, Hashim ND, Nazimi AJ

Case Rep Med, 2018;2018:4053531.
PMID: 29861735 DOI: 10.1155/2018/4053531

The number of maxillofacial trauma (MFT) cases attended in the Emergency Department is progressively increasing in trend, owing to the rising statistics of motor-vehicle accidents (MVAs) and urban assaults in addition to occupational-related injuries. Prompt and thorough assessment is important for accurate diagnosis and paramount treatment plans. We will be discussing a case of unusual presentation of an orbital floor fracture post-MVA which was treated conservatively based on the clinical assessments during follow-ups, supported by radiological findings. We will also briefly discuss the different radiological modalities available in assessing MFT and late presentation of enophthalmos.

Matched MeSH terms: Orbital Fractures
Fulltext Delayed onset porous polyethylene implant-related inflammation after orbital blowout fracture repair: four case reports

Aryasit O, Ng DS, Goh ASC, Woo KI, Kim YD

BMC Ophthalmol, 2016 Jul 07;16:94.
PMID: 27387333 DOI: 10.1186/s12886-016-0287-0

BACKGROUND: Porous polyethylene implants are commonly used in orbital blowout fracture repair because of purported biocompatibility, durability, and low frequency of complications. Delayed inflammation related to porous polyethylene sheet implants is very rare and no case series of this condition have been reported.
CASE PRESENTATION: This is a retrospective review of clinical presentations, radiographic findings, histopathological findings, treatments, and outcomes of patients who developed delayed complications in orbital blowout fracture repair using porous polyethylene sheets. Four male patients were included with a mean age of 49 years (range 35-69 years). Blowout fracture repair was complicated with implant-related inflammation 10 months, 2 years, 3 years, and 8 years after surgery. Chronic and subacute orbital inflammatory signs were noted in two patients and acute fulminant orbital inflammation was found in two patients. Three patients developed peri-implant abscesses and one patient had a soft tissue mass around the implant. All patients underwent implant removal and two of these patients with paranasal sinusitis had sinus surgery. Histopathological findings revealed chronic inflammatory changes with fibrosis, and one patient had foreign body granuloma with culture positive Staphylococcus aureus.
CONCLUSIONS: Delayed complications with porous polyethylene sheets used in orbital blowout fracture repair may occur many years following the initial surgery in immunocompetent patients. Low-grade or fulminant inflammation could complicate blowout fracture repair related with the implant.

Matched MeSH terms: Orbital Fractures/surgery*
Maxillofacial trauma of pediatric patients in Malaysia: a retrospective study from 1999 to 2001 in three hospitals

Rahman RA, Ramli R, Rahman NA, Hussaini HM, Idrus SM, Hamid AL

Int J Pediatr Otorhinolaryngol, 2007 Jun;71(6):929-36.
PMID: 17442408

Maxillofacial trauma in children is not common worldwide. Domestic injuries are frequently seen in younger children while older children are mostly involved in motor vehicle accidents (MVA). The objective of this study was to analyze the pattern of maxillofacial injuries in pediatric patients referred to three government main hospitals in different areas of West Malaysia.

Matched MeSH terms: Orbital Fractures/epidemiology
Combination of vascularized outer-table calvarial bone graft based on the superficial temporal vessels and allomatrix for the repair of an orbito-frontal blow-out fracture in a child

Ali F, Halim AS, Najihah SZ, Ibrahim M, Abdullah J

J Craniomaxillofac Surg, 2005 Oct;33(5):326-30.
PMID: 16125400

A vascularized outer-table calvarial bone graft was used for repairing a Posnick type 2 traumatic orbito-frontal bone defect supported by the use of a calcium-based putty (Allomatrix) in a 7-year-old girl. Gaps between the donor and recipient sites were filled with Allomatrix containing demineralized bone matrix particles. Four years later there was a good cosmetic result using an artificial left eye.

Matched MeSH terms: Orbital Fractures/surgery*
Fulltext Traumatic globe displacement into anterior cranial fossa

Patricia Ann John, Sylves Patrick, Mohtar Ibrahim, Adil Hussein

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):325-327.
MyJurnal

A 64-year-old Malay gentleman alleged occupational injury when a malfunctioned metal hydraulic door hit on his face while unloading sand from his tipper-truck. Post-trauma, he complained of right eye (RE) pain and total loss of vision. On examination, noted RE visual acuity was unable to be assessed and left eye (LE) was 6/24 with pinhole 6/9. No eyeball could be seen in the right socket with superior orbital rim step deformity and left periorbital haema- toma. Computed tomography scan of the brain and orbit confirmed displaced right eye globe into the right anterior cranial fossa with right and left multiple orbital wall fractures. He then underwent successful right eye globe reposi- tioning. Traumatic orbital roof fracture is a rare condition. Repositioning of the eye globe was done to salvage the eye globe for a cosmetic reason and to avoid localised inflammatory reaction at the anterior cranial fossa.

Matched MeSH terms: Orbital Fractures
Fulltext Epidemiology of Maxillofacial Fractures at a Teaching Hospital in Malaysia: A Retrospective Study

Abosadegh MM, Saddki N, Al-Tayar B, Rahman SA

Biomed Res Int, 2019;2019:9024763.
PMID: 30895196 DOI: 10.1155/2019/9024763

Background/Aim: Epidemiology of maxillofacial fractures (MFF) varies between populations. This study investigated the epidemiology of MFF treated at the Oral and Maxillofacial Surgery (OMFS) Unit, Hospital Universiti Sains Malaysia (USM).
Methods: A retrospective review of 473 medical records of patients with MFF treated from June 2013 to December 2015 was conducted. Information on demographic characteristics of patients, aetiology of injury, types of MFF, and treatment was obtained. Descriptive analysis, Pearson's chi-squared test, and multiple logistic regression analysis were conducted. The level of significance was set at 0.05.
Results: Most patients treated for MFF were males (82.2%), aged 30 and below (63.1%), and from Malay ethnic (97.4%). Road traffic accident was the most common cause of MFF (83.1%), with motorcycle accident accounting for most injuries (73.6%). Orbital wall fracture was the most frequent MFF type (51.2%). About half of MFF patients (51.4%) were treated conservatively. Patients aged more than 20 years old were at higher odds of sustaining orbital wall fracture (AOR= 1.76; 95% CI: 1.214-2.558; P= 0.003) but were at lower odds of sustaining mandibular fracture (AOR= 0.47; 95% CI: 0.315-0.695; P= 0.001) than patients who are 20 years old and younger. Helmet use among motorcyclists was significantly associated with the nasal, orbital wall, and maxillary sinus wall fractures (P= 0.006, 0.010, and 0.004, respectively).
Conclusion: Motorcycle accident was the most common cause of MFF in Kelantan, Malaysia. Ages of patient and helmet use were associated with the type of MFF sustained. This study provides important information to facilitate the planning of MFF prevention strategies among motorcyclists and emphasizes the importance of using a helmet when riding a motorcycle.

Matched MeSH terms: Orbital Fractures

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