Evaluation of severity of maxillofacial injuries causing disturbance of ophthalmic apparatus requiring ophthalmic referral and review: a retrospective study
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 7, Pages 4372-4385
AbstractAIM AND OBJECTIVE: The aim of the present study is to acquaint the maxillofacial surgeons with the many complicating intra and extra ocular lesions, which can occur following maxillofacial trauma.
MATERIAL AND METHODS: The clinical material for this study were 53 patients with maxillofacial injuries involving the ophthalmic apparatus irrespective of age and gender reporting to our Department of Oral and Maxillofacial Surgery. Patients who reported to the Department of Maxillofacial Surgery with clinically and radiographically proven maxillofacial fractures were assessed at the time of initial presentation. A detailed examination of eye structure and function was carried out by an ophthalmologist in all cases as a mandatory protocol. The acquired data was divided into
A. General- All routine information
B. Eye abnormalities- All ocular injuries sustained, their functional consequences, complications, treatment and recovery.
C. Motility disorders- Examination of ocular motility, assessment of movements in all directions of gaze and elicitation of diplopia. Each patient was examined by the attendant maxillofacial surgeon and scored as per Al-Qurainy Scoring system from which the patients were categorized as requiring non-referral, routine referral, and early referral. In addition, the reason for referral, as elicited by the maxillofacial surgeon was appended to score sheet.
RESULTS: There was significant (p<0.01) difference in the evaluation by maxillofacial surgeon and ophthalmologist. Maxillofacial referral showed 100% sensitivity and 77.5% specificity with 100% negative predictive value and 0% false negative outcome and 22.5% false positivity.
CONCLUSION: The principal predictor of an adverse ophthalmic prognosis was impaired visual acuity. Our study reaffirms that the assessment of visual acuity should be performed in all patients sustaining maxillofacial injuries involving the ophthalmic apparatus. It is important for the maxillofacial surgeon to document these findings at the initial examination for the medico-legal purpose, as ocular trauma cases may account for all ophthalmology related litigation.
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