Mydriasis during Orbital Floor Fracture Reconstruction: A Novel Diagnostic and Treatment Algorithm.
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ABSTRACT:
SUBMITTER: Yeo MS
PROVIDER: S-EPMC3052704 | biostudies-other | 2010 Dec
REPOSITORIES: biostudies-other
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Project description:In orbital floor fractures, the estimation of the herniated orbital content in the maxillary sinus has traditionally been the dividing line between surgical and nonsurgical management. In this study, we evaluated whether a relative change in volume would function as an indicator for surgical versus nonsurgical treatment of orbital floor fractures. This was a follow-up study in patients with untreated unilateral isolated orbital floor fractures admitted to our department from March 2003 to April 2007. Patients were contacted by regular mail and invited to have a clinical eye examination. The volume of the orbital content was calculated digitally from the patients' computed tomography scans at the time of their injury. Eighteen subjects with no facial skeleton fracture were included for reference of orbital content volumes. Five of 23 patients showed 2 to 4 mm of enophthalmos, and only three of them had intermittent diplopia. No statistical correlation was found between the herniated volume and enophthalmos. No statistical correlation supporting the supposition that 1 mL of herniated orbital content would result in 1 mm of enophthalmos was found. The relative volume change between the fractured and nonfractured orbit in an individual does not appear to be a useful criterion for surgery. The importance of the herniated orbital tissue for the development of enophthalmos is unclear.
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Project description:Aim and objectivesThe aim of this study was to analyse the outcomes of orbital floor reconstruction with two types of orbital implants and assess patients' quality of life.Material and methods39 sequential patients with clinical and radiological evidence of orbital floor fracture, presenting diplopia, enophthalmos, paraesthesia or a post traumatic residual orbital deformity were included in this study and randomised for orbital floor reconstruction using porous polyethylene sheet (Biopore™) or preshaped titanium mesh on a 3D model. Their pre and postoperative quality of life were compared. Success rate was assessed and scored with a minimum of zero (none) and a maximum of ten (excellent) for improvement in the signs of diplopia, enophthalmos, hypoglobus, paraesthesia and aesthetics.ResultsBoth QOL scores and Success score was greater in cases which reconstruction of orbital floor was performed with preshaped titanium mesh as compared to those with Biopore™.ConclusionPreshaped titanium mesh shows better results than reconstruction with Biopore™. However a large sample size and a long term follow up is needed for generating the best evidence. Quality of life extensively improves after orbital floor reconstruction motivating the patients desire to live.
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Project description:BackgroundOrbital exenteration, the removal of the entire globe, eyelids, and orbital content, is indicated in extensive neoplastic disease involving the orbital region. Although a functional reconstruction of orbital exenteration defects is mandatory, aesthetic concerns need to be considered. Facial disfigurement following reconstructive surgery often leads to great discomfort and social retirement, which can limit social interaction. The aim of this study was to explore how the society perceives the aspect of patients who underwent orbital exenteration and subsequent reconstruction, comparing two different types of reconstruction: standard anterolateral thigh (ALT) or "sandwich" fascial ALT (SALT) free flap.MethodsAn online survey was created based on four questions regarding the perception of reconstruction (discomfort at looking at that patient, perception of unhealthiness, hypothesis of social life impairment, etc); five possible answers were provided, ranging from "completely" to "not at all." The survey was administered to the general population and to medical students.ResultsIn total, 255 people participated to the survey (130 medical students and 125 people of the general population); a total of 245 surveys were considered eligible (10 were incomplete and then discharged). Statistical significance was found (P < 0.001) regarding the better overall appearance of the SALT group over the ALT one.ConclusionsAfter analysis, the surgical outcome after SALT reconstruction has been found to be less disruptive in both groups, due to a reduced scar burden and a more pleasant orbital pocket. Our results encourage more research in the field of postexenteration reconstruction to achieve more aesthetic and social acceptability.
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