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White eye blowout fractures - a surgical emergency
Abstracts / British Journal of Oral and Maxillofacial Surgery 46 (2008) e32–e67
14 Paediatric orbital fractures: is the clock ticking? Christopher Bridle ∗ , Z. Killick, J. Collier, S. Holmes Barts and The London NHS Trust Introduction: Orbital fractures in the paediatric population are not common. Due the variable developmental anatomy, paediatric orbital fractures are said to behave differently to those in the adult population. Current literature suggests that paediatric orbital fractures warrant prompt surgical repair with in days, if not, hours of injury. We present and discuss a series of paediatric patients with orbital fractures. Methods: A retrospective review was performed on the time of presentation, mechanism of injury, clinical presentation, management and outcome on patients under 16 years of age identified from the departmental database. Results: For the period January 2002 to December 2007, 249 patients were identified who had sustained orbital wall fractures requiring surgical intervention. From this cohort 16 patients were identified under the age of 16 years. There were 13 males and 3 females with a median age of 10 years (range 3–15 years). The mechanism of injury was assault in 8, RTA in 4 and 4 accidental injury in 4 patients. The time to presentation varied from 2 h to one month from time of injury. Conclusion: The feared sequelae are the entrapment of soft tissue and muscle leading to ischaemia and necrosis of these tissues. This can lead to long term ocular motility restriction, diplopia and enophthalmos. The paediatric ‘white-eyed blowout’ fracture is considered to require urgent surgery. We will discuss not all of such patients present immediately and do not necessarily suffer long term problems associated with late presentation. doi:10.1016/j.bjoms.2008.07.015 15 Management of soft tissue facial injuries by maxillofacial registered general nurses Andrew Sadler ∗ , S. Daniels, E. Purbrick United Lincolnshire Hospitals Many of the tasks formerly carried out by Senior House Officers in our unit are now undertaken by others, often nurses. This includes clerking, organising operating lists and investigations, venepunture, placing drips, consenting and looking after patients at night. Why not also the closing of facial lacerations ? A seven-week survey of out of hour calls showed that 35% of calls were for suturing soft tissue facial lacerations, mostly carried out in the Accident and Emergency where space and time were limited, often with inadequate assistance and poor lighting. We set out to train two Registered Nurses to carry out assessment and treatment of soft tissue injuries on
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patients recalled the following day to the out patient facility. Firstly we had to persuade the Nursing hierarchy of the wisdom of this and then provide a series of seminars and practical sessions followed by treatment of a number of cases under supervision until the nurses were able to treat patients alone. We will report the problems encountered, the success and potential for replacing the role of the Dental SHO on call at night and the impact on patients. doi:10.1016/j.bjoms.2008.07.016 16 White eye blowout fractures - a surgical emergency B.T. Evans ∗ , Madan Ethunandan Southampton University Hospitals White-eye blowout fractures of the orbit are a poorly recognised entity with the result that treatment may be delayed and the outcome compromised. These fractures occur typically in young patients with little in the way of outward signs such as subconjunctival haemorhage and oedema. The pathogmonic features of this injury are painful restriction of eye movement with nausea and occasional vomiting. A series of 7 patients with an age range of 4–21 are presented. The clinical features, results of investigations, operative findings and outcome are presented. The value of early surgical intervention in this group of patients to optimise return of normal ocular movement is emphasised. The pattern of bony injury in the cases presented is that of a pure blowout with an intact orbital rim. The bony defect is linear with entrapment of orbital contents rather than herniation such as occurs in the “adult” blowout fracture. A buckling rather than hydraulic mechanism would seem the most likely in these patients. doi:10.1016/j.bjoms.2008.07.017 17 The role of pre-operative 3-dimension CT evaluation of Type B intracapsular condylar fractures to determine the feasibility of lag screw osteosynthesis Jonathan Collier ∗ , C. Bridle, J. Makdissi, S. Holmes Barts and The London NHS Trust Introduction: Intracapsular fractures of the mandibular condyle may lead to significant long term morbidity, especially if bilateral. CT imaging permits the accurate classification of these fractures as A, B and M. Internal fixation of Type B fractures using cannulated cancellous lag screws with or without associated vertical condylar osteotomies has been described. The aim of this study was to assess intracapsular condylar fragments pre-operatively
14 Paediatric orbital fractures: is the clock ticking? Christopher Bridle ∗ , Z. Killick, J. Collier, S. Holmes Barts and The London NHS Trust Introduction: Orbital fractures in the paediatric population are not common. Due the variable developmental anatomy, paediatric orbital fractures are said to behave differently to those in the adult population. Current literature suggests that paediatric orbital fractures warrant prompt surgical repair with in days, if not, hours of injury. We present and discuss a series of paediatric patients with orbital fractures. Methods: A retrospective review was performed on the time of presentation, mechanism of injury, clinical presentation, management and outcome on patients under 16 years of age identified from the departmental database. Results: For the period January 2002 to December 2007, 249 patients were identified who had sustained orbital wall fractures requiring surgical intervention. From this cohort 16 patients were identified under the age of 16 years. There were 13 males and 3 females with a median age of 10 years (range 3–15 years). The mechanism of injury was assault in 8, RTA in 4 and 4 accidental injury in 4 patients. The time to presentation varied from 2 h to one month from time of injury. Conclusion: The feared sequelae are the entrapment of soft tissue and muscle leading to ischaemia and necrosis of these tissues. This can lead to long term ocular motility restriction, diplopia and enophthalmos. The paediatric ‘white-eyed blowout’ fracture is considered to require urgent surgery. We will discuss not all of such patients present immediately and do not necessarily suffer long term problems associated with late presentation. doi:10.1016/j.bjoms.2008.07.015 15 Management of soft tissue facial injuries by maxillofacial registered general nurses Andrew Sadler ∗ , S. Daniels, E. Purbrick United Lincolnshire Hospitals Many of the tasks formerly carried out by Senior House Officers in our unit are now undertaken by others, often nurses. This includes clerking, organising operating lists and investigations, venepunture, placing drips, consenting and looking after patients at night. Why not also the closing of facial lacerations ? A seven-week survey of out of hour calls showed that 35% of calls were for suturing soft tissue facial lacerations, mostly carried out in the Accident and Emergency where space and time were limited, often with inadequate assistance and poor lighting. We set out to train two Registered Nurses to carry out assessment and treatment of soft tissue injuries on
e37
patients recalled the following day to the out patient facility. Firstly we had to persuade the Nursing hierarchy of the wisdom of this and then provide a series of seminars and practical sessions followed by treatment of a number of cases under supervision until the nurses were able to treat patients alone. We will report the problems encountered, the success and potential for replacing the role of the Dental SHO on call at night and the impact on patients. doi:10.1016/j.bjoms.2008.07.016 16 White eye blowout fractures - a surgical emergency B.T. Evans ∗ , Madan Ethunandan Southampton University Hospitals White-eye blowout fractures of the orbit are a poorly recognised entity with the result that treatment may be delayed and the outcome compromised. These fractures occur typically in young patients with little in the way of outward signs such as subconjunctival haemorhage and oedema. The pathogmonic features of this injury are painful restriction of eye movement with nausea and occasional vomiting. A series of 7 patients with an age range of 4–21 are presented. The clinical features, results of investigations, operative findings and outcome are presented. The value of early surgical intervention in this group of patients to optimise return of normal ocular movement is emphasised. The pattern of bony injury in the cases presented is that of a pure blowout with an intact orbital rim. The bony defect is linear with entrapment of orbital contents rather than herniation such as occurs in the “adult” blowout fracture. A buckling rather than hydraulic mechanism would seem the most likely in these patients. doi:10.1016/j.bjoms.2008.07.017 17 The role of pre-operative 3-dimension CT evaluation of Type B intracapsular condylar fractures to determine the feasibility of lag screw osteosynthesis Jonathan Collier ∗ , C. Bridle, J. Makdissi, S. Holmes Barts and The London NHS Trust Introduction: Intracapsular fractures of the mandibular condyle may lead to significant long term morbidity, especially if bilateral. CT imaging permits the accurate classification of these fractures as A, B and M. Internal fixation of Type B fractures using cannulated cancellous lag screws with or without associated vertical condylar osteotomies has been described. The aim of this study was to assess intracapsular condylar fragments pre-operatively