RESUMEN
INTRODUCTION: Indications for prophylactic antibiotic therapy in nonoperative, closed fractures of the orbit and zygoma remain controversial and are based on anecdotal data. The purpose of this study was to report the incidence of infectious sequelae among patients who presented to our institution with stated fractures and who were not administered prophylactic antibiotic therapy. The authors hypothesized that an increase in infectious complications would not be seen in these patients. METHODS: The authors conducted a prospective single site study from October 2015 to December 2019. Patients with closed, nonoperative fractures involving the orbit and/or zygoma were included. These patients did not receive prophylactic antibiotic therapy for their fracture patterns, and infectious complications including orbital cellulitis, meningitis, and bacterial sinusitis were noted if present during follow-up. RESULTS: Of 301 patients with closed, nonoperative orbital and/or zygomatic fractures, 268 were included in the study and 33 were excluded because of administration of antibiotics. The average age was 60 years, and the most common mechanism of injury was a traumatic fall. Fracture types included 100 orbital wall, 133 orbital floor, 15 orbital rim, 23 orbital roof, 48 zygoma, and 44 zygomaticomaxillary compound fractures. Infectious sequelae were not identified in any patient. CONCLUSIONS: Of the 268 patients included in the study, no infectious complications were identified during the follow-up period. This outcome further supports that the use of prophylactic antibiotics is not indicated for closed, nonoperative fractures involving the orbital and/or zygoma. Prospective randomized control studies would be useful to support this outcome and better guide clinical antibiotic prescribing practices.
Asunto(s)
Fracturas Orbitales , Fracturas Cigomáticas , Antibacterianos/uso terapéutico , Humanos , Persona de Mediana Edad , Órbita , Fracturas Orbitales/tratamiento farmacológico , Estudios Prospectivos , Estudios Retrospectivos , Fracturas Cigomáticas/tratamiento farmacológicoRESUMEN
Orbital blowout fractures are nearly always caused by acute trauma. Non-traumatic cases of orbital blowout fractures have only been rarely described. In this case study, we discuss an orbital blowout fracture directly caused by nose blowing. The patient developed unilateral eye swelling and orbital emphysema. It is important for the clinician to investigate all suspected orbital blowout fractures with imaging and full ophthalmological examination regardless of a trauma history. Most cases of orbital emphysema resolve spontaneously, however one must always exclude compression of the central retinal artery. This may present as acute loss of vision and/or ophthalmoplegia.
Asunto(s)
Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Barotrauma/complicaciones , Epistaxis/etiología , Nariz/lesiones , Fracturas Orbitales/diagnóstico por imagen , Inhibidores de beta-Lactamasas/uso terapéutico , Adulto , Femenino , Humanos , Fracturas Orbitales/tratamiento farmacológico , Fracturas Orbitales/etiología , Educación del Paciente como Asunto , Derivación y Consulta , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Lesiones Oculares/etiología , Granulomatosis con Poliangitis/etiología , Trastornos de la Motilidad Ocular/etiología , Músculos Oculomotores/patología , Fracturas Orbitales/etiología , Adulto , Biomarcadores/metabolismo , Ciclofosfamida/uso terapéutico , Quimioterapia Combinada , Glucocorticoides/uso terapéutico , Granulomatosis con Poliangitis/diagnóstico por imagen , Granulomatosis con Poliangitis/tratamiento farmacológico , Humanos , Factores Inmunológicos/uso terapéutico , Inmunosupresores/uso terapéutico , Masculino , Metilprednisolona/uso terapéutico , Trastornos de la Motilidad Ocular/diagnóstico por imagen , Trastornos de la Motilidad Ocular/tratamiento farmacológico , Fracturas Orbitales/diagnóstico por imagen , Fracturas Orbitales/tratamiento farmacológico , Rituximab/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
The aim of this study was to evaluate the difference between the effect of a 5-day and a 1-day postoperative course of antibiotics on the incidence of infection after midfacial fractures. A total of 98 patients with displaced Le Fort or zygomatic fractures that required operation were randomly assigned into 2 groups, both of which were given amoxicillin/clavulanic acid 1.2g intravenously every 8h from the time of admission until 24h postoperatively. The 5-day group was then given amoxicillin/clavulanic acid 625 mg orally 8-hourly for another 4 days. The 1-day group was given placebo orally at the same time points. Patients were followed up 1, 2, 4, 6, and 12 weeks, and 6 months, postoperatively. The development of an infection of the wound was the primary end point. Ninety-four of the 98 patients completed the study. Two of the 45 patients in the 5-day group (4%) and 2/49 in the 1-day group (4%) developed postoperative wound infections. One in each group had a purulent infection, while the others had only wound breakdown. Two patients of the 5-day group and one in the 1-day group developed rashes on the trunk. There were no significant differences in the incidence of infection or side effects between the groups. In midfacial fractures a 1-day course of antibiotics postoperatively is as effective in preventing infective complications as a 5-day regimen.
Asunto(s)
Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Profilaxis Antibiótica , Fracturas Maxilares/cirugía , Fracturas Cigomáticas/cirugía , Administración Intravenosa , Administración Oral , Adulto , Combinación Amoxicilina-Clavulanato de Potasio/administración & dosificación , Método Doble Ciego , Esquema de Medicación , Exantema/etiología , Huesos Faciales/lesiones , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Humanos , Masculino , Fracturas Maxilares/tratamiento farmacológico , Persona de Mediana Edad , Fracturas Orbitales/tratamiento farmacológico , Fracturas Orbitales/cirugía , Proyectos Piloto , Placebos , Cuidados Posoperatorios , Estudios Prospectivos , Fracturas Craneales/tratamiento farmacológico , Fracturas Craneales/cirugía , Dehiscencia de la Herida Operatoria/etiología , Infección de la Herida Quirúrgica/etiología , Resultado del Tratamiento , Fracturas Cigomáticas/tratamiento farmacológicoRESUMEN
The aim of this study was to evaluate the difference between the effects of a 5-day and a 1-day course of antibiotics on the incidence of postoperative infection after displaced fractures of the orbit. A total of 62 patients with orbital blow-out fractures were randomly assigned to two groups, both of which were given amoxicillin/clavulanic acid 1.2g intravenously every 8h from the time of admission to 24h postoperatively. The 5-day group were then given amoxicillin/clavulanic acid 625 mg orally every 8h for 4 further days. The 1-day group were given placebo orally at the same time intervals. Follow up appointments were 1, 2, 4, 6, and 12 weeks, and 6 months, postoperatively. An infection in the orbital region was the primary end point. Sixty of the 62 patients completed the study. Two of the 29 patients in the 5-day group (6.8%) and 1/31 patients in the 1-day group (3.2%) developed local infections. In the 5-day group 1 patient developed diarrhoea. In the 1-day group 1 patient developed a rash on the trunk. There were no significant differences in the incidence of infection or side effects between the groups. We conclude that in displaced orbital fractures a postoperative 1-day course of antibiotics is as effective in preventing infective complications as a 5-day regimen.
Asunto(s)
Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Profilaxis Antibiótica , Fracturas Orbitales/cirugía , Implantes Absorbibles , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Combinación Amoxicilina-Clavulanato de Potasio/administración & dosificación , Materiales Biocompatibles/química , Método Doble Ciego , Huesos Faciales/lesiones , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Fracturas Orbitales/tratamiento farmacológico , Proyectos Piloto , Placebos , Poliésteres/química , Ácido Poliglicólico/química , Estudios Prospectivos , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Fracturas Craneales/tratamiento farmacológico , Mallas Quirúrgicas , Infección de la Herida Quirúrgica/prevención & control , Titanio/química , Resultado del Tratamiento , Adulto JovenRESUMEN
Bone regeneration methods using bone inductive cytokines show promise, however, due to early diffusion and absorption of single applications of these cytokines, the bone inductive effects are limited. In this study, such a system was applied, using gelatin hydrogel as a carrier to slowly release (bone morphogenetic proteins) BMP-2 over a relatively long period in vivo. By coupling this slow-release system with a biodegradable copolymer, this composite was evaluated by grafting into bone defect sites of a canine orbital floor fracture model. Radio-iodinated BMP-2 incorporated into the gelatin hydrogel carrier and subcutaneously implanted into nude mice showed a similar slow release (approximately, 60% at 3 days and 80% at 14 days) as the radiolabeled hydrogel carrier alone. In contrast, greater than 90% of fluid-injected BMP-2 was lost in the injection site within the first 8 hours. Using a dog model of orbital floor fracture, a complex of BMP-2-saturated gelatin hydrogel and a polylactide-based biodegradable copolymer was implanted into the orbital bone defect. Bone structural analysis, using radiography, histologic examination, and microfocus CT, showed greatly enhanced new bone formation and defect healing at 5 weeks in comparison to implanted biodegradable copolymer directly saturated with the same amount of BMP-2 (no slow-release hydrogel carrier). A trabecular structure resembling that normal bone tissue was restored in the new bone tissue generated by the slow-release constructs. Thus study demonstrates the potential of slow-release BMP-2 for bone healing of difficult defects.
Asunto(s)
Proteína Morfogenética Ósea 2/farmacología , Regeneración Ósea/efectos de los fármacos , Trasplante Óseo , Materiales Biocompatibles Revestidos/farmacología , Curación de Fractura/efectos de los fármacos , Fracturas Orbitales/tratamiento farmacológico , Animales , Proteína Morfogenética Ósea 2/uso terapéutico , Materiales Biocompatibles Revestidos/uso terapéutico , Preparaciones de Acción Retardada , Modelos Animales de Enfermedad , Perros , Femenino , Gelatina , Hidrogeles , Masculino , Ratones , Ratones Endogámicos BALB CRESUMEN
OBJECTIVE: To assess the management of orbital floor fractures and their aftereffects in children. PATIENTS AND METHODS: We retrospectively studied five children with isolated orbital floor fractures who were operated (with a perioperative steroid and antibiotic treatment) between 1998 and 2007 in our pediatric hospital. At the first visit, they all had a complete clinical examination, a Hess-Lancaster test, and a computed tomography (CT) scan. At the last visit, they all had a clinical examination and four children underwent a Hess-Lancaster test. RESULTS: After a median follow-up of 26 months (range, 4-100 months), no child had diplopia, all Hess-Lancaster tests were normal, and two children suffered from infraorbital hypoesthesia. CONCLUSION: Surgical repair associated with steroids and antibiotics in orbital floor fracture with our surgical indications has led to good functional results with minimal complications.
Asunto(s)
Fracturas Orbitales/cirugía , Adolescente , Profilaxis Antibiótica , Niño , Terapia Combinada , Diplopía/etiología , Reacciones Falso Negativas , Femenino , Humanos , Masculino , Músculos Oculomotores/lesiones , Fracturas Orbitales/complicaciones , Fracturas Orbitales/diagnóstico por imagen , Fracturas Orbitales/tratamiento farmacológico , Juego e Implementos de Juego/lesiones , Prednisona/uso terapéutico , Prótesis e Implantes , Radiografía , Reoperación , Estudios Retrospectivos , Esquí/lesiones , Resultado del Tratamiento , Heridas no Penetrantes/complicacionesAsunto(s)
Ciclismo/lesiones , Traumatismos del Nervio Óptico/etiología , Heridas no Penetrantes/etiología , Adolescente , Exoftalmia/diagnóstico por imagen , Exoftalmia/tratamiento farmacológico , Exoftalmia/etiología , Glucocorticoides/administración & dosificación , Humanos , Inyecciones Intravenosas , Masculino , Metilprednisolona/administración & dosificación , Traumatismos del Nervio Óptico/diagnóstico por imagen , Traumatismos del Nervio Óptico/tratamiento farmacológico , Fracturas Orbitales/diagnóstico por imagen , Fracturas Orbitales/tratamiento farmacológico , Fracturas Orbitales/etiología , Trastornos de la Pupila/etiología , Tomografía Computarizada por Rayos X , Trastornos de la Visión/etiología , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/tratamiento farmacológicoRESUMEN
This is a case report of a 15-year-old boy who developed benign intracranial hypertension after 3 weeks of levofloxacin intake. The headache, diplopia, and papilledema resolved within a week after levofloxacin was withdrawn. Physicians must be aware that quinolone antibiotics can potentially cause intracranial hypertension.
Asunto(s)
Antibacterianos/efectos adversos , Hipertensión Intracraneal/inducido químicamente , Levofloxacino , Ofloxacino/efectos adversos , Adolescente , Diplopía/etiología , Cefalea/etiología , Humanos , Masculino , Fracturas Orbitales/tratamiento farmacológicoRESUMEN
The decision to use surgical or nonsurgical treatment for orbital blow-out fractures is still controversial. Previously, it was advocated that all blow-out fractures should be treated surgically based on the conception that extraocular muscles were blown out and trapped in the fracture area. However, a shift to a more conservative approach occurred gradually, most likely due to the evidence of spontaneous improvement. The medical records of two patients who were diagnosed as having an isolated medial wall fracture with medial rectus muscle displacement into the ethmoid sinus, as demonstrated by computed tomography, were reviewed. Both patients showed improvement only with conservative therapy.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Fracturas Orbitales/tratamiento farmacológico , Administración Oral , Adolescente , Antiinflamatorios no Esteroideos/administración & dosificación , Niño , Toma de Decisiones , Diplopía/diagnóstico , Diplopía/tratamiento farmacológico , Diplopía/etiología , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Fracturas Orbitales/diagnóstico por imagen , Fracturas Orbitales/etiología , Tomografía Computarizada por Rayos X , Índices de Gravedad del TraumaRESUMEN
Wobenzim, a drug for systemic enzyme therapy, was used in 26 children with lower orbital wall fractures as monotherapy in early periods (on days 1 to 7) after brain injury to improve healing conditions and to minimize the formation of scar tissues in the fractural area. A control group comprised 24 patients who received systemic dehydration and vessel-strengthening therapy. Systemic enzyme therapy with Wobenzim could reduce the attenuation time of inflammatory manifestations of injury, prevent complications, such as strangulation of the musculus rectus inferior in the fractural area and development of strangulated orbital soft tissue hernia, and substantially decrease the number of patients having indications for surgical plastic repair of the orbital wall, as compared with the control group.
Asunto(s)
Hidrolasas/uso terapéutico , Órbita/cirugía , Fracturas Orbitales/tratamiento farmacológico , Rutina/uso terapéutico , Adyuvantes Inmunológicos/uso terapéutico , Adolescente , Niño , Preescolar , Combinación de Medicamentos , Femenino , Curación de Fractura , Humanos , Hidrolasas/administración & dosificación , Masculino , Fracturas Orbitales/diagnóstico por imagen , Fracturas Orbitales/cirugía , Complicaciones Posoperatorias/prevención & control , Rutina/administración & dosificación , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To report the incidence of orbital cellulitis after orbital blowout fracture. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: All patients with orbital cellulitis and a history of recent orbital fracture. METHODS: A medical record review of clinical history, imaging studies, and surgical and treatment outcome was performed. MAIN OUTCOME MEASURES: Resolution of orbital cellulitis and surgical and imaging findings. RESULTS: Four patients (3 male; mean age, 30 years [range, 4.5-58]) were treated for orbital cellulitis complicating orbital fracture. All patients had evidence of paranasal sinusitis before or after the orbital injury, and 2 also reported forceful nose blowing after sustaining orbital trauma. Although 3 patients received prophylactic oral antibiotics after the fracture, this failed to prevent infection. Sinusitis commenced 1 to 2 weeks before and as late as 5 weeks after orbital injury. All patients were treated with IV antibiotics. Two developed an orbital abscess that required surgical drainage; 1 patient improved after an endonasal maxillary antrostomy. One patient improved on IV antibiotics alone and underwent fracture repair at a later stage. These 4 patients represent 0.8% of all cases of orbital fractures treated in the study period. CONCLUSIONS: Orbital cellulitis is a rare complication of orbital fracture, and seems to be more common when paranasal sinus infection preexists or occurs within several weeks of the injury. Oral antibiotics given after the orbital injury may not prevent orbital cellulitis or abscess formation. Surgery may be required to drain orbital abscess or in nonresolving cellulitis to drain the paranasal sinuses. Fracture repair, if indicated, should be delayed, particularly if an alloplastic implant is used.
Asunto(s)
Celulitis (Flemón)/etiología , Enfermedades Orbitales/etiología , Fracturas Orbitales/complicaciones , Enfermedad Aguda , Adulto , Antibacterianos/uso terapéutico , Celulitis (Flemón)/diagnóstico por imagen , Celulitis (Flemón)/tratamiento farmacológico , Preescolar , Quimioterapia Combinada , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Enfermedades Orbitales/diagnóstico por imagen , Enfermedades Orbitales/tratamiento farmacológico , Fracturas Orbitales/diagnóstico por imagen , Fracturas Orbitales/tratamiento farmacológico , Estudios Retrospectivos , Sinusitis/complicaciones , Sinusitis/diagnóstico por imagen , Sinusitis/tratamiento farmacológico , Tomografía Computarizada por Rayos XAsunto(s)
Equimosis/diagnóstico por imagen , Tratamiento de Urgencia/métodos , Fracturas Orbitales/diagnóstico por imagen , Adolescente , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Equimosis/tratamiento farmacológico , Equimosis/etiología , Humanos , Masculino , Fracturas Orbitales/tratamiento farmacológico , Fracturas Orbitales/etiología , Tomografía Computarizada por Rayos X , ViolenciaRESUMEN
Thirty-eight patients with computed tomography (CT)-proven orbital fractures and diplopia were studied prospectively to determine the efficacy of steroids in the medical management of orbital fractures. The protocol is based on double-blind assignments to steroid (ST) and non-steroid (NT) treatment groups. Outcome analysis was based on sorting fractures into three CT classes: I-without soft tissue prolapse (n = 15); II-with soft tissue prolapse (n = 14); and III-CT evidence of inferior rectus entrapment (n = 9). Results included resolution of diplopia without surgery in both ST and NT groups in CT classes I and II. Median time course of resolution was compressed to less than 5 days in the ST treatment group, however, versus 13 days in the nontreatment group. All fractures in class III had residual diplopia with five of nine patients having surgical results that were enhanced in the ST treatment group. In addition, enophthalmos was unmasked in the ST treatment group within 1 week of treatment versus 5 months without treatment. A protocol for medical management and surgical decision-making in blowout fracture is presented.