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Retrospective analysis of 73 orbital floor fractures
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21st ICOMS 2013—Abstracts: Oral Papers
Methods: After confirmation of a zygomatic complex fracture the patients were divided into groups of surgically and non-surgically treated fractures, with and without fracture displacement. The groups were compared according to age, gender, degree of fracture displacement and clinical signs. Results: 283 patients were included, with a mean age of 43 years and a domination of male patients. All type C-fractures and the majority of type B-fractures were treated surgically. Except for facial swelling, the symptoms frequently found in the surgically treated patients, were found less common in the non-surgically treated patient group. Extraoral steps, intraoral steps, and malar depression were significantly related to surgical treatment. Conclusions: The clinical characteristics extraoral steps, intraoral steps, and malar depression, in contrast to paraesthesia of the infraorbital nerve, were significantly related to surgical treatment of zygomatic complex fractures. Knowledge of the differences between the surgically and non-surgically treated patients may help physicians to develop future methods in clinical decision making. Key words: trauma; zygomatic fracture; treatment; surgical; non-surgical http://dx.doi.org/10.1016/j.ijom.2013.07.217 T7.OR056 Visual recovery following emergent orbital decompression in traumatic retrobulbar haemorrhage—case report B. Santos Gomes ∗ , D. Pratas Vital, A. Millan, C. Semedo, O. Costa, P. Coelho Centro Hospitalar De Lisboa Central, Portugal Background and objectives: Retrobulbar haemorrhage is an uncommon, but potentially devastating complication associated with facial trauma. The rapid increase in orbital pressure can cut off perfusion to vital ocular structures, leading to intermittent or in more severe cases permanent visual loss. The cardinal signs and symptoms of retrobulbar haematoma are pain, diplopia, ophthalmoplegia, a progression of increasing proptosis, and decreasing visual acuity that may lead to blindness. Methods: We report a case of a 35 years old men with protptosis, ophtalmoplegia and complete vision lost of the left eye, after being assaulted. Pathology off the eye ball was excluded by an ophthalmologist. The CT scan showed left multiple orbital fractures of the floor and internal wall, retrobulbar haemorrhage and optic nerve stretching. He underwent an emergency procedure with drainage of the haematoma and reconstruction of the orbit with a titanium plate, trough an infraorbital approach. Steroid therapy was also promptly started. Results: 2 days after the surgery the patient started to recovery eye movements and light perception. 1 month after surgery the patient has a 2/10 visual acuity, still maintaining diplopia in upper gaze. Conclusions: In severe acute retrobulbar haemorrhage, prompt surgical evacuation of the haematoma can reverse visual loss. http://dx.doi.org/10.1016/j.ijom.2013.07.218
T7.OR057 Retrospective analysis of 73 orbital floor fractures C. Semedo ∗ , L. Nunes da Silva, A. Pratas, A. Millán, B. Gomes, M. Oliveira, I. Beleca, P. Coelho Centro Hospitalar De Lisboa Central EPE, Hospita De São José, Servi¸co De Cirurgia Maxilofacial, Portugal Background and objective: The thin orbital floor is particularly vulnerable during facial trauma. Different surgical procedures and materials have been used for orbital floor reconstruction, with therapeutic results not always satisfactory. The objective of this retrospective study is to analyze therapeutic options and postoperative complications in adult patients with orbital floor fractures who underwent surgery. Methods: Review of the files of our institution over a 30 month period. 73 adult patients with orbital floor fractures submitted to surgery were collected. Patients were analyzed for age, sex, diagnostic tools, fracture pattern, surgery delay, implant materials, complications and sequelae. Results: Men in the fifth decade were the most frequently affected. Fracture’s patterns were as follows: orbital floor, 40 cases; orbital floor and other walls 33 cases. Average delay for surgery was 3.75 days. Implant materials used for the reconstruction were: titanium mesh in 38 cases; PDS sheets in 28 patients; Neuro-Patch in 4; pre-formed orbital plates 3. 12 patients needed a second surgery for implant replacement. Permanent sequelae were observed in 12 cases. Conclusions: All implant materials used were successful to variable degrees improvement but a guideline for choice of implant material needs to be developed. Key word: orbital floor fracture http://dx.doi.org/10.1016/j.ijom.2013.07.219 T7.OR058 New approach for the diagnosis and treatment of parotid trauma S. Sivan ∗ , O. Nahlieli Barzilai Medical Center, Israel Introduction: Penetrating injuries to the cheek can lead to significant complications due to intricate structures that lie within it. Multiple methods were described in the literature for diagnosis and treatment of parotid injuries. Methods: During the years 2009–2013 12 cases ages 6 months to 66 years of cheek lacerations with parotid duct and gland trauma were treated. The diagnostic methods that we used in all cases included combination of CT, CBCT and sialography imaging. Repair methods included direct anastomosis under endoscopic visualization and active drains. All participants have been observed for up to 1 year following procedures. Results: All patients gained complete salivary function and no salivary fistula of sialocele were observed. Conclusions: A new innovative technique is described for accurate diagnosis and complete repair of parotid trauma. http://dx.doi.org/10.1016/j.ijom.2013.07.220
21st ICOMS 2013—Abstracts: Oral Papers
Methods: After confirmation of a zygomatic complex fracture the patients were divided into groups of surgically and non-surgically treated fractures, with and without fracture displacement. The groups were compared according to age, gender, degree of fracture displacement and clinical signs. Results: 283 patients were included, with a mean age of 43 years and a domination of male patients. All type C-fractures and the majority of type B-fractures were treated surgically. Except for facial swelling, the symptoms frequently found in the surgically treated patients, were found less common in the non-surgically treated patient group. Extraoral steps, intraoral steps, and malar depression were significantly related to surgical treatment. Conclusions: The clinical characteristics extraoral steps, intraoral steps, and malar depression, in contrast to paraesthesia of the infraorbital nerve, were significantly related to surgical treatment of zygomatic complex fractures. Knowledge of the differences between the surgically and non-surgically treated patients may help physicians to develop future methods in clinical decision making. Key words: trauma; zygomatic fracture; treatment; surgical; non-surgical http://dx.doi.org/10.1016/j.ijom.2013.07.217 T7.OR056 Visual recovery following emergent orbital decompression in traumatic retrobulbar haemorrhage—case report B. Santos Gomes ∗ , D. Pratas Vital, A. Millan, C. Semedo, O. Costa, P. Coelho Centro Hospitalar De Lisboa Central, Portugal Background and objectives: Retrobulbar haemorrhage is an uncommon, but potentially devastating complication associated with facial trauma. The rapid increase in orbital pressure can cut off perfusion to vital ocular structures, leading to intermittent or in more severe cases permanent visual loss. The cardinal signs and symptoms of retrobulbar haematoma are pain, diplopia, ophthalmoplegia, a progression of increasing proptosis, and decreasing visual acuity that may lead to blindness. Methods: We report a case of a 35 years old men with protptosis, ophtalmoplegia and complete vision lost of the left eye, after being assaulted. Pathology off the eye ball was excluded by an ophthalmologist. The CT scan showed left multiple orbital fractures of the floor and internal wall, retrobulbar haemorrhage and optic nerve stretching. He underwent an emergency procedure with drainage of the haematoma and reconstruction of the orbit with a titanium plate, trough an infraorbital approach. Steroid therapy was also promptly started. Results: 2 days after the surgery the patient started to recovery eye movements and light perception. 1 month after surgery the patient has a 2/10 visual acuity, still maintaining diplopia in upper gaze. Conclusions: In severe acute retrobulbar haemorrhage, prompt surgical evacuation of the haematoma can reverse visual loss. http://dx.doi.org/10.1016/j.ijom.2013.07.218
T7.OR057 Retrospective analysis of 73 orbital floor fractures C. Semedo ∗ , L. Nunes da Silva, A. Pratas, A. Millán, B. Gomes, M. Oliveira, I. Beleca, P. Coelho Centro Hospitalar De Lisboa Central EPE, Hospita De São José, Servi¸co De Cirurgia Maxilofacial, Portugal Background and objective: The thin orbital floor is particularly vulnerable during facial trauma. Different surgical procedures and materials have been used for orbital floor reconstruction, with therapeutic results not always satisfactory. The objective of this retrospective study is to analyze therapeutic options and postoperative complications in adult patients with orbital floor fractures who underwent surgery. Methods: Review of the files of our institution over a 30 month period. 73 adult patients with orbital floor fractures submitted to surgery were collected. Patients were analyzed for age, sex, diagnostic tools, fracture pattern, surgery delay, implant materials, complications and sequelae. Results: Men in the fifth decade were the most frequently affected. Fracture’s patterns were as follows: orbital floor, 40 cases; orbital floor and other walls 33 cases. Average delay for surgery was 3.75 days. Implant materials used for the reconstruction were: titanium mesh in 38 cases; PDS sheets in 28 patients; Neuro-Patch in 4; pre-formed orbital plates 3. 12 patients needed a second surgery for implant replacement. Permanent sequelae were observed in 12 cases. Conclusions: All implant materials used were successful to variable degrees improvement but a guideline for choice of implant material needs to be developed. Key word: orbital floor fracture http://dx.doi.org/10.1016/j.ijom.2013.07.219 T7.OR058 New approach for the diagnosis and treatment of parotid trauma S. Sivan ∗ , O. Nahlieli Barzilai Medical Center, Israel Introduction: Penetrating injuries to the cheek can lead to significant complications due to intricate structures that lie within it. Multiple methods were described in the literature for diagnosis and treatment of parotid injuries. Methods: During the years 2009–2013 12 cases ages 6 months to 66 years of cheek lacerations with parotid duct and gland trauma were treated. The diagnostic methods that we used in all cases included combination of CT, CBCT and sialography imaging. Repair methods included direct anastomosis under endoscopic visualization and active drains. All participants have been observed for up to 1 year following procedures. Results: All patients gained complete salivary function and no salivary fistula of sialocele were observed. Conclusions: A new innovative technique is described for accurate diagnosis and complete repair of parotid trauma. http://dx.doi.org/10.1016/j.ijom.2013.07.220