Intraoperative Imaging Changes Management in Orbital Fracture Repair

Borad, Vedant; Lacey, Martin S.; Hamlar, David; Dresner, Harley S.; Yadava, G; Schubert, Warren

doi:10.1016/j.joms.2017.05.002

Cited by 32 publications

(25 citation statements)

References 10 publications

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“…A review of intraoperative imaging practices demonstrated intraoperative revision reduction rates for orbital and ZMC fractures of 9 and 18%, respectively, 19 with a recent report showing a 44% intraoperative revision rate for orbital fractures. 20 Reported intraoperative reduction rates are higher than the revision surgery rates in reports of postoperative imaging following facial fracture repair, [1][2][3][4][5][6][7] which are consistent with the revision surgery rate of the current report (3%). Postoperative imaging findings in asymptomatic patients did not account for this discrepancy.…”

Section: Discussionsupporting

confidence: 87%

The Role of Postoperative Imaging after Orbital Floor Fracture Repair

Carpenter

Shammas

Honeybrook

et al. 2018

Craniomaxillofacial Trauma & Reconstruction

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Obtaining postoperative images of maxillofacial fractures does not affect the clinical management of asymptomatic patients; however, few studies have evaluated the role of postoperative imaging in the context of orbital floor fractures. In this study, we evaluate current practice techniques and the role of postoperative imaging in the management of orbital floor fractures in isolation and with concomitant facial fractures. Retrospective review of patients who underwent open reduction and internal fixation of orbital floor fractures between 2005 and 2015 at a single medical institution. Operative and perioperative records were reviewed to characterize postoperative imaging as routine or as indicated by concerning clinical symptoms, and to correlate clinical outcomes to postoperative imaging patterns across all identified orbital floor fractures. A total of 139 patients underwent open reduction and internal fixation of orbital floor fractures. Of these, 75 (54%) had zygomaticomaxillary (ZMC) involvement. The remaining 64 (46%) were isolated orbital floor fractures. Overall, 54 (39%) patients underwent postoperative imaging. Of these, 38 (70%) had postoperative imaging in the absence of concerning clinical symptoms. There was no observed difference in complication rates in those who underwent postoperative imaging, and those who did not. Patients with orbital + ZMC fractures underwent a significantly higher number of postoperative imaging studies ( < 0.001); however, there was no observed difference in complications between isolated orbital and orbital + ZMC fractures. Routine postoperative imaging is not warranted in the absence of persistent clinical symptoms following open reduction and internal fixation of orbital floor fractures.

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Section: Discussionsupporting

confidence: 87%

The Role of Postoperative Imaging after Orbital Floor Fracture Repair

Carpenter

Shammas

Honeybrook

et al. 2018

Craniomaxillofacial Trauma & Reconstruction

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“…While utilizing the two dimensional aspects of CT is essential for the smaller and more internal CMF fractures, it is well-recognized that the two-dimensional and three-dimensional modalities are best utilized together (9,15,16). In some cases, not only is preoperative CT used for diagnostic and planning purposes, but intraoperative CT is also being utilized during surgery and has been shown to change clinical decision-making (17). Fortunately, there is increasing access to CT in veterinary practice, which may improve the accuracy of diagnosis in CMF trauma patients.…”

Section: Introductionmentioning

confidence: 99%

Craniomaxillofacial Trauma in Dogs—Part I: Fracture Location, Morphology and Etiology

et al. 2020

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Treatment of craniomaxillofacial (CMF) trauma in dogs often requires a multidisciplinary approach and a thorough understanding of the CMF skeletal structures involved. The aim of this retrospective study was to use a large number of CT studies of dogs evaluated for CMF trauma and to describe fracture location and morphology in relation to demographic data and trauma etiology. The medical records and CT studies of 165 dogs over a 10-year period were evaluated. The skeletal location of CMF fractures as well as the severity of displacement and fragmentation of each fracture was recorded. Patient demographic data and trauma etiology were also recorded. Animal bites accounted for the majority of trauma (50%), followed by unknown trauma (15%), vehicular accidents (13%), and blunt force trauma (13%). Small dogs, < 10 kg, and juveniles accounted for the majority of patients (41.8 and 25.5%, respectively). The most likely bone or region to be fractured was the maxillary bone, followed by the premolar and molar regions of the mandible. Up to 37 bones or regions were fractured in any given patient, with an average of 8.2 fractured bones or regions per dog. The most commonly fractured location varied according to trauma etiology. Specifically, vehicular accidents tended to result in more locations with a higher probability of fracture than other trauma types. A major conclusion from this study is that every bone of the CMF region was fractured in at least one case and many cases had a large number of fractured regions. Thus, the need for comprehensive assessment of the entire CMF region, preferably using CT, is underscored.

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“…Tridimensional (3D) imaging is especially important in these cases so that surgical planning can take into account the relative locations, sizes, and shapes of fracture fragments. In the human literature, it is well-accepted that 3D imaging (2,22,23) is superior for treatment planning related to CMF trauma and is commonly being used for intraoperative visualization as well (24).…”

Section: Discussionmentioning

confidence: 99%

Craniomaxillofacial Trauma in Dogs—Part II: Association Between Fracture Location, Morphology and Etiology

et al. 2020

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Treatment of craniomaxillofacial (CMF) trauma in dogs requires a thorough understanding of the CMF skeletal structures involved. The human medical literature has several examples of CMF trauma and fracture classification, including the classically described Le Fort fractures. The recent classification schemes require large studies using computed tomography (CT). In the veterinary medical literature, such studies are lacking. The aims of part II of this retrospective study were to use a large number of CT studies of dogs evaluated for CMF trauma to determine whether specific fracture locations in the CMF region occur concurrently, and whether trauma etiology influences fracture morphology. This information may then be used to form a fracture classification scheme in the future. The medical records and CT studies of 165 dogs over a 10-year period were evaluated. The skeletal location of CMF fractures as well as the severity of displacement and fragmentation of each fracture was recorded. Dogs' demographic data and trauma etiology were also recorded. Fractured portions of the mandible tended to occur with fractures of adjacent bones, with the major exception of symphyseal separation, which occurred simultaneously with fractures of the cribriform plate. Fractures of the maxillary bone were accompanied by many concurrent fractures affecting the majority of the midface, skull base, and cranial vault. When the zygomatic bone was fractured, the other bones comprising the orbit also tended to fracture. Fractures of the relatively superficially located frontal and nasal bones were often accompanied by fractures of the skull base. Fracture etiology influenced fracture morphology such that vehicular trauma resulted in a relatively higher number of severely displaced and comminuted fractures than did other trauma etiologies. This study provides examples of fractures that, when found, should prompt veterinarians to look for additional injuries in specific locations. In addition, it further highlights the need for thorough CT evaluation of the entire CMF region, even when clinically apparent fractures appear relatively superficial.

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Intraoperative Imaging Changes Management in Orbital Fracture Repair

Cited by 32 publications

References 10 publications

The Role of Postoperative Imaging after Orbital Floor Fracture Repair

The Role of Postoperative Imaging after Orbital Floor Fracture Repair

Craniomaxillofacial Trauma in Dogs—Part I: Fracture Location, Morphology and Etiology

Craniomaxillofacial Trauma in Dogs—Part II: Association Between Fracture Location, Morphology and Etiology

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