• Maxillofacial Plastic and Reconstructive Surgery
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• v.12 no.1
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• pp.114-120
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• 1990

This is a case report of correction of posttraumatic diplopia and enophthalmos using autogenous composite conchal cartilage and temporal fascia. The results are as follows. 1. Diplopia and enophthalmos may be persistent complications in zygomatic complex fracture. 2. The concha is a reservior of autogenous cartilage which leaves no cosmetic and functional deformity in reconstruction of orbital floor. 3. Warpping the cartilage in temporal fascia may serve to increase implant stability and get graft with smooth edge. 4. Donor incision lines are well hidden within the scalp and in auriculocephalic fold.

• Journal of the Korean Medical Association
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• v.61 no.12
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• pp.740-748
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• 2018

Posttraumatic facial deformities (PTFDs) are very difficult to correct, and if they do occur, their impact can be devastating. It may sometimes be impossible for patients to return to normal life. The aim of surgical treatment is to restore the deformed bone structure and soft tissue to create symmetry between the affected side and the opposite side. In the process of managing PTFD, correcting enophthalmos is one of the most challenging aspects for surgeons because of difficulties in overcoming the scar tissue and danger of injuring to the optic nerve. In this article, surgical options for reconstruction of the medial wall, floor, lateral wall, and roof of the orbit are described. To optimize aesthetic improvement, additional cosmetic procedures such as facial contouring surgery, blepharoplasty and rhinoplasty can be used. Plastic surgeons should join emergency trauma teams to implement an overall treatment plan containing rational strategies to avoid or minimize PTFD.

• Archives of Craniofacial Surgery
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• v.9 no.2
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• pp.101-104
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• 2008

Purpose: Diplopia and cosmetically unacceptable enophthalmos are the major complications of blow out fracture. Prolapse of orbital tissue into the sinuses, enlarged orbital volume, atrophy of orbital fat and loss of support of orbital walls play a role in the pathogenesis of enophthalmos. To correct post-traumatic enophthalmos, freeing of incarcerated orbital contents combined with reduction of bony orbital volume and reconstruction of suspensory support of globe is necessary. But remained enophthalmos after surgical treatment is difficult to correct completely. In this case, the authors performed implant insertion for affected orbit and endoscopic orbital decompression for unaffected orbit for correction of late enophthalmos. Method: We reviewed a girl patient with right inferomedial orbital wall blow out fracture, right zygoma fracture treated at our hospital for correction of enophthalmos. An 18-year-old female had sustained posttraumatic enopthalmos. Two surgical management was performed for correction blow out fracture at the other hospital. But residual diplopia, enophthalmos, cheek drooping were found. And then she transferred to our hospital. She had severe enophthalmos(5 mm) also had diplopia and extraocular muscle limitation. We performed operation for correction of enophthalmos. After operation, she showed minimal improvement of diplopia and enophthalmos(3 mm). The authors make plan for operation for correction enophthalmos due to cosmetical improvement. Implant insertion was performed for affected orbit. For unaffected orbit, nasoendoscopic medial orbital wall decompression was proceeded. Result: Correction of enophthalmos was found after operation and was maintained for nine years follow-up. Patient expressed satisfaction for the result. Conclusion: To correct persistant enophthalmos, we could have satisfactory result with orbital wall reconstruction on affected eye and decompression on unaffected eye.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.20 no.4
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• pp.373-378
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• 1998

In the midfacial fracture, the orbital region presents many additional complication unique to the orbit. Among them are ectropion, entropion, lid ptosis, injury to the lacrimal apparatus, diplopia or the late development of enophthalmos. The residual problem confronting the surgen is usually enophthalmos or diplopia. Enophthalmos becomes cosmetically obvious at 3mm and if more severe it can interfere with vision from obstruction by the orbital rim. In this clinical situation, many patients prefer the simpler intraorbital volume expansion to the more complex orbital osteotomy. In general, except in mild cases of enophthalmos, the procedure of choice is osteotomy and repositioning for zygoma fracture and volume augmentation for blow-out fracture. Late treatment is performed by volume augmentation based on the CT findings behind the axis of the globe. Inferiorly placed grafts elevate the globe, posterior superior grafts move the globe anterior and medially positioned grafts push the globe laterally. In this two cases, the patients who has stable orbitozygomatic rim, the use of calvarial bone grafts more than 3 areas around intraorbital content, we corrected late enophthalmos combined with diplopia. As result, the first patient had 2mm advance in exophthalmometric check with improvement of the diplopia gradually. The second patient had 1.5mm advance with correction of vertical ocular dystopia and cosmetically good results respectively.

• Archives of Craniofacial Surgery
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• v.9 no.2
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• pp.55-61
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• 2008

Purpose: The purpose of this study is to evaluate the effectiveness of internal fixation method of $Medpor^{(R)}$ implant with $BioSorb^{TM}FX$ screw which is used for prevention of enophthalmos in posteriorly extended large orbital floor fracture. Methods: From Jun. 1997 to Dec. 2007, 21 patients who were diagnosed with posteriorly extended large orbital floor fractures were classified into two groups. One group(n=11) had undergone reduction surgery with regular $Medpor^{(R)}$ sheets without any fixation method, while the other group(n=10) had their $Medpor^{(R)}$ sheets fixed with the $BioSorb^{TM}FX$ screws. The two groups were evaluated by comparison of their enophthalmos degree and effectiveness. Results: In the non-fixation group, six patients had enophthalmos preoperatively and three of them showed persistent enophthalmos postoperatively. In postoperative CT examination, displacement of $Medpor^{(R)}$ implant with soft tissue impaction into maxillary sinus was observed in the patients. In the screw fixation group, three patients had enophthalmos preoperatively, but none of them suffer from complication such as residual enophthalmos, soft tissue impaction, muscle entrapment or optic nerve compression postoperatively. Conclusion: Internal fixation method of $Medpor^{(R)}$ implant with $BioSorb^{TM}FX$ screw on the medial surface of orbital floor provides firm stabilization of implants and surrounding soft tissues and can be an effective option especially when postoperative implant displacement or malposition was expected.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.3
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• pp.205-213
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• 2011

Introduction: The enlargement and deformation of the orbit give rise to a visible enophthalmos. As a consequence, a disturbance of eye motility together with double images is likely to occur. This study examined the degree of enophthalmos according to the extent of orbital wall fracture and volume of herniated orbital tissue in blowout fractures of the medial and inferior orbital wall. Materials and Methods: This study was performed on patients diagnosed with medial and inferior orbital wall fractures at the Department of Oral and maxillofacial surgery, Chonbuk National University Hospital from 2007 to 2009. The patients' age, gender, etiology of fracture and degree of enophthalmos were investigated. The changes in the degree of enophthalomos, diplopia and ocular motility restriction after operation were examined. Results: The degree of enophthalomos increased with increasing extent of orbital wall fracture and volume of herniated orbital tissue. Conclusion: Whether to perform the operation is decided after measuring the extent of the orbital wall fracture and volume of herniated orbital tissue using computed tomography (CT), time for the decision of operation can be shortened. This can cause a decrease in the complications of orbital wall fractures.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.3
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• pp.184-188
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• 2013

Post-traumatic enophthalmos is a relatively common problem following orbitozygomatic fractures. Bony-volume expansion and soft tissue atrophy are considered the main etiological causes of this condition. Enophthalmos is corrected mostly through reducing the enlarged orbit volume. Autogenous graft and various alloplastic materials are used for this purpose. Porous polyethylene is highly biocompatible, durable, and remarkably stable. Also, the titanium plate embedded in a porous polyethylene sheet provides radiographic visibility and increased sheet strength and contour retention. We present experiences of titanium reinforced porous polyethylene for correction of the traumatic enophthalmos with literature review.

• Archives of Craniofacial Surgery
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• v.10 no.1
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• pp.49-54
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• 2009

Purpose: Inevitably, Maxillary structural defect follows maxillary cancer extirpation. Maxillary reconstruction is over every surgeon's head. Every physician tried to overcome limited donor site of craniofacial defect. We considered to suggest optimal method of inferior orbital wall defect in functional point as well as esthetic point. Methods: We performed wide excision of maxilla and vascularized partial thickness calvarial bone flap to reconstruct the defect from cancer extirpation in three cases. We select ipsilateral superficial temporal artery, vein and outer cortex of parietal bone flap as donor. And we applied bone flap as inferior orbital wall structure. The bony surface was wrapped with fascia to prevent direct contact between orbital contents and rough bony flap surface. Computed tomography image was checked during follolw up period. Results: We can observe these patients for over two years. In all three cases, We can get fair inferior orbital wall structure. Even though they got radiation therapy, there was no limitation of extraocular movements, no diplopia. no enophthalmos. Also there was minimal donor site morbidity. Conclusion: We suggest vascularized calvarial bone flap is practically excellent strategy for inferior orbital wall reconstruction.

• Journal of Yeungnam Medical Science
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• v.13 no.1
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• pp.22-31
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• 1996

It is difficult to get a satisfactory result for the correction of malunited fracture of zygoma. Triple osteotomy and reposition of malunited zygoma is accepted as the better surgical method than camouflage surgery by means of onlays, if the orbital floor is to be reconstructed. The surgical approach can be divided into bicoronal, periorbital, intraoral and old scar. In 7 patients with malunited fracture of zygoma, the authors used a limited approach through extension of periorbital incision and intraoral incision instead of wide exposure including bicoronal incision. And we performed triple osteotomy and advancement of zygoma complex. The patients were followed for 4.5 months with acceptable result, and this approach was an effective method for the relatively simple tripod type-malunited fracture of zygoma. The authors obtained following conclusions: 1. Preoperative evaluation through thorough measurement of X-rays, investigation of photographs and detail communication with the patients was an important process. 2. Through lateral extension of subciliary incision, lateral eyebrow and intraoral incision, we could obtain adequate exposure for triple osteotomy and advancement of zygoma. 3. The zygoma should be reduced and fixed in an overcorrected superior and medial direction. 4. Return of zygoma to its anatomical position was possible only when it is completely freed from the surrounding soft tissue including masseter. 5. We could not find any different results between autogenous calvareal bone graft and $Medpor^{(R)}$ insertion on the floor of orbit.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.4
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• pp.292-300
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• 2004

Orbital blowout fractures are common consequence to blunt periorbital trauma. Pure orbital blowout fractures first occur at the weakest point of the orbital wall. Computed tomography(CT) is recognized to be the best imaging technique to evaluate orbital fractures. The extent and location of a blowout fractures in the CT scan were noted to have an effect on the clinical outcome. In the early posttraumatic period, the presence of significant enophthalmos is difficult to detect because of orbital edema. Early surgical intervention may improve the ultimate outcome because open reconstruction becomes more difficult if surgery is delayed. In this study, we evaluated isolated blowout fractures of the orbital floor by region-of-interest measurements from CT scans and their relationship to ophthalmologic findings. Six patients of the medial orbital wall fractures, eleven patients of the inferior orbital wall fractures, nineteen of the medial and the inferior orbital wall fractures confirmed by CT scan, were evaluated. The area of fracture and the volume of the displaced orbital tissue were determined from CT scan using linear measurements. Each of the calculated values for the area and the volume were compared with the degree of the enophthalmos, the diplopia, and the eyeball movement limitation to determine whether there was any significant relationship between them. The fracture area and the volume of the herniated orbital tissue were significantly positively correlated with the enophthalmos and the ocular motility limitation and not correlated with the diplopia. For the enophthalmos of 2mm or greater, the mean fracture area was 3.55{\pm}1.25cm^2$ and the volume of the herniated orbital tissue was $1.74{\pm}0.97cm^3$; for less than 2mm enophthalmos, $1.43{\pm}0.99cm^3$ and $0.52{\pm}0.49cm^3$, respectively. The enophthalmos of 2mm can be expected with $2.92cm^2$ of the fracture area and $1.40cm^3$ of the herniated orbital tissue. In conclusion, the enophthalmos of 2mm or more, which is a frequent indication for surgery. It can be expected when area of fracture is $2.92cm^2$ or more, or the volume of herniated orbital tissue is $1.40cm^3$ or more. And the CT scan using linear measurements has an application in the assessment of patients with blowout fractures and provides useful information in the posttraumatic evaluation of orbital fractures.