1/12. Norian craniofacial repair system bone cement for the repair of craniofacial skeletal defects.PURPOSE: To describe the use of the Norian Craniofacial Repair System (CRS) calcium phosphate bone cement in the restoration of craniofacial skeletal defects. methods: Consecutive case series. RESULTS: calcium phosphate bone cement was used to repair craniofacial skeletal defects in three patients. Indications included repair of a posttraumatic orbital floor defect causing hypo-ophthalmos, reconstruction of frontal craniotomy and temporalis muscle donor sites in a patient who had undergone resection of an invasive squamous cell carcinoma, and augmentation of a post-traumatic anterior maxillary skeletal defect. The primary outcome measure was the restoration of bony volume and support. The use of calcium phosphate bone cement in these patients was effective and without complications. CONCLUSIONS: Norian CRS calcium phosphate bone cement is useful in the repair of craniofacial skeletal defects.- - - - - - - - - - ranking = 1keywords = post-traumatic (Clic here for more details about this article) |
2/12. C-shape extended transconjunctival approach for the exposure and osteotomy of traumatic orbitozygomaticomaxillary deformities.In the treatment of post-traumatic deformities of the orbitozygomaticomaxillary complex resulting from trauma, the most appropriate exposure must be used. The choice of exposures includes the bicoronal approach and the periorbital incisions. When the whole orbitozygomatic complex is malpositioned, the bicoronal approach is desirable; this can be combined with buccal and eyelid incisions. However, the bicoronal approach is complicated by a longer duration of operation time, post-surgical scars that tend to show, and potential damage to the temporal branch of the facial nerve. A new approach using a C-shape extended transconjunctival approach is possible to have one field of vision to osteotomize the frontozygomatic suture, the lateral orbital wall, inferior orbital rim, lateral maxillary buttress, and zygomatic arch. It takes less operating time and the post-surgical scars are shorter than the bicoronal approach.- - - - - - - - - - ranking = 1keywords = post-traumatic (Clic here for more details about this article) |
3/12. Nasoethmoid orbital fractures: diagnosis and management.BACKGROUND AND OBJECTIVES: Trauma to the central midface may result in complex nasoethmoid orbital fractures. Due to the intricate anatomy of the region, these challenging fractures may often be misdiagnosed or inadequately treated. The purpose of this article is to aid in determining the appropriate exposure and method of fixation. methods AND MATERIALS: This article presents an organized approach to the management of nasoethmoid orbital fractures that emphasizes early diagnosis and identifies the extent and type of fracture pattern. It reviews the anatomy and diagnostic procedures and presents a classification system. The diagnosis of a nasoethmoid orbital fracture is confirmed by physical examination and CT scans. Fractures without any movement on examination or displacement of the NOE complex on the CT scan do not require surgical repair. Four clinical cases serve to illustrate the surgical management of nasoethmoid fractures. RESULTS AND/OR CONCLUSIONS: Early treatment using aggressive techniques of craniofacial surgery, including reduction of the soft tissue in the medial canthal area and restoration of normal nasal contour, will optimize results and minimize the late post-traumatic deformity. A high index of suspicion in all patients with midfacial trauma avoids delays in diagnosis.- - - - - - - - - - ranking = 1keywords = post-traumatic (Clic here for more details about this article) |
4/12. Growing-fracture of the orbital roof with post-traumatic encephalocele in an adult patient. Case report.Growing fractures are a rare entity, usually occurring in paediatric age. Localisation at the orbital region is even rarer. We report the case of a growing fracture of the orbital roof with post-traumatic encephalocele in an adult patient, the 1(st) similar case in adulthood at our knowledge. Clinical and neuroimaging aspects are described, underlining the role of MRI in displaying intraorbital encephalocele. Surgical treatment with relevant technical notes is discussed as well.- - - - - - - - - - ranking = 5keywords = post-traumatic (Clic here for more details about this article) |
5/12. Changing concepts in the management of secondary orbital deformities.Techniques borrowed for the correction of congenital craniofacial deformities and acute traumatic reconstruction have improved the quality of secondary post-traumatic orbital reconstruction. These techniques include precise pre- and postoperative assessment made possible by thin section axial and coronal CT imaging. Wide exposure through remote incisions borrowed from aesthetic surgery allows access for repositioning or recontouring of malaligned structures without additional morbidity to the soft tissues. The use of osteotomy and camouflage techniques will depend on the severity of comminution and displacement. Most often, a combination of techniques is employed. Rigid fixation techniques, particularly the use of micro systems, allows the potential for complex configurational reconstruction with little morbidity. The lag microscrew technique allows in-place contouring of onlay grafts and increases volume persistence, thus decreasing the amount of relapse. These techniques taken together provide the potential for unparalleled sophistication in our secondary orbital reconstructions. The factor limiting the quality of the result is most often a function of the damage imparted to the soft tissues at the time of initial injury. The soft tissues are known to absorb more energy at the time of impact than the underlying bones. The resultant contraction of the soft-tissue envelope over the malaligned and compacted skeletal infrastructure can never be restored to its preinjury appearance. For this reason, reconstruction in the acute phase remains the ideal time to prevent or limit post-traumatic orbital deformity.- - - - - - - - - - ranking = 2keywords = post-traumatic (Clic here for more details about this article) |
6/12. Untreated 'blow-in' fracture of the orbital floor causing a mucocele: report of an unusual late complication.BACKGROUND: Several severe complications have been described with blow-in fractures. Therefore, immediate surgical treatment of these fractures has been recommended. To date, there is only minimal knowledge on long-term complications of blow-in fractures that have remained untreated. The present case report describes a late complication of an untreated blow-in fracture of the orbital floor. CASE: A 37-year-old male was involved in a car accident 16 years before. At that time, a non-dislocated midfacial fracture was diagnosed and remained untreated because of the lack of clinical symptoms. Four months before surgery an exophthalmos of the left globe began to develop. CT examination revealed a consolidated blow-in fracture of the left orbital floor and an opaque mass around the dislocated bony fragments. By an infraorbital approach the bony fragments and the surrounding mass were removed. Histological examination of the removed material revealed a cystic structure lined with respiratory epithelium. Therefore, the diagnosis 'post-traumatic mucocele in the orbit caused by dislocated respiratory epithelium from the maxillary sinus' was made. CONCLUSION: Even if blow-in fractures do not cause complications immediately after trauma, late complications like mucoceles can occur after several symptom-free years. Therefore, early reconstruction should be intended even in asymptomatic cases of blow-in fractures with minimal displacement of the bony fragments.- - - - - - - - - - ranking = 1keywords = post-traumatic (Clic here for more details about this article) |
7/12. Correction of late post-traumatic enophthalmos using a tissue expander.We described a new technique to correct late post-traumatic enophthalmos using volume augmentation with a tissue expander. A 47-year-old male requiring enucleation with an implant replacement following orbital fracture with the globe injury had been complaining of persistent enophthalmos and cosmetic defect. Computed tomography scan demonstrated significant enophthalmos resulting from a volume discrepancy between an orbita and the orbital contents. To prevent worsening of the prosthesis motility with correction of enophthalmos, projection of the prosthetic globe was postoperatively adjusted by gradual inflation of an expander placed behind the enucleation implant. As a result enophthalmos was appropriately corrected without any change of the prosthesis motility.- - - - - - - - - - ranking = 5keywords = post-traumatic (Clic here for more details about this article) |
8/12. Anterior limbal approach in the treatment of a late and extensive post-traumatic retrobulbar abscess.The authors report a case of acute development of an extensive retrobulbar abscess 3 weeks after an orbital floor fracture. Urgent drainage of the abscess was performed by an anterior transconjunctival approach. A dramatic recovery was observed a few days following the operation. The visual acuity increased from hand motions to 0.7 to 0.8 in the early postoperative period and to 1.0 shortly thereafter. The severity of infection, the importance of antibiotic prophylaxis for blowout fractures, and the efficacy of the transconjunctival approach on the final visual and functional outcome are described.- - - - - - - - - - ranking = 4keywords = post-traumatic (Clic here for more details about this article) |
9/12. optic nerve decompression via the lateral facial approach.Two cases of visual loss after lateral orbital wall fracture are presented: one with retrobulbar hematoma and evidence of optic nerve compression who failed to respond to lateral canthotomy and high-dose corticosteroid administration, and the second with immediate, total blindness associated with fracture of the bony optic canal. In both, extradural decompression of the orbit and optic nerve was achieved through the lateral facial approach with partial return of visual acuity and without surgical complications. The role of orbital and optic nerve decompression in the management of patients with blindness following orbital trauma is controversial. Orbital decompression may be of value for cases of post-traumatic visual loss unresponsive to medical management. If optic nerve injury is suspected as the cause, the additional step of decompression of the optic nerve is a logical but unproven procedure. The indications for optic nerve decompression are not established and should be considered only within the context of the specific needs of the individual patient.- - - - - - - - - - ranking = 1keywords = post-traumatic (Clic here for more details about this article) |
10/12. The treatment of late post-traumatic orbital deformities.Trauma to the orbital region may result in fractures of the bony orbit, displacement of which gives rise to malposition of the eye and diplopia. If initial treatment is not feasible or is unsuccessful, later correction may be achieved by osteotomy or reduction and stabilisation of the bony fragments, often with bone grafts. Displaced medial or lateral canthi may need to be repositioned, where feasible in an overcorrected position. Where bone grafts are necessary, the skull is now favoured as the best donor site.- - - - - - - - - - ranking = 4keywords = post-traumatic (Clic here for more details about this article) |
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