Quantitative analysis of diplopia following orbital fracture repair.

Orbital fractures can result in devastating functional complications to sight and well-being, yet our understanding of functional sequelae post reconstruction is not well understood in the literature. This research retrospectively analysed the activity of a specialist orbital surgeon over five years to evaluate the incidence of, and risk factors for, debilitating complications such as diplopia and restriction of extraocular movement. Orbital fracture cases repaired between 1 January 2015 and 31 December 2019 were retrospectively analysed. Demographics, orthoptic assessment, injury classification, timing, operative details, outcomes, and complications were recorded. Preoperative and postoperative binocular single vision scores (BSV) were recorded to calculate the effect of orbital repair on residual diplopia. Of 582 patients undergoing orbital access, 472 cases of orbital wall reconstruction satisfied the inclusion criteria, of which 162 (34%) were Jaquiéry 4 or 5. Overall, 10.6% had complications, 4.9% had diplopia, and 5.7% were returned to theatre. All those with residual diplopia had had it preoperatively, and had evidence of an improvement in BSV score. Time to surgery, material, and pure orbital fractures had a significant impact on the incidence of diplopia. Defect size did not. Whilst complication rates were low we conclude that strict adherence to a defined surgical protocol, postoperative imaging, and objective assessment of postoperative function are central to maintaining these standards. Objective orthoptic analysis of patients before and after orbital repair is critical to our understanding of this pathology. Whilst preoperative prediction of the persistence of long-term diplopia currently eludes us, further research should target it.

Highly efficient p-i-n perovskite solar cells that endure temperature variations.

Daily temperature variations induce phase transitions and lattice strains in halide perovskites, challenging their stability in solar cells. We stabilized the perovskite black phase and improved solar cell performance using the ordered dipolar structure of ß-poly(1,1-difluoroethylene) to control perovskite film crystallization and energy alignment. We demonstrated p-i-n perovskite solar cells with a record power conversion efficiency of 24.6% over 18 square millimeters and 23.1% over 1 square centimeter, which retained 96 and 88% of the efficiency after 1000 hours of 1-sun maximum power point tracking at 25° and 75°C, respectively. Devices under rapid thermal cycling between -60° and +80°C showed no sign of fatigue, demonstrating the impact of the ordered dipolar structure on the operational stability of perovskite solar cells.

Orbital Bone Fractures in a Central London Trauma Center: A Retrospective Study of 582 Patients.

ABSTRACT: The aim of the present study was to evaluate the injury patterns and etiology of orbital bone fractures treated at a busy level one trauma center.Between 2015 and 2019, patients with orbital bone fractures from the Department of Oral and Maxillofacial Surgery at the Royal London Hospital, were evaluated in a retrospective analysis. A pro-forma was used to collect data from electronic patient records. Parameters included age, gender, maxillofacial fracture, mechanism of injury, and length of hospital admission.Of 582 patients, 82% (n = 476) were male and 18% (n = 106) were female, with those in the age group 20 to 29 years most affected (36%; n = 212). The most common etiology was interpersonal violence (55%; n = 320), followed by falls (20%; n = 118) and road traffic accidents (12%, n = 68). The most common isolated orbital bone fracture site was the orbital floor (40%; n = 234). Of the impure orbital fractures, the zygoma was the most commonly involved structure adjacent to the orbit (19%, n = 110).In our department, the authors see high numbers of complex orbital bone requiring surgical treatment. Interpersonal violence is a significant cause of orbital bone fractures with young males most affected. This study provides an insight into the current trends in etiology, demographics, and clinical findings of orbital fractures that will help guide prevention and treatment strategies.

Getting into medical school - an updated guide for dental graduates.

Dentists seeking to pursue a career in oral and maxillofacial surgery may apply to medical school to achieve the dual qualification necessary to enter specialist training. While there is a plethora of online material relevant to medical school application, little is specific to the dental graduate. This paper outlines the current admissions process, including the application process, medical schools available, admissions tests and interviews. We discuss criteria helpful to dental graduates in this competitive process and financial support available to successful applicants.

Dental and Nondental Stem Cell Based Regeneration of the Craniofacial Region: A Tissue Based Approach.

Craniofacial reconstruction may be a necessary treatment for those who have been affected by trauma, disease, or pathological developmental conditions. The use of stem cell therapy and tissue engineering shows massive potential as a future treatment modality. Currently in the literature, there is a wide variety of published experimental studies utilising the different stem cell types available and the plethora of available scaffold materials. This review investigates different stem cell sources and their unique characteristics to suggest an ideal cell source for regeneration of individual craniofacial tissues. At present, understanding and clinical applications of stem cell therapy remain in their infancy with numerous challenges to overcome. In spite of this, the field displays immense capacity and will no doubt be utilised in future clinical treatments of craniofacial regeneration.

Injuries caused by the attenuated energy projectile: the latest less lethal option.

OBJECTIVES: To review the injuries resulting from the attenuated energy projectile (AEP) in patients who present to emergency departments. METHOD: Review of case notes of patients presenting with injuries caused by the AEP after three episodes of serious civil disturbance in Northern Ireland from July to September 2005. RESULTS: 14 patients with 18 injuries were identified and included in the study. All patients were male, with an average age of 26.3 years. There were six injuries above the level of the clavicle, to the head, face or neck. There were three chest injuries, seven lower limb injuries and two upper limb injuries. There were no abdominal injuries. Seven patients required hospital admission. Five patients required surgical intervention. One patient required protective, elective intubation and one patient required the insertion of a chest drain. DISCUSSION: Although the study numbers were small, 33.33% of injuries were to the head and neck and 16.67% of the injuries were to the chest. The AEP was introduced as a replacement for its predecessor, the L21A1 plastic baton round, because of a theoretical risk of serious or even life threatening head injury from this projectile in certain circumstances. However, in this first survey of its usage, 50% of the injuries presenting to hospital were to the face, neck, head or chest. This injury pattern was more in keeping with older plastic baton rounds than with the L21A1.

Does the National Emergency X-ray Utilization Study make a difference?

OBJECTIVE: To assess whether the introduction of the National Emergency X-ray Utilization Study guidelines in a UK emergency department reduced the number of patients having cervical spine radiographs and altered the accuracy of diagnosis of cervical spine injury. METHODS: This was a prospective, observational study. The number of patients with recent neck injury who had cervical spine radiographs taken was assessed for 3 months before and three months after the introduction of the National Emergency X-ray Utilization Study guidelines to an urban emergency department in the UK. The number of injuries missed by emergency department doctors during the two 3-month periods was also recorded. RESULTS: Prior to using the guidelines, 252 of 715 patients (35%) were X-rayed and when using the guidelines, 268 of 706 patients (38%) were X-rayed. No significant difference was observed between the rates of X-ray in the two groups (P=0.288). No injuries were missed by emergency department doctors either before or after the introduction of the guidelines. CONCLUSION: Introduction of the National Emergency X-ray Utilization Study guidelines to a UK emergency department did not reduce the number of patients having cervical spine radiographs after neck trauma and had no effect on the pick-up rate for cervical spine injuries.