RESUMEN
BACKGROUND: Orbital floor fractures in the elderly are controversial, with varying guidelines on indications for operative and nonoperative management. Morbidity includes changes to ocular position, inferior rectus muscle injury, and damage to the neurovascular bundle as it traverses the orbital floor. Across all facial fractures, the elderly are less frequently operated on, albeit longer hospital stays and more probably ICU admission. This study's purpose is to describe our experience with orbital floor fractures and the role of operative versus nonoperative management in the context of patient age. METHODS: Retrospective review of orbital floor fracture coronal and sagittal CT images between 2015 and 2018 in those aged 20 to 40 (controls) or over 65 (cases). Patients were excluded if imaging revealed additional complex fractures of the upper third of the face or the midface. RESULTS: Twenty-five subjects met inclusion criteria for the elderly cohort (mean age of 79.4 years) compared to 48 subjects included in the control cohort (mean age 29.9). In the elderly population the most common mechanisms of injury were mechanical fall (72%) and syncope (8%), compared to assault (69%) and MVC (13%) in the controls. Two elderly patients (8%) required operative repair of their injury, whereas fourteen had surgery (29%) in the control cohort. Overall, the mean elderly fracture size was 3.19âcm (SD 1.18) and the mean control fracture size was 2.83âcm (SD 1.67) (Pâ=â0.37). Within the elderly group, the mean fracture size for those who underwent surgery was 3.5âcm compared to 3.2âcm in those treated non-operatively (Pâ=â0.27). Within the control group, the mean fracture size for those who underwent surgery was 2.9âcm compared to 2.8âcm in those treated non-operatively (Pâ=â0.25). CONCLUSIONS: Orbital floor fractures in the elderly do not require operative intervention in most instances for management.
Asunto(s)
Fracturas Orbitales/cirugía , Accidentes por Caídas , Adulto , Anciano , Femenino , Humanos , Masculino , Fracturas Orbitales/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
Ewing sarcoma is a locally aggressive, highly malignant tumor most commonly seen in the skeletal system. The "Ewing family of tumors" also includes other tissue types that are not common, such as soft tissue origin classified as extraosseous Ewing sarcoma (EES) or primitive neuroendocrine origin. Age of onset most often occurs within the first 2 decades of life. Congenital presentation of EES is exceedingly rare. We report the first described case to our knowledge of congenital EES originating from the scalp.
Asunto(s)
Sarcoma de Ewing , Humanos , Cuero CabelludoRESUMEN
There is no clear consensus for the optimal treatment of sagittal craniosynostosis; however, recent studies suggest that improved neurocognitive outcomes may be obtained when surgical intervention imparts active cranial expansion or remodeling and is performed before 6 months of age. The authors consider spring-mediated cranioplasty (SMC) to optimally address these imperatives, and this is an investigation of how helmet orthoses before or after SMC affect aesthetic outcomes.The authors retrospectively evaluated patients treated with SMC and adjunct helmeting for sagittal synostosis. Patients were stratified into 4 cohorts based on helmet usage: preop, postop, both, and neither. The cephalic index (CI) was used to assess head shape changes and outcomes. Twenty-six patients met inclusion criteria: 6 (23%) had preop, 11 (42%) had postop, 4 (15%) had preop and postop, and 5 (19%) had no helmeting. Average age at surgery was 3.6 months. Overall, CI improved from a mean 69.8 to 77.9 during an average 7-month course of care. Mean preoperative change in CI showed greater improvement with preop helmet (1.3) versus not (0.0), (Pâ=â0.029), despite similar initial CI in these cohorts (70.4 and 69.6 respectively, Pâ=â0.69). Nonetheless, all patient cohorts regardless of helmeting status achieved similar final CIs (range 76.4-80.4; Pâ=â0.72).In summary, preoperative molding helmet therapy leads to improved CI at the time of spring-mediated cranioplasty. However, this benefit does not necessarily translate into overall improved CI after surgery and in follow-up, calling into question the benefits of molding helmet therapy in this setting.