UNASSIGNED: To date, no study provides a comprehensive analysis of traumatic orbital floor fractures across the United States. We aimed to characterize patient demographics, injury-related variables, and operative management in this population.
UNASSIGNED: The National Trauma Data Bank was queried for open or closed orbital floor fractures from 2008 to 2016. Clinical data were extracted.
UNASSIGNED: Overall, 148,592 orbital floor fractures were identified, with 142,577 (95.9%) closed- and 6158 (4.1%) open-type fractures. A total of 106,243 (71.5%) patients were male and the median patient age was 41 years. The majority of patients (79.2%) had abbreviated injury scale scores of ≤2, indicating minor/moderate injury. Fracture mechanism of injury (MOI) differed by gender, with the most frequent being unarmed fights in men (34.3%) and falls in women (14.0%). There were 29,600 patients (19.9%) with isolated orbital floor (I-OF) fractures. The MOI most strongly associated with operative intervention of with I-OF fractures were penetrating injuries caused by a firearm (odds ratio [OR]: 2.91; 95% confidence interval [CI]: 1.62-5.20) and cuttings/piercings (OR: 2.17; 95% CI: 1.29-3.65).
UNASSIGNED: This large epidemiological study reveals that orbital floor fractures tend to present with minor or moderate injuries and are more likely to require operative intervention in setting of firearm or cut/pierce injuries.

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.

Fractures of the orbit are frequently noted in craniomaxillofacial trauma. The complexity of the anatomy and the proximity to various vital structures often complicates the surgical management of these fractures. The authors have thus attempted to review the literature on anatomy of the bony orbit and its soft tissue envelope in a simplified manner with due emphasis on surgical anatomy and exploration of the orbit with a surgical perspective. The contents of this narrative literature review may be useful for young maxillofacial surgeons and will aid in the process of management of orbital fractures.

BACKGROUND: Traffic trauma can lead to ocular damage. Open globe injuries usually have a poor prognosis, which can be ameliorated by prompt diagnosis and appropriate treatment. Nonetheless, few studies have focused on the visual outcomes of patients following traffic accidents. In this study, we aimed to examine the characteristics and prognosis of ocular complications in patients following traffic accidents at a specialized tertiary eye hospital.
METHODS: We classified 44 patients from traffic accidents (88 eyes) into groups with equal or better (better group) and worse (worse group) corrected-distance visual acuity than a logarithm of the minimum angle of resolution 0 at the initial presentation. Final corrected-distance visual acuity, intraocular pressure, corneal injury, presence of traumatic cataracts, and treatment were compared between the groups. In addition, a multivariate linear regression analysis was performed to identify factors associated with the final visual acuity.
RESULTS: Globe contusion, orbital blowout fracture, traumatic iritis, and trochlear nerve palsy were observed in 14.8%, 3.4%, 2.3%, and 2.3% of the patients, respectively. Topical instillation and ophthalmological treatment/surgery were performed in 17.0% and 9.1% of the patients, respectively. The better group (68 eyes) had significantly better final visual acuity than the worse group (20 eyes) (P < 0.001). However, there was no between-group difference in demographic characteristics. Multivariate analysis demonstrated that there was a significant correlation between the initial and final visual acuities (P < 0.001).
CONCLUSIONS: Assessing visual acuity at the initial presentation is crucial for predicting the final visual acuity. Our findings will help to inform ophthalmologists aiming to improve the prognosis and treatment of ocular trauma in patients following traffic accidents.

Orbital fractures in the pediatric population are rare. A trapdoor fracture is a special anatomic type of orbital fracture associated with herniation of orbital contents and entrapment of extraocular muscles entrapment with no signs of any soft tissue trauma. A delay in diagnosis can lead to a life-threatening condition known as oculocardiac reflex, characterized by nausea, vomiting, bradycardia, and syncope. Many authors recommend early surgical intervention, but some patients may delay for various reasons. We hereby represent three cases of orbital fracture to prevent long-term persistent diplopia. Depending on the case scenario, two cases were operated on in which an autogenous iliac cortical graft was placed in one patient to prevent postoperative herniation of orbital content, and in one patient, only release of entrapped muscles was done. One patient was managed conservatively with a regular follow-up visit.

OBJECTIVE: This pilot study aims to evaluate the feasibility and effectiveness of computer-assisted surgery protocol with 3D-preformed orbital titanium mesh (3D-POTM), using presurgical virtual planning and intraoperative navigation in primary inferomedial orbital fracture reconstruction.
METHODS: Between March 2021 and March 2023, perioperative data of patients undergoing surgery for unilateral inferomedial orbital fracture treated with 3D-POTM were analyzed. Presurgical virtual planning with a Standard Triangle Language file of preformed mesh was conducted using the mirrored unaffected contralateral side as a reference, and intraoperative navigation was used. The reconstruction accuracy was determined by: correspondence between postoperative reconstruction mesh position with presurgical virtual planning and difference among the reconstructed and the unaffected orbital volume. Pre- and postoperative diplopia and enophthalmos were assessed.
RESULTS: Twenty-six patients were included. Isolated orbital floor fracture was reported in 14 (53.8%) patients, meanwhile medial wall and floor one in 12 (46.1%) cases. The mean difference between final plate position and ideal digital plan was 0.692 mm (95% CI: 0.601-0.783). The mean volume difference between reconstructed and unaffected orbit was 1.02 mL (95% CI: 0.451-1.589). Preoperative diplopia was settled out in all cases and enophthalmos in 19 (76.2%) of 21 patients.
CONCLUSIONS: The proposed protocol is an adaptable and reliable workflow for the early treatment of inferomedial orbital fractures. It enables precise preoperative planning and intraoperative procedures, mitigating pitfalls and complications, and delivering excellent reconstruction, all while maintaining reasonable costs and commitment times.

UNASSIGNED: Foreign body reaction to non-absorbable alloplastic orbital implants utilized for bony reconstruction are infrequently documented in the literature. We present the workup and surgical management of a giant cystic mass encapsulating a patient\'s alloplastic orbital implant, which was ultimately deemed to be a result of foreign body reaction.
UNASSIGNED: A 41-year-old male patient with distant history of a right orbital floor fracture had undergone repair with the placement of a nylon foil implant. The patient presented twenty years later with progressive ipsilateral globe proptosis and was found to have a giant inferior orbital cyst. Surgical exploration and removal of the implant and capsule were performed. Histopathology confirmed a delayed foreign body reaction around the patient\'s alloplastic implant.
UNASSIGNED: Alloplastic implants may result foreign body reaction and cyst encapsulation as a delayed complication.

Background: During blow-out fracture surgery, restoration of the orbital volume and rigid implant fixation are essential. The migration of an implant is a concern of most surgeons. The purpose of this study was to introduce a simple idea of molding and fixing an orbital implant. Methods: In the tongue-in-groove method, an incision of about 2 mm was made on the edge of the implant and it was bent to form a slot. A hole was made in the center of the implant for fitting a bone hook, and the implant was firmly fit into the remaining intact bone. Before and after surgery, computed tomography (CT) was used to evaluate changes in the orbital volume and the location of the implant. Statistically significant restoration of the orbital volume was confirmed on postoperative CT. Results: Compared with the unaffected orbital volume, the affected orbital volume was increased from 87.06 ± 7.92% before surgery to 96.14 ± 6.11% after surgery (p < 0.001). There was one case of implant migration during follow-up. However, the degree of movement was not severe, and there were no events during the follow-up period. Conclusions: The tongue-in-groove technique offers advantages, such as easy fixation of the implant, with minimal trauma to the surrounding tissues. In addition, the method offers advantages, such as being easy to learn, requiring little time for trimming the implant, and being relatively low cost. Therefore, it can be one of the options for implant fixation.

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: To evaluate eye and orbital injuries in non-powered scooter, electric-scooter (e-scooter), and hoverboard riders in the United States (US) between 2014 and 2019.
UNASSIGNED: The National Electronic Injury Surveillance System (NEISS) was queried for head and neck injuries by body part codes related to non-powered scooters and powered scooters/hoverboards from 2014 to 2019. The NEISS complex sampling design was used to obtain US population projections of injuries and hospital admissions. Keywords were queried in case narratives to analyze trends in location, type, and mechanism of eye and orbit injuries.
UNASSIGNED: Since their introduction, a 586% (p=0.01) increase in e-scooter injuries and 866% (p<0.001) increase in hoverboard injuries were observed with an increase in hospital admissions seen in young adults (18-34) in urban areas (e-scooter: 5980% and hoverboard: 479%). Descriptive narratives of the trauma noted eye injuries in 242 unweighted NEISS cases with only 30 cases appropriately documented under body part code 77: eyeball. Eye injuries increased 96.9% during the study period (p=0.23). Specifically, the most common ophthalmic injuries reported included eyebrow (40.9%) and eyelid (11.3%) lacerations, periorbital contusions (18.7%), orbit fractures (6.6%), and corneal abrasions (5.1%).
UNASSIGNED: There was a significant increase in both head and neck injury cases and hospital admissions related to e-scooters. Eye and orbit injuries similarly increased but were underreported by body part code compared to injury narratives. Orbital fractures were reported more frequently in injuries from e-scooters than non-powered scooters.
From 2014 to 2019, there were significant increases in both head and neck injuries and hospital admissions related to e-scooters, with eye and orbital injuries similarly increased but underreported by body part code compared to the injury narratives.