Introduction Traumatic facial injuries, leading to facial fractures represent a significant subset of traumatic events, with age emerging as a crucial determinant influencing both their etiology and outcomes. Understanding the age-related patterns of traumatic facial fractures is essential for developing targeted prevention and management strategies. In this context, the Appalachian tri-state area stands as an underexplored region concerning this issue, necessitating comprehensive research to elucidate the nuances of age-related traumatic facial fractures within this geographic context. Methods This retrospective study delves into the age-related patterns of traumatic facial fractures within the Appalachian tri-state area, drawing upon patient records from Cabell Huntington Hospital and Saint Mary\'s Medical Center spanning a five-year period. The study cohort encompasses 623 patients categorized into three age groups: individuals aged <22 years, those aged 22-65 years, and individuals over 65 years. Data analysis involves meticulous examination of mechanisms of injury, injury severity scores (ISSs), hospital length of stay, and the prevalence of surgical interventions across different age cohorts. Results Out of 623 patients, 104 (16.7%) were under 22 years old, 367 (58.9%) were between 22 and 65 years old, and 152 (24.4%) were over 65 years old. The majority were male (70%). Falls were the most common cause of facial fractures in patients over 65 (78%), while assaults were predominant in the 22-65 age group (24%), and motor vehicle collisions (MCVs) in those under 22 (34%). The median ISS and hospital stay durations were similar across age groups. 28% of patients underwent surgery, with significant variation among age groups (p<0.001): 38% for <22 years, 33% for 22-65 years, and 11% for >65 years. Mandibular fractures were more prevalent in younger patients, with rates of 12% for <22 years compared to 5.3% for >65 years. Logistic regression analysis revealed that patients aged 22-65 had 4.10 times higher odds (95% CI=2.38, 7.45, p<0.001) of undergoing surgery, while those under 22 had 5.14 times higher odds (95% CI=2.73, 10.0, p<0.001) compared to those over 65. Significant associations were found for mandibular and bilateral mandibular outcomes in patients aged 22-65 years. Discussion These findings underscore the imperative for tailored prevention strategies and age-specific treatment protocols to optimize patient outcomes. Fall prevention initiatives for the elderly and interventions addressing sports-related injuries for younger individuals are paramount. Moreover, the study highlights the necessity of specialized care protocols for elderly patients to minimize hospital stay durations and manage age-related comorbidities effectively. Moving forward, further research should address limitations, validate findings, and explore the efficacy of specific interventions, thereby paving the way for enhanced preventive measures and management strategies tailored to the diverse age cohorts affected by traumatic facial fractures in the Appalachian region.

BACKGROUND: Effective surgical access to the orbital floor facilitates surgery and mitigates postoperative complications (PC). The aim of this study was to compare PC between the preseptal and retroseptal transconjunctival approaches (PS-TCA/RS-TCA) for isolated orbital floor fracture (OFF).
METHODS: Using a double-blind, non-inferiority, randomized, split-face study design, patients aged ≥ 18 years with bilateral isolated OFF were enrolled. A sample size of 177 eyes per group was determined through power analysis. The primary predictor variable was the surgical approach, and the main outcome was the PC rate at month 6. Statistical analyses were computed with a significance level at 0.05 and the non-inferiority margin at a relative risk (RR) of 0.045.
RESULTS: The final sample included 193 patients (23.3 % female; age, 42.8 ± 18.1 years). Both TCA variants exhibited comparable PC rates (5.2 % for PS-TCA vs. 7.3 % for RS-TCA; P = 0.53; absolute risk, +2.07 % [95 % CI, -2.74 % to 6.89 %]; RR, 1.4 [95 % CI, 0.64 to 3.07]). Approximately one in every 49 patients experiencing PC with RS-TCA (number needed to harm, 48.3).
CONCLUSIONS: Both TCA methods can be used without different PC rates at 6 months postoperatively. Future research should focus on TCA in combination with other surgical approaches for multiple orbital wall reconstruction.

Subciliary incision is a common approach for facial fracture surgery; however, it has a higher incidence of lower lid ectropion, which can be particularly challenging for beginning surgeons to manage. This study reports the usage of lateral tarsoplasty combined with a full-thickness skin graft (FTSG) to correct severe ectropion following the subciliary approach for infra-orbital rim fractures. We retrospectively reviewed all facial fracture cases involving infra-orbital rim fractures through a subciliary approach treated in our department between March 2021 and May 2023. Electronic medical records and clinical digital photographs of patients who met the inclusion criteria were reviewed. After reviewing 196 cases that used the subciliary approach, we found 6 patients (3.06%; 4 males and 2 females; mean age, 68.5 ± 4.89 years) with postoperative severe ectropion managed using lateral tarsoplasty and FTSG. The mean ectropion development and correction times after facial fracture surgery were 0.78 ± 0.24 and 0.91 ± 0.37 months, respectively. At the 12-month follow-up, all patients showed favorable outcomes, and the position of their lower eyelids was well maintained without ectropion recurrence. Based on these successful outcomes, lateral tarsoplasty combined with FTSG is proposed to be an effective and straightforward method for managing lower eyelid ectropion caused by facial fracture surgery.

UNASSIGNED: Retrospective study.
UNASSIGNED: To evaluate patient demographics, surgical management, and complications of orbital and orbitozygomaticomaxillary complex (OZMC) fractures treated at a district hospital in Norway.
UNASSIGNED: The medical records of patients with orbital fractures treated at Aalesund hospital between January 2002 and July 2017 were reviewed. Data on demographics, signs and symptoms, cause of injury, fracture type, associated fractures, surgical management, and complications were collected.
UNASSIGNED: A total of 36 patients were reviewed. Males predominated (1:4.1), and fractures occurred mostly in patients 40-59 years (mean 41.8 years). Interpersonal violence was the leading cause of injury, followed by falls. Alcohol was significantly associated with assault caused fractures (P = .001). Orbitozygomaticomaxillary fractures were the most frequent, followed by pure orbital fractures. Clinical findings included periorbital ecchymosis (72%), swelling (56%), sensory nerve dysfunction (53%), diplopia (22%), and restricted eye motility (22%). Commotio cerebri was observed in more than half of our sample and 47% had other facial bone fractures. Referral to tertiary hospitals was done in 19% of the cases. The main treatment done was open reduction and internal fixation (ORIF) (45%). Infection was diagnosed in 17% and managed with antibiotics.
UNASSIGNED: The incidence of orbital and OZMC fractures in Moere and Romsdal county in western Norway was low, occurring mainly in males over 40 years. The mechanism of injury was predominantly interpersonal violence and falls. A high proportion of the sample had minor traumatic brain injury (mTBI).

The present study aimed to investigate potential functional network brain-activity abnormalities in individuals with orbital fracture (OF) using the voxel-wise degree centrality (DC) technique. The present study included 20 patients with OF (12 males and 8 females) and 20 healthy controls (HC; 12 males and 8 females), who were matched for gender, age and educational attainment. Functional magnetic resonance imaging (fMRI) in the resting state has been widely applied in several fields. Receiver operating characteristic (ROC) curves were calculated to distinguish between patients with OF and HCs. In addition, correlation analyses were performed between behavioral performance and average DC values in various locations. The DC technique was used to assess unprompted brain activity. Right cerebellum 9 region (Cerebelum_9_R) and left cerebellar peduncle 2 area (Cerebelum_Crus2_L) DC values of patients with OF were increased compared with those in HCs. Cerebelum_9_R and Cerebelum_Crus2_L had area under the ROC curve values of 0.983 and 1.000, respectively. Patients with OF appear to have several brain regions that exhibited aberrant brain network characteristics, which raises the possibility of neuropathic causes and offers novel therapeutic options.

UNASSIGNED: Ocular pathology (OP) following orbital fracture can vary vastly in complexity and severity. Extra-ocular motility (EOM) limitations are frequently present in orbital trauma cases, with patterns of duction limitations being symmetrical or asymmetrical. The aim of this study was to identify if there was any association between increased OP following orbital fracture cases based on the pattern of EOM deficits.
UNASSIGNED: This is a retrospective cohort study of patients with fractured orbits presenting with or without EOM limitations to a level 1 trauma center between August 2015 to January 2018. All pertinent elements of the ophthalmic examination were recorded. Outcome measures: Chi-square analyses assessed for association between symmetrical or asymmetrical EOM limitation and OP. Odds ratios were calculated with 95% confidence interval.
UNASSIGNED: 278 orbits with wall fractures were included in this study. A significant correlation between EOM limitation and increased OP following orbital trauma was found (p = 0.000081). Cases with symmetrical and asymmetrical EOM limitation were 7.9 (95%CI: 2.3-27.2) and 5.22 (95%CI: 1.9-13.9) times more likely to have OP than cases with no EOM limitation, respectively. With extraocular muscle entrapment excluded, cases with symmetrical limitations had a significantly higher incidence of OP than cases with asymmetrical limitations (p = 0.0161).
UNASSIGNED: OP is frequently observed in cases of orbital fracture. While any EOM limitations should prompt the clinicians to anticipate OP, intra-ocular injury may be more likely in cases of symmetrical EOM limitation. Future prospective studies are needed to further elucidate the relationship between EOM symmetricity and OP following orbital trauma.

The aim of the study was to compare automated and manually conducted (slice-by-slice) virtual orbital wall reconstruction in terms of PSI design, manufacture, and clinical application for orbital fracture management. Patients with orbital wall fractures were evaluated for the potential for treatment with PSI, based on automated virtual wall reconstruction; these formed the main group. The surgical outcomes of these main-group patients\' treatments were compared with those of the control group, which comprised patients randomly selected for this study, each of whom had the same orbital trauma patterns and were also managed with PSI. However, the control group patients were treated using \'slice-by-slice\' virtual orbital reconstruction. Mean volume differences between the intact and reconstructed orbit were 0.65 ± 0.26 cm3 in the main group (n = 23) and 0.57 ± 0.23 cm3 in the control (n = 27; p = 0.837). In both groups, no cases of implant malposition or enophthalmos were detected after surgery. Orbital shape difference was similar for the main group and the control, at -3.3 ± 3.5% and 3.25 ± 2.5%, respectively (p = 0.929). Diplopia was diagnosed at the 3-month follow-up in 13.0% of the main group and in 11.1% of the control (p = 0.651). The average times spent on computer-aided design (CAD) procedures, including segmentation, virtual orbital reconstruction, and PSI design, were 36.7 ± 6.9 min in the main group and 72.9 ± 7.7 min in the control group (p < 0.001). Within the limitations of the study it seems that PSI based on automated virtual reconstruction is a relevant alternative treatment option for orbital fractures because of its clinical efficacy that is similar to PSI based on a \'slice-by-slice\' CAD protocol.

OBJECTIVE: We aimed to investigate orbital wall fracture incidence and risk factors in the general Korean population.
METHODS: The Korea National Health Insurance Service-National Sample Cohort dataset was analyzed to find subjects with an orbital wall fracture between 2011 and 2015 (based on the diagnosis code) and to identify incident cases involving a preceding disease-free period of 8 years. The incidence of orbital wall fracture in the general population was estimated, and the type of orbital wall fracture was categorized. Sociodemographic risk factors were also examined using Cox regression analysis.
RESULTS: Among 1,080,309 cohort subjects, 2415 individuals with newly diagnosed orbital wall fractures were identified. The overall incidence of orbital wall fractures was estimated as 46.19 (95% CI: 44.37-48.06) per 100,000 person-years. The incidence was high at 10-29 and 80+ years old and showed a male predominance with an average male-to-female ratio of 3.33. The most common type was isolated inferior orbital wall fracture (59.4%), followed by isolated medial orbital wall fracture (23.7%), combination fracture (15.0%), and naso-orbito-ethmoid fracture (1.5%). Of the fracture patients, 648 subjects (26.8%) underwent orbital wall fracture repair surgeries. Male sex, rural residence, and low income were associated with an increased risk of orbital wall fractures.
CONCLUSIONS: The incidence of orbital wall fractures in Korea varied according to age groups and was positively associated with male sex, rural residency, and low economic income. The most common fracture type was an isolated inferior orbital wall fracture.

BACKGROUND: Several materials for medial orbital wall reconstruction have been mentioned in the literature. Our main purpose was to investigate postoperative enophthalmos and diplopia after medial orbital wall reconstruction with polydextro- and polylevolactic (poly-L/DL) acid (P[L/DL]LA) mesh plates and porous polyethylene plates.
METHODS: Using a retrospective study design, we enrolled a cohort of isolated medial blowout fracture patients treated during a 58-month interval. The predictor variable was medial orbital wall reconstruction materials (P(L/DL)LA mesh plate and porous polyethylene plate. The main outcome variables included the occurrence of postoperative enophthalmos and diplopia at 1 week, 1, 3, 6, and 12 months post-surgery. Appropriate descriptive, uni- and bivariate statistics were computed, and P < 0.05 was considered significant.
RESULTS: Three hundred-two isolated medial blowout fracture patients were included (24.5% females, 67% treated with P(L/DL)LA mesh plate). Exophthalmos measured highest in both groups 1 week after surgery and decreased steadily for 6 months postoperatively. Statistically significant differences were observed between both groups at 1 week, 1 month, and 3 months after surgery, with a higher incidence of exophthalmos observed in the P(L/DL)LA mesh plate group (P < 0.001). No significant differences were observed at 6 and 12 months after surgery.
CONCLUSIONS: The occurrence of enophthalmos after medial blowout fracture reconstruction with P(L/DL)LA mesh plate is comparable with the use of porous polyethylene plate. Both P(L/DL)LA mesh and porous polyethylene plates are, therefore, reliable implants for medial orbital wall reconstruction.

UNASSIGNED: Treating orbital injuries is interesting and difficult in the facial trauma. The balance in facial proportions and also the facial esthetics are required to achieve an anatomical harmony.
UNASSIGNED: To compare the functional results of individual reconstruction of orbital floor using either titanium mesh or Medpor in terms of various factors.
UNASSIGNED: There were two study groups including eight subjects with orbital floor fracture, namely A (Medpor) and B (titanium mesh). Various parameters were analyzed postoperatively at intervals of 1 week, 3 week, 6th week, and 3 months after the surgery.
UNASSIGNED: Comparison of the different time points with respect to pain scores in the two study groups by Wilcoxon matched pairs test was done. P value was significant in the study Group A with P = 0.0431* and was insignificant in the study Group B with P = 0.1088.
UNASSIGNED: All three cases of titanium mesh in orbital floor reconstruction had signs of infection, tenderness, and radiographic proof after 1 week in two subjects and 3 weeks in one patient. Pain was seen in all eight patients 1 week postoperatively.
UNASSIGNED: Although orbital reconstruction is a technique sensitive procedure both Medpore and Titanium mesh functions.