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- Alinasab, Babak, et al.
(författare)
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New algorithm for the management of orbital blowout fracture based on prospective study
- 2018
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Ingår i: Craniomaxillofacial Trauma & Reconstruction. - : SAGE Publications. - 1943-3875 .- 1943-3883. ; 11:4, s. 285-295
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Tidskriftsartikel (refereegranskat)abstract
- Despite extensive debate and publications in the management of blowout fracture (BOF), there are still considerable differences in the surgeons' management of BOF due to a lack of reliable evidence-based studies. This article aimed to evaluate which BOF patients require surgical treatment due to functional and/or cosmetic deformities; evaluate which computed tomography (CT) scan findings predict these problems; and provide an algorithm in the management of BOF. Seventy-nine patients with BOF were treated conservatively and followed up prospectively regarding functional and cosmetic deformities for at least 1 year. The patients' CT scans were analyzed and several measurements were performed. Patients' symptoms and the clinical findings were correlated to the CT scan measurements. We found visible deformity in 37% of the patients, but only 10% chose to proceed to surgery due to cosmetic deformities. In patients with inferior BOF and a herniation < 1.0 mL, a visible deformity was found when the ratio between fracture and the fractured orbital wall areas was ≥42%, or the total area of the fracture was ≥ 2.3 cm 2 . In patients with inferior BOF and a herniation ≥ 1.0 mL, a visible deformity was found when the distance from the inferior orbital rim to the posterior edge of the fracture was ≥ 3.0 cm. In patients with inferomedial fracture, a visible deformity was found when the herniation was ≥ 0.9 mL. Diplopia improved significantly and remained in only 3% of the patients in nonoperated group. Hypoesthesia of the infraorbital nerve improved significantly, but 23% of the nonoperated and 50% of the operated patients still experienced loss of sensation at final control. In this prospective study, we found that not only herniated orbital volume but also other CT scan findings in BOF were crucial to predict late visible deformities. Based on these findings, we propose an algorithm for the prediction of late visible deformity with 83% accuracy. There are indications that diplopia without ocular motility disorder is due to edema and we recommend observation as long as the diplopia improves gradually.
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| 2. |
- Brehmer, Marianne, et al.
(författare)
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Three-dimensional computed tomography planning improves percutaneous stone surgery
- 2014
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Ingår i: Scandinavian journal of urology. - : Medical Journals Sweden AB. - 2168-1813 .- 2168-1805. ; 48:3, s. 316-323
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivePercutaneous nephrolithotripsy (PCNL) has become the gold standard for treatment of renal stones larger than 2 cm. To optimize the surgical procedure a method for meticulous preoperative three-dimensional computed tomography (3D-CT) planning was developed and analysed. The aim of this study was to evaluate how 3D-CT influenced the choice of access route and treatment outcome.Material and methodsPatients planned for PCNL were included in a prospective study. Decision algorithms were studied and recorded before and after 3D-CT planning in a total of 35 patients.ResultsThirty-one of the patients (88%) had a complex stone situation. The CT examinations resulted in change of access plan in 15 out of 28 patients, in addition to seven patients where access could not be planned without 3D-CT, totalling 22 out of 35 (63%). This resulted in 24 patients (69%) being stone free after a single PCNL session. Of these 24 patients, 22 (22/35 = 63%) were stone free with one dilated access track only. In 16 of the 24 patients (76%) who were stone free after one PCNL procedure, evaluation of the 3D-CT images had changed the initial preoperative planning (10 cases) or made planning possible (six cases). A few patients had thoracic complications but there were no cases with bleeding.ConclusionsPreoperative planning of complex stone situations with 3D-CT had a significant impact on operative procedure, resulting in a low number of access punctures.
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| 3. |
- Skogh, Ann-Charlott Docherty, et al.
(författare)
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Variation in Calvarial Bone Healing Capacity : A Clinical Study on the Effects of BMP-2-Hydrogel or Bone Autograft Treatments at Different Cranial Locations
- 2013
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Ingår i: The Journal of craniofacial surgery (Print). - 1049-2275 .- 1536-3732. ; 24:2, s. 339-343
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Tidskriftsartikel (refereegranskat)abstract
- Background: Bone morphogenetic protein-2 (BMP-2) together with a suitable carrier is an attractive option that may be used for craniofacial bone reconstruction. In this prospective randomized study, a hyaluronan-based hydrogel with BMP-2 was used to achieve bone healing in standardized critical-size cranial defects in humans after neurosurgery. Methods: Twelve patients were randomized into the treatment group (N = 6) or control group (N = 6). In the treatment group, holes made during craniotomy were treated with hydrogel with BMP-2, 250 mu g/mL, or hydrogel without BMP-2. In the remaining hole/s in the same patient, Spongostan (Ethicon) alone or Tisseel (Baxter) mixed with autologous bone matrix were used as negative and positive controls, respectively. In the control group, the holes were treated with Spongostan or Tisseel mixed with bone autograft. Bone healing was assessed with CT scans after 3 and 6 months. Bone areas in treated defects were measured and statistical analysis was performed. Results: Independent of location, bone healing in defects treated with Tisseel with autograft, hydrogel alone, or hydrogel with BMP-2 was significantly increased compared to negative control (P < 0.001, P = 0.002, and P = 0.005, respectively). In general, all defects healed significantly better in the frontal bone as compared to parietal-temporal location, except for defects treated with Tisseel and autograft, which healed well independently of location. No local or systemic side effects, including excessive bone overgrowth or inflammatory reaction, were seen in treated patients. Conclusions: Tissue engineering of bone with hyaluronan-based hydrogel shows good healing of cranial defects, comparable with bone autografts. The hydrogel itself may represent a novel alternative to autologous bone transplants in craniofacial bone repair. The study also reveals a general superior healing capacity in the frontal bone as compared to parietal/temporal bones.
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| 4. |
- Uludag, Narin, et al.
(författare)
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Anatomic distribution of hematoma following pelvic fracture
- 2018
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Ingår i: British Journal of Radiology. - : British Institute of Radiology. - 0007-1285 .- 1748-880X. ; 91:1085
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To Assess The Extent Of Pelvic Hemorrhage On Ct And To Estimate Its Significance On Outcome In Patients With Blunt High-Energy Pelvic Trauma.Methods: Test And Fisher'S Exact Test.Results: Pelvic Hemorrhage Extended Beyond The Pelvis To The Abdominal Area In 47% Of The Patients, To The Thighs In 25% And To The Gluteal Areas In 81%. The Extent Of Hemorrhage Was Significantly Associated With The Need For Blood Transfusions (P = 0.011) And Angiography (P < 0.001), But Not With 30-Day Mortality.Conclusion: Traumatic Pelvic Bleeding Frequently Extends Beyond The True Pelvis. Extrapelvic Hemorrhage Correlates With An Increased Need Of Transfusions, But Not With 30-Day Mortality. Further Studies Are Needed To Assess Whether Present Techniques To Control Pelvic Bleeding Need To Be Modified In Order To Further Reduce Mortality In Traumatic Pelvic Hemorrhage.Advances In Knowledge: The Study Shows Localization Of Pelvic Hemorrhage In Trauma Patients. It May Help To Select Patients In Need Of Further Interventions To Control Bleeding.
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