Orbital floor fractures-a comparison between CT images and findings at surgery.

PURPOSE: The present study aims to investigate how well CT images correlate to surgical findings in orbital floor fractures and to the presence of diplopia. METHODS: In this cross-sectional study, 27 consecutive patients already selected for surgery due to an orbital floor fracture underwent a routine CT scan (axial, coronal, sagittal). An ophthalmologist established any presence of diplopia. Extent of fracture/injury seen on CT was compared to that discovered during surgery. RESULTS: In the surgeons´ opinions CT-images were in concordance with surgical findings in 71% of the cases. Agreement for pure blow out fractures was high (92%). Tetrapod fractures as a cause of an orbital floor fracture was only identified as such by surgeons in three of 11 cases, all subjected to orbital exploration, not only a closed reduction. Diplopia showed a significant correlation to rounding of the inferior rectus muscle at coronal CT. "Rounding" significantly correlated with the presence of a floor defect, to herniation of soft tissues and to the volume of displaced tissue. CONCLUSIONS: The results imply that the joint professional interaction between neuroradiology and surgery is important and would benefit from the use of an easy and well-defined classification system of orbital floor fractures. In Sweden a national record to collect data on all zygomaticomaxillary complex fractures assessed is to be started aiming at making general statements possible by time.

Patient-Reported Symptoms after Midfacial Trauma.

Background The aim of this study was to assess patient-reported symptoms and health-related quality of life, 12 to 24 months after injury in patients with midfacial fractures. Methods Patients diagnosed with midfacial fractures were assessed regarding symptoms related to the fracture as well as assessment of the patients overall health-related quality of life using the Gothenburg Trismus Questionnaire (GTQ), the Folkestad facial trauma questionnaire, and EuroQol five-dimensional (EQ-5D). Questionnaires were distributed to the study patients 12 to 24 months after the trauma. Medical records were retrospectively surveyed for age, gender, trauma etiology, date of injury, fracture classification, treatment regimen, and time of surgery. Results Sixty-seven percent of the study group reports sensibility disturbance in the face 12 to 24 months after trauma and 52% reported cosmetic consequences related to the trauma. Numbness in the face was the symptom reported to be most disturbing for the patients. Few of the patients reported severe jaw-related problems, problems with muscular tension, or eating limitation according to the validated questionnaire GTQ. Conclusion Sensibility disturbance remains a significant and common symptom 12 to 24 months after midfacial trauma. There is a need for a validated patient-reported outcome instrument for facial trauma that covers multiple aspects of facial trauma such as vision disturbance and diplopia, jaw-related problems, and facial pain as well as sensibility disturbance and cosmetic consequences.

Voice Range Profile and Health-related Quality of Life Measurements Following Voice Rehabilitation After Radiotherapy; a Randomized Controlled Study.

PURPOSE: The aim of the present study was to investigate the effects of voice rehabilitation in patients treated with radiotherapy for laryngeal cancer. METHOD: A total of 42 patients with laryngeal cancer who are treated with radiotherapy with curative intent participated in a randomized controlled study. The collected data were voice range profiles (VPRs) and patient-reported outcome (PRO) instruments for measurement of self-perceived communication function (Swedish Self-Evaluation for Communication Experiences after Laryngeal cancer (S-SECEL)) and health related quality of life (HRQL) (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30/Head and Neck module). Data were collected 1 month (pre voice rehabilitation), 6 months, and 12 months postradiotherapy. Of the patients, 19 received voice rehabilitation, whereas 23 constituted a control group. RESULTS: There were several statistically significant improvements in the study group concerning the HRQL and self-perceived communication function. The largest improvements occurred between occasions 1 (prevoice rehabilitation) and 2 (6-month postradiotherapy) and then remained constant. VRP area demonstrated a statistically significant difference when comparing changes over time, where the study group improved more than the control group. CONCLUSION: HRQL and self-perceived communication function showed improvement in the study group and trends of impairment in the control group. This result might suggest that it would be beneficial for the patients as well as in a health economic perspecitve, to receive voice rehabilitatiom to make a faster improvement of the HRQL and self-perceived communication function.

Diplopia in orbital fractures: a simple method to evaluate eye motility.

CONCLUSION: This study on eye motility demonstrates a new application of electro-oculography which proved to have a high potential for establishing and diagnosing the cause of diplopia in orbital floor fractures. Electro-oculography is objective and easy to perform even when the restricted eye is covered. The 'uninjured' eye can be used as the reference. Any motility difference between the left and the right eye was easily detected. OBJECTIVE: It is essential in orbital floor fractures to distinguish entrapment from other causes of diplopia. We investigated whether vertical eye motility and restricted elevation can be detected and characterized by means of electro-oculography. MATERIALS AND METHODS: Electronystagmography equipment used for vestibular testing in daily ENT practice was used in a different context. Unilateral mechanical restriction was generated in the test subjects through fixation of one eye bulb. The velocity and range of eye motility of both eyes were measured and compared in 12 healthy test subjects and 7 patients with long-term vertical diplopia after orbital floor fractures. RESULTS: Simulated entrapment was easily detected as a distinct difference between right and left eye motility recordings (p<0.001). Recordings of patients with diplopia differed significantly from those of healthy test subjects with respect to velocity (p<0.05) and range of motility (p<0.05).

A prospective study of orbital fracture sequelae after change of surgical routines.

PURPOSE: The present study was undertaken to investigate the circumstances surrounding the considerable increase in the number of orbital floor fracture repairs at the ORL Clinic at Sahlgrenska University Hospital at the end of the 1990s. PATIENTS AND METHODS: All the patients during a period of 1 year with a fracture involving the orbital floor were followed for 1 year using clinical assessments and questionnaires. Etiology, surgical methods, and the occurrence of long-term sequelae were investigated. RESULTS: Fifty-one patients were included. The main etiologies were assaults and falls. Surgery of the internal orbit was performed in 76%, often combined with a Gillies reduction. Porous polyethylene sheets (Medpor; Porex Surgical Inc, Newnan, GA) were used for the repair of large floor defects. Compared with previous results, the number of computed tomography investigations had considerably increased. The number of operations on the internal orbit due to fractures had doubled. The occurrence of diplopia was reduced compared with the situation when the floor was stabilized with an antral packing. Late enophthalmos developed in 11%. Despite fixation, the majority (67%) reported permanently affected sensibility. CONCLUSION: The frequency and severity of diplopia decreased parallel to the introduction of Medpor implants and the termination of the antral packing technique. Tetrapod zygomatic fractures, possibly unnecessarily submitted for surgery of the internal orbit, were in part responsible for the increase in the number of orbital explorations, in spite of preceding computed tomography scans. This indicates inadequate diagnostic techniques. Studies evaluating alternative complementary diagnostic methods are in progress.