Quality Management in Maxillofacial Surgery and Intensive Care: A Prospective Study of Compliance with a Post Orbital Surgery Observational Chart

摘要

Blindness may follow trauma to the craniofacial skeleton, reconstructive orbitozy-gomatic surgery, endoscopic sinus surgery and soft tissue procedures such as blephro-plasty. Retrobulabar haemorrhage, which may complicate orbital surgery, can lead to a rapid increase in intra orbital pressure when confined to within the orbit. A sustained increase in orbital pressure can lead to acute orbital compression syndrome (OCS). Once the signs and symptoms of acute OCS appear there is very little time for the surgeon to act before irretrievable loss of vision occurs. Indeed, it has been found that the optic nerve can withstand only two hours of sustained ischaemia (Hayreh,1975, 1980). A post orbital surgery observation chart is often used to alert the maxillofacial team of a patient with signs and symptoms of acute OCS. Prompt recognition of this condition followed by early intervention by can lead to a restoration of sight.The purpose of this prospective study is to apply the principles of Total Quality Management (TQM) to both test the robustness of the processes associated with the deployment and implementation of an orbital observation chart used after orbital or orbitozygomatic surgery to monitor and detect signs and symptoms of retrobulbar haemorrhage or OCS.