2017-18 HSC Section 3 Green Book

Mansour TN, Rudolph M, Brown D, et al. Orbital blowout fractures: a novel CT measurement that can predict the likelihood of surgical management. Am J Emerg Med . 2017; 35(1):112-116. EBM level 3..............................................................................80-84 Summary : This paper introduces a new modality, CT imaging, to evaluate patients with orbital floor fractures to help determine the need for surgical intervention. This novel measurement was defined as the difference between the cranial-caudal dimension (CCD), measured just posterior to the globe, of the fractured orbit minus the CCD of the normal side. Using a threshold CCD value of 0.8 cm, the accuracy of CCD predicting development of diplopia and/or enophthalmos needing surgical intervention was 94%. E. Temporal bone trauma Song SW, Jun BC, Kim H. Clinical features and radiological evaluation of otic capsule sparing temporal bone fractures. J Laryngol Otol . 2017; 131(3):209-214. EBM level 4...........................................................................................................................85-90 Summary : This case series reviewed otoscopic findings and symptoms, facial paralysis, and hearing loss in otic capsule–sparing temporal bone fractures. The authors concluded that initial conservative treatment for facial paralysis or conductive hearing loss may be an appropriate option for some patients. Summary : This study is a retrospective chart review of 80 patients at one institution. It explored patients with House-Brackmann I and II function and divided them into groups based on age, onset of paralysis, and timing of repair. There was no significant difference in recovery based on age and onset; however, early intervention was found to be superior. F. Neurological considerations in head and neck trauma Grant AL, Ranger A, Young GB, Yazdani A. Incidence of major and minor brain injuries in facial fractures. J Craniofac Surg . 2012; 23(5):1324-1328. EBM level 2...........................................................................................................................94-98 Summary : In this article, 100 consecutive patients with maxillofacial fractures were assessed prospectively for brain injury. There were significant associations between mechanism of injury and type of facial fractures with brain injury. Specifically, patients involved in a motor vehicle accident with either LeFort or combined fractures were most likely to suffer brain injury. Xie S, Wu X, Zhang Y, et al. The timing of surgical treatment of traumatic facial paralysis: a systematic review. Acta Otolaryngol . 2016; 136(12):1197-1200. EBM level 4.........................................................................................................................99-102 Summary : This meta-analysis assesses the ideal timing for surgical intervention of traumatic facial paralysis. The authors identified that surgical decompression performed within 2 weeks yields the best clinical prognosis, and that surgical exploration performed within 2 months results in acceptable outcomes. Xu P, Jin A, Dai B, et al. Surgical timing for facial paralysis after temporal bone trauma. Am J Otolaryngol . 2017; 38(3):269-271. EBM level 4..............................................91-93