Clinical management and reconstruction of isolated orbital floor fractures: The role of computed tomography during preoperative evaluation

Baser, Nesrin Tan; Bulutoğlu, Refika; Celebi, Nihal Uzun; Aslan, Gürcan

doi:10.5505/tjtes.2011.47135

Cited by 7 publications

(2 citation statements)

References 45 publications

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“…Blumer Michael, MD 1) , Gander Thomas, MD, DMD 2) , Kruse Gujer Astrid, MD, DMD 2) , Seifert Burkhardt, Prof. Dr. 4) , Rücker Martin, MD, DMD 5) , Lübbers Heinz-Theo, MD, DMD …”

Section: Influence Of Mirrored Ct Scans On Decision-making For Revisimentioning

confidence: 99%

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Influence of Mirrored Computed Tomograms on Decision-Making for Revising Surgically Treated Orbital Floor Fractures

Blumer

Gander

Gujer

et al. 2015

Journal of Oral and Maxillofacial Surgery

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PURPOSE This study evaluated whether intraoperative imaging with computer-assisted virtual reconstruction would be advantageous in reconstructions of orbital floor fractures. The surgeon's intention to revise a reconstructed primary orbital floor fracture by evaluating a postoperative mirrored computed tomographic (CT) scan was analyzed intraoperatively before wound closure, during inpatient hospitalization, and after hospitalization. The inter-rater agreement and the match of intention to revise and actual revision were analyzed. MATERIALS AND METHODS Fifty-one anonymized postoperative CT scans of patients with a unilateral orbital floor fracture were mirrored using software. These computer-assisted virtual reconstructions were consecutively examined by 4 examiners. Seven of these patients underwent a revision. In the first part, the inter-rater agreements for all 3 times were analyzed. In the second part, the examiners' intentions to revise were compared with the actual performed revisions. RESULTS The overall inter-rater agreements were 0.69 for the intraoperative phase, 0.55 for the in-hospital phase, and 0.39 for the post-hospital phase. The intraoperative inter-rater agreement for each examiner was 0.58 to 0.80. The Fleiss value for the in-hospital and post-hospital phases was lower. The comparison of the examiners' intention to revise and the actual revisions showed that 15 to 24 additional would have been revised. In contrast, 6 of 7 actual revisions would have been revised intraoperatively. The missed actual revision was the same case by all 4 examiners. The accordance of intention to revise with the actual revisions decreased during hospitalization and even more after hospitalization. This study showed strong agreement among examiners for revising anatomically incorrectly reduced orbital floor fractures intraoperatively by evaluating postoperative mirrored CT scans. During the in-hospital and post-hospital phases, the restraints against revision seemed to increase, thus leading to poorer interrater agreement. This analysis of postoperative CT scans with computer-assisted virtual reconstructions of the orbit would have led to considerably more revisions intraoperatively, but all actual revisions were detected except for 1 case. This case was the same for all 4 examiners. Operation time would have been prolonged in the additional revised cases, but a better anatomic reconstruction would have been achieved. Furthermore, the intraoperative result of the reconstruction would have been controlled instantly and corrected immediately, if needed. CONCLUSION This study showed that of 6 of 7 actual revisions, implant placement would have been revised intraoperatively by all 4 examiners, if intraoperative imaging with computer-assisted virtual reconstruction of the orbit would have been applied. Therefore, the authors suggest that intraoperative imaging with computer-assisted virtual reconstruction could be advantageous in the prevention of later revisions of orbital floor fractures. In this study, the t...

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“…Blumer Michael, MD 1) , Gander Thomas, MD, DMD 2) , Kruse Gujer Astrid, MD, DMD 2) , Seifert Burkhardt, Prof. Dr. 4) , Rücker Martin, MD, DMD 5) , Lübbers Heinz-Theo, MD, DMD …”

Section: Influence Of Mirrored Ct Scans On Decision-making For Revisimentioning

confidence: 99%

“…If not operated on in time and appropriately, complications like enophthalmia or diplopia may occur [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Influence of Mirrored Computed Tomograms on Decision-Making for Revising Surgically Treated Orbital Floor Fractures

Blumer

Gander

Gujer

et al. 2015

Journal of Oral and Maxillofacial Surgery

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Approaches to the Orbit: A 360-Degree View

Koerbel

2014

Samii's Essentials in Neurosurgery

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Use of Copolymer Polylactic and Polyglycolic Acid Resorbable Plates in Repair of Orbital Floor Fractures

Lin

German²,

Wong

2014

Facial plast Surg

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The fractures of the orbital floor are common after craniofacial trauma. Repair with resorbable plates is a viable reconstructive option; however, there are few reports in the literature. This study describes our experience using copolymer polylactic and polyglycolic acid (PLLA/PGA) orbital reconstruction plates (LactoSorb, Lorenz Surgical, Jacksonville, FL) in 29 cases of the orbital floor fracture repair. We conducted a retrospective review of 29 orbital floor fractures at a single institution repaired through transconjunctival, preseptal dissection using PLLA/PGA plates fashioned to repair the orbital floor defect. Associated fractures included zygomaticomaxillary, LeFort, and nasoethmoid fractures. There were six patients with complications. Four patients had transient diplopia with complete resolution of symptoms within 1 year. One patient had diplopia postoperatively, but was later lost to follow-up. Two patients have had persistent enophthalmos since 1 year. In each of these cases, the floor fracture was coincident with significant panfacial or neurotrauma. We did not encounter any adverse inflammatory reactions to the implant material itself. The study concluded that orbital floor fracture repair with resorbable plates is safe, relatively easy to perform, and in the majority of cases was effective without complications. In the presence of severe orbital trauma, more rigid implant materials may be appropriate.

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Clinical management and reconstruction of isolated orbital floor fractures: The role of computed tomography during preoperative evaluation

Cited by 7 publications

References 45 publications

Influence of Mirrored Computed Tomograms on Decision-Making for Revising Surgically Treated Orbital Floor Fractures

Influence of Mirrored Computed Tomograms on Decision-Making for Revising Surgically Treated Orbital Floor Fractures

Approaches to the Orbit: A 360-Degree View

Use of Copolymer Polylactic and Polyglycolic Acid Resorbable Plates in Repair of Orbital Floor Fractures

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