Orbital Injury Research Articles

Computed tomography of acute orbital trauma in children: a retrospective study

INTRODUCTION: Orbital injuries account for 36 to 64% of all blunt trauma to the facial bones. Diagnosis of orbital wall fractures is carried out using conventional radiography in several projections and computed tomography; magnetic resonance imaging is less commonly used. Often, due to the small displacement of orbital bone fragments, X-ray diagnosis is difficult. Multislice CT with reconstruction of sagittal, coronal projections and 3D in the bone window in such cases is the best visualization method. However, there are still no clear indications for the use of each method and there is no complete view of the CT characteristics of orbital damage.OBJECTIVE: To study the diagnostic value of computed tomography of orbital fractures in pediatric patients with acute trauma.MATERIAL AND METHODS: Retro- and prospectively analyzed the results of CT scans of 94 patients with facial fractures from 01/01/2023 to 09/01/2023 to assess combined orbital injuries. Orbital fractures were detected in 63 children (67.0%). There were 44 boys (69.84%), 19 girls (30.15%) aged from 7 months to 17 years 10 months (average age 10.3). Statistics: For statistical analysis, the method of calculating the nominal correlation using the Kramer coefficient (V) using the IBM SPSS Statistics software package was used.RESULTS: Concomitant injury was observed in 30 (47.6%); isolated 33 (52.36%). The number and frequency of fractures observed were as follows: superior wall of the orbit — 39 (61.9%); zygomatic complex — 19 (30.1%); lower wall of the orbit — 43 (68.2%); nasal bone — 17 (26.9%); lower jaw — 6 (9.5%); medial wall of the orbit — 28 (44.4%); upper jaw — 27 (42.8%); alveolar process — 6 (9.5%); isolated zygomatic arch — 14 (22.2%); Le Fort type I — 1 (1.5%); Le Fort type II — 2 (3.1%); and Le Fort type III — 0 (0%). Orbital hematomas were found in 25 patients (39.6%). It was revealed a strong correlation between the presence of contiguous skull fractures and multiple skull fractures (V=0.878, p<0.001), frontal sinus fractures and frontal sinus hemosinus (V=0.69, p<0.001).CONCLUSION: Orbital fractures are a frequent type of facial fracture occurring in children with blunt isolated and combined trauma. In children with blunt trauma, head CT combined with clinical examination is currently the optimal tool for diagnosing clinically significant orbital injuries. There is a strong correlation between orbital hematomas and orbital vault fractures, orbital hematomas and lattice fractures, adjacent skull and orbital vault fractures, and adjacent skull and lattice fractures. CT examination should include multiplanar (in coronal and sagittal planes) and 3D reconstructions, which help to assess the extent of the fracture, the presence of diastasis, the degree of muscle impingement. Based on the data obtained, the clinician determines the need for surgical intervention.

Orbital injuries: aspects of forensic medical examination in assessing the severity of harm caused to human health

Background: Forensic examination plays a key role in establishing the severity of injuries, especially of orbital trauma, which can lead to serious consequences, including vision loss. Examination of forensic reports associated with orbital trauma provides valuable information about the nature of the injuries, their prevalence, and factors influencing the severity of the injury. Aim: Analysis of the possibilities of an interdisciplinary approach based on the presence of a full ophthalmological status and computed tomography data of the skull in conducting a forensic medical examination of living persons and in the final qualification of the degree of harm to health in orbital injuries. Materials and methods: An analysis of 37 completed forensic medical examinations of living persons with orbital injuries who were treated in multidisciplinary hospitals in Moscow was carried out. The forensic medical examination was carried out in the Bureau of Forensic Medical Examination of the Moscow Health Department. In 23 cases, the ophthalmological status was assessed at periods from 1 week to 6 months after the injury. In all cases (n = 37; 100%), computed tomography of the facial and cerebral skull was performed. The age of the victims at the time of injury ranged from 12 to 82 years (average 39.7 ± 9.2 years). There were 29 adults among the victims (78.3%), 8 children (21.6%). In terms of gender distribution, there was a significant male predominance — 27 men (73%) versus 10 women (27%). Results: According to the results of the analysis of forensic medical reports, polytrauma with the simultaneous presence of several severe injuries to various organs and systems, combined with orbital trauma, was recorded in 12 victims (32.4%). A combination of traumatic brain injury and orbital injury without involvement of other organs and systems was detected in 9 victims (24.3%), isolated orbital trauma — in 13 people (35.1%), isolated injury of two orbits simultaneously — in 3 victims (8.1%). From the conclusions of forensic experts, it follows that in 89% of cases, the bone walls of the orbits, formed by the frontal, ethmoid and sphenoid bones, as well as the upper jaw, were damaged, which could subsequently lead to damage to the globe, optic nerve and other orbital structures. Damage to the soft tissue of the orbits with globe contusion was noted in 11% of cases. In 3 cases (n = 3; 8.1%), moderate harm to health was determined based on significant persistent loss of general ability to work. In 14 cases (n = 14; 37.8%), it was not possible to focus on the acuteness of the injured globe before the traumatic episode, due to the fact that the victims had no documented visits to an ophthalmologist before the injury. Conclusions: To objectively assess of the orbital trauma and determine the degree of harm to human health, it is necessary to have a full ophthalmological status, including such clinical and instrumental criteria as visual acuteness, presence or absence of ophthalmoplegia and globe dystopia, as well as computed tomography data of the skull, which must be presented in the primary medical documentation.

Exploring 3D Printed Implants With Anti-Dropout Function to Overcome Time Constraints in Acute Orbital Fractures for Patient-Specific Implants.

Orbital wall reconstruction and implant insertion are crucial procedures for temporarily replacing the orbital walls in cases of significant fractures. Traditional methods using planar orbital implants have faced challenges owing to their flat shape, which increases the risk of dislocation from improper cuts and necessitates the use of screws in the orbital rim. This study aims to improve outcomes by employing customized 3-dimensional implants, thereby reducing complications and risk of dislocation resulting from external shock or implant weight postinsertion. This prospective study included 12 Korean individuals diagnosed with facial fractures (orbital wall injuries). Surgeries were performed on 12 patients, and follow-up CT scans were conducted on 10 of them. Therefore, the authors could only address the results for the 10 patients. The authors used bioactive glass ceramics and medical-grade poly-e-caprolactone to 3D print personalized implants, completing the manufacturing process in an average of 4.6 days. Computed tomography scans guided measurements of orbital volumes and exophthalmos. After surgery, we found that the difference values for bone orbital volumes (<0.1mL) and exophthalmos (<1mm except one) decreased compared with presurgery values. Independent t tests and Pearson correlation analysis revealed no significant changes between normal and affected sides in both phases. However, R-values increased in the postsurgery phase. Patients monitored postsurgery at 2 weeks, 3 months, and 6 months showed no complications. The 3D-printed patient-specific implants, customized to individual fracture shapes and featuring distinct implants and locking parts with notches, effectively restore bony orbital volumes and reduce exophthalmos. They have been proven feasible and applicable for reconstructing acute orbital wall fractures.

Dental Rehabilitation of Patients with Extreme Resorption of the Alveolar Process of the Upper Jaw with the Use of Zygomatic Implantation

The innovative method of zygomatic implantation is a rational method of dental rehabilitation for extreme resorption of the alveolar ridge. However, like any method, it is associated with certain disadvantages. These include: difficult surgical access requiring significant experience, risk of orbital injury, prolonged speech dysfunction, postoperative sinusitis, oroantral fistula, periorbital and conjunctival hematoma. The aim of the study was to evaluate the long–term results of maxillofacial and dental rehabilitation using zygomatic implantation. A comparative analysis of the obtained data revealed a significantly lower frequency of early postoperative complications with the use of zygomatic implantation 3 (2,6 % p = 0,112) compared with classical implantation 8 (11,5 % p &lt; 0,002). There were no cases of zygomatic implants rejection, unlike traditional implantation, 8 (11,5 % p &lt; 0,002). Conclusion. Rehabilitation of patients with extreme alveolar process resorption using zygomatic implants has shown high efficiency, with a significantly lower frequency of local complications and fewer lost implants compared with traditional implantation.

Post Traumatic Intra Orbital Encephalocele, a Rare Cause of Pulsating Orbit: Case Report

Orbital trauma is a prevalent condition in clinical practice, particularly in situations of head trauma. Orbital roof fractures following a blunt trauma are an uncommon consequence of trauma. Traumatic encephaloceles in the orbital cavity are much more uncommon, with only a few examples reported to date. Early detection and therapy of raised intraorbital pressure can avoid irreparable optic nerve injury. In trauma patients with concomitant orbital injuries, orbital computed tomography (CT) with thin axial and coronal slices is beneficial. Decompression of the orbital roof is the most important stage in surgical therapy and should be done in all cases. We report the case of an adult with a post-traumatic orbital encephalocele. A few hours after a road traffic accident with head injury, the patient developed progressive pulsatile enophtalmosis. Computed tomography revealed multiple fractures of the orbital rim with herniation of the left frontal lobe into the orbit.

Experimental Reconstruction of the Optic Nerve with a Sural Nerve Graft: An in Vivo Experimental Study

IntroductionNeurosurgical interventions and trauma are common causes of damage to the optic nerve. This determines the relevance of research for solutions aimed at restoration of the nerve’s anatomical integrity, electrical conductivity, and subsequently – restoration of its function. Purpose of the studyRestore a damaged (cut) optic nerve using n. suralis autograft in vivo. Materials and methods. The experiment involved reconstruction of the optic nerve through injury modulation, graft placement and restored nerve harvest and evaluation. Injury modulation included removal of a fragment of the optic nerve. Autograft harvesting and placement involved resection of a fragment of the sural (sensory) nerve and its subsequent anastomosis in place of the removed fragment of the optic nerve. As an experimental model, a rabbit of the “Burgundy” breed was used The animal was previously examined for the presence of infectious and other diseases to confirm it’s health. ResultsFour months post operatively when stimulating the operated right eye, low-amplitude components altered in shape are registered. Thus, signs of mild restoration of electrical conductivity on the treated optic nerve were seen. ConclusionOur initial experience shows the technical feasibility of reconstructing the optic nerve using an autograft, the possibility of axonal growth through the graft and, in the future, using this method for direct optic nerve reconstruction, as well as abypass method for damage to the optic nerve with various tumor diseases of the optic nerve, tumors of the chiasmatic-sellar localization, orbital injuries.

PEDIATRIC OCULAR TRAUMA MANAGEMENT: A CASE STUDY OF EFFECTIVE INTRA-ORBITAL FOREIGN BODY IOFB EXTRACTION

Highlights: The rare nature of Orbitocranial Injury with Intraorbital Foreign Body (IOFB). Utilizing a 3D Head CT Scan to ascertain the precise location of the IOFB and its impact on anatomical structures is pivotal in shaping immediate treatment strategies, thereby reducing the potential for complications. Abstract: Introduction: Penetrating intraorbital foreign body (IOFB) injuries are a rare form of traumatic injury. Recognized as a surgical emergency, meticulous history-taking and a thorough examination are essential for determining the trauma's mechanism and cause, facilitating accurate diagnosis and effective disease management. Case Illustration: In the emergency room, a 5-year-old female patient was presented with a craniofacial injury resulting from an IOFB. An evacuation procedure, conducted through a subsidiary incision, was performed to extract the foreign body. Interestingly, the object removed from the orbital cavity was a plastic foreign body, initially suspected to be a fractured orbital bone. Discussion: The clinical presentation, management, and outcomes of orbital foreign body injuries can differ based on the material composition of the foreign body. In cases of intraorbital foreign body trauma, the primary treatment goal is foreign body removal. Conclusion: Precise and accurate initial management in the emergency department is crucial. Early diagnosis, aided by a 3D head CT scan, is instrumental in locating the IOFB and identifying the involved anatomical structures. This, in turn, enables timely treatment decisions to minimize the risk of complications.

Pediatric Head and Neck Dog Bites in the United States: A NEISS Database Investigation of Risk Factors and Escalation of Care.

Pediatric patients experience increased morbidity secondary to head and neck dog bites. The authors examined risk factors among pediatric head and neck dog bite patients and which factors are associated with admission to inform prevention efforts. All patients who suffered head and neck dog bites from 2013-2022 in the National Electronic Injury Surveillance System (NEISS) database were reviewed. Demographics among discharged and escalation of care (EOC) patients were compared using multinomial logistic regression (MLR), and linear regression was employed to analyze yearly emergency room (ER) visit incidence. Among 949 pediatric patients, 57.2% were male, 43.4% were 2-6 years old, and 77.7% sustained face or mouth injuries. Attacks were commonly provoked (60.5%), occurred in the home (82.3%), and involved a dog known to the patient (61.7%). The most common dog breed involved was Pitbull (33.1%). MLR revealed increased EOC among patients with neck injury (OR=11.82, SE=0.68, P<0.001), orbital injury (OR=12.91, SE=0.55, P<0.001), unprovoked attacks (OR=2.67, SE=0.16, P<0.001), and those under 2 years old (OR=1.83, SE=0.19, P=0.002). There was a significant yearly rise in the number of pediatric head and neck dog bites (model coefficient=6.467, SE=1.40, P=0.002). Overall, increased caution around particular dog breeds in households with children under 2 years old may decrease head and neck dog bite injuries. While pediatricians should perform general safety education, enhanced knowledge of risk factors is essential for proper inpatient counseling by surgical specialists.

Evaluation of Complications of Midface Fracture Including the Orbital Floor.

Choosing an appropriate course of treatment for midface fracture can be challenging due to the variable presentations of midfacial fractures and concurrent orbital floor injuries. To evaluate complications of midface fracture including the orbital floor. It was a cross-sectional study carried out on 456 patients diagnosed with midface fracture, including the orbital floor, clinically and radiographically. The computed tomography radiograph of each study participant was evaluated. There was a thorough clinical assessment of each study participant. There were complications like laceration (47.3%), hematoma (54.2%), infraorbital nerve paraesthesia (13.05%), Contusio bulbi (13.30%), and diplopia (13.35%). No complications were observed in 8.25% of study participants. The most common complication was laceration. The eyeball, orbit, soft tissues, and surrounding structures should be precisely examined clinically and radiologically in midface fractures.

Titanium Implants Coated with Hydroxyapatite Used in Orbital Wall Reconstruction-A Literature Review.

With the increasing incidences of orbital wall injuries, effective reconstruction materials and techniques are imperative for optimal clinical outcomes. In this literature review, we delve into the efficacy and potential advantages of using titanium implants coated with nanostructured hydroxyapatite for the reconstruction of the orbital wall. Titanium implants, recognized for their durability and mechanical strength, when combined with the osteoconductive properties of hydroxyapatite, present a potentially synergistic solution. The purpose of this review was to critically analyze the recent literature and present the state of the art in orbital wall reconstruction using titanium implants coated with nanostructured hydroxyapatite. This review offers clinicians detailed insight into the benefits and potential drawbacks of using titanium implants coated with nanostructured hydroxyapatite for orbital wall reconstruction. The highlighted results advocate for its benefits in terms of osseointegration and provide a novel strategy for orbital reconstruction, though further studies are essential to establish long-term efficacy and address concerns.

Aesthetic Surgery &amp; the Indications at A Sub-Urban Tertiary Hospital in Edo State, Nigeria

Background: Aesthetic surgery though growing at an exponential rate in developed countries is still not well developed in Nigeria. Though lately, there has been an increasing demand for cosmetic procedures in Nigeria but still, the practice is still slow growing. Objective: Few reports of the scope of aesthetic surgery are available from the sub region and Nigeria as a whole. In this study we seek to determine the aesthetic procedures and its indications in our centre, a sub urban teaching hospital in Irrua, Edo State, Southern Nigeria. Methods: A retrospective study of all aesthetic surgery cases carried out over a 5-year period – Jan 2019 to December 2023 at Irrua Specialist Teaching Hospital. Data from theatre records and case notes were analysed with respect to age, sex, procedure and indications for surgery done. Descriptive analysis of variables, means and percentages were considered. Results: In the period of study, 1,066 plastic surgery procedures were documented: 34 (3.19%) were for aesthetic indications. Sixteen of the patients (47.1%) were male and 18 (52.9%) female. Age range of patients that had aesthetic surgery was 1 - 60 years and the mean age was 24.1 + 18.08 years. The commonest aesthetic procedure was cleft repair 14 (41.17%) following cleft lip/palate, the rest were scar revisions 6 (17.65%) with the commonest indication being unsightly scar, otoplasties 5 (14.70%) following traumatic injury to the ear, liposuction 3 (8.82%) indicated by lipodystrophy, rhinoplasties 3 (8.82%) post traumatic injury to the nose, mammoplasties 2 (5.88%) which were done post mastectomy, and one (2.94%) cranioplasty following gun-shot orbital injury. Conclusion: There is paucity in the volume of cosmetic procedures in Irrua and the pattern of requests here differs in many respects from western centres. With the current reduced pool of aesthetic surgery, it is advisable to establish an aesthetic surgery sub-unit in most tertiary institutions. This sub-unit should be fully functional including special clinic days, as this could help attract future clients and develop this branch of Plastic Surgery.

Eye and Orbit Injuries Caused by Electric Scooters and Hoverboards in the United States.

To evaluate eye and orbital injuries in non-powered scooter, electric-scooter (e-scooter), and hoverboard riders in the United States (US) between 2014 and 2019. The National Electronic Injury Surveillance System (NEISS) was queried for head and neck injuries by body part codes related to non-powered scooters and powered scooters/hoverboards from 2014 to 2019. The NEISS complex sampling design was used to obtain US population projections of injuries and hospital admissions. Keywords were queried in case narratives to analyze trends in location, type, and mechanism of eye and orbit injuries. Since their introduction, a 586% (p=0.01) increase in e-scooter injuries and 866% (p<0.001) increase in hoverboard injuries were observed with an increase in hospital admissions seen in young adults (18-34) in urban areas (e-scooter: 5980% and hoverboard: 479%). Descriptive narratives of the trauma noted eye injuries in 242 unweighted NEISS cases with only 30 cases appropriately documented under body part code 77: eyeball. Eye injuries increased 96.9% during the study period (p=0.23). Specifically, the most common ophthalmic injuries reported included eyebrow (40.9%) and eyelid (11.3%) lacerations, periorbital contusions (18.7%), orbit fractures (6.6%), and corneal abrasions (5.1%). There was a significant increase in both head and neck injury cases and hospital admissions related to e-scooters. Eye and orbit injuries similarly increased but were underreported by body part code compared to injury narratives. Orbital fractures were reported more frequently in injuries from e-scooters than non-powered scooters.

Patterns of concomitant traumatic brain injury and ocular trauma in US service members

BackgroundConcomitant traumatic brain injury (TBI) and ocular trauma (OT) are caused by the same physical mechanisms, which may complicate therapeutic intervention if screening and evaluation of each condition are not...

Customized Prosthetic Management for Post Orbital Exenteration Patient: A Case Report

Introduction : Orbital exenterations are performed to treat malignancies, orbital injury or other chronic conditions unresponsive to conservative therapy. Exenteration can result in depression, difficulties in daily activities, and aesthetic problems. Orbital prosthetic is an alternative therapy for aesthetic rehabilitation and protection of the orbital cavity.&#x0D; Case Illustration : A 46-year-old woman came with a chief complain of a black mass on the left lower eyelid ten years ago. Patient was diagnosed with basal cell carcinoma and underwent extirpation of the mass with skin graft reconstruction. On histopathological examination, it was discovered that the incision base was not free of tumor. Patient came two years later with recurrent black mass invaded cornea and sclera, and then underwent exenteration of the left eye (Figure 1). Patient completed 40 cycles of radiotherapy and then used spectacle retained orbital prosthetic (Figure 2 &amp; 3).&#x0D; Discussion : Orbital prosthetics are synthetic replacement after exenteration that can restores orbit, eyelid, eye and periorbita anatomy. Orbital prosthetic retention can be aided by attachment to spectacle, use of magnets, adhesives or osseointegrated implants. Spectacle retained orbital prosthetic is the easiest and the most affordable prosthetic to construct.&#x0D; Conclusion : Orbital defects rehabilitation improves physical and psychological well-being. Due to the complexity of prosthetic fabrication and production cost, retention of the orbital prosthetic with spectacles is the most suitable alternative treatment option in some cases, it is also the easiest prosthetic to construct and inexpensive.

A Case of Pediatric Eyelid Laceration ec Unusual Foreign Body

Introduction : Eyelid lacerations refer to partial or full-thickness defects in the eyelid and constitute a significant subset of facial trauma which is often accompanied by other injuries including foreign bodies.&#x0D; Case Illustration : A 16-year-old boy was brought to the emergency department with a laceration and penetrating orbital injury in his right upper eyelid. On examination, there was a 4 cm x 0,5 cm upper eyelid laceration caused by tooth penetrating, CT scan revealed a high density foreign body measuring 1,5 cm x 0,5 cm in the right upper eyelid as deep as levator muscle and no globe injury. The patient underwent an emergency operation under general anesthesia, the foreign body was removed completely and the size of the foreign body was 2,6cm x 0,5cm. After the removal of the foreign body, debridement was performed and then sutured layer by layer. After surgery, he was treated with Tetanus prophylaxis, antibiotic, and analgetic.&#x0D; Discussion : Eyelid laceration is one of the most encountered ocular trauma, but needed to be evaluated and treated carefully. Although the rate of ocular foreign bodies found was low, it can lead to devastating ocular morbidities. After surgery and treatment, there is no other complaint from the patient. Visual acuity and ophthalmology examination are all in normal condition.&#x0D; ConclusionEyelid trauma with foreign bodies must undergo a complete examination. A good prognosis and outcomes can be achieved when appropriate medical and surgical treatment is performed.

Orbital Fat Herniation Through Inferior Orbital Fissure and Persistent Diplopia Caused by Facial Trauma.

Orbital fat herniation is often accompanied by orbital floor fractures. Furthermore, herniation through the inferior orbital fissure (IOF) is rare, and its pathophysiology remains largely unknown. Here, the authors report a case of a patient with IOF herniation and diplopia caused by orbital trauma. The patient was a 58-year-old male who had undergone reduction of a left zygomatic fracture 15 years previously; however, reduction of the lateral orbital wall displacement was not performed at that time. The patient presented with refractory diplopia following a sports-related orbital injury. Although no new facial fractures occurred, an asymmetric IOF herniation was observed in the left orbital fissure, which caused persistent diplopia. Surgical repair of the orbital fat herniation was performed 46 days after injury. Two months after the surgery, the herniation of the orbital fat and diplopia completely disappeared. Surgery for an IOF herniation should be considered when ocular symptoms persist after orbital trauma.

Характеристика множественной и сочетанной офтальмотравмы у детей на современном этапе

Aim: to identify the medical and epidemiological hallmarks of eye damage in children with complex and multiple injuries in a specialized surgical department. Patients and Methods: this study included 403 children aged 1 month to 18 years with eye injuries associated with multiple or complex injuries of varying severity on the day before hospital admission. All children were admitted between 2014 and 2020. The following data were evaluated: patient's age, gender, severity of complex trauma based on the ISS score, cause of trauma, combination of anatomical areas involved. Results: among children with mechanical complex eye injuries, 255 (63%) were boys and 148 (37%) were girls. The mean age of boys was 10.2±0.34 years, and the mean age of girls was 8.5±0.42 years. Furthermore, more than half (67.5%) of those included in the study were school-aged children and adolescents. The most common types of injuries were those resulting from falls from height, school, sports, gunshot/mine blast, and street incidents. In more than half of the children (n=227, 56.4%), orbital traumas affecting the walls and/or content were reported. The most common type of eye damage was a complex damage to the orbit and ocular adnexa (most often as a periorbital hematoma). The percentage of children with multiple fractures of the orbital walls increases with an increase in the severity of polytrauma. Conclusions: children most often received mechanical complex eye injuries as a result of road traffic accidents. The percentage of children with minor, moderate, and severe complex injuries (assessed by the ISS) was 47.1%, 18.4%, and 33.5%, respectively. Orbital fractures are the most common surgical entities in children with complex mechanical eye injuries. Unilateral orbital fractures were diagnosed in 56.4% of cases, while bilateral orbital fractures were diagnosed in 17.9%. In the majority of instances, mechanical complex eye injuries are associated with traumatic brain injury (99%). KEYWORDS: complex eye injuries, multiple injury, combined injury, mechanical complex eye injury, orbital fracture, orbital injury, morbidity pattern, damage to eye. FOR CITATION: Arzhimatova G.Sh., Karaseva O.V., Koroleva E.A., Chernakova G.M. Multiple and complex eye injuries in children. Russian Journal of Clinical Ophthalmology. 2024;24(2):78–82 (in Russ.). DOI: 10.32364/2311-7729-2024-24-2-6.

Orbital Structure Involvement in Midface Fractures Impacting Ocular Injury at a Tertiary Hospital in Eastern Indonesia

ABSTRACT Introduction: The midface is a complex anatomical area consisting of several areas. Although various factors protect the eye from trauma, such as orbital rim, blink reflex, elasticity of ocular structures, and protective eye movements by hands and head, ocular injuries remain common in patients with midface fractures, with an incidence rate of up to 90.6%. This study, the first of its kind conducted in Indonesia, aims to evaluate the characteristics and incidence of ocular injuries in midface fractures and to examine the relationship between the treatment. Methods: This observational analytic study employed a retrospective cohort design, utilizing medical record data of midface fracture patients. The independent variables included age, sex, cause, incidence, segment and severity of ocular injury, number of orbital wall involvements, and treatment options. The dependent variable was midface fracture patients. The Mann–Whitney and Fisher’s exact tests were employed to analyze the multivariate data. Results: Individuals aged 32–37 were most commonly affected due to accidents, with the anterior ocular segment and maxilla bone frequently affected. There are no special factors that differentiate a person from experiencing an ocular injury in a midface fracture (P &gt; 0.05). Ocular injuries correlated with orbital wall injury (P = 0.008) at least one discontinuity. Impaired functions included movement and visual disturbances, diplopia, and dystopia (P = 0.134). Conclusions: No significant relationship was found between age, sex, and cause of trauma with ocular injuries in patients with midface fractures. However, a significant relationship was observed between the amount of orbital rim involvement and at least one wall discontinuity occurring in midface fracture patients.

Orbitoethmoidal foreign body through traumatic penetrating orbital injury

Foreign bodies in the nasal cavity, paranasal sinuses, and orbit are commonly related to high-velocity maxillofacial injuries. Cases of foreign bodies in paranasal sinuses are very rare. They may present with non-specific symptoms which make them easily neglected during history taking and clinical assessment. High clinical suspicion and radiological assessments are essential in patients with high-velocity insult to rule out the possibility of impalement injury. The course of management is determined by the location and type of foreign body. We share a rare case of metallic foreign bodies in the orbitoethmoidal region which took a combined surgical and conservative course of treatment involving a multidisciplinary team.

Association of Complication Rates and Intensive Care Unit Use With Sinonasal and Skull Base Malignancies: A Propensity Score Matching Analysis.

Background: Patients with sinonasal and skull base malignancies experience many types of complications after surgery. The intensive care unit (ICU) provides a high level of care for these patients; however, the effect of ICU care on complication rates remains unclear. Methods: Between November 2014 and November 2022, we retrospectively analyzed 151 patients with sinonasal and skull base malignancies. Fifty-six of these patients were admitted to the ICU and 95 were admitted to the non-ICU after surgery. Propensity score matching (PSM) was performed to balance baseline characteristics. The complication rates of the ICU and non-ICU groups were compared. Results: Before PSM, the complication rate was 28.5%. Patients admitted to the ICU had a higher incidence of medical complications (P = .032). Orbital injury (n = 9) and diplopia or visual changes (n = 9) were the most common surgical complications, whereas respiratory tract infections (n = 7) were the most common medical complications. After PSM, the incidences of surgical, medical, and all complications in the ICU and non-ICU groups were 23.8% and 19.0% (P = .791), 16.7% and 9.5% (P = .520), and 38.1% and 26.2% (P = .350), respectively. Conclusions: This preliminary study revealed that ICU admission did not reduce the complication rate of patients with sinonasal and skull base malignancies. Further studies are required to validate these findings and clarify the potential role of the ICU.