Eye Trauma in Mixed Martial Arts and Boxing.

PURPOSE: To evaluate and compare eye and face trauma in mixed martial arts (MMA) and boxing. DESIGN: Retrospective cohort study. METHODS: Data from boxing and MMA competitions were extracted from the Nevada Athletic Commission (NAC) between 2000 and 2020. Details of competitions, contestants, outcomes, and injuries were extracted. RESULTS: In total 1539 boxing injuries (from 4313 contests) and 1442 MMA injuries (from 2704 contests) were identified. Boxing had higher eye injury rates compared to MMA ( p < 0.0001), with an odds ratio of 1.268 (95% CI, 1.114-1.444). Eye trauma represented 47.63% of boxing injuries and 25.59% of MMA injuries, with periocular lacerations being the most common eye injury in both. Orbital fractures represented 17.62% of eye injuries in MMA and 3.14% in boxing contests. However, 2%-3% were retinal in both sports, and 3.27% were glaucomatous in boxing. MMA contestants had an odds ratio of 1.823 (95% CI, 1.408-2.359) for requiring physician evaluation following an eye injury compared with boxing. MMA contestants also had a higher rate of face ( p < 0.0001) and body ( p < 0.0001) injuries. For both sports, an increased number of rounds and being the losing fighter were associated with increased odds of eye and face injury. CONCLUSION: Although boxing has a higher rate of eye injuries, MMA eye injuries are more likely to require physician evaluation. MMA contestants also have a higher rate of orbital fractures and face and body trauma. A detailed postfight examination and long-term follow-up of ocular injury in combat sports will be vital in proposing reforms to prevent eye trauma.

Efficacy of transconjunctival approach for the treatment of orbital fractures: A protocol for systematic review and meta-analysis.

BACKGROUND: This study aims to assess the efficacy of transconjunctival approach (TCA) for the treatment of orbital fractures (OF) comprehensively and systematically. METHODS: In this study, we plan to search electronic databases of Cochrane Library, MEDLINE, EMBASE, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and for relevant randomized controlled trials. All these databases will be searched from inception to the March 1, 2020 without limitations of language and publication status. Two independent authors will carry out study selection, data collection, and study quality assessment. Any disagreements will be resolved by discussion with another author if necessary. The study quality will be assessed using Cochrane risk of bias tool. Statistical analysis will be conducted using RevMan 5.3 software. RESULTS: This study will be the first 1 to exert direct evidence to evaluate the efficacy of TCA for the treatment of OF. CONCLUSIONS: The findings of this study will provide an exhaustive view of TCA for the treatment of OF. STUDY REGISTRATION NUMBER: INPLASY202040154.

Adding Injury to Insult: A National Analysis of Combat Sport-Related Facial Injury.

OBJECTIVES/HYPOTHESIS: To estimate the incidence of patients presenting to emergency departments (EDs) for facial trauma sustained from participation in combat sports and evaluate injury patterns and patient demographics. METHODS: The National Electronic Injury Surveillance System (NEISS) was evaluated for facial injuries from wrestling, boxing, and martial arts leading to ED visits from 2008 to 2013. Relevant entries were examined for injury mechanism, location, type, as well as other patient characteristics. RESULTS: There were 1143 entries extrapolating to an estimated 42 395 ED visits from 2008 to 2013. Injury rates for boxing, marital arts, and wrestling were, respectively, 44, 56, and 120 injuries per 100 000 participants. Males comprised the majority (93.7%). A plurality of injuries involved lacerations (46.0%), followed by fractures (26.2%) and contusions/abrasions (19.3%). The proportion of fractures was highest among boxers (36.9%). Overall, the most common mechanisms of injury were punching, kicking, and head butting. CONCLUSIONS: The significant number of ED visits resulted from combat sports facial trauma, reinforcing the importance of familiarity with injury patterns among practitioners managing facial trauma. As most injuries involve individuals younger than 19 despite guidelines suggesting children and adolescents avoid combat sports, these findings may be used for patient education and encouragement of the use of personal protective equipment. Furthermore, injury patterns reported in this analysis may serve as an adjunct for enhancing clinical history taking and physical examination.

Infectious Complication Following Midface Reconstruction With Calcified Triglyceride.

This case report describes an infectious complication related to the use of calcified triglyceride (Kryptonite Bone Cement) in post-traumatic midface reconstruction. Ultimately, the infected material required removal, and the facial deformity was repaired with subsequent procedures. The literature suggests that bone cement products should be used with caution when in contact with the paranasal sinuses.

Transient ipsilateral mydriasis during correction of left blowout fracture.

Mydriasis, either bilateral or unilateral, seldom occurs during reconstruction of periorbital fracture. Anisocoria, a unilateral mydriasis, requires more urgent assessment than bilateral mydriasis does. Pharmacologic agents, local anesthetic infiltration, as well as direct or indirect oculomotor nerve damage are possible causes of unilateral mydriasis. Few cases have been reported about intraoperative temporary ipsilateral mydriasis during correction of blowout fracture. We have experienced an unusual case of anisocoria and report the case with literature reviews.

Calcium phosphate cement in orbital reconstructions.

Treatment of facial trauma sequelae is a complex and challenging process. There is still controversy over suitable materials for orbital wall reconstruction. This study evaluated calcium phosphate cement (CPC) implants manufactured by rapid prototyping in the repair of orbital wall defects secondary to trauma. Computed tomographic scans of 5 patients were used for surgery planning and production of CPC implants. Implants were used to restore orbital wall anatomy, ocular alignment, and facial contour. Benefits resulting from the use of implants, such as a reduced operating time, patient response to biomaterial implantation, biomaterial integrity and stability, and patient satisfaction with treatment, were analyzed qualitatively. Our results suggest that CPC is an effective and safe material for orbital reconstruction because of its biocompatibility and easy production and placement.

Outcome analysis of sports-related multiple facial fractures.

In this paper, we report a retrospective study of 236 patients with facial bone fractures from various sports who were treated at the Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, South Korea, between February 1996 and April 2007. The medical records of these patients were reviewed and analyzed to determine the clinical characteristics and treatment of the sports-related facial bone fractures. The highest frequency of sports-related facial bone fractures was in the age group 11 to 20 years (40.3%); there was a significant male predominance in all age groups (13.75:1). The most common causes of the injury were soccer (38.1%), baseball (16.1%), basketball (12.7%), martial arts (6.4%), and skiing or snowboarding (11%). Fractures of the nasal bone were the most common in all sports; mandible fractures were common in soccer and martial arts, orbital bone fractures were common in baseball, basketball, and ice sports, and fractures of the zygoma were frequently seen in soccer and martial arts. The main causes of the sports injuries were direct body contact (50.8%), and the most commonly associated soft tissue injuries were found in the head and neck regions (92.3%). Nasal bone fractures were the most common (54.2%), and tripod fractures were the most common type of complex injuries (4.2%). The complication rate was 3.0%. Long-term epidemiological data regarding the natural history of sports-related facial bone fractures are important for the evaluation of existing preventative measures and for the development of new methods of injury prevention and treatment.

High resolution magnetic resonance imaging with an orbital coil as an alternative to computed tomography scan as the primary imaging modality of pediatric orbital fractures.

PURPOSE: The computed tomography (CT) scan is currently the gold standard in the imaging of orbital fractures. The weak points of this imaging modality, however, include restricted soft tissue depiction as well as the radiation. Both attributes are of particular importance in children because of the high rate of trapdoor fractures and the radiation to the lens. Although magnetic resonance imaging (MRI) is not associated with these drawbacks, it has not been established in the primary diagnosis of pediatric orbital fractures. The aim of our study was to establish the use of MRI with a special orbital coil for the primary diagnosis of pediatric orbital trauma. PATIENTS AND METHODS: In our retrospective study, 14 pediatric patients presented to our department with a blunt orbital trauma from 2003 to 2007. Twelve of 14 patients with orbital floor fractures required surgical reconstruction. Until 2004, imaging was carried out by plain x-rays and CT scan for a decision regarding the necessity of surgery. Since introducing the MRI microscopy orbital coil in 2004, CT scans have been replaced by MRI for the primary fracture diagnosis in 8 pediatric cases. Kappa statistics have been applied to assess inter- and intraobserver reliability for CT scans and MRI. This study shows our experiences using MRI in combination with conventional x-rays to determine the operative approach in 2 of the 8 pediatric cases suffering from blunt orbital trauma. RESULTS: The most common causes for pediatric orbital trauma in our collective were accidents. In 8 cases using MRI as the primary imaging modality, depiction of the fracture dislocation and differentiation of the adjacent fatty and muscle tissue was excellent and indication for surgery was distinct. MRI reached a high intra- and inter-rater agreement level (kappa=0.80). CONCLUSION: MRI combined with a microscopy orbital coil is a valuable alternative to the CT scan in the primary diagnosis of pediatric orbital fractures. Floor fractures, and particularly muscle incarceration, should be diagnosed by high resolution MRI combined with a microscopy coil instead of CT to avoid radiation to the lens and to obtain a better soft tissue depiction.

Orbitozygomatic complex fracture reduction under local anesthesia and light oral sedation.

PURPOSE: Closed hook reduction is a well-accepted approach in reducing selected cases of isolated orbitozygomatic complex fractures. The potential of achieving such reductions under light sedation and local anesthesia has many potential benefits over general anesthesia and should therefore not be overlooked. The goal of this study was to verify if closed reduction under local anesthesia is a feasible alternative to reduction under general anesthesia for selected cases of orbitozygomatic complex fractures. Furthermore, an attempt was made at identifying those who would benefit from such an option without compromising end results as opposed to those who would require open reduction with the use of internal fixation devices (ORIF) to ensure favorable outcomes. MATERIALS AND METHODS: Over the period of July to October 2005, we attempted to reduce 8 consecutive orbitozygomatic complex fractures on an outpatient basis with the use of local anesthesia. RESULTS: We have successfully reduced 6 of 8 such fractures. CONCLUSION: Closed hook reduction under light sedation and local anesthesia is a feasible and safe procedure in selected cases of noncomminuted zygomatic fractures. Coupling both physical examination and immediate postoperative radiographic evaluation ensures substantiation of accurate reduction and permits immediate final corrections if considered necessary.

Cavernous sinus/orbital apex syndrome associated with indwelling orbital catheter use.

A 46-year-old man with a history of right orbital fractures and blindness underwent simultaneous fracture repair and enucleation with orbital implantation. During surgery, an orbital catheter was placed for administering local anesthesia to control postoperative pain. After administration of local anesthesia through the catheter on postoperative day 1, the patient had development of a complete ptosis, total ophthalmoplegia, mydriasis, vision loss from 20/20 to NLP, and hypesthesia of the V1 and V2 trigeminal nerve distribution. Intraocular pressures and dilated funduscopic examination were normal. There was no evidence of central nervous system effects or respiratory depression. After 4 hours of observation, the vision, sensation, motility, ptosis, and pupil response all returned to normal. Although rare, contralateral cavernous sinus/orbital apex syndrome may occur with indwelling orbital catheter administration of local anesthetic in an orbit with fractures.

Acquired simulated brown syndrome following surgical repair of medial orbital wall fracture.

Simulated Brown syndrome is a term applied to a myriad of disorders that cause a Brown syndrome-like motility. We encountered a case of acquired simulated Brown syndrome in a 41-year-old man following surgical repair of fractures of both medial orbital walls. He suffered from diplopia in primary gaze, associated with hypotropia of the affected eye. We performed an ipsilateral recession of the left inferior rectus muscle as a single-stage intraoperative adjustment procedure under topical anesthesia, rather than the direct approach to the superior oblique tendon. Postoperatively, the patient was asymptomatic in all diagnostic gaze positions.

Artistic assault: an unusual penetrating head injury reported as a trivial facial trauma.

The authors report a case of penetrating head injury that presented with a deceptively mild complaint. To our knowledge, it is the first report of a paint brush penetrating the brain. The patient reported being punched in the left eye and presented with a minor headache, swelling around the left orbit, a small cut on the cheek and slightly reduced left eye abduction. After radiological evaluation, a penetrating head injury was diagnosed. Under general anesthesia, through a lateral eyelid incision a 10.5 cm long paint brush, which had penetrated from the left orbit to the right thalamus, was removed. No post-operative infection was seen at six months follow-up. This brief report serves to highlight that penetrating brain injury can occur without neurological deficit and that a minimally invasive surgical approach was successful in avoiding any complications.

Acquired Simulated Brown Syndrome following Surgical Repair of Medial Orbital Wall Fracture

Simulated Brown syndrome is a term applied to a myriad of disorders that cause a Brown syndrome-like motility. We encountered a case of acquired simulated Brown syndrome in a 41-year-old man following surgical repair of fractures of both medial orbital walls. He suffered from diplopia in primary gaze, associated with hypotropia of the affected eye. We performed an ipsilateral recession of the left inferior rectus muscle as a single-stage intraoperative adjustment procedure under topical anesthesia, rather than the direct approach to the superior oblique tendon. Postoperatively, the patient was asymptomatic in all diagnostic gaze positions.

Bloqueio do nervo maxilar para redução de fraturas do osso zigomático e assoalho da órbita / Maxillary nerve block for zygoma and orbital floor fractures reduction

JUSTIFICATIVA E OBJETIVOS: Poucos relatos existem sobre reduçäo de fraturas da órbita zigomática e do arco zigomático sob anestesia regional. O objetivo deste estudo é verificar a qualidade do bloqueio do nervo maxilar por via extraoral, para reduçäo de fraturas do osso zigomático e do assoalho da órbita. MÉTODO: Quinze pacientes foram submetidos à bloqueio do nervo maxilar pela técnica de Moore (abordagem infrazigomática) para reduçäo de fraturas isoladas do arco zigomático (oito pacientes) e associadas ao assoalho da órbita (sete pacientes). Nenhum paciente recebeu medicaçäo pré-anestésica. Após sedaçäo e anestesia local com 2 ml de lidocaína a 1,5 por cento com adrenalina a 1:300.000, o nervo maxilar foi abordado com 8 ml da mesma soluçäo anestésica através de uma agulha 22G, 10 cm de comprimento de ponta romba. Foram avaliados: o tempo de bloqueio, a latência, o tempo de analgesia, a incidência de falhas, a necessidade de anestesia geral e as complicações. RESULTADOS: Os primeiros três bloqueios foram difíceis, resultando em dois bloqueios parciais e uma falha. Os restantes foram efetivos e os pacientes näo referiram nenhum desconforto ou dor durante o bloqueio e a cirurgia. O tempo para a realizaçäo do bloqueio variou de 5 a 20 minutos, enquanto a latência anestésica ficou entre 3 e 10 minutos. Foram registradas 7 ocorrências de punçäo vascular, porém sem relatos de formaçäo de hematomas. CONCLUSÕES: Reduçäo de fraturas zigomáticas säo factíveis sob bloqueio do nervo maxilar, quando realizadas na fossa ptérigo palatina, permitindo anestesia de seus dois ramos distais, nervo zigomático-temporal e nervo zigomático-frontal

An assessment of maxillofacial fractures: a 5-year study of 237 patients.

PURPOSE: This descriptive analytical study assesses the cause, type, incidence, demographic, and treatment data of maxillofacial fractures managed at our medical center during a 5-year period and compares them with the existing body of literature on the subject. PATIENTS AND METHODS: A 5-year retrospective clinical and epidemiologic study evaluated 237 patients treated for maxillofacial fractures from 1996 to 2001 at one medical center. There were 211 male patients (89%) and 26 (11%) female patients. The patients ranged in age from 3 to 73 years, with 59.0% (140 patients) in the 20- to 29-year age group. A number of parameters, including age, gender, cause of injury, site of injury, type of injury, treatment modalities, and complications, were evaluated. All maxillofacial injuries were assessed and treated by a single oral and maxillofacial surgeon. Other concomitant bodily injuries were treated by appropriate consultant specialists. RESULTS: There were 173 (72.9%) mandibular, 33 (13.9%) maxillary, 32 (13.5%) zygomatic, 57 (24.0%) zygomatico-orbital, 5 (2.1%) cranial, 5 (2.1%) nasal, and 4 (1.6%) frontal injuries. Car accidents caused 73 (30.8%), motorcycle accidents caused 55 (23.2%), altercations 23 (9.7%), sports 15 (6.3%), and warfare caused 23 (9.7%) of the maxillofacial injuries. Regarding distribution of mandibular fractures, 32% were seen in the condylar region, 29.3% in the symphyseal-parasymphyseal region, 20% in the angle region, 12.5% in the body, 3.1% in the ramus, 1.9% in the dentoalveolar, and 1.2% in the coronoid region. The distribution of maxillary fractures was Le Fort II in 18 (54.6%), Le Fort I in 8 (24.2%), Le Fort III in 4 (12.1%), and alveolar in 3 (9.1%). Of the 173 mandibular fractures, 56.9% were treated by closed reduction, 39.8% by open reduction, and 3.5% by observation only. Of 33 maxillary fractures, 54.6% were treated using closed reduction, 40.9% using open reduction, and 4.5% with observation only. Approximately 52.1% of the patients were treated under general anesthesia, and 47.9% were treated under local anesthesia and sedation. Postsurgical complications were recorded in 5% of patients. These complications included infection, asymmetry, and malocclusion. Overall mortality in this series was 0.84% (2 patients); mortality was caused by pulmonary infection. CONCLUSION: The findings of this study, compared with similar studies reported in the literature, support the view that the causes and incidence of maxillofacial injuries vary from 1 country to another.

The use of maxillary sinus endoscopy in the diagnosis of orbital floor fractures.

PURPOSE: The goal of the current study was to evaluate the ability to diagnose the presence of an inferior orbital wall fracture through the use of a transantral endoscopy technique at bedside. PATIENTS AND METHODS: Seven trauma patients with initial axial computed tomography (CT) scan findings consistent with an orbital floor fracture were studied. Before endoscopy, the patients underwent a coronal CT scan with 3-mm cuts for later comparison with the endoscopic findings. The surgeon performing the endoscopy procedure was blinded to the results of the coronal CT scan. Visual acuity, intraocular pressure, and measurement for enophthalmos were performed before endoscopy. The endoscopic procedure was performed at the bedside using local anesthesia. A trocar was used in the canine fossa to gain access to the maxillary sinus. A 30 degrees and then a 70 degrees endoscope were introduced through the trocar to evaluate the integrity of the orbital floor (ie, maxillary sinus roof). The degree of mucosal injury of the orbital floor and the presence of blood or orbital contents in the sinus were recorded. The ophthalmologic examination was repeated after completion of endoscopy. RESULTS: The endoscopic procedure was able to be completed in all patients. There was no change in the ophthalmologic examination in any patient as a result of endoscopy. In six of the seven patients studied, the endoscopic findings correlated with the need for surgical intervention to repair the orbital floor predicted on the basis of coronal CT scan. This was determined by the degree of injury to the orbital floor and the presence of hematoma, exposed bone, or fat. In the remaining case, endoscopy was not diagnostic for the presence of a fracture because only ecchymosis of the orbital floor was noted. CONCLUSIONS: The ability to perform endoscopy under local anesthesia at the bedside is useful in those trauma patients whose concomitant injuries may prohibit other diagnostic modalities.

Bilateral simultaneous optic nerve dysfunction after periorbital trauma: recovery of vision in association with with chiropractic spinal manipulation therapy.

OBJECTIVE: To discuss the recovery of optic nerve function after chiropractic spinal manipulation in a patient with loss of vision as a result of facial fracture from a fall. CLINICAL FEATURES: In a fall down a stairwell, a 53-year-old woman with migraines fractured her right zygomatic arch, which was later treated surgically. Approximately 3 weeks after the accident, vision in her contralateral eye became reduced to light perception. Electrophysiologic studies revealed that the function of both optic nerves was diminished, the right significantly more than the left. Single photon emission tomography showed pancerebral ischemic foci. INTERVENTION AND OUTCOME: Chiropractic spinal manipulation was used to aid recovery of vision to normal over a course of 20 treatment sessions. At times, significant improvement in vision occurred immediately after spinal manipulation. Progressive recovery of vision was monitored by serial visual field tests and by electrophysiologic studies. Unfortunately, the patient refused a further single photon emission tomographic study when visual recovery was complete. CONCLUSION: This case report adds to previous accounts of progressive and expeditious recovery of optic nerve function in association with spinal manipulation therapy.

Transnasal Edoscopic Reduction Of Medial Orbital Blowout Fracture

As the use computed tomographic (CT) scanning spread, the diagnosis of blowout fractures of the medial orbital wall increased. Now, the diagnosis of blowout fracture in the medial wall are not uncommon. Conventionally, the surgery of blowout fractures in medial orbital wall was performed by the various approach with external incision. The conventional method had seveal possible disadvantages, including an external scar, incomplete reduction, increased mobidity rate and general anesthesia. Recently, endoscopic reconstruction of the medial orbital wall has provided good functional and cosmetic results. We performed endoscopic transnasal reduction surgery without external incision in 12 cases of medial blowout fracture under local anesthesia. The fractured bony fragments were removed after the intranasal ethmoidectomy and the entrapped medial rectus was released. And then a sheet of silicone late or uncinate process were placed on the fracture site. For the maintain of the position of fractured wall, Merocel packing or urinary ballon catheter were used in orbital fracture site for 1-3 weeks. There were no specific complications related to this procedure. Result of the surgery in all cases were satisfactory. In this article, we discussed the surgical procedure, the benifit of the transnasal endoscopic approach, the indications for surgery, and possible comlications.