[Show abstract][Hide abstract] ABSTRACT: Fractures of the mid-face are commonly accompanied by injury to the visual system. Three hundred and sixty three patients who had sustained mid-facial fractures were assessed prospectively for evidence of such injury. The data have been used to devise a scoring system for the maxillofacial surgeon in order to help identify those patients at risk of eye injury. The scoring system has been evaluated on a further cohort of 100 patients with a similar spectrum of injury and the sensitivity and specificity of the system have been determined. The results of these studies have been reported in the maxillofacial literature. This paper reviews the data and results obtained. In summary, impaired visual acuity with a comminuted or out blow fracture, a motility abnormality, or facial fracture combined with head injury, sufficient to cause both retrograde and post-traumatic amnesia, emerged as major risk factors which are indicative of an adverse ophthalmic outcome deemed to warrant referral. The scoring system which was developed from this data was found to have a sensitivity of 94.4% and a specificity of 89% for the detection of patients thought to merit ophthalmic assessment. Failure to assess central visual function as objectively as practicable in patients who have sustained mid-facial fractures may lead to potentially treatable ophthalmic pathology not being identified.
[Show abstract][Hide abstract] ABSTRACT: Maxillofacial trauma is often complicated by injury to the eye. Such injuries may be difficult to detect and may therefore be missed. Detailed ophthalmic examinations were carried out prospectively on 363 patients who had sustained midfacial fractures. Fifty four parameters comprising maxillofacial, radiological and ophthalmic data were recorded and coded for each patient. All encoded data were divided into predictors (the data potentially available to the maxillofacial surgeon) and outcome (the data potentially available to the ophthalmologist). Statistical methods of regression, and the analysis of contingency tables, led to the identification of the principal predictors indicative of underlying ophthalmic injury and thence to a scoring system which predicts the severity of such injuries. Impaired visual acuity is the principal predictor and when employed alone gives a sensitivity value of 80%. Pure blow-out fracture or comminuted facial fracture, double vision and amnesia emerged as additional factors which yielded an efficient scoring system with a sensitivity of 89% and specificity of 90% for the population upon which it was based. A score sheet is provided in the paper. These predictors can be remembered from the acronym Blow-out fracture, Acuity, Diplopia, Amnesia, Comminuted Trauma. As many such injuries result from a BAD ACT, it is easily remembered. This scoring system requires to be tested upon a new population of individuals in order to determine its efficacy.
British Journal of Oral and Maxillofacial Surgery 01/1992; 29(6):363-7. DOI:10.1016/0266-4356(91)90001-L · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Midfacial trauma is often complicated by ocular disorder. A scoring system has been devised to help the maxillofacial surgeon identify patients who warrant referral to an ophthalmologist. A prospective pilot study was carried out on 100 patients with midfacial fractures to evaluate the effectiveness of this system in clinical practice. The sensitivity value was 94.4% and the specificity value was 89%. Only 1 patient, who clinically warranted referral to an ophthalmologist, was missed by the system whilst 9 others were incorrectly classified as warranting referral. The results of this evaluation demonstrate the competence of the system.
British Journal of Oral and Maxillofacial Surgery 01/1992; 29(6):368-9. DOI:10.1016/0266-4356(91)90002-M · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Ocular injuries commonly occur in patients with facial fractures. This prospective study was set up to determine the incidence of ocular injuries, as assessed by an ophthalmologist, in patients who had sustained midfacial fractures. Over a 2-year period, a study of 363 patients who had sustained midfacial trauma sufficient to lead to a facial bone fracture (438 fractures) was undertaken and patients received a comprehensive examination by an ophthalmologist and an orthoptist within 1 week of injury. The characteristics of the eye injuries sustained were related to the aetiology of the fracture, the type of fracture, and the sex and age of each patient. Ninety percent of patients sustained ocular injuries of various severities. Sixty three percent of patients sustained only minor or transient ocular injuries, 16% suffered moderately severe ocular injury and 12% experienced severe eye injuries. Road traffic accident was associated with the highest incidence of severe ocular disorder (9/45 = 20%) whilst assaults had the second highest incidence at 11% (20/181). One third of all patients with comminuted malar fracture suffered a severe ocular disorder (9/27) whilst blow-out fracture came second at 16.7% (6/36). Fifty six patients (15.4%) had a decrease in their visual acuity and 9 patients (2.5%) had significant traumatic optic neuropathy. Decrease in visual acuity was the main clinical finding accompanying the majority of significant eye injuries. When ocular injuries were related to aetiology, it was apparent that road traffic accidents and assaults associated with alcohol abuse showed the highest incidence of major ocular dysfunction. It is suggested that all patients sustaining midfacial fracture associated with a significant decrease in visual acuity either pre- or postoperatively should have an early ophthalmological review.
British Journal of Oral and Maxillofacial Surgery 11/1991; 29(5):291-301. DOI:10.1016/0266-4356(91)90114-K · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Over a period of 2 years, 363 patients who had sustained a total of 438 midfacial fractures due to blunt trauma received a full ophthalmological examination within 1 week of injury. Of these, 72 patients (19.8%) developed diplopia. Diplopia was most common following road traffic accidents (31%) and least common with simple falls (10%). Blow-out fractures of the orbit led to double vision in 58% of cases. Eighty two percent of patients recovered from diplopia within 6 months of injury; only 1 patient required squint surgery for double vision. The principal risk factors for diplopia comprise road traffic accidents, blow-out fractures and comminuted malar fractures. Early surgical reconstruction of midfacial fractures with conservative management of concomitant motility disorders has, in our series, resulted in very few patients having diplopia in the long term.
British Journal of Oral and Maxillofacial Surgery 11/1991; 29(5):302-7. DOI:10.1016/0266-4356(91)90115-L · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The active and passive behaviour of the extraocular muscles can be investigated by measuring the force that must be applied to rotate the eyeball when the muscles are relaxed (the forced duction test) or the force required to maintain the eyeball stationary while the contralateral eye follows a moving target (the force generation test). Apparatus and test procedures for carrying out both tests are described. Normal values and confidence intervals for the tests have been obtained and the results of muscle entrapment and palsy illustrated.
Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine 02/1991; 205(2):101-8. DOI:10.1243/PIME_PROC_1991_205_275_02 · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Two cases of iatrogenic acquired Brown's syndrome are presented, and other causes of this disorder and its treatment are discussed. Care should be taken not to cause damage when operating in the region of the trochlea.
Journal of Oral and Maxillofacial Surgery 05/1990; 48(4):420-4. DOI:10.1016/0278-2391(90)90445-8 · 1.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Fractures of the orbital roof are rare. Entrapment of the extraocular muscles in such fractures has not, to our knowledge, been reported previously. A case of acquired Brown's syndrome due to entrapment of the superior oblique muscle tendon in an orbital roof fracture is reported.
British Journal of Oral and Maxillofacial Surgery 09/1988; 26(4):336-40. DOI:10.1016/0266-4356(88)90054-X · 1.08 Impact Factor