Clinical outcome after orbital floor fracture reduction with special regard to patient's satisfaction.

PURPOSE: Primary reconstruction via transconjunctival approach is a standardized treatment option for orbital floor fractures. The aim of this study was to compare the findings of specific ophthalmologic assessment with the patient's complaints after fracture reduction. METHODS: A retrospective medical chart analysis was performed on patients who had undergone transconjunctival orbital floor fracture reduction for fracture therapy with resorbable foil (ethisorb sheet or polydioxanone foil). A follow-up assessment including ophthalmological evaluation regarding visual acuity (eye chart projector), binocular visual field screening (Bagolini striated glasses test) and diplopia (cover test, Hess screen test) was conducted. Additionally, a questionnaire was performed to assess patients' satisfaction. RESULTS: A total of 53 patients with a mean follow-up of 23 months (ranging from 11 to 72) after surgical therapy were included. Diplopia was present preoperatively in 23 (43.4%) and reduced in follow-up examination (n = 12, 22.6%). Limitations in ocular motility reduced from 37.7% to 7.5%. The questionnaire about the patient's satisfaction revealed excellent outcomes in relation to the functional and esthetical parameters. CONCLUSION: Transconjunctival approach is a safe approach for orbital fracture therapy. Postoperative diplopia is nearly never perceptible for the individual and differs to pathologic findings in the ophthalmic assessment.

Quality of life after orbito-facial trauma.

In the wake of high incidence of orbito-facial trauma, there has been a growing need to assess not only the visual outcome, but also the psychological impact of the traumatic event. This is a single questionnaire based evaluation of 100 consecutive patients with orbito-facial trauma (blow-out and Le fort type II and III fractures) at six months of trauma. 84% of the patients had a NEI VFQ- 25 score of less than 50, with 49% having a score less than 25, reflecting the grim impact the trauma has on the quality of life. The three parameters of the questionnaire - general health, difficulty with activities and response to vision problems were significantly positively correlated. Quality of life is considerably affected following orbito-facial trauma, disturbing physical, mental and social health. Poor vision is positively correlated with poor general health. Psycho-social impact of trauma needs to be recognized as an important sphere in the management of orbito-facial trauma.

Influence of kinesiologic tape on postoperative swelling, pain and trismus after zygomatico-orbital fractures.

Surgical treatment of zygomatico-orbital (ZO) fractures is a common procedure in maxillofacial surgery. Often accompanied by pain, trismus and swelling, postoperative morbidity is a major disadvantage, affecting patients' quality of life. The appliance of kinesiologic tape (KT) improves the blood and lymph flow, removing congestions of lymphatic fluid and haemorrhages. The aim of this study was to find out if the application of kinesiologic tape prevents or improves swelling, pain and trismus after zygomatico-orbital fracture surgery, improving patients' postoperative quality of life. A total of 30 patients were assigned for treatment of zygomatico-orbital fractures and were randomly divided into treatment either with or without kinesiologic tape. Tape was applied directly after surgery and maintained for at least 5 days postoperatively. Facial swelling was quantified using a five-line measurement at six specific time points. Pain and degree of mouth opening was measured. Patient's subjective feeling and satisfaction was queried. The results of this study show that application of kinesiologic tape after zygomatico-orbital surgery significantly reduced the incidence of swelling with an earlier swelling maximum, and decreased the maximum turgidity for more than 60% during the first 2 days after surgery. Although, kinesiologic tape has no significant influence on pain control and trismus, mouth opening increased earlier after operation in the kinesiologic tape group compared to the no-kinesiologic tape group. Furthermore, patients with kinesiologic tape felt significantly lower morbidity than those without kinesiologic tape. Therefore kinesiologic tape is a promising, simple, less traumatic, economical approach, which is free from adverse reaction and improves patients' quality of life.

Causes and effects of zygomatico-orbital and zygomatico-maxillo-orbital fractures managed by open reduction and rigid internal fixation.

Progressive violence, the quickening pace of life and transport facilities' development have as a consequence an increased number of traumas. Midface fractures involving zygomatic bone fractures take one of the leading positions in the total number of traumas. It seems appropriate to study the causes and the effects of zygomatico-orbital and zygomatico-maxillo-orbital fractures managed by open reduction and rigid internal fixation at the present time of the medical service being reformed and economic rules being included in the treatment. The analysis of the economic consequences of midface traumas and their causes as well as the search for the influence of social and cultural changes on fracture management was the aim of the study. Histories of 61 injured patients treated by open reduction and rigid internal fixation in 1st Department of Maxillofacial Surgery of the Silesian Medical University in Zabrze between 1996 and 2001 were studied. Patients' sex, the most frequent trauma causes and their disposition in different age groups were taken into consideration. It was observed that certain symptoms of the fracture tend to coexist with high energy traumas (traffic accidents, violent assaults). The influence of injury's extension on the prolongation of hospitalization time was emphasized. It was concluded that assaults and traffic accidents are the most frequent and devastating causes of zygomatico-orbital and zygomatico-maxillo-orbital fractures. The fractures usually involve men aged from 21 to 40 years. The rapid growth of violence and the pace of life have in recent times necessitated the general use of advanced and expensive operating techniques in injured patients recently. The break in social and professional activity of injured individuals and the scale of the problem indicate the necessity of change in medical service financing.

Conducta pseudopsicopática y lesiones cerebrales / Pseudopsychopathic behaviour and brain injuries

Ya en el siglo XIX aparece la primera y más famosa referencia a cambios de conducta social secundarios a lesiones frontales, se trata del famoso caso de Phineas Gage. Durante el siglo XX diversas descripciones de casos de lesión cerebral centran en la región frontal orbital o ventromedial el síndrome de pseudopsicopatía o de sociopatía adquirida. Este síndrome se caracteriza por pérdida de la conducta socialmente adecuada con irritabilidad, agresividad ocasional, desorganización de la conducta, alteración de la toma de decisiones, egocentrismo, desinhibición e incluso conductas delictivas. Este patrón aparece en adultos que han sufrido una lesión en esta región prefrontal. Cuando las lesiones se dan en la primera infancia las características son aún más destacadas, con alteración del razonamiento moral y falta de culpabilidad hacia las propias acciones. Este síndrome conductual puede ir acompañado de rendimiento intelectual y prefrontal cognitivo absolutamente normal, sobre todo en lesiones adultas. En el caso de lesiones infantiles acostubran a aparecer trastornos cognitivos frontales variables (AU)

Ocular psychiatric disorders in maxillofacial injuries. Two case reports and a review of psychogenic ocular symptoms.

Ocular signs and symptoms associated with facial trauma can be a manifestation of an underlying psychiatric disorder which may exist prior to the traumatic incident, or even develop as a result of the stressful traumatic experience in a psychologically vulnerable individual. Two such cases are presented. A brief review of psychogenic ocular symptoms as well as suggestions for evaluation and treatment are discussed.