Search

Importance: Create validated criteria to identify orbital fracture patients at higher risk for significant ocular injuries. Objective: Determine history and physical examination findings in orbital...

Despite common goals of frontal sinus fracture treatment (restoring forehead contour and creating a safe sinus), there remains significant variability in evaluation and treatment.To describe our experience with a minimally disruptive treatment protocol for the treatment of frontal sinus fractures.Analysis of prospectively collected data from 2010 through 2015 at a level 1 trauma center. All patients with frontal sinus fractures treated with our protocol from January 2010 to December 2015. Patients with poor follow-up and/or incomplete medical records were excluded from analysis.Presence of an aerated frontal sinus and aesthetically acceptable forehead contour. Secondary outcome measures were complications related to frontal sinus fractures.A total of 39 patients were treated under our minimally disruptive protocol, and 25 patients were included in the study; 18 (72%) were male and 7 (28%) were female. Their ages ranged from 6 to 62 years. After review, 22 patients had both clinical and radiographic follow-up. No patients underwent immediate frontal sinus repair. Five of 22 patients underwent surgery for indications other than their frontal sinus fracture: 1 of 5 patients underwent immediate surgical repair due to bilateral LeFort fractures, and 4 of 5 underwent delayed surgery due to nasal polyps (1 patient), scar revision (1 patient), and concomitant LeFort fractures (2 patients). Two of 22 patients (9%) underwent frontal sinus repair after outpatient surveillance due to persistent cerebrospinal fluid leak (1 patient) and orbital roof fracture (1 patient). The remaining 20 patients were treated nonoperatively, and 19 of 20 (95%) had spontaneous improvement in opacification and/or contour deformity. Twelve of 20 patients (60%) had improvement or resolution in both. One patient had ongoing partial opacification and deformity at the 3-month follow-up but was asymptomatic and had bony contour that was aesthetically acceptable to the patient. There were no complications. The median of all follow-up was 3 months.Frontal sinus fractures treated nonoperatively had a high rate of spontaneous ventilation and bony autoreduction with aesthetically acceptable frontal bone remodeling. There were no complications in the nonoperative group. The initial results of this study support further study of the safety and efficacy of a minimally disruptive protocol for frontal sinus fractures.4.

(1) To describe repair of complex orbital fractures using computer planning with preoperative virtual reconstruction, mirror image overlay, endoscopy, and surgical navigation. (2) To test the hypothesis that this technique improves outcomes in complex orbital fractures.A series of 113 consecutive severe orbital fracture cases was analyzed, 56 of which were performed with mirror image overlay guidance, and 57 of which were repaired without. Data were collected on patient characteristics, fracture severity, diplopia and globe position outcomes, complications, and need for revision surgery.The mirror image overlay group showed decreased postoperative diplopia in all fracture types (P = .003); the effectiveness was maximal for fractures that involved 3 or 4 walls or the posterior one-third of the orbital floor (P.001). The need for revision surgery was greatly reduced in this cohort (4% vs 20%; P = .03).The efficacy of mirror image overlay navigation and orbital endoscopy was studied in one of the largest series of complex orbital fractures in the literature. Based on statistically significant improved outcomes in postoperative diplopia and orbital volume, as well as the decreased need for revision surgery, we accept the hypothesis that mirror image overlay guidance improves outcomes in complex orbital reconstruction and recommend its use for complex orbital fracture repair.

To develop and evaluate a minimally invasive technique of lateral orbitotomy that provides improved orbital access with fewer complications.A cadaver study was undertaken to develop a technique of transconjunctival lateral orbitotomy that preserves the structural integrity of the eyelid support system and provides extended access to the orbit from floor to roof. We then evaluated the procedure in an outcome study of 30 consecutive patients.The cadaver investigations demonstrated that a transconjunctival lateral retrocanthal approach is technically possible and provides improved direct access to the lateral orbit. In the study of 30 consecutive procedures, there were no complications resulting from the surgical access. The wound healing was rapid, without tissue distortion or scars. The exposure was ample for all surgical interventions.Lateral retrocanthal orbitotomy is a new approach that provides extended access to the entire lateral orbit. The technique is rapid and can be extended in a single continuous incision to the medial orbit. The structural integrity of the lateral retinaculum is preserved, which appears to improve the postoperative cosmetic and functional result.

To describe a new 3-dimensional technique for medial canthal repositioning, precaruncular medial canthopexy (PMC), and to present an outcome study demonstrating its efficacy.Data (age, sex, cause, and initial symptoms) were collected prospectively on patients with malposition of the lower eyelid. All patients were photographed before and after surgery in a set protocol. The type and severity of eyelid malposition were documented using the Ectropion Grading Scale (EGS) before and after each procedure. Surgical outcome was evaluated by objective improvement of ectropion grading and subjective resolution of symptoms.Precaruncular medial canthopexy was performed on 30 eyelids of 27 consecutive patients (10 were revisions) for correction of medial eyelid laxity or malposition. Twenty-six patients had ectropion, and 1 had bilateral entropion. The most common cause of eyelid malposition was facial paralysis (n = 21). Ancillary procedures, most commonly lateral transorbital canthopexy (for correction of lateral ectropion), were performed on 60% of the eyelids at the time of PMC. Twenty-eight procedures resulted in complete restoration of the medial canthus to a normal position (EGS grade I). Two patients had minimal residual medial scleral show after surgery (EGS grade II) but experienced symptom relief. There were no wound infections or perioperative complications.Precaruncular medial canthopexy rapidly and safely restores support in all 3 dimensions without blocking the visual field or damaging the lacrimal system, with minimal morbidity and excellent wound healing. In addition to being a primary technique for correcting medial eyelid malposition, PMC should be routinely considered as an adjunct procedure when correcting lateral eyelid malposition.

There are numerous approaches to correcting laxity of the lateral canthal tendon, each with advantages and drawbacks. Critical evaluation of these techniques is not possible, however, as there is no grading system currently in use to describe this condition or to report outcomes, and prospective trials are lacking.To report and assess a new procedure for repair of the lateral canthus (lateral transorbital canthopexy) and to describe the Ectropion Grading Scale (EGS), with a prospective outcome analysis of their use.Prospective outcome study of 15 consecutive patients (16 procedures).Tertiary referral center in Zurich, Switzerland.Consecutive sample of patients referred for treatment of ectropion of various causes.Preoperative and postoperative EGS grades were recorded, a preoperative and postoperative patient-based questionnaire was administered, and lateral transorbital canthopexy was performed.Outcome was determined by improvement in EGS grade and results of the patient-based symptom questionnaire.There were no surgical failures or complications in the study. An average of 83% reduction in patient-reported discomfort was achieved. Two patients with facial paralysis needed medial canthal repositioning. The EGS allowed clear recording of lower eyelid position before and after lateral transorbital canthopexy, and the procedure was uncomplicated to perform.Lateral transorbital canthopexy is an effective technique for the correction of lower eyelid laxity and appears to allow refined, durable adjustment of the lateral canthus. Self-reported patient satisfaction confirmed the high rate of success of the procedure in this study. The EGS permits critical evaluation and reporting of results and may assist in predicting which patients will need concomitant correction of the medial canthus. Arch Facial Plast Surg. 2000;2:9-15

We sought to examine the efficacy of vacuum-assisted closure (VAC) therapy for the reconstruction of full-thickness forehead defects and to determine the appropriate therapeutic strategies for its use. Medical records and photographs were reviewed for 3 patients with full-thickness tissue loss of the forehead region treated with a VAC system. All 3 patients had complete formation of healthy granulation tissue with VAC therapy alone. One patient was treated to full reepithelization of her wound; the other 2 patients underwent successful surgical closure after VAC reduction of the defect. The treatment was well tolerated, with no complications. Although this represents an initial study, it seems that the protocol for VAC therapy presented herein is a reliable technique for the repair of forehead defects that provides excellent functional and aesthetic outcomes.