The aim of this study was to compare the changes of diplopia and enophthalmos in patients with blowout fractures. Three hundred sixty-two patients who presented with blowout fractures between March 2006 and February 2011 were analyzed. The sequential time changes of diplopia and enophthalmos were measured in the operated group and the observed group according to (1) the duration of preoperative observation (early: within 7 days, late: 8-14 days, delayed: >15 days); (2) the defect size (minimal: <1 cm(2), small: 1.1-2.0 cm, medium: 2.1-3.0 cm(2), large: >3.0 cm(2)); and (3) the age of the patients (<20, 21-40, 41-60, >61 years).Among the 362 patients, 242 (66.9%) had an operation, and 120 (33.1%) did not. The duration of preoperative observation did not affect the postoperative diplopia or enophthalmos. There were significant differences of enophthalmos among the operated groups with a different defect size at the preoperative period (P = 0.036 [Pearson χ(2)]). There were significant differences of diplopia among the operated groups with different defect sizes at the 6 months' follow-up period (P = 0.014 [Pearson χ(2)]). The diplopia in the older age group (>60 years) was significantly greater than that of the other 3 groups at 6 months (P = 0.023) and at 12 months (P = 0.023, [Pearson χ(2)]).We think surgery should be delayed until the swelling is decreased unless the medial rectus muscle is incarcerated. We also think that the defect size is not an important factor for whether to perform surgery. We think that the reason for the greater diplopia in the older age group is that the adaptation of binocular convergence is decreased in the older age group.

Epicanthoplasty is commonly performed on Asian eyelids. Consequently, overcorrection may appear. The aim of this study was to introduce a method of reconstructing the epicanthal fold and to apply this method to the patients. A V flap with an extension (eagle beak shaped) was designed on the medial canthal area. The upper incision line started near the medial end of the double-fold line, and it followed its curvature inferomedially. For the lower incision, starting at the tip (medial end) of the flap, a curvilinear incision was designed first diagonally and then horizontally along the lower blepharoplasty line. The V flap was elevated as thin as possible. Then, the upper flap was deeply undermined to make it thick. The lower flap was made a little thinner than the upper flap. Then, the upper and lower flaps were approximated to form the anteromedial surface of the epicanthal fold in a fashion sufficient to cover the red caruncle. The V flap was rotated inferolaterally over the caruncle. The tip of the V flap was sutured to the medial one-third point of the lower margin. The inferior border of the V flap and the residual lower margin were approximated. Thereafter, the posterolateral surface of the epicanthal fold was made. From 1999 to 2011, 246 patients were operated on using this method. Among them, 62 patients were followed up. The mean intercanthal distance was increased from 31.7 to 33.8 mm postoperatively. Among the 246 patients operated on, reoperation was performed for 6 patients. Among the 6 patients reoperated on, 3 cases were due to epicanthus inversus, 1 case was due to insufficient reconstruction, 1 case was due to making an infold, and 1 case was due to reopening the epicanthal fold.This V-Y and rotation flap can be a useful method for reconstruction of the epicanthal fold.

The aim of this study was to evaluate the demographics and treatment of facial lacerations in pediatric patients. A retrospective record-based analysis was administered on 3783 patients (<15 years of age) presenting with facial lacerations from March 2002 to February 2011. Males were injured more frequently across all age groups (65.3%) and especially in the 13- to 15-year-old group (81.3%) (P = 0.012, Pearson χ). Overall, 48.9% of injuries occurred outdoors and 45.1% in homes. Only 6.0% occurred in schools or kindergartens. Injuries that occurred in schools or kindergarten increased with the age groups (from 2.3% for 0- to 3-year-olds to 19.1% for 13- to 15-year-olds). In the age groups younger than 12 years, injury occurred more frequently on the weekend. In the 13-to 15-year-old group, however, injury occurred more frequently on weekdays (odds ratio, 2.46). Injury occurred most frequently at the times of 7 to 9 PM and least frequently from midnight to 6 AM. The most frequent cause of injury in children was by being struck or by bumping something (32.5%), followed by slip-down (31.5%). Accidents involving furniture and stairs accounted for 9% each. Accidents caused by stairs decreased with age (from 10.2% for 0-3 years of age to 5.5% for 13-15 years of age, P = 0.000, Pearson χ). In a little less than half (47.2%) of the cases, parents accompanied their children at the time of injury. In the 13- to 15-year age group, only 17.9% of the children were accompanied by their parents. Foreheads (26.4%) took the brunt of most frequent injuries, followed by the eyelids (20.6%), eyebrows including the glabella (19.7%), and chin injuries (15.7%). Only 58 cases had associated injuries. Among 3783 cases of facial lacerations, 3745 patients did not have facial bone fractures or associated injuries and were managed under local anesthesia or through dressings only. A sound knowledge about the epidemiology of lacerations might be beneficial for the prevention of pediatric facial lacerations, which occurs more frequently than facial fractures. It is noteworthy that slip-down showed a peak in kindergarteners (4-6 years, 36.1%) and then decreased with age. The incidence of slip-down might be reduced if attention is paid when the kindergarteners are walking on steep stairs or steep flights of stairs. Injury at the educational institutions increases with the pupil's age, and therefore safety management in schools is important.

In this study, we attempted to compare facial trauma of late-middle-age patients (55-64 years, LM group) and old-age patients (>65 years old, OL group). The goal of this study was to evaluate the natural history of facial trauma in geriatric patients.The medical record of patients older than 55 years seeking treatment for facial trauma between March 2006 and February 2009 were reviewed, and parameters were collected. Seven hundred seventy-two patients (553 male, 219 female) were analyzed. There were 438 patients of the LM group (55-64 years old) and 334 patients of the OL group (>65 years old).In men (n = 553), the number of patients within the LM group (n = 336, 60.8%) was greater than the number in the OL group (n = 217, 39.2%). Of the 219 women, the number within the OL group (n = 117, 53.4%) was greater than that within the LM group (n = 102, 46.6%) (P = 0.000, χ). Facial lacerations comprised a significantly higher proportion in the OL group (79.3%) than that in the ML group (70.1%), whereas facial bone fractures were more frequent in the ML group (29.9%) than in the OL group (20.7%), which was significant (P = 0.004, χ). Assault and automobile accidents were significantly more frequent in the ML group (n = 65 [15.1%] and n = 31 [7.2%], respectively) than the OL group (n = 20 [6.0%] and n = 11 [3.3%]), whereas falls and pedestrian accidents were more significantly frequent in the OL group (n = 30 [9.0%] and n = 23 [6.9%], respectively) than in the LM group (n = 30 [7.0%] and n = 19 [4.4%]) (P = 0.000, χ). During the hours of the day, between 4 to 6 PM and 6 to 8 PM, injuries occurred more frequently in the OL group (14.5% and 12.4%, respectively) than in the LM group (10.5% and 11.0%, respectively). At the times of 8 to 10 PM and 10 PM to midnight, however, injuries occurred more frequently in the LM group (17.1%, 12.1%, respectively) than in the OL group (12.1% and 8.2%, respectively) (P = 0.03, χ). Frequency of injuries at home within the OL group (n = 68, 22.2%) was significantly higher than within the LM group (n = 55, 14.4%) (P = 0.001, χ), whereas frequency of injuries at the workplace of the LM group (n = 47, 12.3%) was significantly higher than that of the OL group (n = 16, 5.2%) (P = 0.001, χ). Alcohol ingestion at the time of injury was significantly more frequent in the LM group (n = 146, 34.1%) than in the OL group (n = 57, 17.3%) (P = 0.000, χ). In regard to diabetes, the OL group (35.6%) showed a higher prevalence than that of the LM group (25.4%; odds ratio, 2.65).Prevention of injury is important for elderly patients. It is worthy of notice that more than one fourth (26.8%) were in a drunken state at the time of injury. There were no significant differences in the days of hospitalization or in the interval from injury to operation. However, there were significant differences in the place of the injuries, causes of injuries, and time of injuries, which is important in the prevention of injuries. Attention should be paid to assault and automobile accidents in the LM group and to falls and pedes...

The aims of this study were to compare the degree of swelling of the medial rectus muscle (MR) in a recent fracture group, an old fracture group, and a normal group and to use this to differentiate old medial orbital wall fracture from recent fracture.We made measurements of the computed tomography images of 43 patients with a recent medial orbital wall fracture (the recent fracture group), 46 patients with depression of the medial wall and who were without a recent trauma history (the old fracture group), and 86 patients who were without any facial injury (the normal group). On the axial view, the width of the MR was measured bilaterally, and the width ratio to the contralateral side was calculated. On the coronal view, the height of the MR was measured bilaterally, and the height ratio to the contralateral side was calculated. The width-to-height ratio was also measured on the involved side.The width ratio of the recent fracture group was 1.42 ± 0.31, and it was significantly higher than that of the old fracture group (1.25 ± 0.15) or the normal group (1.00 ± 0.09). The width ratio of the old fracture group was also significantly higher than that of the normal group. The height ratio of the normal group (1.00 ± 0.04) was significantly higher than that of the recent fracture group (0.91 ± 0.15) or the old fracture group (0.86 ± 0.07). The height ratio of the recent fracture group was also significantly higher than that of the old fracture group (P = 0.043). The width-height ratio of the recent fracture group (0.63 ± 0.23) was significantly higher than that of the old fracture group (0.55 ± 0.09) or the normal group (0.37 ± 0.05). The height-to-width ratio of the old fracture group was also significantly higher than that of the normal group.We think the width ratio of the MR of the injured side to the MR of the contralateral side can be the better parameter to differentiate a recent fracture from an old fracture.