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Purpose: To describe a case of a maxillofacial trauma that occurred during a mixed martial arts (MMA) match and to perform a literature review of maxillofacial injuries related to MMA match to determine whether preventive models are applicable., Methods: The authors described a maxillofacial injury with orbital and optic nerve involvement that happened during a professional MMA match. A literature review on maxillofacial trauma in MMA was conducted on Scopus and Pubmed with specific keywords., Results: Open reduction and internal fixation of the maxillofacial complex fractures with right eye optic neuropathy following an MMA match is described. Six articles were selected for the description of trauma in the maxillofacial complex associated with MMA fights., Discussion: Literature has paid little attention to injuries during MMA matches. The most common injury locations that emerged from the literature review were the head, face, and neck. Middle facial third injuries were the most common type. Frequently the injury involved the ophthalmic area., Conclusions: The timing of maxillofacial trauma in MMA is critical. Protective devices should be strongly promoted to prevent catastrophic consequences., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Purpose: To analyze the visual outcome in patients with traumatic optic neuropathy (TON) with respect to different treatment modalities, to study the correlation of initial visual loss with the final visual outcome, and to find out the predictor of final visual outcome in patients with indirect TON., Methods: A retrospective analysis of 36 eyes with TON was done. Data on clinical profile, including demographics, mode of trauma, best corrected visual acuity (BCVA), pupillary reflex examination, and anterior and posterior segment examination, was collected. Presence and location of orbital and cranial fractures were identified from computed tomography scan. Visual outcomes following steroid therapy, optic nerve (ON) decompression, and in untreated patients were analyzed. Pre- and post-treatment BCVA were divided into three groups based on logarithm of the minimum angle of resolution (logMAR) as follows: group A: 3, group B: 2.9-1.3, and group C<1.3. BCVA values at follow-up visits were taken as the primary outcome measure. Association between various risk factors and final visual outcome in patients with indirect TON was also analyzed., Results: Out of 34 patients whose 36 eyes were studied, three (8.8%) patients were females and 31 (91.2%) patients were males. Most common mode of trauma was road traffic accident (RTA; 91.2%), which was followed by fall (8.8%) and assault (2.9%). Pre- and post-treatment BCVA values of 36 eyes were compared, and improvement in BCVA after treatment was found to be statistically significant. Also, 28.6% of patients with presenting BCVA of no light perception showed improvement compared to 94.1% and 100% in groups B and C, respectively. Orbital wall fractures were seen in 80.5% (n = 29) of the patients, with lateral wall fracture being the most common (58.3%) followed by medial wall (33.3%), roof (27.7%), floor (27.7%), and optic strut (5%)., Conclusion: Baseline BCVA had significant association with final vision improvement. Lateral wall fracture was the most common fracture associated with indirect TON. Patients treated with high-dose corticosteroids, irrespective of the time of presentation, had a better visual outcome.

Purpose: This retrospective study aimed to analyze the relationship between the volume of the fractured and the normal orbit in patients with unilateral orbital fractures with and without indirect traumatic optic neuropathy (TON)., Subjects: Data of 25 patients with unilateral orbital fractures who underwent computer tomography between January 2016 and December 2020 were investigated. Emergency imaging was performed within 2 hours of arrival at the emergency room. The subjects were categorized into two groups: unilateral orbital fractures with and without TON., Methods and Measures: The assessment of TON was performed during a comprehensive ophthalmologic examination by an ophthalmologist. The stereographic orbit was reconstructed, and the volume was calculated. Other variables examined included age, sex, and cause of orbital trauma. The variables were compared using paired t-tests. Statistical significance was set at p < 0.05., Results: The orbital volume of the non-fractured orbit was 27.50  ± 2.26 and 27.48  ±  2.64 cm 3 in the groups with and without TON, respectively. The average volume of the fractured orbit in the TON group was 27.78  ± 2.56 cm 3 , and there was no significant volumetric difference between the fractured and non-fractured sides in this group. However, the average volume of the fractured orbit without TON was 28.76  ±  3.18 cm 3 , larger than that of the non-fractured orbit (p = 0.016)., Conclusions: Non-expansion of the fractured orbit was a risk factor for indirect TON in patients with unilateral orbital fractures. Volumetric analysis from primary imaging would expedite the diagnosis and treatment of TON, resulting in optimal outcomes., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: The aim of the study was to evaluate the associated patterns of orbital wall fractures, diagnostic parameters of Traumatic optic neuropathy and its progress with Mega dose steroid therapy., Materials and Methods: 25 patients with unilateral orbital wall fractures of traumatic aetiology were evaluated with ophthalmologic and radiographic parameters. All patients were prescribed Mega Dose Intravenous steroids irrespective of the timing of presentation. Ophthalmic assessment was repeated for same parameters every alternate day upto 2 weeks., Results: Lateral orbital wall was found to be most commonly involved. Visual acuity, Pupillary Reactivity, Visual Field and Visual Evoked Potential showed statistically significant improvement post steroid therapy in early as well as late presenters., Discussion: Highest incidence of Traumatic optic neuropathy was noted in multiple linear orbital wall fractures with highest incidence with lateral orbital wall involvement. Literature regarding Choice and timing of initiation of steroids based on timing of presentation is inadequate to justify skipping steroids to observe or undertake surgical intervention. In the present study marked improvement was noted post steroid therapy regardless of timing of presentation. The authors conclude that Visual evoked potential should be objectively tested and Mega dose steroid therapy should be initiated for all patients with Traumatic optic neuropathy for maximum benefit to the patient., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Traumatic optic neuropathy (TON) is a rare disease but leaves critical sequelae to patient. Purpose of this study is to evaluate the incidence of TON in each orbital wall fracture., Materials and Methods: Retrospective review of 2629 patients with orbital wall fracture was performed in from January 2010 to March 2019, based on diagnostic code, Korean Standard Classification of Diseases, 7th Revision. The orbital wall fractures were divided into 4 subtypes: superior, medial, inferior, and lateral wall. Incidence of TON is analyzed according to subtypes, single and multiple wall fracture., Results: Among 2629 patients with orbital wall fractures, 27 patients were diagnosed with TON with an incidence of 1.02%. In single wall fracture, only lateral wall showed significantly high TON incidence, which only zygomatic fracture was included in single lateral wall fracture. In multiple wall fracture, it was statistically significant in the superior wall., Conclusions: Fracture on lateral and superior orbital wall showed a tendency to increase the incidence of TON. Based on the above results, radiologic evaluation and physical examination is necessary for patient who has lateral and superior orbital wall fracture., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)

Purpose: To establish a more sensitive diagnostic tool for traumatic optic neuropathy (TON), we explored the diagnostic efficacy of isolated-check visual evoked potential (ic-VEP) for TON in orbital fracture and compared ic-VEP with pattern-reversal visual evoked potential (P-VEP) testing., Methods: This was a prospective single-center study. A total of 137 eyes from 131 patients diagnosed between December 2016 and October 2019 with orbital fractures were included in the study. Injury history, best-corrected visual acuity (BCVA), visual field, computed tomography (CT), P-VEP, and ic-VEP data were collected. Parameters of ic-VEP (signal-to-noise ratio [SNR]) and P-VEP (peak latency and amplitude of P100) were compared and diagnostic accuracy was analyzed., Results: TON was associated with worse BCVA than non-TON (median 0.52 versus 0.10 logMAR, P < 0.001). SNRs were negatively associated with the P100 peak latency while positively associated with the P100 amplitude. The sensitivity of ic-VEP for TON (79.6%) was higher than that of P-VEP (61.2%, P = 0.049), although this difference was not statistically significant after Bonferroni correction. Using ic-VEP and P-VEP together could increase sensitivity (87.8%). Maximum areas under curve were obtained using the SNR criteria of 1.3, 1.47, and 1.54 at 8%, 16%, and 32% depth of modulation, respectively., Conclusion: ic-VEP was more sensitive than P-VEP in diagnosing TON, and a combination of the two examination tests was recommended. The use of ic-VEP as the new diagnostic standard technique for TON should be considered.

Background: Fractures of the orbital roof require high-energy trauma and have been linked to high rates of neurologic and ocular complications. However, there is a paucity of literature exploring the association between injury, management, and visual prognosis., Methods: The authors performed a 3-year retrospective review of orbital roof fracture admissions to a Level I trauma center. Fracture displacement, comminution, and frontobasal type were ascertained from computed tomographic images. Pretreatment characteristics of operative orbital roof fractures were compared to those of nonoperative fractures. Risk factors for ophthalmologic complications were assessed using univariable/multivariable regression analyses., Results: In total, 225 patients fulfilled the inclusion criteria. Fractures were most commonly nondisplaced [n = 118 (52.4 percent)] and/or of type II frontobasal pattern (linear vault involving) [n = 100 (48.5 percent)]. Eight patients underwent open reduction and internal fixation of their orbital roof fractures (14.0 percent of displaced fractures). All repairs took place within 10 days from injury. Traumatic optic neuropathy [n = 19 (12.3 percent)] and retrobulbar hematoma [n = 11 (7.1 percent)] were the most common ophthalmologic complications, and led to long-term visual impairment in 51.6 percent of cases., Conclusions: Most orbital roof fractures can be managed conservatively, with no patients in this cohort incurring long-term fracture-related complications or returning for secondary treatment. Early fracture treatment is safe and may be beneficial in patients with vertical dysmotility, globe malposition, and/or a defect surface area larger than 4 cm2. Ophthalmologic prognosis is generally favorable; however, traumatic optic neuropathy is major cause of worse visual outcome in this population., Clinical Question/level of Evidence: Risk, III., (Copyright © 2020 by the American Society of Plastic Surgeons.)

Traumatic optic neuropathy is sinister sequelae of craniofacial trauma leading to vision loss. The decision between early medical or surgical intervention is usually individualised. Visual evoked potentials may guide the treatment plan. We describe a young male presenting 5 days after a road traffic accident with no perception of light vision in the right eye. He was managed medically with high dose of intravenous steroids. At the 3-month follow-up, he reported a reversal of vision loss with return of visual acuity to 3/60, which improved to 6/36 at 5 months and remained stable at 8 months., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Detection of optic canal fractures is often difficult because of the subtleness of the fracture. If we could clarify impact on which region around the orbit is likely to accompany the fracture of the optic canal, the knowledge should be useful to make early diagnosis of optic canal fractures. The present study was conducted to elucidate this issue., Methods: Ten finite element models were produced simulating the skulls of ten humans (8 males and 2 females; 43.8 ± 10.2 y/o). The peri-orbital area of each of the ten models was divided into eight regions in a clockwise fashion per 45 degrees. These regions were defined as Superior-Medial (0-45 degrees), Medial-Superior (45-90 degrees), Medial-Inferior (90 to 135 degrees), Inferior-Medial (135 to 180 degrees), Inferior-Lateral (180-225 degrees), Lateral-Inferior (225 to 270 degrees), Lateral-Superior (270-315 degrees), and Superior-Lateral regions (315-360 degrees), respectively. Dynamic simulation of applying traumatic energy on each of these regions was conducted. Resultant fracture patterns were evaluated using finite element analyses. Thereafter, frequencies of fracture involvement of the optic canal were evaluated for each of the eight regions., Results: The involvement of the optic canal was most frequent for the Superior-Medial region (7/10), followed by the Medial-Superior region (5/10)., Conclusion: Optic canal fracture is likely to occur when the area between the supra-orbital notch and the medial canthus are strongly impacted. When evident fracture or serious damage of soft tissue is observed in this area, occurrence of optic canal fracture should be suspected.

The anatomical location of fractures following blunt cranio-orbital trauma is important for neurosurgeons and maxillofacial surgeons. In this study, 588 cranio-orbital fractures following blunt trauma were evaluated retrospectively with regard to the anatomical site and surgical treatment. Orbital cranial nerve injuries and the outcomes of the medical and/or surgical treatment are described. Distribution of the zygomatic complex and orbital fractures were as follows: zygomatic complex fractures (n:304), isolated orbital fractures (n:58), complex comminuted fractures (n:226). In 58 cases, 69 orbit fractures were found (11 bilateral and 47 unilateral fractures). The lateral wall was the most frequent fracture (n:63). The least frequent fracture was the roof of the orbit (n:11). The accompanying lesions were as follows: 89.65% of cases were associated with periorbital haematoma (n:52), 13.79% of cases with retrobulbar haemorrhage (n:8), 96.55% cases with periorbital soft tissue oedema (n:56), 53.45% cases with pneumocephalus (n:31), 8.62% cases with intra-parenchymal contusion (n:5), 6.89% cases with enophthalmia (n:4), 5.17% of cases with rhinorrhoea (n: 3), 5.17% cases with optic bulb injury and adnexial trauma (n:3), 32.76% cases with intra-orbital emphysema (n:19), and 20.69% with vision dysfunctions (n:12), of whom 2 had no optic nerve injury., (Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose:  This is a unique case report of a self-inflicted orbital injury that presented as a simple upper vestibulum laceration. A 43-year-old man presented to the Oral and Maxillofacial Surgery Unit with a small laceration in his mouth and complaints of pain in his left eye due to a snooker cue penetration. Upon admission, clinical findings included a small laceration on the upper left vestibulum and a subdermal hematoma in the left eye lid with restricted movements of the left eye. Further examination revealed remote trauma to the orbit, penetrating through the oral cavity, passing the maxillary sinus, and the orbital floor causing traumatic optic neuropathy with partial visual loss. The patient was treated conservatively with antibiotics and corticosteroids and a 6-week follow up., Conclusion:  In cases of remote penetrating injury, meticulous examination revealing precise injury mechanism is crucial. All cases of Dento-maxillofacial trauma should include a high degree of clinical suspicion for ocular injury, requiring early diagnosis and treatment to reduce risk of visual loss., (© 2011 John Wiley & Sons A/S.)

This report describes the only case in the literature of globe luxation due to traumatic cerebrospinal fluid fistula to the orbit caused by fire gun with ocular globe maintenance. E.N., female, white, 7 months, admitted with left orbitocranial injury by fire gun. Ocular globe luxation was detected with complete ocular motility restriction and absence of pupillary reflex in the left orbit. Computed tomography showed fracture of the medial orbital wall; bone fragments near the apex of the orbit and a stretched optic nerve. Surgical exploration was performed, showing liquor fistula through the ethmoid-sphenoid wall that was blocked with sponge (Gelfoam®) plus organic glue in the left orbit posterior wall, with immediate resolution of the proptosis and ocular integrity maintenance. Although controversial, maintenance of the ocular globe instead of enucleation was performed due to the integrity of the globe in this case. Despite the blindness, we considered the result to the proposed treatment excellent, once the maintenance of the ocular globe provides a good appearance and will contribute to an adequate facial bone development.

The visual outcome of 39 patients who had unilateral indirect type traumatic optic neuropathy and periorbital facial bone fracture treated at the Chang Gung Memorial Hospital in Kaohsiung between June 1996 and June 2001 was retrospectively evaluated, based on the results of computed tomography studies that grouped the associated fractures as anterior orbital fracture, posterior orbital fracture, orbital blow-in or blow-out fracture. Pretreatment and posttreatment visual acuities were obtained from the medical records and measurements of visual improvement degree and percentage were calculated after converting the visual acuities into log of the minimum angle of resolution (log MAR) units. This study reveals that posterior orbital fracture is associated with a worse prognosis in visual outcome than anterior orbital fracture, with visual improvement degree and percentage being 0.86 +/- 0.17 log MAR and 34.2 +/- 1.7% versus 1.56 +/- 0.27 log MAR and 58.9 +/- 1.7%, respectively (P = 0.02 and 0.004). Blow-in fractures such as an impacted lateral orbital wall did not predict significant deterioration in visual outcome. In addition, orbital floor or medial wall blow-out fractures did not predict significant improvement in visual outcome.

The treatment results of 1000 patients with traumatic orbit deformations covering a 40-year experience gathered by personnel of the chair for eye diseases of Sechenov's Moscow Medical Academy are presented. The authors define the key clinical symptoms of orbit trauma during the late period, i.e. enophthalmos, hypophthalmos and diplopia; pathogenetic motivations for the onset of the above symptoms are described. A scheme of complex treatment is suggested for patients with fractures in the orbit walls, including, with respect to individual indications, conservative therapy, restoration of the osseous orbit skeleton and myoplastic correction of residual diplopia. It is pointed out that, provided the scope and peculiarities of surgical treatment are correctly determined, the efficiency of treatment of patients with traumatic orbit deformations reaches 99.7%. Subsequent methods of optimizing the complex treatment of patients with fractures in the orbit walls are defined.

Results of ophthalmologic examinations of a total of 65 patients with traumatic orbit deformations and a pronounced dislocation of the eyeball (a mean time elapsed from trauma to surgery is 19 months) are presented in the article. Enophthalmos was diagnosed in 89% of patients, ptosis of the eyeball--in 69% of patients and ophthalmoplegia--in 77% of patients. Pathology of the posterior eye segment was recorded in a majority of cases, while pathology of the optic nerve was recorded in more than 43% of cases. Inferior orbital wall plasty was performed in all patients. A reduced optic neuropathy (a mean postoperative follow-up of 15 months) was registered in a number of cases after the surgical repositioning of the eyeball and conservative treatment.

Objectives: This is a retrospective descriptive case study which will look into the spectrum of ophthalmic involvement in cases with orbital and eye injuries after cranio-facial trauma and to analyse the visual and motility outcome., Material: One hundred and four cases with ophthalmic involvement after cranio-facial trauma that were referred to and seen in the eye department of a tertiary teaching hospital in Singapore between 1991-97 were included in the study., Methods: The case records of 104 such patients were traced. The demographic data, the mode of injury, the type of fracture sustained and presence of serious eye injury were noted. The details about visual acuity, significant diplopia and enophthalmos at the first and last visits were charted. Presence of traumatic optic neuropathy including the type of treatment given was recorded., Results: There was a male preponderance (82%). The industrial accidents were 21%, only next to road traffic accidents, which constituted approximately 36.5%. The predominant types of fractures seen were blow-out orbital fractures, complex fractures comprising of Le-Fort II, III, panfacial and fronto-basilar skull fractures. Diplopia was the most common presenting feature (40%) with visual acuity disturbance (23% having <6/60) as the next most common finding. Traumatic optic neuropathy was seen in 20% of patients and serious eye injury was present in 9% of patients. The incidence of traumatic optic neuropathy was significantly higher (p<0.001) in patients with complex fractures and fronto-basilar fractures, as compared to the blow-out and zygomatico-maxillary fractures. Analysis of final results indicated 15% as having significant diplopia in one or more gazes and 12.5% as having a vision of <6/60., Conclusion: Diplopia and visual acuity disturbances seem to be the most common ophthalmic presentations in cranio-facial trauma. A significant number of patients suffer from poor vision and significant diplopia despite treatment., (Copyright 2000 European Association for Cranio-Maxillofacial Surgery.)

A case of visual loss following cranio-maxillofacial trauma is reported. The patient had a sudden partial blindness associated with a fracture of the roof, medial and lateral orbital walls. Access to the orbit was achieved through a transethmoidal approach using the Howarth-Lynch medial incision and resecting the bone fragments which impinged on the optic nerve. The patient had total return of visual acuity, without surgical complications. The role of orbital and optic decompression in the management of patients with traumatic optic neuropathy is discussed. Its indications are controversial and the procedure should be considered only within the context of the specific needs of the individual patient.

Optic nerve decompression is a procedure that is now receiving increasing clinical attention. However, there are currently no standardized treatment protocols in the therapy of traumatic or pressure insults to the nerve. The present retrospective study was designed to report our experience with microscopic endonasal transethmoid-sphenoid optic nerve decompression in 24 unilateral trauma cases and 11 unilateral skull base tumor patients. In general preoperative visual acuities in the trauma patients were worse than in the tumor patients. Following surgery, 9 of 11 tumor patients (82%) had at least some improvement of their vision, including 5 complete recoveries. In the group with traumatic visual impairment, 16 of the patients had no light perception preoperatively. Postoperatively, 13 patients (54%) had at least some improvement, with 4 patients regaining normal or near normal vision. Compared to other techniques and approaches, our technique is a minimally invasive procedure for optic nerve decompression, reducing unnecessary operative trauma to nasal structures, skin incisions or even craniotomy and frontal lobe retraction.