Improving Patient Education of Facial Fractures Using 3-Dimensional Computed Tomography.

OBJECTIVE: Advances in 3-dimensional modeling have revolutionized presurgical planning for maxillofacial reconstruction, yet little is known about how this technology may affect patient education. This study was designed to evaluate the efficacy of 2-dimensional computed tomography versus 3-dimensional computed tomography for patient education in maxillofacial reconstruction. STUDY DESIGN: Crossover study. SETTING: General otolaryngology outpatients from a tertiary referral center were recruited. METHODS: A single computed tomography data set of a zygomaticomaxillary complex fracture was used to generate 2 educational video tutorials: one in a 2-dimensional format and one in a 3-dimensional format. The tutorials were embedded into the QualtricsXM platform. Participants were randomly assigned into 2 groups. Group 1 viewed the 2-dimensional tutorial, took a self-assessment survey, took an information recall survey, viewed the 3-dimensional tutorial, and finally took a tutorial comparison survey. Group 2 followed the same sequence but viewed the 3-dimensional tutorial followed by the 2-dimensional tutorial. RESULTS: Group 2 participants (viewing the 3-dimensional tutorial first) scored better on the self-assessment survey than their counterparts in group 1 did (P = .023). Group 2 also scored better on the recall survey (P = .042). Of all participants, 61% preferred the 3-dimensional tutorial, and 31% preferred the use of both tutorials together in the comparison survey. CONCLUSIONS: Three-dimensional patient educational tutorial regarding a zygomaticomaxillary complex fracture resulted in better knowledge retention and was preferred over the 2-dimensional format.

Bleb morphology characteristics and effect on positional intraocular pressure variation.

BACKGROUND AND OBJECTIVE: To study bleb morphology and positional intraocular pressure (IOP) change (IOP supine to IOP sitting). PATIENTS AND METHODS: In this observational case series, blebs were graded for height, extent, vascularity, microcysts, and "ring of steel." Positional IOP change was analyzed using the paired t test. Associations between IOP change and bleb morphologies were evaluated by regression adjusting for inter-eye dependency. RESULTS: Ninety-five eyes of 68 subjects were included. Decreased bleb height (P = .05), absence of microcysts (P = .02), and increased bleb vascularity (P = .02) were associated with larger positional IOP change. Twenty patients with a filter in one eye and a medically treated fellow eye had larger positional IOP change in the medically treated eye (6.1 vs 4.6 mm Hg, respectively; P = .01). CONCLUSION: Successful filtration surgery results in both lower IOP and less positional IOP change compared with medically treated eyes. Bleb features associated with smaller positional IOP change include higher elevation, microcysts, and less vascularity.

Anatomical 3-dimensional pre-bent titanium implant for orbital floor fractures.

PURPOSE: This cadaver study evaluates the use of pre-bent 3-dimensional titanium mesh implants for orbital floor and medial wall reconstruction. DESIGN: Nonrandomized comparative study. PARTICIPANTS: Eight human cadaveric heads (n = 16 orbits). METHODS: Transcutaneous incisions were used to expose both orbital floors in each cadaveric head. Unilateral orbital floor and medial wall fractures were generated in each specimen. The contralateral orbit remained uninjured. The fractures then were repaired with pre-bent titanium mesh fan plates molded from aluminum templates presenting different sizes. The templates were generated from topographical computed tomography (CT) data previously obtained from normal subjects. The accuracy of orbital reconstruction was evaluated with postoperative CT scans. MAIN OUTCOME MEASURES: The mean value of the distances between the implant and the bony orbit was evaluated. RESULTS: The mean distance between all 16 plates and their respective orbital floors/medial walls was 0.81+/-0.74 mm. Mean values were 0.68+/-0.63 mm for the unfractured side and 0.93+/-0.82 mm for the fractured side. No significant differences were found between orbits when evaluated for side of injury, gender, or size of defect. CONCLUSION: Pre-bent 3-dimensional titanium mesh implants provide accurate reconstruction of orbital floor and medial orbital wall fractures. The mean implant error was <1 mm for all orbits studied.

Topical cyclosporine inhibits conjunctival epithelial apoptosis in experimental murine keratoconjunctivitis sicca.

PURPOSE: Increased apoptosis in the conjunctival epithelium has been observed in experimental murine keratoconjunctivitis sicca (KCS). Topical cyclosporine (CsA) has been noted to reduce conjunctival epithelial apoptosis in chronic canine and human KCS. The purpose of this study is to determine if topical CsA treatment inhibits conjunctival epithelial apoptosis in a murine model of KCS. METHODS: Dry eye was induced in 3 groups of C57BL6 mice by subcutaneous injection of scopolamine TID and exposure to an air draft and low-humidity environment for 16 hours per day for 12 days. The dry eye control group received no topical treatment; a second group received 1 microL of 0.05% CsA topically TID (dry eye + CsA); and the third group received 1 microL of the castor oil vehicle of CsA topically TID (dry eye + vehicle). Normal mice were used as untreated controls. After 12 days, the mice were killed, and the right eyes and eyelids were excised, frozen, and cryosectioned. Transmission electron microscopy (TEM) was performed on conjunctival and corneal samples taken from the left eyes. Apoptosis was detected in frozen sections with the ApopTag (ISOL) In Situ Oligo Ligation Kit, which specifically detects DNA fragmentation. Immunohistochemical staining was performed to detect activated caspase-3. Conjunctival goblet cell number was counted in tissue sections stained with period acid Schiff (PAS) reagent. These assays were performed on 2 separate sets of mice. RESULTS: Compared with untreated controls and dry eye mice receiving CsA, the number of ISOL-positive epithelial cells in the bulbar and tarsal conjunctiva was significantly greater in the dry eye control and dry eye mice + vehicle groups (P < 0.01 for both groups). There was no significant difference in the number of ISOL-positive conjunctival epithelial cells between the dry eye control and dry eye + vehicle mice. There was no significant difference in ISOL-positive cells in the corneal epithelium between the untreated controls and the 3 treatment groups. Dry eye + CsA mice showed less activated caspase-3 staining than the dry eye control and the dry eye + vehicle groups. TEM showed loss of superficial differentiated cells and extensive nuclear fragmentation characteristic of apoptosis in the dry eye control and dry eye + vehicle groups but not in the dry eye + CsA group. There was significant loss of goblet cells in the bulbar and tarsal conjunctivae of the dry eye control and the dry eye + vehicle groups compared with untreated controls and the dry eye + CsA group. CONCLUSIONS: Topical CsA significantly reduced conjunctival epithelial apoptosis and protected against goblet cell loss in experimental murine KCS. Inhibition of apoptosis appears to be a key mechanism for the therapeutic effect of CsA for KCS.