ABSTRACT
To assess the frequency and severity of ophthalmic injuries in patients with orbito-zygomatic fractures. A case series. Oral and Maxillofacial Department, KEMU/Mayo Hospital Lahore, from January 2009 to December 2011. Patients with orbito-zygomatic fractures were divided into three groups. Group-1 patients had fracture of floor/medial wall of the orbit [orbital-blow out fracture]. Group-2 had comminuted orbito-zygomatic fractures. Group-3 had simple zygomatic bone fractures. Frequency and types of ocular injuries were determined on each group. There were 296 [260 male, 36 female] patients with mean age of 31.7 years. Group-1 [n = 20] had 28 ocular findings in 12 [60%] patients including diplopia [n = 10, 36%], enophthalmos [n = 6, 14%], and hyphema, vitreous hemorrhage, retinal hemorrhage, choroidal rupture, traumatic mydriasis, and commotio retinae in 2 cases, 7% each. In Group-2 [n = 106], 44 ocular findings were identified in 30 [28%] patients including diplopia [n = 10, 23%], enophthalmos [n = 4, 9%], commotio retinae [n = 10, 23%], reduced visual acuity [n = 6, 14%], retinal hemorrhage [n = 4, 9%] and corneal laceration, corneal abrasion, retinal detachment, traumatic mydriasis, and canthal laceration in 2 cases, 4.5%. In Group-3 [n = 170], 22 ocular findings were seen in 16 [9%] patients included diplopia [n = 10, 45%], enophthalmos [n = 4, 18%], and retinal tear, hyphema, angle recession, and traumatic mydriasis in 2 cases, [9%] each. Ophthalmic injuries are a common complication of orbitozygomatic fractures occurring in about 20% of patients in this study, most frequent in the orbital blow fractures subgroup. Ophthalmology consultation is recommended for patients presenting with midface fractures
ABSTRACT
Marginal mandibular nerve is a motor branch of facial nerve which supplies the muscles of the peri oral region. Surgical and cosmetic procedures might cause injury to this nerve resulting in functional loss and cosmetic imperfection. This study on the anatomical relation of marginal mandibular nerve, with respect to the lower border of mandible and facial artery, will benefit maxillofacial and plastic surgeons in its safe identification, hence preserving the functional integrity of this significant branch of facial nerve. Careful dissection was done on one hundred [100] hemi-faces of adult cadavers in Forensic and Anatomy departments of King Edward Medical University, Lahore from September 2009 to March 2010. Cadavers with scar, disfigurement or putrefaction in face and/or neck region were excluded. In 100 hemi faces, Marginal mandibular nerve present singly above the lower border of mandible was seen in 74% of cases. Marginal mandibular nerve having two rami, both located above the lower border was seen in 14% of cases. Two rami of marginal mandibular nerve, one present above and one below the lower border of mandible was seen in 6% of cases. Three rami of marginal mandibular nerve, two rami above and one below lower border of mandible were present in 6% of cases. In our population marginal mandibular nerve normally exits from anterior border of parotid gland above the lower border of mandible. When two or more rami of nerve are present; chances of lower most rami of nerve coursing below the inferior border of mandible increases. The nerve rami are present superficial to facial artery. It is at risk of iatrogenic injury overlying and anterior to massetter muscle where the nerve lies superficially underneath a thin layer of superficial musculoaponeurotic system