Blindness after reduction of facial fractures

John A. Girotto, William Bryan Gamble, Bradley Robertson, Rick Redett, Thomas Muehlberger, Mike Mayer, James Zinreich, Nicholas Iliff, Neil Miller, Paul N. Manson

Research output: Contribution to journalArticle

Abstract

Blindness in patients suffering maxillofacial trauma is usually caused by optic nerve or optic canal injuries. It is, however, an uncommon complication of facial trauma, with a reported incidence of only 2 to 5 percent. Blindness may also follow surgical repair of facial fractures. Many mechanisms, such as intraoperative direct nerve injury, retinal arteriolar occlusion associated with orbital edema, or delayed presentation of indirect optic nerve injury sustained at the time of the initial trauma, have been implicated in causing this blindness. In this article, four cases of visual loss after surgical repair of facial trauma are reported. In a review of the University of Maryland Shock Trauma experience with facial trauma over 11 years, we discovered that 2987 of the 29,474 admitted patients (10.1 percent) sustained facial fractures, and that 1338 of these fractures (44.8 percent) involved one or both of the orbits. One thousand two hundred forty of these patients underwent operative repair of their facial fractures. Three patients experienced postoperative complications that resulted in blindness, a total incidence of only 0.242 percent. Postoperative ophthalmic complications seem to be primarily mediated by indirect injury to the optic nerve and its surrounding structures. The most frequent cause of postoperative visual loss is an increase in intraorbital pressure in the optic canal. When our data were added to the summarized cases, blindness was attributable to intraorbital hemorrhage in 13 of 27 cases (48 percent). In addition, 5 cases in our review attribute the visual loss to unspecified mechanisms of increased intraorbital pressure, bringing the total cases of visual loss caused by intraorbital pressure or hemorrhage to 18 of 27 cases, or 67 percent. Within the restricted confines of the optic canal, even small changes in pressure potentially may cause ischemic optic nerve injury.

Original languageEnglish (US)
Pages (from-to)1821-1834
Number of pages14
JournalPlastic and Reconstructive Surgery
Volume102
Issue number6
StatePublished - 1998

Fingerprint

Fracture Fixation
Blindness
Wounds and Injuries
Optic Nerve Injuries
Pressure
Hemorrhage
Incidence
Orbit
Optic Nerve
Shock
Edema

ASJC Scopus subject areas

  • Surgery

Cite this

Girotto, J. A., Gamble, W. B., Robertson, B., Redett, R., Muehlberger, T., Mayer, M., ... Manson, P. N. (1998). Blindness after reduction of facial fractures. Plastic and Reconstructive Surgery, 102(6), 1821-1834.

Blindness after reduction of facial fractures. / Girotto, John A.; Gamble, William Bryan; Robertson, Bradley; Redett, Rick; Muehlberger, Thomas; Mayer, Mike; Zinreich, James; Iliff, Nicholas; Miller, Neil; Manson, Paul N.

In: Plastic and Reconstructive Surgery, Vol. 102, No. 6, 1998, p. 1821-1834.

Research output: Contribution to journalArticle

Girotto, JA, Gamble, WB, Robertson, B, Redett, R, Muehlberger, T, Mayer, M, Zinreich, J, Iliff, N, Miller, N & Manson, PN 1998, 'Blindness after reduction of facial fractures', Plastic and Reconstructive Surgery, vol. 102, no. 6, pp. 1821-1834.
Girotto JA, Gamble WB, Robertson B, Redett R, Muehlberger T, Mayer M et al. Blindness after reduction of facial fractures. Plastic and Reconstructive Surgery. 1998;102(6):1821-1834.
Girotto, John A. ; Gamble, William Bryan ; Robertson, Bradley ; Redett, Rick ; Muehlberger, Thomas ; Mayer, Mike ; Zinreich, James ; Iliff, Nicholas ; Miller, Neil ; Manson, Paul N. / Blindness after reduction of facial fractures. In: Plastic and Reconstructive Surgery. 1998 ; Vol. 102, No. 6. pp. 1821-1834.
@article{1c6927fd69194f60ae0f7453be9b104c,
title = "Blindness after reduction of facial fractures",
abstract = "Blindness in patients suffering maxillofacial trauma is usually caused by optic nerve or optic canal injuries. It is, however, an uncommon complication of facial trauma, with a reported incidence of only 2 to 5 percent. Blindness may also follow surgical repair of facial fractures. Many mechanisms, such as intraoperative direct nerve injury, retinal arteriolar occlusion associated with orbital edema, or delayed presentation of indirect optic nerve injury sustained at the time of the initial trauma, have been implicated in causing this blindness. In this article, four cases of visual loss after surgical repair of facial trauma are reported. In a review of the University of Maryland Shock Trauma experience with facial trauma over 11 years, we discovered that 2987 of the 29,474 admitted patients (10.1 percent) sustained facial fractures, and that 1338 of these fractures (44.8 percent) involved one or both of the orbits. One thousand two hundred forty of these patients underwent operative repair of their facial fractures. Three patients experienced postoperative complications that resulted in blindness, a total incidence of only 0.242 percent. Postoperative ophthalmic complications seem to be primarily mediated by indirect injury to the optic nerve and its surrounding structures. The most frequent cause of postoperative visual loss is an increase in intraorbital pressure in the optic canal. When our data were added to the summarized cases, blindness was attributable to intraorbital hemorrhage in 13 of 27 cases (48 percent). In addition, 5 cases in our review attribute the visual loss to unspecified mechanisms of increased intraorbital pressure, bringing the total cases of visual loss caused by intraorbital pressure or hemorrhage to 18 of 27 cases, or 67 percent. Within the restricted confines of the optic canal, even small changes in pressure potentially may cause ischemic optic nerve injury.",
author = "Girotto, {John A.} and Gamble, {William Bryan} and Bradley Robertson and Rick Redett and Thomas Muehlberger and Mike Mayer and James Zinreich and Nicholas Iliff and Neil Miller and Manson, {Paul N.}",
year = "1998",
language = "English (US)",
volume = "102",
pages = "1821--1834",
journal = "Plastic and Reconstructive Surgery",
issn = "0032-1052",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Blindness after reduction of facial fractures

AU - Girotto, John A.

AU - Gamble, William Bryan

AU - Robertson, Bradley

AU - Redett, Rick

AU - Muehlberger, Thomas

AU - Mayer, Mike

AU - Zinreich, James

AU - Iliff, Nicholas

AU - Miller, Neil

AU - Manson, Paul N.

PY - 1998

Y1 - 1998

N2 - Blindness in patients suffering maxillofacial trauma is usually caused by optic nerve or optic canal injuries. It is, however, an uncommon complication of facial trauma, with a reported incidence of only 2 to 5 percent. Blindness may also follow surgical repair of facial fractures. Many mechanisms, such as intraoperative direct nerve injury, retinal arteriolar occlusion associated with orbital edema, or delayed presentation of indirect optic nerve injury sustained at the time of the initial trauma, have been implicated in causing this blindness. In this article, four cases of visual loss after surgical repair of facial trauma are reported. In a review of the University of Maryland Shock Trauma experience with facial trauma over 11 years, we discovered that 2987 of the 29,474 admitted patients (10.1 percent) sustained facial fractures, and that 1338 of these fractures (44.8 percent) involved one or both of the orbits. One thousand two hundred forty of these patients underwent operative repair of their facial fractures. Three patients experienced postoperative complications that resulted in blindness, a total incidence of only 0.242 percent. Postoperative ophthalmic complications seem to be primarily mediated by indirect injury to the optic nerve and its surrounding structures. The most frequent cause of postoperative visual loss is an increase in intraorbital pressure in the optic canal. When our data were added to the summarized cases, blindness was attributable to intraorbital hemorrhage in 13 of 27 cases (48 percent). In addition, 5 cases in our review attribute the visual loss to unspecified mechanisms of increased intraorbital pressure, bringing the total cases of visual loss caused by intraorbital pressure or hemorrhage to 18 of 27 cases, or 67 percent. Within the restricted confines of the optic canal, even small changes in pressure potentially may cause ischemic optic nerve injury.

AB - Blindness in patients suffering maxillofacial trauma is usually caused by optic nerve or optic canal injuries. It is, however, an uncommon complication of facial trauma, with a reported incidence of only 2 to 5 percent. Blindness may also follow surgical repair of facial fractures. Many mechanisms, such as intraoperative direct nerve injury, retinal arteriolar occlusion associated with orbital edema, or delayed presentation of indirect optic nerve injury sustained at the time of the initial trauma, have been implicated in causing this blindness. In this article, four cases of visual loss after surgical repair of facial trauma are reported. In a review of the University of Maryland Shock Trauma experience with facial trauma over 11 years, we discovered that 2987 of the 29,474 admitted patients (10.1 percent) sustained facial fractures, and that 1338 of these fractures (44.8 percent) involved one or both of the orbits. One thousand two hundred forty of these patients underwent operative repair of their facial fractures. Three patients experienced postoperative complications that resulted in blindness, a total incidence of only 0.242 percent. Postoperative ophthalmic complications seem to be primarily mediated by indirect injury to the optic nerve and its surrounding structures. The most frequent cause of postoperative visual loss is an increase in intraorbital pressure in the optic canal. When our data were added to the summarized cases, blindness was attributable to intraorbital hemorrhage in 13 of 27 cases (48 percent). In addition, 5 cases in our review attribute the visual loss to unspecified mechanisms of increased intraorbital pressure, bringing the total cases of visual loss caused by intraorbital pressure or hemorrhage to 18 of 27 cases, or 67 percent. Within the restricted confines of the optic canal, even small changes in pressure potentially may cause ischemic optic nerve injury.

UR - http://www.scopus.com/inward/record.url?scp=0031797402&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031797402&partnerID=8YFLogxK

M3 - Article

C2 - 9810975

AN - SCOPUS:0031797402

VL - 102

SP - 1821

EP - 1834

JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

IS - 6

ER -