ABSTRACT
Background: Orbital fractures are a common presentation to acute care and carry an associated risk of ocular injury, however, previous research has not investigated injury rates by fracture category. These patients are frequently assessed by non-ophthalmic clinicians, however, limited data exists regarding referral patterns and how this impacts recorded injury rates (1-3). Methods: We performed a retrospective review of all orbital fractures presenting to a tertiary hospital in Christchurch, New Zealand between March 2019 and March 2021. Data including mechanism of injury, fracture type, demographic characteristics, and associated ocular injury were recorded. Results: 284 patients with orbital fractures were identified. 41% of patients had isolated wall fractures, while 59% had complex orbitofacial fractures. Fractures were more common in males, and occurred more frequently in young individuals. The most common mechanism of injury was interpersonal violence (32%), followed by falls (23%). 41% of patients were reviewed by ophthalmology (n = 118). Of those, 33% had an associated ocular injury. Severe ocular injury (defined as vision threatening, requiring globe surgery or acute lateral canthotomy and cantholysis) occurred in 4.9% of those with formal ophthalmic review. 0.7% of patients required intraocular surgery or lateral canthotomy due to their orbital fracture. Conclusion: Orbital fractures have a high rate of concurrent ocular injury in our study population, though rates of subsequent intraocular surgery are low. There was no significant difference in injury rates between isolated and complex fracture categories. Vision-threatening ocular injury occurred in 4.9% of fractures.
ABSTRACT
Post-traumatic reconstruction of the orbit can pose a challenge due to inherent intraoperative problems. Intra-orbital adipose tissue is difficult to manipulate and retract making visualization of the posterior orbital contents difficult. Rapid prototyping (RP) is a cost-effective method of anatomical model production allowing the surgeon to produce a patient specific implant (PSI) which can be pre-surgically adapted to the orbital defect with exact reconstruction. Intraoperative imaging allows immediate assessment of reconstruction at the time of surgery. Utilization and combination of both technologies improves accuracy of reconstruction with orbital implants and reduces cost, surgical time, and the rate of revision surgery.
ABSTRACT
PURPOSE: Rapid prototyping and intraoperative computed tomography (CT) are increasingly used in orbital reconstruction when placement of implants is indicated and accurate anatomic restoration is mandatory. The purpose of this study was to review the outcomes of orbital reconstructions at a single institution and the influence of intraoperative CT and rapid prototyping on the rate of return to the operating theater. MATERIALS AND METHODS: A retrospective cohort analysis was performed from 2013 through 2016 to assess whether rapid prototyping and intraoperative imaging were used and the need for further revision surgery. Clinical notes were reviewed and data were collected for patient gender, age, fracture pattern, preoperative diplopia, and enophthalmos. Also noted were whether rapid prototyping and intraoperative imaging were used, the number of "spins" required, plating systems, postoperative diplopia and enophthalmos, restoration of orbital form, and the need for further surgical intervention. Patients were excluded if no orbital implants were inserted or if they were lost to follow-up. RESULTS: Three hundred thirty-one cases of orbital trauma were reviewed (248 male and 83 female patients; age range, 7 to 96 yr; mean age, 37.5 yr). In total, 154 orbital reconstructions were performed from 2013 through 2016. Five cases required a return to the operating theater for implant revision. All 5 cases did not use intraoperative imaging (P = .0016), and 4 did not have a rapid prototype bio-model (P = .006). Twenty-five of 110 cases (22.7%) using intraoperative CT required intraoperative revision. CONCLUSION: The present study shows improved outcomes for patients treated for orbital fractures when intraoperative imaging and rapid prototyping bio-modeling are used. As a result, postoperative imaging and the morbidity of revision surgery can be avoided. These technologies should be available and considered standard of care to any surgeon performing reconstruction of orbital fractures.
Subject(s)
Dental Implants , Enophthalmos , Orbital Fractures , Plastic Surgery Procedures , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
In Christchurch Hospital, rapid prototyping (RP) and intraoperative imaging are the standard of care in orbital trauma and has been used since February 2013. RP allows the fabrication of an anatomical model to visualize complex anatomical structures which is dimensionally accurate and cost effective. This assists diagnosis, planning, and preoperative implant adaptation for orbital reconstruction. Intraoperative imaging involves a computed tomography scan during surgery to evaluate surgical implants and restored anatomy and allows the clinician to correct errors in implant positioning that may occur during the same procedure. This article aims to demonstrate the potential clinical and cost saving benefits when both these technologies are used in orbital reconstruction which minimize the need for revision surgery.
ABSTRACT
A case of bilateral swelling of the submandibular salivary glands is presented. The histopathological features were diffuse periductal sclerosis with a lymphoplasmacytic infiltrate which was rich in eosinophils. Some acinar atrophy was seen. Salivary ducts showed mucous and squamous prosoplasia, with focal inspissated mucin. Numerous dilated and congested blood vessels were prominent throughout the stroma. These features overlapped with those of Kimura's disease and angiolymphoid hyperplasia with eosinophils. The features of these conditions and a differential diagnosis are discussed.
