Timing of return to normal activities after orbital floor fracture repair
ABSTRACT Orbital floor fractures are among the most common facial fractures, and patients and surgeons often ask when the patient can resume normal activities after surgical treatment. This study attempted to address this basic issue by examining wound strength and histologic characteristics after orbital floor fracture repair with three commonly used materials.
Twenty-one female goats were anesthetized under general anesthesia. A systematic approach was used to fracture both orbits (n = 42 orbits) and measure the energy required to create the fractures. The orbits were repaired with one of three different materials. One-third of the orbits were then refractured at 10, 24, or 45 days after the initial injury. The energy required to fracture the orbit was measured, and histopathologic samples were taken.
Preoperative fracture strength was largely regained after 10 days and before 24 days following the initial injury and repair, regardless of fracture repair material. LactoSorb and polyamide sheeting were associated with a lower incidence of postoperative seroma formation and thicker capsule formation than was Silastic sheeting. Wound strength in orbits repaired with Silastic sheeting during the initial postoperative period was inferior compared with orbits repaired with LactoSorb or polyamide sheeting. However, in the longer term, wound strength was not statistically different for any of the materials used in fracture repair.
Orbital floor strength is regained 24 days after repair. The authors now let patients resume normal activities approximately 3 weeks after uncomplicated orbital floor fracture repair. This is one of many clinical factors in assessing the return to normal activities. In addition, LactoSorb and polyamide sheeting are adequate for the repair of simple floor fractures.
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ABSTRACT: ABSTRACT Purpose: To evaluate the influence of saline irrigation on temperature rise in orbit bones and the optic canal during high-speed drilling. Methods: An experimental study measuring temperature rise in an orbit during high-speed drilling was conducted. The orbital rims, sphenoid bone, and optic canals of 6 unpreserved caprine orbits were drilled with a 3.1-mm diamond drill bit at 35,000 rpm. Each orbit was divided into groups receiving no irrigation, continuous or intermittent external irrigation at 5-second intervals during the procedures. The temperature rise of each site was compared among the groups, along with the duration of drilling. Results: The mean (±SD) temperature elevation in the optic canal without irrigation was 2.38 °C (±0.30 °C). This was significantly higher than in the canals receiving intermittent irrigation (0.90 °C ± 0.40 °C; p < 0.001) and continuous irrigation (0.66 °C ± 0.40 °C; p < 0.001). Mean temperature rise in the orbital rim without irrigation was significantly higher (3.51 °C ± 1.30 °C) than with intermittent (1.05 °C ± 0.31 °C; p < 0.001) and continuous (0.98 °C ± 0.61 °C; p < 0.001) irrigation. Mean temperature rise in the sphenoid was significantly higher (3.68 °C ± 1.66 °C) without irrigation than with intermittent (1.36 °C ± 1.17 °C; p = 0.005) and continuous (0.90 °C ± 0.33 °C; p < 0.001) irrigation. There were no statistically significant differences between any of the intermittent and continuous irrigation groups. Conclusions: The presence of either continuous or intermittent irrigation during orbital drilling procedures significantly decreases the temperature rise in the region adjacent to the surgical site. This has important implications for surgical technique when operating near the optic canal. Further studies regarding potential effects on the optic nerve are warranted.Orbit (Amsterdam, Netherlands) 02/2013; 32(1):27-9. DOI:10.3109/01676830.2012.747215
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ABSTRACT: Background: Orbital blowout fractures can be managed by several surgical specialties including plastic and maxillofacial surgery, otolaryngology, and ophthalmology. Recommendations for surgical fracture repair depend on a combination of clinical and imaging studies to evaluate muscle/nerve entrapment and periorbital tissue herniation. Methods: The aim of this study was to verify the applicability of regional anesthesia when repairing orbital floor fractures. A retrospective chart review was performed for isolated orbital floor fractures treated at the Department of Maxillofacial Surgery in Florence between May 2011 and July 2012. The study included 135 patients who met the inclusion criteria: 96 subjects were male (71%) and 39 were female (29%). The mean age was 45.3 years, ranging from 16 to 77 years. Results: The results revealed that isolated anterior orbital floor fractures can be safely repaired under regional and local anesthesia. Regional and local anesthesia should be combined with intravenous sedation when the fracture involves the posterior floor. The surgical outcome was comparable to the outcome achieved under general anesthesia. There was a lower rate of surgical revisions due to concealed malposition or entrapment of the inferior rectus muscle (19% vs 22%). However, this result was not statistically significant (P > 0.05). Conclusions: There are several advantages to surgically repairing isolated orbital floor fractures under regional and local anesthesia that include the following: surgeons can check the surgical outcome (enophthalmos and extrinsic ocular muscles function) intraoperatively, thereby reducing the reoperation rate; patient discomfort due to general anesthesia is eliminated; and the hospital stay is reduced, thus decreasing overall healthcare costs.01/2014; 2(1):e97. DOI:10.1097/GOX.0000000000000039
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ABSTRACT: Introduction The aim of this study was to look at the follow-up process for adult facial trauma throughout the UK to see if there was any agreement in opinion. Methods A pilot questionnaire was sent to 10 Maxillofacial Consultants across the UK. The questionnaire focused on both a selection of fractures and simple lacerations. It asked specifically about the frequency and duration of follow up. It also asked if there were any specific factors that would influence the follow-up process and for advice given to the patient. A literature review was undertaken to see if there is any evidence base to guide in the management of complications of facial injuries or describe the timeframe for morbidity. Results Eight Consultants out of 10 completed the questionnaire. None had the same protocol either for duration of follow-up or frequency of follow-up. Clinicians based follow-up either on local policy or personal opinion, with only one using an evidence base for one specific fracture. Review of the literature found a relatively strong evidence base examining functional and cosmetic outcomes of only three facial fractures. Conclusion There appears to be no universally accepted protocol for adult maxillofacial trauma follow-up leading to inconsistencies in patient treatment throughout Maxillofacial departments in the UK. Instead, follow-up seems to be based on personal experience and opinion rather than any evidence-based protocols. This suggests there may be a role for benchmarking and guidelines which would hopefully lead to consistency in patient care.09/2014; 27(4). DOI:10.1016/j.ajoms.2014.08.001