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.
Diabetic retinopathy (DR) is the most prevalent type of retinal vasculopathy and the most widespread cause of preventable blindness in adults. Excessive increases in reactive oxygen species (ROS) and vascular endothelial growth factor are major initiators and drivers of DR progression, respectively. However, current DR treatment options remain limited, particularly for early DR. Nanotechnology‐mediated antioxidant strategies are gaining increasing popularity to treat ocular diseases. Quercetin has excellent ROS scavenging efficiency but poor stability and low bioavailability in physiological environments. In this study, ultrasmall Fe‐Quer nanozymes (NZs) formed by coupling quercetin with low‐toxic iron ions are reported that can mimic the activities of three important antioxidant enzymes, superoxide dismutase, catalase, and peroxidase, thereby exhibiting excellent water dispersion and efficient ROS scavenging ability. In vitro and in vivo assays validate the effects of Fe‐Quer NZs against inflammation, oxidative stress damage, microvascular leakage, and angiogenesis, particularly their vascular protective effect in early DR. Transcriptomic analysis further reveals a potential multitarget‐specific therapeutic mechanism of Fe‐Quer NZs against DR. These observations open avenues for Fe‐Quer NZs, composed of molecules of a natural product and metal ions with artificial NZ activity, as microvascular protective agents for DR and other ROS‐related diseases.
A modified pre-auricular approach with dissection deep to the temporalis fascia offers a safe and reliable surgical technique for accessing the malar arch in orbital zygomatic maxillary complex fractures.
The Tessier Number 4 cleft is one of the rarest, most complex craniofacial anomalies that presents difficulties in surgical treatment. In this article, we report a case of simultaneous facial depression, eye displacement, and medial canthus deformity. In this case, the maxillary bony defect was reconstructed using computer-assisted design computer-assisted manufacturing (CAD-CAM) polyether-ether-ketone (PEEK) material, and the orbital floor defect was repaired with AO prefabricated titanium mesh. Additionally, the medial canthus was modified with canthopexy and a single Z-plasty flap. Owing to its relative rarity and varied clinical presentations, no definitive operative methods have been accepted for Tessier No. 4 facial cleft. This study presents the combination of CAD-CAM manufactured PEEK material and titanium mesh as an alternative approach for reconstructing the bony defect of Tessier No. 4 facial clefts.
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