Management Of Blow-out Fractures Research Articles

Blowout Fracture Complex Type

Functional problems and appearance may emerge if careful therapy is not applied in orbital fracture caused by maxillofacial trauma. Recently, the focus of fracture management on fragment fixation most possibly uses anatomy approach. The management of blowout fracture should be overcome by involving several departments. First, identification was carried out in emergency room and then it is consulted to occuloplasty and maxillofacial trauma surgeon. Multidisciplinary management will provide better outcome to retrieve face structural function and improve the appearance. We reported two cases of blowout fracture complex in Dr. Soetomo Hospital, Surabaya, Indonesia, done by Plastic Reconstruction Division of ORL-HNS Department in collaboration with Plastic Reconstruction Division of Ophthalmology Department. In the first case, a 64-year-old female was consulted by Plastic Reconstruction Division of Ophthalmology Department with diagnosis of right orbital adnexal injury, open eye globe injury, scleral laceration, and blowout fracture. In the second case, a 37-year-old male came to Plastic Reconstruction Division of ORL HNS Department, consulted by Plastic Reconstruction of Ophthalmology Department with diagnosis of left cornea and scleral laceration, left full thickness laceration palpebral at 1/3 nasal inferior, rupture of lacrimal canal, and blowout fracture. These cases of blowout fracture with rim orbita fracture complex type were managed well by Plastic Reconstruction Division of ORL-HNS and Plastic Reconstruction Division of Ophthalmology Department. It is apparent that multidisciplinary management was required for optimum outcome.

Case Report: Blowout Fracture Complex Type

Functional problems and appearance may emerge if careful therapy is not applied in orbital fracture caused by maxillofacial trauma. Recently, the focus of fracture management on fragment fixation most possibly uses anatomy approach. The management of blowout fracture should be overcome by involving several departments. First, identification was carried out in emergency room and then it is consulted to occuloplasty and maxillofacial trauma surgeon. Multidisciplinary management will provide better outcome to retrieve face structural function and improve the appearance. We reported two cases of blowout fracture complex in Dr. Soetomo Hospital, Surabaya, Indonesia, done by Plastic Reconstruction Division of ORL-HNS Department in collaboration with Plastic Reconstruction Division of Ophthalmology Department. In the first case, a 64-year-old female was consulted by Plastic Reconstruction Division of Ophthalmology Department with diagnosis of right orbital adnexal injury, open eye globe injury, scleral laceration, and blowout fracture. In the second case, a 37-year-old male came to Plastic Reconstruction Division of ORL HNS Department, consulted by Plastic Reconstruction of Ophthalmology Department with diagnosis of left cornea and scleral laceration, left full thickness laceration palpebral at 1/3 nasal inferior, rupture of lacrimal canal, and blowout fracture. These cases of blowout fracture with rim orbita fracture complex type were managed well by Plastic Reconstruction Division of ORL-HNS and Plastic Reconstruction Division of Ophthalmology Department. It is apparent that multidisciplinary management was required for optimum outcome.

New Algorithm for the Management of Orbital Blowout Fracture Based on Prospective Study.

Despite extensive debate and publications in the management of blowout fracture (BOF), there are still considerable differences in the surgeons' management of BOF due to a lack of reliable evidence-based studies. This article aimed to evaluate which BOF patients require surgical treatment due to functional and/or cosmetic deformities; evaluate which computed tomography (CT) scan findings predict these problems; and provide an algorithm in the management of BOF. Seventy-nine patients with BOF were treated conservatively and followed up prospectively regarding functional and cosmetic deformities for at least 1 year. The patients' CT scans were analyzed and several measurements were performed. Patients' symptoms and the clinical findings were correlated to the CT scan measurements. We found visible deformity in 37% of the patients, but only 10% chose to proceed to surgery due to cosmetic deformities. In patients with inferior BOF and a herniation < 1.0 mL, a visible deformity was found when the ratio between fracture and the fractured orbital wall areas was ≥42%, or the total area of the fracture was ≥ 2.3 cm 2 . In patients with inferior BOF and a herniation ≥ 1.0 mL, a visible deformity was found when the distance from the inferior orbital rim to the posterior edge of the fracture was ≥ 3.0 cm. In patients with inferomedial fracture, a visible deformity was found when the herniation was ≥ 0.9 mL. Diplopia improved significantly and remained in only 3% of the patients in nonoperated group. Hypoesthesia of the infraorbital nerve improved significantly, but 23% of the nonoperated and 50% of the operated patients still experienced loss of sensation at final control. In this prospective study, we found that not only herniated orbital volume but also other CT scan findings in BOF were crucial to predict late visible deformities. Based on these findings, we propose an algorithm for the prediction of late visible deformity with 83% accuracy. There are indications that diplopia without ocular motility disorder is due to edema and we recommend observation as long as the diplopia improves gradually.

Management of Blowout Fracture With Support of Video Endoscopy in a Pediatric Patient.

Pure orbital fractures have the tendency to occur on medial wall and orbital floor; because these points are more fragile, the endoscopy can be utilized for accomplishing the task of repositioning the herniated content, as well as serving as an additional tool, helping to view the orbital defects through a transantral approach. The presented case is a female patient, 12 years old, who was diagnosed as having a pure blowout fracture, on right orbital floor, type trapdoor, with orbital content herniated toward the maxillary sinus. It was realized that a surgical procedure for reduction of orbital content through video endoscopy, via antral, allowed a great viewing of soft and hard structures, checking the positioning of implants and its relation with the orbital cavity, enabling installing through a small surgical access and minimum detachment, and favoring postoperative recovery.

Still no reliable consensus in management of blow-out fracture

BackgroundManagement of blow-out fractures (BOF) is addressed by different specialties. The general agreement is that patients with the potential for late enophthalmus development require early surgical intervention. In this study we wanted to: (i) evaluate the differences in opinions between the specialties that manage BOF and also whether there was a difference between surgeons from different countries, (ii) evaluate if surgeons handle these cases based upon their own individual criteria,1 (iii) evaluate the correlation between the management of patients with orbital floor fractures and any late sequelae detected upon eye examination. Materials and methodsEleven patients with BOF were selected from the records of the Department of ENT and Head & Neck Surgery, Karolinska University Hospital between 2003 and 2008. The cases were presented with a case history and CT scans to 46 surgeons from different countries and specialties and they were asked to give their opinions regarding the need for surgery, timing of surgery and the risk for late enophthalmus. We considered a group of surgeons to be in agreement if there was ≥75% agreement on whether or not to operate, when to operate and on the risk for late enophthalmus. ResultThe surgeons agreed on the choice of management for the patients (whether or not to operate) in only 5 of the 11 cases. Similarly, in only 5 of the 11 cases did the surgeons agree upon the risk for late enophthalmus. There was a greater difference between specialities than between physicians from the participating countries. ConclusionThere are considerable differences in opinions regarding the management of BOF due to a lack of a reliable consensus. The management of BOF appears to be based on both individual and local traditions. Guidelines based on a randomized prospective study in BOF are required.

Late correction of complications of orbital trauma

Koornneef L: Current concepts on the management of orbital blowout fractures. Ann Plast Surg 9:185, 1982 Bartkowski SB, Krzystkowa KM: Blow-out fracture of the orbit. Diagnostic and therapeutic considerations and results in 90 patients treated. J Oral Maxillofac Surg 10:155, 1982 Putterman AM, Stevens T, Uris TMG: Non-surgical management of blow-out fractures of the orbital floor. Am J Ophthmal 76:232, 1974

Management of Facial Fractures

Maxillofacial fractures are usually diagnosed easily by history, clinical findings, and standard roentgenograms. Emergency treatment centers around airway management; the conscious patient should be allowed to clear his own airway whenever possible. Treatment of lower and upper jaw fractures focuses on reducing the fragments so that dental occlusion is normal. Other midface fracture reductions require additional exact orbital rim alignment. Immobilization of fractures can require various combinations of intermaxillary fixation, interosseous wiring, suspensory wires from intraoral arch bars, transfacial Kirschner wires, occasional maxillary antral packs, and rare external fixation with headframes or external pins. Patients who may be comatose or seriously ill for several weeks should have a simple and safe compromise reduction and K-wire fixation done at the bedside. Management of blow-out fractures of the orbit and frontal sinus fractures is somewhat controversial. Naso-orbital central factial fractures are especially difficult to maintain in proper reduction. Listed are possible late postoperative complications after treatment of facial fractures.

Diagnosis and Management of Blowout Fractures of the Orbit with Clinical, Radiological and Surgical Aspects

Diagnosis and Management of Blowout Fractures of the Orbit with Clinical, Radiological and Surgical Aspects