Anna A E Persson, Hanna M Lif, Alberto Falk-Delgado, Daniel Nowinski
{"title":"Treatment of orbital fractures - a critical analysis of ophthalmic outcomes and scenarios for re-intervention.","authors":"Anna A E Persson, Hanna M Lif, Alberto Falk-Delgado, Daniel Nowinski","doi":"10.2340/jphs.v58.6580","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Malplaced implants in orbital reconstruction may lead to serious complications and necessitate re-intervention. The aim of this study was to describe outcomes, complications and scenarios of re-intervention in a historical case series of orbital fractures treated with free-hand orbital wall reconstruction. The main hypothesis was that early re-interventions are mainly because of malplaced implants in the posterior orbit.</p><p><strong>Methods: </strong>Retrospective review of 90 patients with facial fractures involving the orbit, reconstructed with radiopaque orbital wall implants, from 2011 to 2016. Data were obtained from medical records and computed tomography images. Recorded parameters were fracture type, ocular injury, ocular motility, diplopia, eye position, complications and re-interventions. Secondary reconstructions because of enophthalmos were volumetrically evaluated.</p><p><strong>Results: </strong>Early complications requiring re-intervention within 1 month were seen in 12 (13%) patients, where all except two were because of malplaced implants. The implant incongruence was without exception found in the posterior orbit. Late complications consisted of four (4%) cases of ectropion and five (5%) cases of entropion that needed corrective surgery. The majority of the patients with eye-lid complications had undergone repeated surgeries. Secondary orbital surgeries were performed in nine (10%) patients. Five of these patients had secondary reconstruction for enophthalmos and associated diplopia. None of these patients became completely free from either enophthalmos or diplopia after the secondary surgery.</p><p><strong>Conclusion: </strong>Re-intervention after orbital reconstruction is mainly related to malplaced implants in the posterior orbit. Incomplete results in patients requiring secondary surgery for enophthalmos infer the importance of accurate restoration of the orbit at primary surgery. Abstract presented at: Swedish surgery Week 2021 and SCAPLAS 2022.</p>","PeriodicalId":16847,"journal":{"name":"Journal of Plastic Surgery and Hand Surgery","volume":"58 ","pages":"1-7"},"PeriodicalIF":1.0000,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Plastic Surgery and Hand Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2340/jphs.v58.6580","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Malplaced implants in orbital reconstruction may lead to serious complications and necessitate re-intervention. The aim of this study was to describe outcomes, complications and scenarios of re-intervention in a historical case series of orbital fractures treated with free-hand orbital wall reconstruction. The main hypothesis was that early re-interventions are mainly because of malplaced implants in the posterior orbit.
Methods: Retrospective review of 90 patients with facial fractures involving the orbit, reconstructed with radiopaque orbital wall implants, from 2011 to 2016. Data were obtained from medical records and computed tomography images. Recorded parameters were fracture type, ocular injury, ocular motility, diplopia, eye position, complications and re-interventions. Secondary reconstructions because of enophthalmos were volumetrically evaluated.
Results: Early complications requiring re-intervention within 1 month were seen in 12 (13%) patients, where all except two were because of malplaced implants. The implant incongruence was without exception found in the posterior orbit. Late complications consisted of four (4%) cases of ectropion and five (5%) cases of entropion that needed corrective surgery. The majority of the patients with eye-lid complications had undergone repeated surgeries. Secondary orbital surgeries were performed in nine (10%) patients. Five of these patients had secondary reconstruction for enophthalmos and associated diplopia. None of these patients became completely free from either enophthalmos or diplopia after the secondary surgery.
Conclusion: Re-intervention after orbital reconstruction is mainly related to malplaced implants in the posterior orbit. Incomplete results in patients requiring secondary surgery for enophthalmos infer the importance of accurate restoration of the orbit at primary surgery. Abstract presented at: Swedish surgery Week 2021 and SCAPLAS 2022.
期刊介绍：
The purpose of the Journal of Plastic Surgery and Hand Surgery is to serve as an international forum for plastic surgery, hand surgery and related research. Interest is focused on original articles on basic research and clinical evaluation.
The scope of the journal comprises:
• Articles concerning operative methods and follow-up studies
• Research articles on subjects related to plastic and hand surgery
• Articles on cranio-maxillofacial surgery, including cleft lip and palate surgery.
Extended issues are published occasionally, dealing with special topics such as microvascular surgery, craniofacial surgery, or burns. Supplements, usually doctoral theses, may also be published.
The journal is published for the Acta Chirurgica Scandinavica society and sponsored by the Key Foundation, Sweden.
The journal was previously published as Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
