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Retrobulbar hemorrhage—Case report
Int. J. Oral Maxillofac. Surg. 2005; 34 ( S u p p l e m e n t 1): $ 1 - $ 1 8 1
160 and Maxillofacial Surgery, Dokkyo University Hospital. The mean age of the patients (±S.D.) was 32.9±19.3 years (range, 15-89 years) with a gender distribution of 46 males and 11 females. To evaluate maxillary fractures, radiography with posteroanterior view, water's view, panoramic radiography, and computed tomography (CT) were used. Then, we classified the fracture lines by superimposing fracture line of radiography. We also examined the relationship between type of fracture line and causes of trauma, mandibular fracture and treatment modality. According to the Le Fort classification, 14 cases (14.3%) were classified into Le Fort I, 6 cases (8.7%) into Le Fort II, 5 cases (7.2%) into Le Fort III, however, the classification was not possible either group for 44 cases. It was possible to classify the fracture lines which could not be classified by Le Fort classification into the type of two fractures. One fracture line involves frontomaxillary suture, orbital floor, anterior and posterior maxillary wall and temporozygomatic suture or zygomatic arch, and another fracture line results in only anterior or posterior maxillary wall. As a result of examining conventional classification and new subclassification by the difference of the behavior of the fracture, a diversity of the causes of the injury seemed to be one of the reasons for not applying the conventional classification. 1.) In the conventional classification, there were many cases in which the classification was not possible. 2.) The diversification of the cause of the injury was considered as one of the reasons. 3.) We strongly recommend that the new subclassification is added to the conventional maxillary fracture.
(9.0%). The main mechanisms of trauma were motor vehicle accidents (54.6%), followed by falls (22.4%), assaults (10.9%), self inflicted injuries (2%) and others (10.1%). Fractures happened more frequently in the orbital region (22.3%), followed by the mandible (20.7%) and the cranial vault (20.1%). Cranial base (4.5%) and dentoalveolar (5.5%) fractures were less frequent. It was possible to verify a significant relation of orbital and nasal fractures with motor vehicle accidents. Other significant associations included: orbital and cranial vault fractures in males, orbital and nasal fractures in females, orbital fractures in white patients and mandible fractures in black patients. This study showed relevant data for the knowledge and management of craniomaxillofacial trauma and may provide a contribution to implement prevention protocols and improve treatment conditions.
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Retrobulbar hemorrhage is rare complication that may occur after mid face injuries or following soft and hard tissue surgery around eyes. If left untreated blindness can result. The cardinal signs and symptoms of retrobulbar hemorrhage are pain, diplopia, ophthalmoplegia, a progression of increasing proptosis and decreasing visual acuity leading to blindness. Bleeding into intraorbital space may cause acute visual loss by compressing the optic nerve and its vascular supply. The diagnosis can be confirmed with computed tomography of the orbit or with ocular ultrasound. These images exams are also important to define the size of the haematoma. Some pharmacological therapies may include administration of mannitol, acetazolamide, topical timolol as eye drops, corticosteroids and possibly inhaled carbon dioxid.This report describes a traumatic retrobulbar hemorrhage. The aim of this study was to report a case of retrobulbar haemorrhage and to review the literature about this pathology. A 14-year-old male patient, sought to Oral and Maxillofacial Surgery Service at Cristo Redentor Hospital in Porto Alegre, Brazil, complaining about pain and huge swelling in left orbit region. He was involved in a bicycle accident 12 days before. Right after the accident the teenager was assisted in another service, where no one facial fracture was diagnosed. Physical examination revealed several dermal abrasions, edema in mid face and left orbit region, enormous exophthalmia, diplopia, epiphora in left eye and pain. Due to swelling itwas impossible to evaluate by palpation any possible fracture. It was requested an orbit computed tomography images. 3D reconstruction image showed intact orbital walls leading to a diagnosis of retrobulbar haematoma. Coronal, axial and sagittal CT showed an image compatible to haematoma. The patient was referred to an ophthalmologist that confirmed the diagnosis and performed an adequate treatment. The recommended treatment was conservative, using just medications. The patient was admitted to the hospital and improvement was evident by the 3rd postadmission day. He was discharged on the 8th day with normal eye findings. The last follow-up examination, at 3 months after the trauma, demonstrated no complications with normal visual acuity. Patients with periorbital trauma are often best evaluated radiographically with CT of the orbit, preferably with 3 mm axial and coronal sections, and an early diagnosis is crucial to preservation of vision.
THE EFFECT OF INTERNAL RIGID FIXATION USED IN THE TREATMENT OF M A N D I B U L A R FRACTURES ON THE JAW OPENING HABILITY: LONGITUDINAL STUDY
J.G.C. Luz, K. Saciloto. Department of Oral and Maxillofacial Surgery, University of S#o Paulo, Brazil Use of internal rigid fixation in the treatment of mandibular fractures can obviate postoperative intermaxillary fixation. Thus, the patient may have better diet and oral hygiene, as well as improvement of temporomandibular joint function. The purpose of this study was to evaluate, as a longitudinal study, the effect of internal rigid fixation used to treat mandibular fractures on the jaw opening hability. Sixteen patients with mandibular fractures who underwent tretment by internal rigid fixation were admitted in this study. In the postoperative period, mensuration of maximal jaw opening was made in millimeters, being obtained values after one, two, three, and six months. With the value of 40mm as a reference, cases were classified as having normal or limited jaw opening. Crossed tabulations between classification of jaw opening and demographic data, cause, and location of the fractures were obtained. Statistical tests were used to evaluate the significance among periods and in crossed tabulations. There was partial limitation of jaw opening in the initial period, having progressive improvement with time, being highly significant the difference among periods (p < 0.001). Most of the patients recovered jaw opening after two months. There was no significant difference in the crossed tabulations between classification of fractures and studied factors. It was concluded that patients recovered jaw opening at two months postoperatively, with progressive improvement, but without influence of studied factors. OF FP263• CE PRIADNEIMOIMOALXOIGL ILCOAFLA C IANALYSIS A L T R A U M A IN
PENNSYLVANIA,
USA, FROM 1994 TO 2002 R.W.R Moreira, L.A. Passeri, M. Moraes, R. Mazzonetto, C.L. Pereira. Department of Oral Diagnosis - Area of Oral and Maxillofacial Surgery, Campinas State University, Piracicaba, Brazil The aim of this study was to investigate the epidemiologic distribution of craniomaxillofacial trauma at the Pennsylvania Trauma Foundation, Harrisburg, PA, USA. A retrospective analysis of the 98,253 adult patients from 22 hospitals who sustained craniomaxillofacial trauma from 1994 to 2002 was undertaken. Data of patients were recorded including the characteristics of the patient and the trauma and their relevant relation. The sample showed a distinct predominance of the male gender (66.2%) over female gender (33.8%), resulting in a male/female ratio of nearly 2:1. According to race, a highest prevalence of white patients was shown (83.0%), followed by black (14.1%), asian (0.6%) and others (2.3%). The age ranged from 20 to 104 years, with a mean age of 47.8 years. The majority of the traumas occurred in the second decade of life (24.2%), decreasing in the third (20.0%), fourth (15.2%), fifth (10.4%) and sixth
[-P-2"-~ R E T R O B U L B A R H E M O R R H A G E - CASE REPORT R.A. Machado 1, L.M. Sassi 2, R.L. Silveira 1, H.O.I. Borges 1, A.M. Bourguignon Filho 1 , G.M. de Oliveira 3. 1MSc Student - Schoo/ of Dentistry PUCRS, Oral and Maxillofacial Surgery Department, 2Masters in Head and Neck Surgery; PhD Student - UNIFESP - SP (presenting author), 3 phD, Head Professor, Coordinating Professor of Masters Course in Orthodontics and Masters and PhDs course in Oral and Maxillofacial Surgery, School of Dentistry PUCRS, Pontificia Universidade Cat6fica, Rio Grande do Sul, Brazil
[-P-'~'-~ M A N D I B U L A R FRACTURES RETROSPECTIVE STUDY
- A FIVE-YEAR
B. Vladimirov, S. Dimitrov. Department of Maxillofacial Surgery Faculty of Dentistry Medical University Bulgaria, Plovdiv, Bulgaria The fracture of the mandible is one of the most frequent traumatic injuries to the facial skeleton. The aim of the present study was to characterize mandibular fracture patients and their treatment, as performed in the Department of Maxillofacial Surgery, Faculty of Dentistry, Plovdiv. The available information was obtained retrospectively from the records of 612 patients with 911 fractures of the mandible, treated for a period of five years - from 1998 to 2002. 81.2% of the patients were male, and 18.8% - female (Sp = 1.58%). Mean age was 33.5 years (Sx = 15.219).
160 and Maxillofacial Surgery, Dokkyo University Hospital. The mean age of the patients (±S.D.) was 32.9±19.3 years (range, 15-89 years) with a gender distribution of 46 males and 11 females. To evaluate maxillary fractures, radiography with posteroanterior view, water's view, panoramic radiography, and computed tomography (CT) were used. Then, we classified the fracture lines by superimposing fracture line of radiography. We also examined the relationship between type of fracture line and causes of trauma, mandibular fracture and treatment modality. According to the Le Fort classification, 14 cases (14.3%) were classified into Le Fort I, 6 cases (8.7%) into Le Fort II, 5 cases (7.2%) into Le Fort III, however, the classification was not possible either group for 44 cases. It was possible to classify the fracture lines which could not be classified by Le Fort classification into the type of two fractures. One fracture line involves frontomaxillary suture, orbital floor, anterior and posterior maxillary wall and temporozygomatic suture or zygomatic arch, and another fracture line results in only anterior or posterior maxillary wall. As a result of examining conventional classification and new subclassification by the difference of the behavior of the fracture, a diversity of the causes of the injury seemed to be one of the reasons for not applying the conventional classification. 1.) In the conventional classification, there were many cases in which the classification was not possible. 2.) The diversification of the cause of the injury was considered as one of the reasons. 3.) We strongly recommend that the new subclassification is added to the conventional maxillary fracture.
(9.0%). The main mechanisms of trauma were motor vehicle accidents (54.6%), followed by falls (22.4%), assaults (10.9%), self inflicted injuries (2%) and others (10.1%). Fractures happened more frequently in the orbital region (22.3%), followed by the mandible (20.7%) and the cranial vault (20.1%). Cranial base (4.5%) and dentoalveolar (5.5%) fractures were less frequent. It was possible to verify a significant relation of orbital and nasal fractures with motor vehicle accidents. Other significant associations included: orbital and cranial vault fractures in males, orbital and nasal fractures in females, orbital fractures in white patients and mandible fractures in black patients. This study showed relevant data for the knowledge and management of craniomaxillofacial trauma and may provide a contribution to implement prevention protocols and improve treatment conditions.
~-~-]
Retrobulbar hemorrhage is rare complication that may occur after mid face injuries or following soft and hard tissue surgery around eyes. If left untreated blindness can result. The cardinal signs and symptoms of retrobulbar hemorrhage are pain, diplopia, ophthalmoplegia, a progression of increasing proptosis and decreasing visual acuity leading to blindness. Bleeding into intraorbital space may cause acute visual loss by compressing the optic nerve and its vascular supply. The diagnosis can be confirmed with computed tomography of the orbit or with ocular ultrasound. These images exams are also important to define the size of the haematoma. Some pharmacological therapies may include administration of mannitol, acetazolamide, topical timolol as eye drops, corticosteroids and possibly inhaled carbon dioxid.This report describes a traumatic retrobulbar hemorrhage. The aim of this study was to report a case of retrobulbar haemorrhage and to review the literature about this pathology. A 14-year-old male patient, sought to Oral and Maxillofacial Surgery Service at Cristo Redentor Hospital in Porto Alegre, Brazil, complaining about pain and huge swelling in left orbit region. He was involved in a bicycle accident 12 days before. Right after the accident the teenager was assisted in another service, where no one facial fracture was diagnosed. Physical examination revealed several dermal abrasions, edema in mid face and left orbit region, enormous exophthalmia, diplopia, epiphora in left eye and pain. Due to swelling itwas impossible to evaluate by palpation any possible fracture. It was requested an orbit computed tomography images. 3D reconstruction image showed intact orbital walls leading to a diagnosis of retrobulbar haematoma. Coronal, axial and sagittal CT showed an image compatible to haematoma. The patient was referred to an ophthalmologist that confirmed the diagnosis and performed an adequate treatment. The recommended treatment was conservative, using just medications. The patient was admitted to the hospital and improvement was evident by the 3rd postadmission day. He was discharged on the 8th day with normal eye findings. The last follow-up examination, at 3 months after the trauma, demonstrated no complications with normal visual acuity. Patients with periorbital trauma are often best evaluated radiographically with CT of the orbit, preferably with 3 mm axial and coronal sections, and an early diagnosis is crucial to preservation of vision.
THE EFFECT OF INTERNAL RIGID FIXATION USED IN THE TREATMENT OF M A N D I B U L A R FRACTURES ON THE JAW OPENING HABILITY: LONGITUDINAL STUDY
J.G.C. Luz, K. Saciloto. Department of Oral and Maxillofacial Surgery, University of S#o Paulo, Brazil Use of internal rigid fixation in the treatment of mandibular fractures can obviate postoperative intermaxillary fixation. Thus, the patient may have better diet and oral hygiene, as well as improvement of temporomandibular joint function. The purpose of this study was to evaluate, as a longitudinal study, the effect of internal rigid fixation used to treat mandibular fractures on the jaw opening hability. Sixteen patients with mandibular fractures who underwent tretment by internal rigid fixation were admitted in this study. In the postoperative period, mensuration of maximal jaw opening was made in millimeters, being obtained values after one, two, three, and six months. With the value of 40mm as a reference, cases were classified as having normal or limited jaw opening. Crossed tabulations between classification of jaw opening and demographic data, cause, and location of the fractures were obtained. Statistical tests were used to evaluate the significance among periods and in crossed tabulations. There was partial limitation of jaw opening in the initial period, having progressive improvement with time, being highly significant the difference among periods (p < 0.001). Most of the patients recovered jaw opening after two months. There was no significant difference in the crossed tabulations between classification of fractures and studied factors. It was concluded that patients recovered jaw opening at two months postoperatively, with progressive improvement, but without influence of studied factors. OF FP263• CE PRIADNEIMOIMOALXOIGL ILCOAFLA C IANALYSIS A L T R A U M A IN
PENNSYLVANIA,
USA, FROM 1994 TO 2002 R.W.R Moreira, L.A. Passeri, M. Moraes, R. Mazzonetto, C.L. Pereira. Department of Oral Diagnosis - Area of Oral and Maxillofacial Surgery, Campinas State University, Piracicaba, Brazil The aim of this study was to investigate the epidemiologic distribution of craniomaxillofacial trauma at the Pennsylvania Trauma Foundation, Harrisburg, PA, USA. A retrospective analysis of the 98,253 adult patients from 22 hospitals who sustained craniomaxillofacial trauma from 1994 to 2002 was undertaken. Data of patients were recorded including the characteristics of the patient and the trauma and their relevant relation. The sample showed a distinct predominance of the male gender (66.2%) over female gender (33.8%), resulting in a male/female ratio of nearly 2:1. According to race, a highest prevalence of white patients was shown (83.0%), followed by black (14.1%), asian (0.6%) and others (2.3%). The age ranged from 20 to 104 years, with a mean age of 47.8 years. The majority of the traumas occurred in the second decade of life (24.2%), decreasing in the third (20.0%), fourth (15.2%), fifth (10.4%) and sixth
[-P-2"-~ R E T R O B U L B A R H E M O R R H A G E - CASE REPORT R.A. Machado 1, L.M. Sassi 2, R.L. Silveira 1, H.O.I. Borges 1, A.M. Bourguignon Filho 1 , G.M. de Oliveira 3. 1MSc Student - Schoo/ of Dentistry PUCRS, Oral and Maxillofacial Surgery Department, 2Masters in Head and Neck Surgery; PhD Student - UNIFESP - SP (presenting author), 3 phD, Head Professor, Coordinating Professor of Masters Course in Orthodontics and Masters and PhDs course in Oral and Maxillofacial Surgery, School of Dentistry PUCRS, Pontificia Universidade Cat6fica, Rio Grande do Sul, Brazil
[-P-'~'-~ M A N D I B U L A R FRACTURES RETROSPECTIVE STUDY
- A FIVE-YEAR
B. Vladimirov, S. Dimitrov. Department of Maxillofacial Surgery Faculty of Dentistry Medical University Bulgaria, Plovdiv, Bulgaria The fracture of the mandible is one of the most frequent traumatic injuries to the facial skeleton. The aim of the present study was to characterize mandibular fracture patients and their treatment, as performed in the Department of Maxillofacial Surgery, Faculty of Dentistry, Plovdiv. The available information was obtained retrospectively from the records of 612 patients with 911 fractures of the mandible, treated for a period of five years - from 1998 to 2002. 81.2% of the patients were male, and 18.8% - female (Sp = 1.58%). Mean age was 33.5 years (Sx = 15.219).