Medial Buttressing in Orbital Blowout Fractures

Ramesh, Sathyadeepak; Bokman, Christine L.; Mustak, Hamzah; Lo, Christopher; Goldberg, Robert A.; Rootman, Daniel B.

doi:10.1097/iop.0000000000001049

Cited by 8 publications

(14 citation statements)

References 10 publications

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“…The absence of detailed anatomy of the ethmoid is a limit of our model. Ramesh et al [26] proved that ethmoidectomy on post mortem human subject reduces the impact energy necessary to induce orbital fractures and increases the prevalence of the medial wall's involvement.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of an optimized finite element model of the human orbit

Foletti

Martinez

Graillon

et al. 2019

Journal of Stomatology, Oral and Maxillofacial Surgery

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HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

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Section: Discussionmentioning

confidence: 99%

Development and validation of an optimized finite element model of the human orbit

Foletti

Martinez

Graillon

et al. 2019

Journal of Stomatology, Oral and Maxillofacial Surgery

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“…Ramesh et al performed a similar study to the one presented here and found almost 50% less force was required to cause an orbital fracture after ethmoidectomy. They also found that all specimens with an ethmoidectomy had medial fractures versus 20% in controls [8].…”

Section: Discussionmentioning

confidence: 94%

Does endoscopic sinus surgery alter the biomechanics of the orbit?

Sowerby

Harris

Joshi

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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Objective: The purpose of this study is to determine if removal of ethmoid cell septations as commonly performed in endoscopic sinus surgery leads to a change in orbital wall fracture patterns and the force required to create them. Methods: Six fresh-frozen cadaveric heads were acquired and underwent endoscopic uncinectomy, maxillary antrostomy, and anterior and posterior ethmoidectomy on one, randomized, side. The contralateral sinuses were used as intra-specimen control. Hyaluronic acid gel globe injections were performed to simulate normal intra-ocular pressure. Post-op CT scans confirmed no orbital fractures or violation of the lamina papyracea prior to trauma testing. Orbital trauma was induced using a guided weight-drop technique. Both orbits were tested in random order, and sequentially higher drops were performed until both the test and control side demonstrated an orbital fracture on CT scan. Results: In all six heads, the post-sinus surgery side incurred a medial orbital wall fracture, and no orbital floor fractures were identified. On the other hand, on the control side, all six heads incurred orbital floor fractures at drop heights equal to, or higher than, the surgical side. Fisher's exact test demonstrated a significant difference in fracture pattern (p < 0.001). Conclusions: To our knowledge, this is the first demonstration that the structures removed during sinus surgery may act as a buttress for the medial orbital wall. The anatomic changes of sinus surgery may alter the biomechanics of the orbit and affect the pattern of subsequent traumatic blowout fractures.

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“…The applied pressure and energy may also be significantly lower. In the case of repeated trauma to the orbit, surgical procedures in the nasopharyngeal region (ethmoidectomy), or cancer in the vicinity associated with atrophy of the orbital skeleton, the pressure and energy needed can be significantly lower, as seen in a report by Ramesh and Bokman, who observed a pressure of only 11.8 mm Hg and an energy of 2.14 J [32]. Based on the above, it is clear that a relatively low-energy impact can fracture the orbital walls, but in order to push the eye outside the orbit, it is necessary to apply a repeated force of higher intensity, as was the case with the victim in our report.…”

Section: Discussionmentioning

confidence: 99%

Traumatic dislocation of the eye into the maxillary sinus: Case report and literature review

Vránová

Chytilová

Dobiáš

et al. 2021

Journal of Forensic Sciences

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We describe a case of a 63-year-old woman who was murdered.While the immediate cause of death was asphyxiation due to manual strangulation accompanied by mechanical asphyxia, another accompanying rare injury was traumatic dislocation of an eye into the maxillary sinus, coupled with orbital fracture. The eye dislocation was inflicted when the woman was assaulted and repeatedly punched in the face, while her head was being held against a solid surface.Although limited by the rarity of the condition, we provide a synopsis of the available literature describing eye dislocation in an attempt to critically examine the forensic issues involved in assessing such cases. | C A S E REP ORTA 63-year-old woman was found dead at home. At the crime scene, a man was arrested who was suspected of committing the murder.External examination of the deceased woman revealed swollen soft tissues in the face, multiple contusions, abrasions, and superficial lacerations of the skin, which were found around the eyelids, on

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Medial Buttressing in Orbital Blowout Fractures

Abstract: Endoscopic ethmoidectomy in fresh cadavers reduces impact energy necessary to induce orbital fracture and increases the prevalence of medial wall involvement. Clinicians may wish to counsel patients undergoing endoscopic sinus surgery about these relative risks.

Cited by 8 publications

References 10 publications

Development and validation of an optimized finite element model of the human orbit

Development and validation of an optimized finite element model of the human orbit

Does endoscopic sinus surgery alter the biomechanics of the orbit?

Traumatic dislocation of the eye into the maxillary sinus: Case report and literature review

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