Orbital fractures, constituting 10-25% of facial traumas, result from diverse mechanisms such as traffic accidents and assaults. These fractures present with characteristic symptoms like edema, diplopia, and infraorbital paraesthesia. Timely diagnosis and surgical intervention are paramount to mitigate long-term complications. Recent advancements in materials science and surgical methodologies have ushered in innovative approaches including 3D printing and computer-aided design implants. This article details a case study of successful reconstructive orbital surgery in a patient following a traumatic incident where a car accident caused extensive facial fractures. Leveraging 3D printing technology, a precisely tailored titanium mesh aided in the meticulous restoration of the orbital floor. During surgery, entrapped soft tissues were released, and the zygomatic-maxillary complex was carefully repositioned. Postoperative evaluation revealed promising outcomes, affirming the efficacy of contemporary surgical strategies. This case highlights the evolving role of 3D printing in enhancing the accuracy, cost-effectiveness, and accessibility of orbital reconstruction procedures, demonstrating its potential for broader clinical applications.

BACKGROUND: The eyes are the central aesthetic unit of the face. Maxillofacial trauma can alter facial proportions and affect visual function with varying degrees of severity. Conventional approaches to reconstruction have numerous limitations, making the process challenging. The primary objective of this study was to evaluate the application of three-dimensional (3D) navigation in complex unilateral orbital reconstruction.
METHODS: A prospective cohort study was conducted over 19 months (January 2020 to July 2021), with consecutive enrollment of 12 patients who met the inclusion criteria. Each patient was followed for a minimum period of 6 months. The principal investigator carried out a comparative analysis of several factors, including fracture morphology, orbital volume, globe projection, diplopia, facial morphic changes, lid retraction, and infraorbital nerve hypoesthesia.
RESULTS: Nine patients had impure orbital fractures, while the remainder had pure fractures. The median orbital volume on the normal side (30.12 cm3; interquartile range [IQR], 28.45-30.64) was comparable to that of the reconstructed orbit (29.67 cm3; IQR, 27.92-31.52). Diplopia improved significantly (T(10) = 2.667, p = 0.02), although there was no statistically significant improvement in globe projection. Gross symmetry of facial landmarks was achieved, with comparable facial width-to-height ratio and palpebral fissure lengths. Two patients reported infraorbital hypoesthesia at presentation, which persisted at the 6-month follow-up. Additionally, five patients developed lower lid retraction (1-2 mm), and one experienced implant impingement at the infraorbital border.
CONCLUSIONS: Our study provides level II evidence supporting the use of 3D navigation to improve surgical outcomes in complex orbital reconstruction.

暂无摘要。

The aim of this systematic review was to investigate the relationship between fractures of the floor of the orbit (blow outs) and their repercussions on eye movement, based on the available scientific literature. In order to obtain more reliable results, we opted for a methodology that could answer the guiding question of this research. To this end, a systematic review of the literature was carried out, using a rigorous methodological approach. The risk of bias was assessed using version 2 of the Cochrane tool for the risk of bias in randomized trials (RoB 2). This systematic review was carried out according to a systematic review protocol previously registered on the PROSPERO platform. The searches were carried out in the PubMed (National Library of Medicine), Scopus, ScienceDirect, SciELO, Web of Science, Cochrane Library and Embase databases, initially resulting in 553 studies. After removing duplicates, 515 articles remained, 7 were considered eligible, of which 3 were selected for detailed analysis. However, the results of the included studies did not provide conclusive evidence of a direct relationship between orbital floor fractures and eye movement.

UNASSIGNED: Orbital fractures are a common presentation to acute care and carry an associated risk of ocular injury, however, previous research has not investigated injury rates by fracture category. These patients are frequently assessed by non-ophthalmic clinicians, however, limited data exists regarding referral patterns and how this impacts recorded injury rates (1-3).
UNASSIGNED: We performed a retrospective review of all orbital fractures presenting to a tertiary hospital in Christchurch, New Zealand between March 2019 and March 2021. Data including mechanism of injury, fracture type, demographic characteristics, and associated ocular injury were recorded.
UNASSIGNED: 284 patients with orbital fractures were identified. 41% of patients had isolated wall fractures, while 59% had complex orbitofacial fractures. Fractures were more common in males, and occurred more frequently in young individuals. The most common mechanism of injury was interpersonal violence (32%), followed by falls (23%). 41% of patients were reviewed by ophthalmology (n = 118). Of those, 33% had an associated ocular injury. Severe ocular injury (defined as vision threatening, requiring globe surgery or acute lateral canthotomy and cantholysis) occurred in 4.9% of those with formal ophthalmic review. 0.7% of patients required intraocular surgery or lateral canthotomy due to their orbital fracture.
UNASSIGNED: Orbital fractures have a high rate of concurrent ocular injury in our study population, though rates of subsequent intraocular surgery are low. There was no significant difference in injury rates between isolated and complex fracture categories. Vision-threatening ocular injury occurred in 4.9% of fractures.

暂无摘要。

A man in his 60s presented with diminution of vision of the left eye with nasal bleeding after accidental fall. On examination his left upper eyelid was lacerated and left temporal sclera was punctured which was repaired under local anaesthesia after which he was discharged by ophthalmologists but continued to complain of pain and left nasal obstruction. A non-contrast CT of paranasal sinuses revealed fracture of medial wall of left orbit, left ethmoid haemosinus and a metallic foreign body (FB) in the septum and anterior face of sphenoid. Diagnostic nasal endoscopy performed to remove the metallic FB showed plastic splinters embedded in the mucosa of nasal cavity which was unexpected. Hence, the FB was removed in two sittings because of diagnostic dilemma.

OBJECTIVE: Various materials have been proposed for reconstructing orbital fractures. The materials used must meet certain criteria to ensure their suitability for restoring the structure and function of the organ. These criteria include biocompatibility, ease of application, non-toxicity, hypo-allergenicity, and non-carcinogenicity. In this study, we systematically reviewed the studies regarding the biomaterials in orbital implants and their clinical application.
METHODS: A comprehensive search across various databases, including PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science, was conducted until April 10th, 2023. After retrieving the search results and eliminating duplicates, final studies were included after screening through defined criteria. Human and animal studies assessing the clinical application of biomaterials in orbital implants were included. The quality of the case series and controlled intervention studies were evaluated using the NIH tool, and for animal studies, the risk of bias was assessed using SYRCLE\'s tool.
RESULTS: Seventeen studies were included according to defined criteria. These studies aimed to explore the clinical application of biomaterials and examine the associated complications in orbital implants.
CONCLUSIONS: We found that using biomaterials did not result in elevated intraocular pressure (IOP). However, we did observe certain complications, with infection, residual diplopia, and enophthalmos being the most frequently reported issues.

BACKGROUND: Orbital floor fractures result in critical changes in the shape and inferior rectus muscle (IRM) position. Radiological imaging of IRM changes can be used for surgical decision making or prediction of ocular symptoms. Studies with a systematic consideration of the orbital floor defect ratio in this context are missing in the literature. Accordingly, this study on human cadavers aimed to systematically investigate the impact of the orbital floor defect ratio on changes in the IRM and the prediction of posttraumatic enophthalmos.
METHODS: Seventy-two orbital floor defects were placed in cadaver specimens using piezosurgical removal. The orbital defect area (ODA), orbital floor area (OFA), position and IRM shape, and enophthalmos were measured using computed tomography (CT) scans.
RESULTS: The ODA/OFA ratio correlated significantly (p < 0.001) with the shape (Spearman\'s rho: 0.558) and position (Spearman\'s rho: 0.511) of the IRM, and with enophthalmos (Spearman\'s rho: 0.673). Increases in the ODA/OFA ratio significantly rounded the shape of the IRM (ß: 0.667; p < 0.001) and made a lower position of the IRM more likely (OR: 1.093; p = 0.003). In addition, increases in the ODA/OFA ratio were significantly associated with the development of relevant enophthalmos (OR: 1.159; p = 0.008), adjusted for the defect localization and shape of the IRM. According to receiver operating characteristics analysis (AUC: 0.876; p < 0.001), a threshold of ODA/OFA ratio ≥ 32.691 for prediction of the risk of development of enophthalmos yielded a sensitivity of 0.809 and a specificity of 0.842.
CONCLUSIONS: The ODA/OFA ratio is a relevant parameter in the radiological evaluation of orbital floor fractures, as it increases the risk of relevant enophthalmos, regardless of fracture localization and shape of the IRM. Therefore, changes in the shape and position of the IRM should be considered in surgical treatment planning. A better understanding of the correlates of isolated orbital floor fractures may help to develop diagnostic scores and standardize therapeutic algorithms in the future.

Facial fractures and their historical link to potential blindness have been well-documented, often attributed to optic canal injuries or retinal vascular occlusion. This dire consequence can result from both direct and indirect ocular trauma, including retrobulbar hemorrhage. Traumatic orbital compression can manifest in various forms, such as hematomas, fractured bone fragments, and emphysema, all posing a significant threat to vision, necessitating immediate intervention. In this study, 9 clinical cases of traumatic orbital compression are presented, each characterized by distinct etiologies. The study delves into traumatic orbital compressive syndromes, underscoring the critical imperative of early recognition and treatment to prevent vision loss. Orbital compression, whether from edema, hematoma, or emphysema, collectively culminates in elevated intraorbital pressure and the potential for optic nerve ischemia. Through the presentation of these 9 clinical cases, the article emphasizes the pressing need for timely intervention in addressing orbital compressive syndromes to avert vision loss. Various surgical techniques are elucidated, highlighting the pivotal role of expeditious medical intervention. This article offers invaluable insights into the diagnosis, management, and outcomes of traumatic orbital compressive syndromes.