PEDO-AMELOBLASTOMA

Journal club : 

Journal club

Article full reference: 

Article full reference Title:- Reconstruction of Traumatic Orbital Floor Fractures With Resorbable Mesh Plate Journal :- The Journal of Craniofacial Surgery May 2007 Vol :-18 Page : -598-605 Authors: Serhan Tuncer , Reha Yavuzer , Sebahattin Kandal , Yucel H. Demir,Selahattin Ozmen , Osman Latifoglu , Kenan Atabay ,

Orbit: 

Orbit

Weakening structures: 

Weakening structures Lateral wall:- superior orbital fissure and inferior orbital fissure Medial wall:- nasolacrimal system Roof:- at the medial junction ,thin lamina papyrecia of ethmoid Floor :-very thin bone, 0.5 mm in most areas.

Classification of orbital fractures: 

Classification of orbital fractures As a component of ZMC Fractures Isolated fractures of orbital rim Isolated orbital wall fractures As a component of NOE Fractures As a component of Le Fort 2 and 3 Fractures

Orbital floor fracture: 

Orbital floor fracture Blow out fracture Pure Impure Blow in fracture

Clinical features of orbital fracture: 

Clinical features of orbital fracture Periorbital tissues Eyelids Ptosis Palpabral fissure Ligaments Medial and lateral canthus Ocular level Intercanthal distance

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Eye:- Vision Ocular movement Diplopia Exopthalmos / Enopthalmos Pupillary reflexes I nterpupillary distance Opthalmic injuries

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Lacrimal Apparatus Neurological deficits Orbit: Extraorally : all the margins and sutures Intraorally : zygomatic butress and lateral wall of antrum Mandible: Limitation of movement

Imaging : 

Imaging Water’s view:- Orbital rims and Floor of orbit Cald well view:- Inf orbital rim and floor Lateral wall Superior orbital rim Reverse Towne’s view :- inf orbital rim and floor Bilateral oblique/lateral head What are the radiographic signs of fracture?

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CT Scan :- best Axial sections :-2 mm slices from infraorbital rim till roof of orbit. Coronal section :-2 mm slices from nasal pyramid till the orbital apex. Provides better information for orbital floor fractures. Saggital section:-if no bony step is present in the orbital apex to support an implant then autogenous graft should be used. 3 D Reconstruction

Treatment of Orbital Floor Fracture: 

Treatment of Orbital Floor Fracture Indications for surgical exploration :- Depressed globe resulting in enopthalmos,limitation of eye movement and positive forced duction test Imaging defect > 5mm / comminuted floor fractures. Herniation of orbital contents in sinus Diplopia that does not resolve within 7-10 days The need for surgical access to infraorbital rim.

Treatment options: 

Treatment options Antral packing:- when the fractured fragments are still attached to the periosteum and nasal mucosa Trap door type of fracture when the fracture fragment hinges about one margin such that it can be easily repositioned to restore the continuity. Orbital implants to reconstruct floor and restore orbital volume :- Loss of portion of the orbital floor in its entirety such that framents are detached from the periosteum and lying free in the antrum .

Choice of implants: 

Choice of implants Autogenous grafts :- bone or cartilage Better for Larger defects Homografts ( allografts ):- bone or cartilage,lyophilised dura and gelatin film Risk of Transmission of infection Alloplasts ( allelografts ):- porous polyethylene,teflon,silastic,titanium mesh, hydroxyapatite etc Used for smaller defects.

Surgical approaches to orbital floor:-: 

Surgical approaches to orbital floor:- Transconjunctival approach Subciliary approach Infraorbital approach

REASONS FOR SELECTING THE ARTICLE: 

REASONS FOR SELECTING THE ARTICLE To understand the various clinical presentations of orbital fractures. To know about the basic radiographs for diagnosing orbital fractures. To understand the treatment modalities of orbital fractures. To critically analyse the study

Introduction : 

Introduction The author briefly mentions about:- the cause of orbital fractures. Mechanism and Complications of orbital floor fractures. The importance of imaging. The Various treatment modalities. The Purpose of their study.

Patients and method: 

Patients and method Duration period of study:-2002-2004 Sample size:- 17 patients Male-11, Female-6 Age:- 9-65 yrs (mean 34 yrs) 6 pure blow out 9 with ZMC 2 with Panfacial

Patients and method contd: 

Patients and method contd Subciliary incision:- 14 patients Transconjunctival incision:- 3 patients Limited Fractures with small soft tissue herniation :- were treated with resorbable plates.

Results : 

Results Out of 12 patients with enopthalmos , 11 patients recovered. 1 pt had to undergo retreatment with autogenous graft. Out of 2 patients with diplopia,both recovered. Patients were followed up for 3-28 months(mean 14 months) and complications were encountered.

Discussion : 

Discussion The author highlights about:- Various autogenous and allogenic grafts and their advantages and disadvantages. Then he briefly elaborates about various alloplastic materials including resorbable implants. He also mentions about the controversy in the timing of the surgical repair.

CRITICS: 

CRITICS Purpose of Publication :-the publication is a research report. The purpose of the study :- to find out the safety and value of using resorbable mesh plate for orbital floor fractures. AUTHORS HAVE MADE THE PURPOSE OF STUDY CLEAR TO THE READERS

CRITICS: 

CRITICS STATEMENT OF PROBLEM problem ( research question) to be solved(the efficacy of resorbable mesh plates in orbital floor fractures) is clearly stated. out come will definetly improve current practices in the management of orbital floor fractures.

CRITICS: 

CRITICS AUTHORS: - The qualification of the authors has been specified. But their designation has not been mentioned. Their respective affiliation has also not been specified. The published material is from the authors area of specialisation as per their affiliation. Basis source of knowledge is presented in a scientific method.

CRITICS: 

CRITICS TITLE: - Is suggestive of what the study is all about.

CRITICS: 

CRITICS INTRODUCTION: - It is quite brief and has emphasised on the relevance of the study. The purpose and the contents of the article has been stated.

CRITICS : 

CRITICS MATERIALS AND METHODS :- STUDY DESIGN :- Prospective single centred study. Sample size appears small with only 17 patients. 3. Inclusion an exclusion criteria has not been clearly mentioned. 4. Ethical committee approaval has not been mentioned. 5. Study design appropriate for studying the problem.

CRITICS: 

CRITICS DISCUSSION: - Appears adequate and relevant. Analysis of the topic has been done.. Conclusion is unstructured.

CRITICS: 

CRITICS OVER ALL CONSIDERATIONS :- Writing of article is literate. The author has not deviated from the aim of the study.

CRITICS: 

CRITICS OVER ALL STRENGTHS :- Prospective study. Widely distributed sample in terms of age and gender. Did not deviate from the topic of the study.

CRITICS: 

CRITICS OVER ALL WEAKNESSES:- Single centre study. Designations and affiliations of the authors not given. Size of the floor defect which is so critical for deciding treatment modality has not been mentioned. Previous experience of the authors regarding orbital floor recostruction is not known.

CRITICS: 

CRITICS CONCLUSION :- Prospective,randomised and multicentric studies ,with more sample size are required to support the findings of the article. The findings of the study are nevertheless still helpful in planning for treatment of prbital floor fractures.

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