Injury Duty - “Hurt-Locker” Installment: Do You See What I See? lyrics

Perhaps the most exciting part about the anticipation leading up to big boxing fight is the infamous pre-fight stare down between fighters. Everybody hoping to catch a rare glimpse into the soul of each man… Is he scared? Did he look cool, calm and collected? Who cracked first? The truth is, the stare down rarely reveals anything of value. Instead, most of us make what we want of it by exaggerating even the slightest of looks, the simplest of gestures. Leading up to Antonio Margarito's rematch with Miguel Cotto however, the significance of this stare down was different. After sustaining what many considered to be career ending eye injuries at the hands of Manny Pacquiao in November of 2011, all eyes would be on Margarito's, well, eye. The word was out, he'd undergone surgery to repair an orbital fracture (broken eye-socket) and needed surgery to remove a cataract from his eye, which also involved placement of an artificial lens (to read more about it click here: “Hurt Locker”). Margarito's camp insisted the eye was fine and ready for battle, but details were sketchy about the specifics of his operations. But the questions remain: What exactly happened to his eye socket in his fight with Pacquiao? Did it happen again in his rematch with Cotto? Will/Should Margarito ever fight again? Well, you're in the right place to help find the answers to these questions. (Take a look at the clip below to see Margarito's eye right after they stopped the fight.) “Hurt-Locker” Report: Margarito's Broken Face Following Pacquiao Fight: Given the nature of the injury (i.e. repeated blows to the face), Margarito most likely suffered what is know as an orbital blow-out fracture (see: Figure A)with most descriptions of the likely fracture involving the orbital plate of the maxilla (broken eye-socket; where the eye-ball sits) (see: Figure B)and possibly a zygomatic fracture (broken cheek bone) (see: Figure C). The nuts-and-bolts of it all is fairly simple: Your eyeball sits in its socket, nice and snug. There really isn't much room for anything else to move in. So, imagine if all the tissue around the eye is swollen (lets say, from being punched), that space becomes way too crowded. From here one of three things can happen; You choose to stop doing whatever it is you were doing that resulted in the constant blows to your face (In Margarito's case, he or his corner throws the towel in, the ref or ring doc stops the fight). You suffer an orbital blow-out fracture, the more common result amongst fighters (for the fear of ridicule had any of the alternatives in option 1 been chosen). Your eye could burst open/fall out of your face in effort to relieve pressure in the orbital. This is way less likely because, thankfully, in most cases the object striking the face (i.e. gloved fist) is larger than the diameter of the orbital (eye socket), so the bone absorbs most of the impact (and the surrounding fat, muscle, and the eye itself absorb some of the impact as well). The characteristic points of weakness in the orbit (again, the eye socket) are the floor (specifically, the maxilla) and the medial wall (a combination of the ethmoid and lacrimal bones) (see figure D). In other words, the old saying “pressure busts pipes” works perfect here. At some point the pressure has to be relieved, and in controlled settings (albeit more extreme circumstances) this can be done surgically. In this case, mother nature was Margarito's surgeon. What most likely happened was the floor of his eye-socket ( the maxilla) and the the medial wall (the side closest to the nose) both sit right above a sort of air-sac (the maxillary and ethmoid sinuses; see figure E), and when the pressure became too great- BAM! Like a trapdoor in the floor, it breaks open. For the time being this is great news for your eye, because now the blood vessels, nerves and muscles are not getting pinched off (which could obviously lead to all sorts of badness). The bad news, this pressure-relief system doesn't have an off-switch. With continued trauma (punches, knees etc.) and swelling contents of the orbital (specifically the muscles that move the eye) may herniate through the fracture defect (bulge through the broken bone), clinically resulting in diplopia (double-vision). How is it fixed?: Depending on the severity and location of the fracture treatment may vary. In this case he had surgical reconstruction of the orbit. Surgical repair (see: Figure F) of orbital and maxillofacial fractures typically involves several steps, as follows: Exposure with degloving (completely removing the skin off) the facial skeleton Anatomic reduction (correcting the fracture) Rigid fixation with replacement of lost or damaged bone (screwing/bonding any broken bone(s) or adding artificial parts to replace bone that is unable to be used) Soft-tissue resuspension (reconnecting any tissue that was detached) Closure To repair the break itself, the material used depends on the surgeons preference. Titanium and polylactide plates (see: Figure G) are the two most commonly used materials. How long is a person out of action?: Again, depending on the severity of the injury, most patients will be followed by their surgeon for anywhere from 3 to 6 months. Any risks?: Intraoperative complications include, but are not limited to, the following: Globe (the eye ball) and optic nerve injury caused by direct trauma, excessive retraction, or vascular compromise (eg, nerves and/or blood vessels could be cut or injured) Injury to the infraorbital nerve (the nerve that provides feeling to your lower eye lid and upper lip/teeth) Inadequate reduction of prolapsed tissue (incomplete fixing of damaged parts) Orbital hemorrhage (bleeding of the eye). Postoperative complications include, but are not limited to, the following: Blindness Persistent diplopia (permanent double vision) Globe malpositioning, particularly enophthalmos or hypoglobus (inproper alignment/positing of the eye) Infection that presents as orbital cellulitis (eye infection) Infraorbital nerve dysfunction in an orbital floor repair (nerve damage) Lid malpositioning, especially lower-lid retraction or entropion (damage to the eye lid) Implant infection, migration, or extrusion (infection in are of hardware that was used/placed or the hardware could come lose at a later time) Epistaxis leakage in medial wall repairs (an “internal” nose bleed) Sinus disease, especially sinusitis Injury-Duty Insight: It seems to be that most people want to know “If this happened once, is this same sort of injury likely to happen again after its fixed with surgery?” This is a great question, and there are two schools of thought about it. One idea is that the orbital fracture happened for an obvious reason: there was too much pressure and not enough space. Once that pressure reaches a critical maximum, it's gotta go some place and that's when the break happens, but it's where the break happens that varies from person to person, from case to case. However, it's safe to say that the break usually happens at the weakest point. Once that “weak-spot” is surgically repaired (with pretty strong materials), it is not very likely to break (in that same exact spot) again. However, now the “second weakest spot” is the place that will give way the next time the orbit is subjected to all that pressure again- so the question is how much more pressure can that second spot take? Nobody knows, really. As human beings, we all have our genetic variations so sometimes broad conclusions about things like this just can't be made. The second school of thought is that the orbital floor, for most people, isn't the “weakest part” of the orbital. This theory suggests that there are other parts that should logically give way first, long before the the floor would. But, seeing as how the floor is most often the region involved in these sorts of scenarios, this theory suggest that there is just something about how it all comes together (the eye, the surrounding fat, muscles- and how it all fits into the orbital) and way the pressure is distributed when the swelling starts that focuses most of the force on the floor, causing it buckle. So, if you're able to reenforce the floor, then you should not be very likely to suffer a similar fracture. Of course, it's hard to know for sure simply because there are not a ton of these sorts of scenarios for people to study. Instead, you just have doctors giving their “professional opinions” on what their experiences with these types of situations are. What is Injury-Duty's stance on the matter, you ask? We feel you have to consider the whole story line before “choosing sides”. In the case of Margarito, he had recently undergone surgery for a cataract in the same eye, which included implantation of an artificial lens (to read more about it click here: “Hurt Locker”). Now, as we mentioned before, when pressure builds in the orbit, the eye itself is absorbing some of those forces. Regardless of which school of thought you subscribe to regarding the likelihood of re-injuring the eye socket- they both suggest that the newly repaired socket will be able to withstand increased pressure, right? If that's true, then the eye will be on the the receiving end of some of this pressure, no? And we don't feel that is a wise predicament to put you, or your eye-ball in. It's just too risky- the chances for permanent damage to your vision, or even losing your eye sight all together just doesn't make any sense. 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