2017-18 HSC Section 3 Green Book

The Journal of Craniofacial Surgery & Volume 25, Number 1, January 2014

Evolving Trends in Orbit Fractures

TABLE 1. Demographics

TABLE 3. Preferred Implants in Orbital Floor Reconstruction Among CSPS Members

Demographics

Frequencies, n (%)

Implants

Frequency

Postresidency training

Autologous

Craniofacial fellowship

18 (17.4) 54 (62.7) 17 (19.8) 16 (18.6) 24 (27.9) 10 (11.6)

Calvarium

1% 1% 1% 1% 1%

Non Y craniofacial fellowships, courses

Rib

None

Maxilla Cartilage

Years in practice G 5

Orbital floor fragments

5 Y 10

Alloplastic Medpor

11 Y 15 16 Y 20

45% 29%

6 (7)

Titanium

9 20

30 (34.9)

Composite Medpor/titanium

9% 4% 8%

No. cases of orbital fractures per year G 5

Silicone Others*

33 (38.4) 30 (34.9) 15 (17.4)

5 Y 10

*Nylon (Supramid), PDS, Vitallium, polyglycolide, polylactide.

11 Y 20

9 20

8 (9.3)

operative decision, operative timing, implant choice, and surgical approach. A W 2 test was used for comparisons as appropriate. P G 0.05 was considered statistically significant. Analysis was done using SPSS software, version 20.0 (IBM Corp, Armonk, NY). RESULTS The survey was sent to all 353 practicing members of the Canadian Society of plastic surgeons, of whom 198 responded with a response rate of 56%. Of the respondents, 86 surgeons were identified as currently managing orbit fractures and hence deemed Table 1 summarizes the demographics data. Only 17% of surgeons have postgraduate craniofacial training. More than half of participants had more than 10 years of experience. With regard to continuing medical education in craniomaxillofacial trauma, 32 surgeons (37%) reported to have attended an AO and/or an American Society of Maxillofacial Surgeons course in the last 5 years. Management of Orbit Fractures Preoperative Planning Almost a third of participating surgeons reported they were less likely to operate on these fractures compared with earlier in eligible for this study. Demographics

manage orbital floor fractures were eliminated. The remainder of the survey was composed of 2 sections: ( a ) demographics and ( b ) man- agement of orbit fractures with 5 subsections: preoperative planning, indications for surgery, timing of surgery, operative approach, and implants. The survey was sent electronically to all 353 practicing members of the Canadian Society of Plastic Surgeons (CSPS) through SurveyMonkey (www.surveymonkey.com, Palo Alto, CA). The following variables were stratified for the analysis process: & the influence of different factors on the decision making to op- erate was stratified into positive influence (very strong and strong) and zero influence (no effect, weak, and very weak) & operative timing scale was stratified into early ( G 2 weeks), late ( 9 2 weeks), and no intervention & postresidency training: craniofacial and noncraniofacial fellowships & experience of surgeons: 10 years or less and more than 10 years & continuing education: current (attended courses in last 5 years) and none & implants: autologous (bone, cartilage) and alloplastic (all others) Postgraduate training, surgeon’s experience, and continuing education were examined against each of the following variables to determine if there was any significant impact: factors influencing Statistical Analysis

TABLE 2. Influence of Different Factors on the Decision to Operate on a Patient With Isolated Orbital Floor Fracture and the Timing of Surgical Intervention if Indicated

Influence *

Timing of OR *

G 24 h 24 Y 96 h 96 h Y 2 wk

Factor

Very Strong Strong No Effect

Weak Very Weak

9 2 wk No OR

Defect size

40% 72% 66%

47% 27% 28%

4% 1% 4%

8%

1%

1% 31% 1% 28% 2% 29% 1% 17% 25% 27% 36% 35% 1% 11%

57% 55% 52% 24% 31% 20% 33% 34%

9% 2% 15% 1% 15% 2% 7% 51% 12% 5% 7% 2% 13% 42% 35% 13% 1% 62% 10% 81%

Enophthalmos Hypophthalmos

0

0 0

2%

Change of muscle shape on CT Vertical motility restriction Positive forced-duction test

7%

20% 45% 22%

6%

48% 64%

34% 25%

8% 10%

0 0

7%

4%

Early diplopia

5%

17% 33% 33% 43% 11% 13% 10% 52% 11% 2% 43% 12%

12%

Persistent diplopia (at 2 wk)

30% 12%

3%

0

18%

Oculocardiac reflex Cranial nerve V 2

15% 43%

22% 7%

8% 8%

paresthesia

0

0

1%

* † P = 0.000.

* 2014 Mutaz B. Habal, MD

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