Complication Of Orbital Fractures Research Articles

New Extraocular Muscle Entrapment after Facial Fracture Repair

Extraocular muscle entrapment is a well-recognized complication of orbital fracture, wherein the inferior rectus muscle becomes lodged within the fracture fragments at the time of the initial trauma. New onset entrapment cannot occur without new force applied to the orbit, displacing the fragments and the inferior rectus. Theoretically, in complex orbital fractures, manipulation of disjunct fragments may apply pressure to the orbital contents and induce new entrapment in an otherwise non-operative orbital floor fracture. Here we present the only described case of new extraocular muscle entrapment after open reduction and fixation of a supraorbital rim and frontal sinus fractures and emphasize the need for careful assessment after repair of such a fracture to ensure that new entrapment has not occurred.

Inferior Oblique Entrapment After Orbital Fracture With Transection and Repair.

Extraocular muscle (EOM) entrapment with resulting reduction in motility and diplopia is a known complication of orbital fractures. Less commonly, transection of the EOMs due to trauma, iatrogenic injury, or intentional myotomy may lead to persistent diplopia. The inferior oblique (IO) is often encountered during orbital surgery along the medial wall and floor, and may be disinserted to aid in visualization. The authors present a case of IO entrapment which occurred during zygomaticomaxillary fracture reduction. Intraoperatively, an IO transection was performed and the muscle was reattached within the orbit. Postoperatively, the patient did not develop diplopia or motility disruption. This technique may provide a useful solution to an unusual problem during orbital fracture repair.

Diplopia secondary to orbital fracture in adults

Abstract Objective To evaluate the incidence and evolution of diplopia as a complication of orbital fractures in adults. Patients and methods A review was conducted on medical records of all consecutive adults with orbital fracture referred between January 2014 and December 2015. An analysis was made of the incidence of diplopia secondary to fracture in the acute phase and its evolution. A descriptive study was performed on the variables related to patients, fractures, and fracture and diplopia treatment. Results The study included 39 patients with a mean age of 48 years (17–85). Of all the patients, 17 (43.6%) presented with diplopia in the acute phase. Differences were found between the groups with and without diplopia in relation to muscle entrapment diagnosed by orbital computed tomography, duction limitation, and fracture surgery ≤1 week (p = 0.02, p = 0.00, p = 0.04, respectively). Out of the 17 patients with diplopia, 12 had a mean follow-up of 18 weeks (1–72), and in 10 (83.3%) diplopia was resolved in a mean time of 10 weeks (1–72). There were spontaneous resolution in 4 (33.3%) patients, and resolution after fracture surgery in 4 (57%) of the 7 that underwent surgery. In 4 cases (33.3%) prisms were prescribed, and 2 (16.6%) required strabismus surgery. Conclusions Diplopia secondary to orbital fracture in adults is frequent, but it is resolved in most cases spontaneously or after fracture surgery. A few patients will require prisms and/or strabismus surgery.

Diplopía secundaria a fractura orbitaria en adultos

ObjectiveTo evaluate the incidence and evolution of diplopia as a complication of orbital fractures in adults. Patients and methodsA review was conducted on medical records of all consecutive adults with orbital fracture referred between January 2014 and December 2015. An analysis was made of the incidence of diplopia secondary to fracture in the acute phase and its evolution. A descriptive study was performed on the variables related to patients, fractures, and fracture and diplopia treatment. ResultsThe study included 39patients with a mean age of 48years (17-85). Of all the patients, 17 (43.6%) presented with diplopia in the acute phase. Differences were found between the groups with and without diplopia in relation to muscle entrapment diagnosed by orbital computed tomography, duction limitation, and fracture surgery ≤1week (P=.02, P=.00, P=.04, respectively). Out of the 17patients with diplopia, 12 had a mean follow-up of 18weeks (1-72), and in 10 (83.3%) diplopia was resolved in a mean time of 10weeks (1-72). There were spontaneous resolution in 4 (33.3%) patients, and resolution after fracture surgery in 4 (57%) of the 7 that underwent surgery. In 4cases (33.3%) prisms were prescribed, and 2 (16.6%) required strabismus surgery. ConclusionsDiplopia secondary to orbital fracture in adults is frequent, but it is resolved in most cases spontaneously or after fracture surgery. A few patients will require prisms and/or strabismus surgery.

COORDIMETRY IN DIAGNOSIS OF OCULOMOTOR DISORDERS IN PATIENTS WITH ‘BLOW-UP’ ORBITAL FRACTURES: CASE REPORTS

Приведены три клинических наблюдения больных со «взрывными» переломами орбиты в до- и послеоперационном периоде. Выполнена дифференциальная диагностика последствий и осложнений переломов глазницы, определен характер повреждений глазодвигательных мышц, оценена динамика восстановления их функции в послеоперационном периоде. Методом коордиметрии выявлены причины выраженного ограничения подвижности глазных яблок и диплопии. Коордиметрические исследования позволили достоверно определить характер и локализацию повреждения глазодвигательных мышц. Доказано, что коордиметрические исследования, проведенные в динамике, позволяют проследить восстановление функций глазодвигательных мышц на этапах лечения и реабилитации пациентов с последствиями и осложнениями травмы средней зоны лица.

Massive Orbital Emphysema-An Unusual Clinical Presentation of Isolated Medial Orbital Wall Fracture

Orbital emphysema is an unusual complication of orbital fractures which are the common sequelae of periorbital trauma. Most cases are due to inferior orbital wall fractures. Here we report a case with an unusual clinical presentation of isolated left medial orbital wall fracture complicated with massive orbital emphysema. Without ophthalmic or neurologic defect, conservative management with cold compression and analgesics was prescribed. He was also advised not to blow his nose. On follow-up at 1 and 4 months, the orbital emphysema subsided, and the patient remained free of any optic impairment. Relevant literature is also reviewed.

Orbital Fractures Complicated by Late Enophthalmos: Higher Prevalence in Patients With Multiple Trauma

To present our experience with orbital fracture treatment outcomes in patients with multiple trauma and those suffering localized orbital trauma. Retrospective data review of all patients examined for ocular motility problems and/or enophthalmos following orbital trauma in a 4-year period. Forty-three patients were included in the study: 31 (72%) had localized orbital trauma (LOT) and 12 (28%) had concomitant traumatic insults to other organs (MT). More orbital walls were affected in MT patients than in LOT patients, and the incidence of zygomatic fracture was higher in MT patients. Late enopthalmos was much more prevalent in the MT group compared with the LOT group. Differences of outcome of extra ocular motility disturbance between groups in our series did not reach statistical significance. The findings of more walls affected and higher incidence of zygomatic fractures in MT patients probably represent a stronger impact of the original insult, causing both more damage to other organs and more severe damage to the orbit. The increased rate of late enophthalmos in MT patients may be associated with their primary presentation to the emergency room with potentially life-threatening injuries. Under such circumstances, thorough ophthalmologic examination is nearly impossible, both because the patient cannot cooperate sufficiently and because medical priorities dictate concentration on taking care of the injuries threatening life. The lack of a thorough ophthalmic examination prevents early comprehensive treatment.

Long Term Results Following Immediate Reconstruction of Orbital Fractures: A Critical Morphometric Analysis

M Dawar, OM Antonyshyn. Long term results following immediate reconstruction of orbital fractures: A critical morphometric analysis. Can J Plast Surg 1993; 1(1):24-29. The purpose of this study is to review the long term morphological results following primary reconstruction and bone grafting of orbital fractures. All patients presenting to the Victoria General Hospital in Halifax, Nova Scotia between July 1988 and December 1990 with orbital fractures of sufficient severity to require immediate reconstruction were included in the study. The series consists of 39 fractured orbits in 29 patients. In all patients, a standardized data sheet was used in recording patient demographics, and clinical and intraoperative findings. The surgical management of orbital fractures and in particular the redraping of periorbital soft tissues was performed according to a standard protocol. Long term morphometric assessment was performed between 11 and 38 months postoperatively, with a mean follow-up of 27 months. A McCoy facial trisquare and Hertel exophthalmometer were used in the anthropometric evaluation of ocular globe position and position of the periorbital soft tissue landmarks. Postoperative assessment of globe position revealed a 5% incidence of enophthalmos and an 11 % incidence of hyperophthalmia. Minor asymmetries in globe position measuring less than 2 mm were noted in a further 61 % of patients. Ectropion was documented in 8% of patients, but an asymmetry in the height of the palpebral fissure was noted in a further 34% of patients. In terms of canthal relations, lateral canthal dystopia was the most commonly observed deformity, with vertical dystopia occurring in 18% of patients and transverse dystopia in 33% of patients. The observed sequelae and complications of orbital fractures are discussed and possible causative factors identified.

Severe Orbital Infection as a Complication of Orbital Fracture

The article by Silver et al is important because of the potentially devastating complication it considers, severe orbital infection as a complication of orbital fracture. While it is surprising that this complication does not occur more commonly, this probably reflects the usual integrity of the periorbita and its excellent blood supply presenting a barrier to infection. The authors raise two questions: (1) Are severe orbital infections a "frequent" (reviewer's quotes, but not defined by authors) sequela of orbital fractures that are secondary to blunt trauma? And, if so, are there certain patients at increased risk? (2) In the nonsurgical management of orbital fractures secondary to blunt facial trauma, can orbital infections be prevented and can antibiotic prophylaxis assume a role? A retrospective chart review was accomplished, focusing on postorbital septal infections, defining these as "severe" infections presenting shortly after fracture of the orbit secondary to blunt trauma. Three cases See

Severe Orbital Infection as a Complication of Orbital Fracture

Orbital fractures secondary to blunt trauma, and their complications, have been the subject of numerous reports, with little mention of an association with severe orbital infection. Conversely, studies of severe (postseptal) orbital infections rarely make reference to orbital fractures as being a significant pathogenetic factor. In a retrospective study of 130 orbital infections, three cases of severe orbital infection were identified as being associated with an orbital fracture, and are thus presented. In the literature, only anecdotal reports and inconclusive studies address this problem, and its possible prevention. The consequences of a pathologic communication between the paranasal sinuses and the orbit secondary to blunt facial trauma are discussed, along with recommendations for prophylactic management.

Complications of orbital fractures. Their prevention and treatment

Complications of orbital fractures. Their prevention and treatment

Ocular Muscle Complications of Orbital Fractures

Ocular Muscle Complications of Orbital Fractures