Functional outcome after non-surgical management of orbital fractures—the bias of decision-making according to size of defect: critical review of 48 patients

The treatment of mild and moderate fractures of the orbital wall is controversial. Apart from clinical signs, the size of the defect is often used to aid the decision about treatment. We hypothesised that variables would be present that had an impact on the position and motility of the globe but were independent of the size of the defect, and prevented a balanced judgement of the outcome of conservative treatment. Between January 2000 and December 2007, 48 of 127 patients were included in this retrospective study to analyse the functional outcome of orbital fractures managed without operation. Selection was dependent on the availability of complete clinical records, post-traumatic computed tomographic (CT) scans (axial and coronal sections) and ophthalmic examination. All 48 defects were analysed and allocated to categories of a semiquantitative classification. The area of fracture of each defect was calculated with an integral calculus or geometrical formula and correlated with the associated category. Category A included all orbital walls as a single unit (A1) and combined fracture patterns (A2 and higher). Category B described isolated fractures of the medial wall. There was a significant correlation between classes A1 and A2 (p < 0.01) and absolute area of the fracture (0.98 (0.4) cm² and 2.42 (0.8) cm²). Diplopia was most often seen in fractures in category B1 (the anterior third of the medial wall) and the post-traumatic position of the globe significantly correlated with the area of the fracture (p = 0.04). The degree of diplopia was less severe in fractures of the posterior portion of the orbit (zones 2 and 3) compared with fractures of the anterior orbit, even if the defect was larger. The conservative management of category A1-3 and B1-3 fractures up to 2.42 (3.15) cm² showed no functional impairment, provided that enophthalmos was less than 2 mm and there was no entrapment of periorbital tissue or extraocular muscles. We found good correlation between enopthalmos and the size of the fracture, but not for diplopia or motility of the eye. We conclude that conservative management of an orbital fracture in which the defect is less than 3 cm² has a low risk of permanent functional damage if enophthalmos is less than 2 mm and entrapment of soft tissue or muscles is excluded.     

The Influence of Bone Tissue Deficiency on the Outcome of Endodontic Microsurgery: A Prospective Study

IntroductionThis study assessed the influence of deficiencies of the periapical and marginal bone tissue on clinical outcomes after endodontic microsurgery.MethodsData were collected from the Microscope Center of the Department of Conservative Dentistry at the Dental College of Yonsei University, Seoul, South Korea, between August 2004 and March 2011. In total, 199 teeth that required endodontic surgery were included in the study. During the surgical procedure, deficiencies of the periapical and marginal bone tissue were measured immediately before the flap was repositioned. The patients were recalled 6 months and 1 year after the surgical procedure to assess the clinical and radiographic signs of healing. The Student's t test or the Mann-Whitney U test and logistic regression were performed to evaluate the parameters. Significant associations between the outcome and all the evaluation parameters were analyzed using the Pearson chi-square test or the Fisher's exact test with a significance level of 0.05.ResultsA recall rate of 67.8% (135/199 teeth) was obtained. The height of the buccal bone plate was the only significant predictor (P = .040) of the healing outcome, suggesting that teeth with a buccal bone plate >3 mm presented a higher success rate than teeth with a buccal bone plate that was ≤3 mm high (94.3% vs 68.8%, P < .001).ConclusionsThese data suggest that a favorable prognosis can be expected when teeth are covered with a buccal bone plate that is >3 mm in height regardless of the amount of marginal bone loss.     

Maxillofacial Injuries in Children: A 10 year Retrospective Study

Objectives

Fractures of facial bones in children are relatively uncommon although both children and adults are subjected to similar types of injuries. This study aims to evaluate the epidemiology of facial bone fractures among children under 14 years, their management and outcome.

Materials and Methods

This retrospective study included maxillofacial injuries treated in 112 children under 14 years admitted due to maxillofacial injuries during the period from 2001 to 2011.

Results

Of them ten (8.93 %) were below 5 years, 44 (39.29 %) between 6 and 10 years and 58 (51.78 %) between 11 and 14 years of age. Male to female ratio was 1.8:1. Fall from a height was the most common etiology. The most common jaw involved in the fracture was the mandible. Conservative management was done in 83.04 % of cases and open reduction and internal fixation was performed in 16.96 % of cases. Five (4.46 %) cases accounted for post-operative wound infection.

Conclusion

Fracture of the mandible is the most common maxillofacial injury in children, most often caused by fall from a height. The osteogenic potential of the mandible in children leads to conservative management of these fractures. Opportunities for prevention of maxillofacial trauma should be taken into consideration by parents and care takers.     

Plexus Injury after Reduction of Anterior Caudal Dislocation of the Shoulder

The case is reported of a 45-year-old male patient who fell when his ladder slipped away from underneath him. He sustained a bilateral dislocation of the shoulders (bilateral luxatio erecta humeri). The injury on one hand was a glenohumeral dislocation of the humerus head right to ventral and caudal, accompanied by a suspected fracture of the tuberculum major and on the other hand a glenohumeral dislocation of the left humerus head to ventral and caudal, accompanied by a suspected total collum fracture. Based on this case and the pertinent literature, the patho-physiology, diagnosis and treatment of this rare injury are discussed.

After immediate closed reduction, soft tissue damage, fractures or neurovascular lesions should be operated on as soon as possible.     

Comparison of short- and long-term outcomes after early versus late liver retransplantation: a single-center experience

Background

As the survival of patients after liver transplantation (LT) improves, the requirement of liver retransplantation (reLT) for late graft failure has grown. Although some have reported that the short-term outcome of late reLT was comparable with that of early reLT, it remains unknown whether long-term survival of late reLT is inferior to that of early reLT patients.

Materials and methods

We reviewed early (<6 mo after primary LT) and late (≥6 mo after primary LT) reLT cases performed between January 2000 and December 2010.

Results

Sixteen early and 32 late reLT cases were analyzed. There was no significant difference regarding the number of units of red blood cells transfused during the transplantation between the groups, whereas operative time was significantly longer in the late reLT cases. Graft loss within 3 mo after early and late reLT was 18.6% and 15.6%, respectively. Patient and graft survival rates after 1, 3, 5, and 10 y in the late reLT group were 80.6%, 73.3%, 73.3%, and 67.7% and 80.7%, 69.1%, 63.3%, and 54.3%, respectively, whereas those in the early reLT group were 75.0%, 75.0%, 64.3%, and 64.3% and 81.3%, 75.0%, 64.3%, and 32.1%, respectively. There was no significant difference in patient or graft survival rates between the groups (P = 0.91 and 0.91, respectively).

Conclusions

Acceptable short- and long-term survival were provided in early and late reLT. The time between the primary LT and reLT does not seem to play significant role in the prognosis of reLT in the long term.     

成功置入FIREBIRD支架和CYPHER支架远期临床疗效比较:单中心注册研究分析结果

背景:近年来的数据显示,西罗莫司洗脱支架(SES)不仅可以减少再狭窄的发生率,同时也能减少靶血管血运重建率。CYPHER支架和FIREBIRD支架是目前中国使用最广泛的SES。然而,目前尚缺乏比较国人使用CYPHER支架和FIREBIRD支架远期有效性和安全性的数据资料。方法:自2004-04至2006-06我院共3 979例成功植入SES的患者入选本注册研究。入选患者根据支架类型分为FIREBIRD组2 274例,CYPHER组1 705例。随访指标包括术后24个月死亡、心肌梗死、血栓形成、靶病变血运重建、靶血管血运重建和主要心脏不良事件(死亡、心肌梗死和靶血管血运重建的复合终点)。采用Cox’s比例风险模型评估两组倾向性评分匹配后所有终点的相对风险。结果:经倾向性匹配后,术后24个月两组所有临床事件的发生率差异均无统计学意义(P>0.05)。两组间各终点发生的风险差异均无统计学意义(P>0.05)。两组间学术研究联合会(ARC)定义的所有血栓形成发生率均相似(P>0.05)。结论:使用国产FIREBIRD支架与进口CYPHER支架相比具有相同的有效性和安全性。