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Injuries of the eye and ocular adnexa in midface fractures
1076
Trauma
between the two groups and two-plate fixation may not offer advantage. doi:10.1016/j.ijom.2007.08.428
O17.22 Prospective clinical outcome of monocortical miniplate fixation in mandibular fractures S. Fathima*, J. N. Shetty Department of Maxillofacial Surgery, St Martha’s Hospital, Nrupathunga Road, Bangalore, India Objective: This prospective study evaluates the outcome and complications in isolated mandibular fractures treated with monocortical miniplate fixation. Methods: From May 2003 to September 2006, a total of 60 patients with fractures of the mandible including symphysis, parasymphysis, body and angle of the mandible were treated with monocortical miniplate fixation along Champy’s lines of osteosynthesis and maxillomandibular fixation was placed 15 days postoperatively. Postoperative complications including infection, wound dehiscence, malocclusion, malunion, nonunion and nerve injury due to surgical manipulation were tabulated. Follow-up examinations were performed up to 12 weeks postoperatively. Panoramic radiographs were obtained in all the cases. Results: Malunion and osteomyelitis were not observed in any of the cases. Out of 60 patients, 12 were identified as having at least one postoperative complication. Postoperative infection occurred in four patients (6.6%) which was controlled with antibiotic therapy, wound dehiscence in two patients (3.3%) with exposure of underlying plate, slight occlusal disturbances were noted in three patients (5%), nonunion was seen in one patient (1.6%) and nerve injury in two patients (3.3%). Conclusion: Monocortical miniplate fixation for mandibular fractures is a reliable and effective technique with minimal complications for providing functionally stable fixation. doi:10.1016/j.ijom.2007.08.429
O17.23 Osteotomy techniques in the management of malunited orbitomalar trauma—a clinical evaluation Y. Bharadwaj Department of Oral and Maxillofacial surgery, Government Dental College and Hospital, Shimla, Himachal Pradesh, India
The aim of this paper is to highlight various osteotomy techniques that are employed to treat various malunited fractures of the orbit and zygomatic complex at our institute. Our centre being the only tertiary care centre for maxillofacial surgery catering to hilly and often remote areas of northern India in the state of Himachal Pradesh, patients report at a delayed stage when fractures have already malunited leading to functional, aesthetic and psychosocial problems to these patients .The chief reasons for seeking treatment are facial deformity, diplopia, enophthalmos, restricted mouth opening, paraesthesia of IO nerve. Various osteotomies like malar osteotomy, lateral orbital osteotomy, Tessier’s inferior orbital marginotomy and delayed orbital floor reconstruction will be discussed with individual case illustrations. The mean followup of these patients ranges from 6 years to 9 months. The surgical exposure, osteotomy technique, fixation techniques, postoperative results and complications of each procedure would be addressed in detail. Titanium plates and screws were used for achieving osteosynthesis. Results with long-term stability of these osteotomy techniques will be evaluated. doi:10.1016/j.ijom.2007.08.430
O17.24 Injuries of the eye and ocular adnexa in midface fractures N. Aljinovic*, L. R. Mutevelic Department of Maxillofacial and Oral Surgery, Department of Ophtalmology, University Hospital Dubrava, Zagreb, Croatia Objectives: The data on incidence and severity of ocular injuries in midface fractures are still controversial and depend upon the investigator (MS surgeon versus ophtalmologist). The aim of the study was to evaluate the eye impairment (visual function, motility etc.) in relation to the type of the midface fracture. Patients and methods: Five hundred and sixty-seven patients with midface fracture, who were treated at the Department of Maxillofacial and Oral Surgery in Zagreb, were assessed by the opthalmologists and maxillofacial surgeon. In 370 out of 567, associated injury of the eye and/or ocular adnexa was found. Results: Ocular/ocular adnexa injuries were present in 93.7% of blow out fractures, in 84.6 of panorbital/combined orbital fractures, 70% of NOE fractures, 64.9% of Le Fort fractures, 60% of
zygomatic/lateral orbital fractures and 50% of upper orbital fractures. According to severity ocular injuries were divided into mild, medium and severe. Mild injuries were present in 72.4%, medium in 18.9% and severe in 8.6%. The incidence of severe injuries was highest in NOE fractures (23.8%). Conclusion: Midface injuries are more often associate with ocular and/or ocular adnexa injuries than recognized in everyday surgical practice. The risk incidence is outlined in relation to fracture localisation. doi:10.1016/j.ijom.2007.08.431
O17.25 Orbital trauma: a beauty or beast? A clinical study based on 28 cases M. Goyal*, R. Anand Santosh Medical and Dental College, Ghaziabad, India Although orbital trauma management has become an integral part of Maxillofacial Surgeon’s domain, still there is a greater need to emphasise, on making accurate preoperative diagnosis, ophthalmic evaluation and at times ophthalmology referral. Based on our clinical experience in more than 25 cases treated at our Unit in last 5 years. The focus of this study was on surgical challenge of orbit including correct diagnosis, approaches, management, materials, challenges and outcomes in primary orbital trauma and post-traumatic deformity of orbit. This study highlights different materials, newer procedures, developments and innovations in the repair of complex orbital trauma and problem faced in management of enopthalmus in cases of severe post-traumatic blast out deformity leading to orbital dystopia at times. A quick protocol has been devised based on parameters like (visual acuity, forced duction test, diplopia, etc.) for early ophthalmology referral and intervention. It may be concluded finally, that orbital blast out is the planning and operative beast to orbital blow out beauty. doi:10.1016/j.ijom.2007.08.432
O17.26 Treatment of zygomatic fractures through upper buccal sulcus incision Review of 200 cases P. Praveen*, S. Parmar, N. Bhujel, O. Krishnan, S. Kaur Johal Craniofacial Unit, University Hospitals Birmingham NHS TRUST, Selly Oak
Trauma
between the two groups and two-plate fixation may not offer advantage. doi:10.1016/j.ijom.2007.08.428
O17.22 Prospective clinical outcome of monocortical miniplate fixation in mandibular fractures S. Fathima*, J. N. Shetty Department of Maxillofacial Surgery, St Martha’s Hospital, Nrupathunga Road, Bangalore, India Objective: This prospective study evaluates the outcome and complications in isolated mandibular fractures treated with monocortical miniplate fixation. Methods: From May 2003 to September 2006, a total of 60 patients with fractures of the mandible including symphysis, parasymphysis, body and angle of the mandible were treated with monocortical miniplate fixation along Champy’s lines of osteosynthesis and maxillomandibular fixation was placed 15 days postoperatively. Postoperative complications including infection, wound dehiscence, malocclusion, malunion, nonunion and nerve injury due to surgical manipulation were tabulated. Follow-up examinations were performed up to 12 weeks postoperatively. Panoramic radiographs were obtained in all the cases. Results: Malunion and osteomyelitis were not observed in any of the cases. Out of 60 patients, 12 were identified as having at least one postoperative complication. Postoperative infection occurred in four patients (6.6%) which was controlled with antibiotic therapy, wound dehiscence in two patients (3.3%) with exposure of underlying plate, slight occlusal disturbances were noted in three patients (5%), nonunion was seen in one patient (1.6%) and nerve injury in two patients (3.3%). Conclusion: Monocortical miniplate fixation for mandibular fractures is a reliable and effective technique with minimal complications for providing functionally stable fixation. doi:10.1016/j.ijom.2007.08.429
O17.23 Osteotomy techniques in the management of malunited orbitomalar trauma—a clinical evaluation Y. Bharadwaj Department of Oral and Maxillofacial surgery, Government Dental College and Hospital, Shimla, Himachal Pradesh, India
The aim of this paper is to highlight various osteotomy techniques that are employed to treat various malunited fractures of the orbit and zygomatic complex at our institute. Our centre being the only tertiary care centre for maxillofacial surgery catering to hilly and often remote areas of northern India in the state of Himachal Pradesh, patients report at a delayed stage when fractures have already malunited leading to functional, aesthetic and psychosocial problems to these patients .The chief reasons for seeking treatment are facial deformity, diplopia, enophthalmos, restricted mouth opening, paraesthesia of IO nerve. Various osteotomies like malar osteotomy, lateral orbital osteotomy, Tessier’s inferior orbital marginotomy and delayed orbital floor reconstruction will be discussed with individual case illustrations. The mean followup of these patients ranges from 6 years to 9 months. The surgical exposure, osteotomy technique, fixation techniques, postoperative results and complications of each procedure would be addressed in detail. Titanium plates and screws were used for achieving osteosynthesis. Results with long-term stability of these osteotomy techniques will be evaluated. doi:10.1016/j.ijom.2007.08.430
O17.24 Injuries of the eye and ocular adnexa in midface fractures N. Aljinovic*, L. R. Mutevelic Department of Maxillofacial and Oral Surgery, Department of Ophtalmology, University Hospital Dubrava, Zagreb, Croatia Objectives: The data on incidence and severity of ocular injuries in midface fractures are still controversial and depend upon the investigator (MS surgeon versus ophtalmologist). The aim of the study was to evaluate the eye impairment (visual function, motility etc.) in relation to the type of the midface fracture. Patients and methods: Five hundred and sixty-seven patients with midface fracture, who were treated at the Department of Maxillofacial and Oral Surgery in Zagreb, were assessed by the opthalmologists and maxillofacial surgeon. In 370 out of 567, associated injury of the eye and/or ocular adnexa was found. Results: Ocular/ocular adnexa injuries were present in 93.7% of blow out fractures, in 84.6 of panorbital/combined orbital fractures, 70% of NOE fractures, 64.9% of Le Fort fractures, 60% of
zygomatic/lateral orbital fractures and 50% of upper orbital fractures. According to severity ocular injuries were divided into mild, medium and severe. Mild injuries were present in 72.4%, medium in 18.9% and severe in 8.6%. The incidence of severe injuries was highest in NOE fractures (23.8%). Conclusion: Midface injuries are more often associate with ocular and/or ocular adnexa injuries than recognized in everyday surgical practice. The risk incidence is outlined in relation to fracture localisation. doi:10.1016/j.ijom.2007.08.431
O17.25 Orbital trauma: a beauty or beast? A clinical study based on 28 cases M. Goyal*, R. Anand Santosh Medical and Dental College, Ghaziabad, India Although orbital trauma management has become an integral part of Maxillofacial Surgeon’s domain, still there is a greater need to emphasise, on making accurate preoperative diagnosis, ophthalmic evaluation and at times ophthalmology referral. Based on our clinical experience in more than 25 cases treated at our Unit in last 5 years. The focus of this study was on surgical challenge of orbit including correct diagnosis, approaches, management, materials, challenges and outcomes in primary orbital trauma and post-traumatic deformity of orbit. This study highlights different materials, newer procedures, developments and innovations in the repair of complex orbital trauma and problem faced in management of enopthalmus in cases of severe post-traumatic blast out deformity leading to orbital dystopia at times. A quick protocol has been devised based on parameters like (visual acuity, forced duction test, diplopia, etc.) for early ophthalmology referral and intervention. It may be concluded finally, that orbital blast out is the planning and operative beast to orbital blow out beauty. doi:10.1016/j.ijom.2007.08.432
O17.26 Treatment of zygomatic fractures through upper buccal sulcus incision Review of 200 cases P. Praveen*, S. Parmar, N. Bhujel, O. Krishnan, S. Kaur Johal Craniofacial Unit, University Hospitals Birmingham NHS TRUST, Selly Oak