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Teoh Ryan Liang Wei,Fong Pei Yuan,Cai Elijah Zhengyang,Yap Yan Lin,Hing Eileen Chor Hoong,Lee Han Jing,Nallathamby Vigneswaran,Ong Wei Chen,Lim Jane,Sundar Gangadhara,Lim Thiam Chye 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.1
Nasolacrimal duct (NLD) damage is associated in the majority of type II and III naso-orbito-ethmoid (NOE) fractures.1 Our study aims to investigate the efficacy and safety of prophylactic NLD intubation in the setting of facial fractures, by comparing incidence of postoperative epiphora and wound infection. A retrospective matched control study was conducted on all patients with surgically treated facial fractures from 2008 to 2013 (n = 280) (IRB ref number: DSRB 2013/01198). Patients with the following fracture types were included: NOE (n = 16), frontal sinus (n = 2), Le Fort II/III (n = 8), and > 1 type (n = 48). All patients in this study were included with the intention to treat. The study group comprised patients who were intubated, while the control group patients were not intubated. Each group had 37 patients matched for age, gender, fracture type, and injury type. A single oculoplastic surgeon skilled in lacrimal surgery performed the procedure for all intubated patients. Patients with more severe and complex facial fractures were intubated with bicanalicular Crawford stents. Postoperative epiphora and infective complications (both facial wound and dacryocystitis) were assessed at 1, 3, 6, and 12 months. There was no significant difference in incidence of either postoperative epiphora (p = 0.152) or wound infection (p = 0.556) comparing both groups. Reduced incidence of postoperative epiphora in the study group is statistically not significant and does not support the need for prophylactic intubation. If radiographic evidence of NLD disruption or regurgitation seen on syringing on the NLD intraoperatively is present, intubation is safe and efficacious only if performed by an expert.
Teoh Ryan Liang Wei,Fong Pei Yuan,Cai Elijah Zhengyang,Yap Yan Lin,Hing Eileen Chor Hoong,Lee Han Jing,Nallathamby Vigneswaran,Ong Wei Chen,Lim Jane,Sundar Gangadhara,Lim Thiam Chye 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.2
Nasolacrimal duct (NLD) damage is associated in the majority of type II and III naso-orbito-ethmoid (NOE) fractures.1 Our study aims to investigate the efficacy and safety of prophylactic NLD intubation in the setting of facial fractures, by comparing incidence of postoperative epiphora and wound infection. A retrospective matched control study was conducted on all patients with surgically treated facial fractures from 2008 to 2013 (n = 280) (IRB ref number: DSRB 2013/01198). Patients with the following fracture types were included: NOE (n = 16), frontal sinus (n = 2), Le Fort II/III (n = 8), and > 1 type (n = 48). All patients in this study were included with the intention to treat. The study group comprised patients who were intubated, while the control group patients were not intubated. Each group had 37 patients matched for age, gender, fracture type, and injury type. A single oculoplastic surgeon skilled in lacrimal surgery performed the procedure for all intubated patients. Patients with more severe and complex facial fractures were intubated with bicanalicular Crawford stents. Postoperative epiphora and infective complications (both facial wound and dacryocystitis) were assessed at 1, 3, 6, and 12 months. There was no significant difference in incidence of either postoperative epiphora (p = 0.152) or wound infection (p = 0.556) comparing both groups. Reduced incidence of postoperative epiphora in the study group is statistically not significant and does not support the need for prophylactic intubation. If radiographic evidence of NLD disruption or regurgitation seen on syringing on the NLD intraoperatively is present, intubation is safe and efficacious only if performed by an expert.
Mapping the Posterior Ledge and Optic Foramen in Orbital Floor Blowout Fractures
Wong Yu Cong,Goh Doreen S.L.,Yoong Celine S.Y.,Ho Cowan,Cai Elijah Z.,Hing Angela,Lee Hanjing,Nallathamby Vigneswaran,Yap Yan L.,Lim Jane,Gangadhara Sundar,Lim Thiam C. 대한성형외과학회 2023 Archives of Plastic Surgery Vol.50 No.4
Background The posterior ledge (PL) is a vital structure that supports the implant posteriorly during orbital floor reconstruction. This study describes a technique for mapping the PL in relation to the infraorbital margin (IM) in patients with orbital floor blowout fractures. This study establishes the location of the optic foramen in relation to the PL. Methods Facial computed tomography (FCT) scans of 67 consecutive patients with isolated orbital floor blowout fractures were analyzed using Osirix. Planes of reference for orbital fractures, a standardized technique for performing measurements on FCT, was used. Viewed coronally, the orbit was divided into seven equal sagittal slices (L1 laterally to L7 medially) with reference to themidorbital plane. The distances of PL from IM and location of optic foramen were determined. Results The greatest distance to PL is found at L5 (median: 30.1mm, range: 13.5– 37.1mm). The median and ranges for each slice are as follows: L1 (median: 0.0mm, range: 0.0–19.9mm), L2 (median: 0.0mm, range: 0.0–21.5mm), L3 (median: 15.8mm, range: 0.0–31.7mm), L4 (median: 26.1mm, range: 0.0–34.0mm), L5 (median: 30.1mm, range: 13.5–37.1mm), L6 (median: 29.0mm, range: 0.0– 36.3mm), L7 (median: 20.8mm, range: 0.0–39.2mm). The median distance of the optic foramen from IM is 43.7mm (range: 37.0– 49.1) at L7.