Orbital Floor Fractures

Kirby, Emily J.; Turner, Jenn; Davenport, Daniel L.; Vásconez, Henry C.

doi:10.1097/sap.0b013e31820b3c7a

Cited by 51 publications

(8 citation statements)

References 25 publications

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“…In 2003 Ellis 3 rd and Tan were able to show that titanium meshes are more accurate to reconstruct the orbital floor than bone grafts [ 7 ]. Kirby et al confirmed these findings in a retrospective study with 317 adult patients comparing patients who had been reconstructed with bone grafts to patients reconstructed with titan-mesh and/or polyethylene [ 8 ]. Even though chronic enophthalmus (persisting more than 4 weeks) was significantly reduced in those patients with alloplastic reconstruction, (23 to 14 %) diplopia was increased (17 to 14 %) in comparison to patients reconstructed with bone grafts.…”

Section: Introductionmentioning

confidence: 91%

Orbital floor fractures – short- and intermediate-term complications depending on treatment procedures

et al. 2016

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BackgroundMany reconstruction materials for orbital floor fractures have been described in the past including autologous bone transplants, resorbable polymers and titan meshes. So far evidence is missing which material is used successfully regarding indication and particular size of defect. Therefore the aim of this study was to evaluate which reconstruction technique produces best clinical outcome and least complications associated with indication.MethodsRetrospectively, surgical and ophthalmological data plus CT scans from a collective of 775 patients between 2005 and 2012 were analyzed. Furthermore included patients were sounded on satisfaction and potential problems postoperatively.ResultsOverall 593 patients offered full pre- and postoperative short-time data appropriate to inclusion criteria – of these 507 (85,5 %) underwent primary surgical treatment. Smallest average defect size was found in cases with no indication for surgical treatment (81 mm2), largest in cases indicating titanium mesh reconstruction (601.5 mm2). In 15 cases exact fragment reposition was possible without insertion of alloplastic material. Best clinical results obtained reconstruction using polydioxanone foil (PDS). 0.15 mm PDS-foil: 444 patients, reduced diplopia pre to postoperative 16 to 6 % (p < 0.01), ex- and enophthalmus < 2 % after surgery. 0.25 mm PDS-foil: 26 patients, reduced diplopia from pre- to postoperative 34,6 to 3,8 % (p < 0.01), postoperative exophthalmus rate was higher than preoperative (3,8 to 7,7 %). In comparison to reconstruction with PDS-foil a higher percentage of patients reconstructed with titanium meshes (n = 22) revealed no significant reduction of diplopia (45,5 to 31,8 %; p = 0.07). Furthermore 63 of all included patients agreed to complete a questionnaire on intermediate-term postoperative symptoms and surgical contentedness. Remarkably 50 % of the patients reconstructed with titanium meshes indicated foreign body sensations and cold feeling in the long-term.ConclusionsShort- and intermediate-term results of clinical outcome in our patients with surgical treated orbital floor fractures (i.e. diplopia, en- or exophthalmus) reveal that thin resorbable foils, particularly 0.15 mm diameter PDS-foil seem to generate best results referring to orbital floor defects with a size of 250 to 300 mm2.Trial registrationStudy number 4222, year 2013, ethics committee of the medical faculty of the Heinrich Heine university of Duesseldorf.

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Section: Introductionmentioning

confidence: 91%

Orbital floor fractures – short- and intermediate-term complications depending on treatment procedures

et al. 2016

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“…From the present retrospective review, the complication rate following orbital floor fracture repair under regional anesthesia with conscious sedation when necessary is comparable to the result obtained under general anesthesia in our Level I Trauma Center and in the literature. 1,3,5,7,17,18,20,23 However, the decreased reoperative rate for surgical repair under local anesthesia compared to that under general anesthesia was not statically significant ( P > 0.05). Topical injections and nerve blocks render insensitivity to pain in the affected area only.…”

Section: Discussionmentioning

confidence: 97%

“…1 Blowout fractures are further classified as pure (orbital rim not involved) and impure (orbital rim involved), and pure blowout fractures are categorized as trapdoor (the bone fragment is partially attached to intact bone with frequent incarceration of the periorbita) or punched-out (the fractured bone segment is detached on all sides with infrequent incarceration of the periorbita). 2–4 Typically, orbital floor fractures do not occur in isolation but are associated with other facial fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Orbital floor fracture management has changed significantly over the past decades with the introduction of new materials (porous polyethylene and titanium plates) and different fixation methods. 1–6 Recommendations for surgical fracture repair mostly depend on a combination of clinical examination (diplopia, enophthalmos, visual acuity, impaired ocular movements) and imaging studies (computed tomography) to evaluate muscle or nerve entrapment. 3 Concomitant evaluation of symptoms, signs, and radiographs reduces ambiguity and confusion due to local edema and/or subcutaneous emphysema, which may pose clinical doubts because of transitory diplopia and lead to overtreatment.…”

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confidence: 99%

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Infraorbital Nerve Block for Isolated Orbital Floor Fractures Repair

Spinelli¹,

Rocchetta²,

Carnevali³

et al. 2014

Plastic and Reconstructive Surgery Global Open

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Background:Orbital blowout fractures can be managed by several surgical specialties including plastic and maxillofacial surgery, otolaryngology, and ophthalmology. Recommendations for surgical fracture repair depend on a combination of clinical and imaging studies to evaluate muscle/nerve entrapment and periorbital tissue herniation.Methods:The aim of this study was to verify the applicability of regional anesthesia when repairing orbital floor fractures. A retrospective chart review was performed for isolated orbital floor fractures treated at the Department of Maxillofacial Surgery in Florence between May 2011 and July 2012. The study included 135 patients who met the inclusion criteria: 96 subjects were male (71%) and 39 were female (29%). The mean age was 45.3 years, ranging from 16 to 77 years.Results:The results revealed that isolated anterior orbital floor fractures can be safely repaired under regional and local anesthesia. Regional and local anesthesia should be combined with intravenous sedation when the fracture involves the posterior floor. The surgical outcome was comparable to the outcome achieved under general anesthesia. There was a lower rate of surgical revisions due to concealed malposition or entrapment of the inferior rectus muscle (19% vs 22%). However, this result was not statistically significant (P > 0.05).Conclusions:There are several advantages to surgically repairing isolated orbital floor fractures under regional and local anesthesia that include the following: surgeons can check the surgical outcome (enophthalmos and extrinsic ocular muscles function) intraoperatively, thereby reducing the reoperation rate; patient discomfort due to general anesthesia is eliminated; and the hospital stay is reduced, thus decreasing overall healthcare costs.

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“…Many surgeons, however, feel that bone grafts are relatively more resistant to radiation-associated complications than alloplasts are [ 24 ]. In a recent review of orbital floor reconstruction for trauma, Kirby et al [ 25 ] found that autologous bone reconstructions were more likely to be complicated by orbital dystopia and enophthalmos compared to titanium mesh and porous polyethylene reconstructions, possibly due to increased difficulty in shaping the reconstructed orbital floor, irregular thickness, and unpredictable resorption. Obviously, alloplastic materials have the advantage of being available in virtually unlimited quantities and carry with them no donor site morbidity.…”

Section: Mid-facial Reconstructionmentioning

confidence: 99%

Reconstructive Surgery for Head and Neck Cancer Patients

Hanasono

2014

Advances in Medicine

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The field of head and neck surgery has gone through numerous changes in the past two decades. Microvascular free flap reconstructions largely replaced other techniques. More importantly, there has been a paradigm shift toward seeking not only to achieve reliable wound closure to protect vital structures, but also to reestablish normal function and appearance. The present paper will present an algorithmic approach to head and neck reconstruction of various subsites, using an evidence-based approach wherever possible.

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Orbital Floor Fractures

Cited by 51 publications

References 25 publications

Orbital floor fractures – short- and intermediate-term complications depending on treatment procedures

Orbital floor fractures – short- and intermediate-term complications depending on treatment procedures

Infraorbital Nerve Block for Isolated Orbital Floor Fractures Repair

Reconstructive Surgery for Head and Neck Cancer Patients

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