1/10. Long-term sequelae after surgery for orbital floor fractures.A surgical technique involving exact repositioning and rigid fixation is required for the reduction of fractures of the orbital floor. Even then, sequelae may be present long after the trauma. The aim of this study was to establish the frequency and type of sequelae after surgery for orbital floor fractures and to investigate the extent to which the method of surgery had any impact on the severity of the sequelae. A questionnaire was sent to all 107 patients (response rate 77%) 1 to 5 years after the injury. Further clinical data were obtained from the patients' charts. Eighty-three percent of the patients were affected by some kind of permanent sequelae in terms of sensibility, vision, and/or physical appearance. A high frequency of diplopia (36%) was related to the reconstruction of the orbital floor with a temporary "supporting" antral packing in the maxillary sinus, a technique which has now been abandoned at our department in favor of orbital restoration with sheets of porous polyethylene. Our conclusion is that, because long-term sequelae are common, the surgical technique must be subjected to continuous quality control to minimize future problems for this group of patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. Nasoethmoid orbital fractures: diagnosis and management.BACKGROUND AND OBJECTIVES: Trauma to the central midface may result in complex nasoethmoid orbital fractures. Due to the intricate anatomy of the region, these challenging fractures may often be misdiagnosed or inadequately treated. The purpose of this article is to aid in determining the appropriate exposure and method of fixation. methods AND MATERIALS: This article presents an organized approach to the management of nasoethmoid orbital fractures that emphasizes early diagnosis and identifies the extent and type of fracture pattern. It reviews the anatomy and diagnostic procedures and presents a classification system. The diagnosis of a nasoethmoid orbital fracture is confirmed by physical examination and CT scans. Fractures without any movement on examination or displacement of the NOE complex on the CT scan do not require surgical repair. Four clinical cases serve to illustrate the surgical management of nasoethmoid fractures. RESULTS AND/OR CONCLUSIONS: Early treatment using aggressive techniques of craniofacial surgery, including reduction of the soft tissue in the medial canthal area and restoration of normal nasal contour, will optimize results and minimize the late post-traumatic deformity. A high index of suspicion in all patients with midfacial trauma avoids delays in diagnosis.- - - - - - - - - - ranking = 10.618167894893keywords = physical examination, physical (Clic here for more details about this article) |
3/10. Superior orbital fissure syndrome: current management concepts.The superior orbital fissure syndrome is an uncommon complication of craniofacial fractures: middle-third facial fractures and lesions of the retrobulbar space. This article reviews the anatomy and etiology of the superior orbital fissure as it relates to pathophysiology and physical findings. Cases reported in the literature are reviewed, emphasizing diagnosis and established treatment options. Two cases are presented and their management discussed, including the use of pre- and postoperative steroids as an adjunct to standard fracture reduction and stabilization therapy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/10. Nasoethmoid orbital fractures. Current concepts and management principles.The proper management of nasoethmoid orbital fractures relies upon early accurate diagnosis and treatment. A surgical plan must be established after careful review of the physical examination and CT scans. Identification of the extent and type of fracture pattern determines the operative approach. Extended (wide) exposure, using craniofacial techniques, facilitates precise reduction and rigid fixation of all bone fragments. Transnasal reduction of the canthus-bearing central segment (medial orbital rim) is the critical operative maneuver required to achieve normal intercanthal distance. Immediate bone grafting replaces severely comminuted or missing bone fragments. The skin overlying the nasoethmoid area is carefully redraped by gentle pressure from padded external compression bolsters. These principles form the basis for superior aesthetic and functional results.- - - - - - - - - - ranking = 10.618167894893keywords = physical examination, physical (Clic here for more details about this article) |
5/10. Recognition and management of an orbital blowout fracture in an amateur boxer.STUDY DESIGN: Case report. OBJECTIVES: To identify key elements in the recognition and management of a patient with an orbital blowout fracture and make recommendations on diagnosis, treatment, referral, imaging, and return to sports. BACKGROUND: Orbital blowout fractures are uncommon but important injuries for physical therapists to recognize. Immediate management is essential in preventing complications. The mechanism of injury is a direct blow to the orbital rim or orbit. CASE DESCRIPTION: The patient reported to the athletic training room 15 minutes after completing a boxing match and reported that his left eye had suddenly inflated after blowing his nose. We suspected an orbital blowout fracture and referred him immediately to the emergency department where conventional radiographs were ordered. On follow-up the next day, after determining that the radiographs were normal, but still having a high index of suspicion for an orbital blowout fracture, we referred him to his primary care manager. The primary care manager ordered a computed tomography scan that revealed the fracture and referred the patient to ophthalmology. OUTCOMES: The patient was restricted from the remaining 4 weeks of the boxing season. He completed a rigorous Army physical fitness test 7 days postinjury and the Marine Corps Marathon 47 days postinjury. DISCUSSION: Orbital blowout fractures without double vision, extraocular muscle entrapment, or persistent numbness can be treated with time and protection. The patient can continue with normal fitness activities except contact or collision sports.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
6/10. Management of orbital blow-out fractures. case reports and discussion.Blow-out fractures are fractures of the orbital floor or medial wall that occur as a consequence of blunt trauma. Impact increases the intraorbital pressure, forcing the nondistensible orbital contents through the orbital floor. The fracture is commonly caused by impact from a baseball or tennis ball. However, any blunt trauma to the orbit, as from a knee or elbow, can result in a blow-out fracture. The characteristic clinical findings include double vision, a sunken globe, and numbness in the distribution of the infraorbital nerve. Sometimes, the only sign of a blow-out fracture is the abrupt inflation of periorbital tissue with air when the patient blows his nose. Standard evaluation of these fractures includes history, physical examination, and radiographs. Some patients benefit from computed tomography (CT), which can be both diagnostic and prognostic. Blow-out fractures do not often produce serious sequelae, and the current trend is toward no treatment. However, it is imperative to rule out any serious injury to the eye itself that would require emergency treatment.- - - - - - - - - - ranking = 10.618167894893keywords = physical examination, physical (Clic here for more details about this article) |
7/10. Fractures of the medial orbital wall.Two cases of patients with isolated medial orbital wall fractures are described. Presenting physical findings were minimal; however, both patients were noted to have bleeding into the nasopharynx from unidentified sources. Routine radiographs failed to disclose the fractures, which were clearly shown by computed tomography. Reconstructive surgery was planned for one patient. Frequently overlooked, this injury may be the cause of delayed enophthalmos, meningitis, or blindness. The presentation, diagnosis, and management of medial orbital wall fractures are reviewed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/10. Value of computed tomography for the diagnosis of a ruptured eye.The diagnosis of scleral perforation of the globe following ocular trauma is often obvious on physical examination, but occult perforations occur frequently. In addition to locating intraorbital foreign bodies and associated facial bone fractures, computed tomography of the orbit can suggest an occult scleral rupture. Posterior collapse of the sclera causes flattening of the posterior contour of the globe, the "flat tire" sign. Other associated findings that are suggestive of scleral rupture are intraocular foreign body or gas, thickening of the sclera posteriorly, and a blood-vitreous fluid-fluid level.- - - - - - - - - - ranking = 10.618167894893keywords = physical examination, physical (Clic here for more details about this article) |
9/10. Cranial injury from unsuspected penetrating orbital trauma: a review of five cases.Penetrating orbital-cranial injury is potentially life threatening. The history of the trauma and ophthalmologic examination may be misleadingly innocent; serious injury may be overlooked. We present five cases of orbital injury in which the diagnosis of intracranial extension was not obvious at the time of initial examination. A thorough history and physical examination should be performed on all patients, even those with apparently trivial injuries. Intracranial extension should be considered in any case where the injury was caused by an instrument small enough to enter the orbit. The threshold for obtaining a coronal CT scan of the orbits should be lowered, since this is the best way to detect an orbital roof fracture.- - - - - - - - - - ranking = 10.618167894893keywords = physical examination, physical (Clic here for more details about this article) |
10/10. Strategies for the treatment of enophthalmos.The surgical correction of post-traumatic enophthalmos is among the most challenging problems for the surgeon. A thorough understanding of orbital anatomy and the purposed mechanisms of enophthalmos is crucial to the ultimate success or failure of the procedures. The successful orbital reconstruction begins with a careful physical examination of the patient that is attentive to ocular function, soft-tissue position, and visible or palpable defects of the facial skeleton. The physical examination combined with thin section CT scanning in the axial and coronal planes provides the basis of the operative plan. The anatomy of the deformity should dictate the anatomy and shape in the surgical correction. In many cases, multiple surgical incisions will be required; therefore, care must be taken to maximize exposure and minimize the cosmetic problems associated with large incisions. We advocate a step-wise approach consisting of mobilization of the soft tissues in the area of the fracture, repositioning of the anterior and middle sections of the bony orbit, and reattachment of the soft tissue to the bone at the proper location. The approach to reconstruction of the bony orbit that we advocate is to first sequentially reposition each segment of the rim, carefully examining each articulation. Once rim reconstruction is complete, reconstruction of the internal wall is performed. Recall that the largest source of error is in inadequate reduction of the orbital rim, owing to the fact that this error is "squared" (according to the model) in the computation of the orbital volume. Through the application of these principles, the cosmetic and functional sequelae of post-traumatic enophthalmos can be improved greatly with minimal complications.- - - - - - - - - - ranking = 21.236335789786keywords = physical examination, physical (Clic here for more details about this article) |
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