Diplopia in facial fractures.

A prospective study was made on facial fracture patients who received treatment in Siriraj Hospital from 1 Jan 1997 to 31 Dec 1998. We recorded the types of fractures which involved the orbit, diplopia, operations and results. From the 675 facial fracture patients in this period, there were 256 cases that involved the orbit. Diplopia was found in 17 cases; Orbital floor fracture 8, Zygomatic fracture 4, Le Fort fracture 4, and Medial aspect fracture of maxilla 1. Ten cases were recent fractures and seven cases were old fractures. The floor of the orbits were explored in all cases and repaired with silastic sheath, except 2 severe enophthalmos cases whose medial wall and the floor of the orbits were repaired with titanium mesh. Diplopia disappeared after operation in 14 cases. Three cases still had minimal diplopia in the upward-gaze position and all of them were old fracture cases. The authors concluded that diplopia was found in 6.64 per cent of orbital fractures. Fracture of the floor of the orbit was the most common cause. An early operation will give a better result than late repair.

Correction of severe enophthalmos with titanium mesh.

The aim of this study was to analyse the types of facial fractures that caused severe enophthalmos and the outcome after repair of the medial wall and the floor of the orbit with titanium mesh. Eighteen cases with severe enophthalmos were repaired with titanium mesh in Siriraj Hospital between January 1992 and December 1999. We recorded the types of facial fractures of the patients, the results after operations and the complications. All cases were followed-up for at least 6 months. Le Fort fracture was the most common cause of severe enophthalmos from orbital fracture. The results after operations were satisfactory in 17 cases. Only one case still had enophthalmos after the first correction with titanium mesh and needed further repair with bone graft. Few complications happened post-operatively. They were 4 cases of chemosis and 4 cases of temporary diplopia. All subsided spontaneously. The author concludes that titanium mesh can be used to repair the medial wall and the floor of the orbit with good results.

The benefits of 7.5 NaCl/6 dextran 70 (HSD) for prehospital resuscitation of hemorrhagic shock: improved oxygen transport

The purpose of this study was to compare the benefit of small volume hyperonic saline/dextran (HSD) versus the risk of obligatory time to administer it on-scene in a model of acute hemorrhagic shock. Dogs were bled to a mean arteiral pressure (MAP) of 20 mmHg and the randomized to either: a) direct transport to the emergency department (ED) or b) 10 min delay to insert an iv HSD (4 ml/Kg) infusion over 5 min, and then transport. The animals receiving HSD had improved (P<0.05) cardiac work and oxigen consumption during transport (MAP = 59 ñ 3 vs 38 ñ 4 mmHg; cardiac index (CI) = 3.2 ñ 0.2 vs 1.3 ñ 0.1 L min-1 M-2; O2CI = 115 ñ 7 vs 104 ñ 7 mlmin-1M-2), paralleled by reduced serum lactate (5.3 ñ 0.8 vs 7.0 ñ 2.3 mmol/L) and decreased metabolic acidosis. The benefitsof HSD in attenuating shock-induced oxygen debt were corroborated by lower O2CI(98 ñ 4 vs 112 ñ 5 ml min-1 M-2) and higher pH (7.30 ñ 0.01 vs 7.24 ñ 0.02) in the postresuscitation period