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A peculiar orbital floor ‘blow-out’ fracture – or should that be ‘blow-in’ fracture?
e210
E-Poster Presentation
Comparison with previously recognised therapies such as systemic and intra-lesional steroids, pulsed-dye laser therapy and cryotherapy is made. The continuing role of conservative management and surgical intervention in many cases of IH is considered, along with an introduction to genetic and cellular biology studies on IH and their role in targeting future therapies. Conclusions: Systemic beta-blockers have evolved as the front-line therapy for ‘problematic’ IH, although early experience of topical forms shows promise. Continued molecular and cellular biological research suggests future targeted novel therapies.
Reference Mulliken, J. B., & Glowacki, J. (1982). Haemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg, 69, 412–422.
http://dx.doi.org/10.1016/j.ijom.2015.08.085 A peculiar orbital floor ‘blow-out’ fracture – or should that be ‘blow-in’ fracture? C. Fowell ∗ , H. McQuillan, T. Martin University Hospitals Birmingham NHSFT, Birmingham, UK Background: Orbital ‘blow-out’ fracture is a commonly seen maxillofacial injury. There are three recognized theories regarding mechanism of injury; globe-to-wall theory, hydraulic theory and bone conduction theory. Most injuries are associated with traumatic injury through interpersonal violence, sport or road-traffic collision. We present an unusual case of a ‘blow-out’ fracture of the orbital floor caused by increased upper airway barotrauma. Objectives: Through the description and illustration of our case, we will highlight an unusual cause of orbital floor fracture. Accompanying literature review highlights the infrequency of this mechanism of injury and allows discussion of recognized theories of orbital floor fracture. Terminology regarding ‘blow-out’ and ‘blow-in’ fractures is discussed. Methods: A 65-year-old male patient was referred with sudden onset pain, peri-orbital swelling and diplopia following a severe coughing fit. Past medical history included chronic obstructive airways disease (COAD), with recent chest infection. Clinical and radiological examination revealed an orbital floor fracture with associated enopthalmos, hypoglobus and diplopia on upward gaze. The patient was successfully treated with alloplastic reconstruction of orbital floor defect via transconjunctival approach. Conclusions: Few cases of orbital floor fracture are due to minor trauma. ‘Blow-in’ fractures are usually typified by decreased orbital volume. Our case describes an orbital floor ‘blow-out’ fracture with features of increased orbital volume in which the orbital floor was ‘blown-in’ by raised airway pressure. This supports the hydraulic theory of mechanism. http://dx.doi.org/10.1016/j.ijom.2015.08.086
Clinical study of the modified Caldwell-Luc operation by using 3-D image analysis T. Fujimoto ∗ , S. Nishino, C. Shinmura, Y. Koma, M. Sugiyama, S. Uejima Department of Oral and Maxillofacial Surgery, Iwata City Hospital, Shizuoka, Japan Background: Post-operative maxillary cyst sometimes occurs after Caldwell-Luc operation because of scar tissue invasion from the bone defect of the anterior wall and closure of the inferior meatal antrostomy (IMA). Many authors recommended replacement of the anterior bone, which is referred to as the modified Caldwell-Luc operation. Objectives: The purpose of this study was to use computed tomography to compare the pre- and post-surgical maxillary sinus and to indicate which type of modified Caldwell-Luc procedure is better. Methods: From July 2006 to March 2014, 17 patients underwent the modified Caldwell-Luc operation with anterior bone replacement. The capacities of the maxillary sinus before and 1 year after surgery were calculated by using the Fuji Film 3-D image analysis system, SYNAPSE VINCENT, and were classified into 4 groups with or without IMA (Table 1). Membrane thickness was classified as class 1 (>3 mm, without natural orifice closure), class 2 (<3 mm, without natural orifice closure), class 3 (<3 mm, with natural orifice closure) (Table 2). Findings: The patients were classified into 4 groups based on whether they had undergone IMA and the excision range of the sinus mucous membrane; these groups were examined by using the chi-square test. Statistically, the modified Caldwell-Luc operation without IMA, and with reimplantation of the maxillary sinus anterior wall and minimal removal of the Schneiderian membrane gave the best results (Table 3).
Table 1 Residual ratio of maxillary sinus capacity. Partial mucosal resection With IMA Without IMA Mean
64.2% (Group A) 80.8% (Group C) 75.3%
Radical mucosal resection 75.6% (Group B) 79.8% (Group D) 77.7%
Mean 67.6% 80.6% 75.7%
IMA, inferior meatal antrostomy. Table 2 Postoperative maxillary sinus classification.
Class 1 Class 2 Class 3
Thickness of mucosa
Natural orifice closure
Number of cases
<3 mm >3 mm >3 mm
(−) (−) (+)
8 6 3
Class 1, excellent; class 2, fair; class 3, not good.
E-Poster Presentation
Comparison with previously recognised therapies such as systemic and intra-lesional steroids, pulsed-dye laser therapy and cryotherapy is made. The continuing role of conservative management and surgical intervention in many cases of IH is considered, along with an introduction to genetic and cellular biology studies on IH and their role in targeting future therapies. Conclusions: Systemic beta-blockers have evolved as the front-line therapy for ‘problematic’ IH, although early experience of topical forms shows promise. Continued molecular and cellular biological research suggests future targeted novel therapies.
Reference Mulliken, J. B., & Glowacki, J. (1982). Haemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg, 69, 412–422.
http://dx.doi.org/10.1016/j.ijom.2015.08.085 A peculiar orbital floor ‘blow-out’ fracture – or should that be ‘blow-in’ fracture? C. Fowell ∗ , H. McQuillan, T. Martin University Hospitals Birmingham NHSFT, Birmingham, UK Background: Orbital ‘blow-out’ fracture is a commonly seen maxillofacial injury. There are three recognized theories regarding mechanism of injury; globe-to-wall theory, hydraulic theory and bone conduction theory. Most injuries are associated with traumatic injury through interpersonal violence, sport or road-traffic collision. We present an unusual case of a ‘blow-out’ fracture of the orbital floor caused by increased upper airway barotrauma. Objectives: Through the description and illustration of our case, we will highlight an unusual cause of orbital floor fracture. Accompanying literature review highlights the infrequency of this mechanism of injury and allows discussion of recognized theories of orbital floor fracture. Terminology regarding ‘blow-out’ and ‘blow-in’ fractures is discussed. Methods: A 65-year-old male patient was referred with sudden onset pain, peri-orbital swelling and diplopia following a severe coughing fit. Past medical history included chronic obstructive airways disease (COAD), with recent chest infection. Clinical and radiological examination revealed an orbital floor fracture with associated enopthalmos, hypoglobus and diplopia on upward gaze. The patient was successfully treated with alloplastic reconstruction of orbital floor defect via transconjunctival approach. Conclusions: Few cases of orbital floor fracture are due to minor trauma. ‘Blow-in’ fractures are usually typified by decreased orbital volume. Our case describes an orbital floor ‘blow-out’ fracture with features of increased orbital volume in which the orbital floor was ‘blown-in’ by raised airway pressure. This supports the hydraulic theory of mechanism. http://dx.doi.org/10.1016/j.ijom.2015.08.086
Clinical study of the modified Caldwell-Luc operation by using 3-D image analysis T. Fujimoto ∗ , S. Nishino, C. Shinmura, Y. Koma, M. Sugiyama, S. Uejima Department of Oral and Maxillofacial Surgery, Iwata City Hospital, Shizuoka, Japan Background: Post-operative maxillary cyst sometimes occurs after Caldwell-Luc operation because of scar tissue invasion from the bone defect of the anterior wall and closure of the inferior meatal antrostomy (IMA). Many authors recommended replacement of the anterior bone, which is referred to as the modified Caldwell-Luc operation. Objectives: The purpose of this study was to use computed tomography to compare the pre- and post-surgical maxillary sinus and to indicate which type of modified Caldwell-Luc procedure is better. Methods: From July 2006 to March 2014, 17 patients underwent the modified Caldwell-Luc operation with anterior bone replacement. The capacities of the maxillary sinus before and 1 year after surgery were calculated by using the Fuji Film 3-D image analysis system, SYNAPSE VINCENT, and were classified into 4 groups with or without IMA (Table 1). Membrane thickness was classified as class 1 (>3 mm, without natural orifice closure), class 2 (<3 mm, without natural orifice closure), class 3 (<3 mm, with natural orifice closure) (Table 2). Findings: The patients were classified into 4 groups based on whether they had undergone IMA and the excision range of the sinus mucous membrane; these groups were examined by using the chi-square test. Statistically, the modified Caldwell-Luc operation without IMA, and with reimplantation of the maxillary sinus anterior wall and minimal removal of the Schneiderian membrane gave the best results (Table 3).
Table 1 Residual ratio of maxillary sinus capacity. Partial mucosal resection With IMA Without IMA Mean
64.2% (Group A) 80.8% (Group C) 75.3%
Radical mucosal resection 75.6% (Group B) 79.8% (Group D) 77.7%
Mean 67.6% 80.6% 75.7%
IMA, inferior meatal antrostomy. Table 2 Postoperative maxillary sinus classification.
Class 1 Class 2 Class 3
Thickness of mucosa
Natural orifice closure
Number of cases
<3 mm >3 mm >3 mm
(−) (−) (+)
8 6 3
Class 1, excellent; class 2, fair; class 3, not good.