• Archives of Plastic Surgery
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• 제34권5호
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• pp.599-604
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• 2007

Purpose: Blowout fractures of the orbit are common sequelae to blunt facial trauma and now increasing in number due to automobile accidents, violence and industrial disasters. There are some reports of diagnosis and treatment of this fracture, but detailed data provided in overall aspects are very few. We analysed extensive data to provide guide line of blowout fracture patients care. Methods: We retrospectively studied 387 orbital blowout fracture patients who had been followed up at least 3-6 months. Their hospital records were reviewed according to causes, fracture site, operation methods, and follow up results, etc. Results: The ratio of males to females was 7 : 3 and fractures were most often seen in the 20-29 age group. 180(47%) patients had medial orbital wall fractures, 155(40%) patients had floor fractures and 52(13%) patients had a combination of orbital floor and medial wall fractures. The highest associated bone fracture was the nasal bone(37%). The open reduction was done in the 324 patients(83.7%) and insertion materials were used in the 249 patients(77%). Total 45 patients(14%) complained of residual diplopia and 26 patients(8%) kept mild enophthalmos. 24 patients(7%) showed some restriction of extraocular muscle movements. Conclusion: We broadly surveyed the information of blow out fracture patients and believe that this study provides important prognostic information that can be of benefit to both patient and surgeon during preoperative counseling and postoperative analysis of orbital blowout fractures.

• Journal of Trauma and Injury
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• 제19권1호
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• pp.89-92
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• 2006

Penetrating facial wounds are uncommon and are usually life threatening because of the possibility of brain damage. There are three possible pathways for penetrating the cranium through the orbit: via the orbital roof, via the superior orbital fissure, or between the optic canal and lateral wall of the orbit. Brain injuries resulting from the penetrating wounds show extensive parenchymal damage, hemorrhage, and brain edema. Transorbital penetrating wounds can lead to diverse lesions of the optical apparatus, including the eye globe, the optical nerve, and the chiasm. Moreover, intracerebral structures may be hurt, and bleeding and infection may occur. Early diagnosis and prompt debridement are the fundamental factors affecting the outcome of a penetrating facial wound. An 87-year-old man was admitted to the emergency department with a grinder impacted into the medial aspect of the right eye. On presentation, the man was fully conscious with a Glasgow Coma Scale score of 15 and complained of a visual disturbance of the right eye. Computed tomography demonstrated a right orbital medial and inferior wall fracture, a frontal bone fracture, and a contusional hemorrhage in frontal lobe of the brain. A craniotomy with hematoma removal and repair of the orbital floor was done. He showed no neurological deficits except right visual loss. This appears to be the first report of a man with a penetrating facial wound caused by a grinder, who presented with a potentially disastrous craniocerebral injury that did not lead to any serious neurological seguelae.

• 대한두경부종양학회지
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• 제13권1호
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• pp.40-44
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• 1997

Background: Lateral rhinotomy and medial maxillectomy, an en bloc resection of the medial maxillary sinus, ethmoid sinus with the lamina papyracea, medial orbital floor, and lacrimal fossa-duct, have been advocated for lateral nasal wall neoplasms as a standard approach method. Objective: This report was conducted to investigate the clinical efficacy of lateral rhinotomy and medial maxillectomy for lateral nasal wall neoplasms. Materials and Methods: We retrospectively analyzed clinical data of 31 patients who were treated at department of otolaryngology-head and neck surgery, Catholic university of Korea, school of medicine between 1990 and 1996. Results: Twenty five patients had benign lesions(80.6%). By far, the largest percentage was inverted papillomas(80%, 20/25). Of the six malignant lesions(19.4%), 33.3%(2/6) was squamous cell carcinoma and other lesions were metastatic renal cell carcinoma, adecarcinoma, transitional cell cacinoma, and hemangiopericytoma. There were a 4% recurrence for benign tumors(1/25), 5% especially for inverted papilloma(1/20), and 50% for malignant neoplasms(3/6). The overall complication rate was 9.7%. Conclusion: Despite the various approach for treatment of lateral nasal wall neoplasms including inverted papilloma, we continue to advocate a lateral rhinotomy and medial maxillectomy as the treatment of choice.

• 대한두개안면성형외과학회지
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• 제17권3호
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• pp.111-118
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• 2016

The medial wall and floor of the bony orbit are frequently fractured because of the delicate anatomy. To optimize functional and aesthetic results, reconstructive surgeons should understand the anatomy and pathophysiology of orbital fractures. Appropriate treatment involves optimal timing of intervention, proper indications for operative repair, incision and dissection, release of herniated tissue, implant material and placement, and wound closure. The following review will discuss the management of orbital floor fractures, with the operative method preferred by the author. Special considerations in operation technique and the complication are also present in this article.

• 대한두개안면성형외과학회지
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• 제20권4호
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• pp.219-222
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• 2019

The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.

• 대한두개안면성형외과학회지
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• 제18권2호
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• pp.128-131
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• 2017

With advances in diagnostic technology, radiologic diagnostic methods have been used more frequently, and physical examination may be neglected. The authors report a case of pediatric medial orbital trapdoor fracture in which the surgery was delayed because computed tomography (CT) findings did not indicate bone displacement, incarceration of rectus muscle, or soft tissue herniation. A healthy 6-year-old boy was admitted to the emergency room for right eyebrow laceration. We could not check eyeball movement or diplopia, because the patient was irritable. Thus, we performed facial CT under sedation, but there was normal CT finding. Seven days later, the patient visited our hospital due to persistent nausea and dizziness. We were able to perform a physical examination this time. Lateral gaze of right eye was limited. CT still did not show any findings suggestive of fracture, but we decided to perform exploratory surgery. We performed exploration, and found no bone displacement, but discovered entrapped soft tissue. We returned the soft tissue to its original position. The patient fully recovered six weeks later. To enable early detection and treatment, thorough physical examination and CT reading are especially needed when the patient shows poor compliance, and frequent follow-up observations are also necessary.

• Archives of Plastic Surgery
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• 제33권2호
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• pp.237-240
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• 2006

The simultaneous correction of the hypertelorism and exophthalmos combined with craniosynostosis is very rarely performed operative procedures in the world. The craniosynostosis is the congenital anomaly that designates premature fusion of one or more sutures in either cranial vault or cranial base. Hypertelorism is not a distinct clinical syndrome in itself, but is a physical finding secondary to facial and cranial maldevelopment and it is defined as a increase in the distance between the medial orbital walls. Exophthalmos can occur following the decrease in the size of the orbit in patients with developmental skeletal disorders such as craniofacial synostosis. The authors experienced 9-year-old male patient, who has complex cranio-facial abnormality. The craniosynostosis was oxycephaly type and primary fronto-orbital advancement surgery had been performed in other hospital. The abnormal cranial vault combined with hypertelorism and exophthalmos due to maldeveloped both orbital walls. Surgical correction was obtained by various cranio-fronto-orbital remodeling technique such as calvarial bone craniotomy, fronto-orbital advancement, paramedian resection, medial canthopexy, Tessier-Wolfe three wall orbital expansions. We achieved a quite satisfactory result both functionally and aesthetically in a complex cranio-facial deformity patient by combination and modification of previously developed various cranio-facial plasty technique and hereby report the case with brief discussion and review of literature.

• Journal of Yeungnam Medical Science
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• 제23권2호
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• pp.240-246
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• 2006

미세절단기를 이용한 내시경 수술이 기존의 부비동 내시경 수술에 비해 출혈이 적고 수술 시간도 단축되는 장점들이 있어 선호되고 있지만, 안와나 뇌 등의 중요 구조물에 심각한 합병증들을 발생시키기도 한다. 저자들은 만성 부비동염으로 부비동 내시경 수술 중 미세절단기에 의해 지판과 내직근 손상으로 인해 심한 복시와 외측 편위가 있었던 50세 여자 환자를 경험하였기에 문헌 고찰과 함께 보고한다. 환자는 부비동 내시경 수술 중 미세절단기에 의해 좌측 내직근 손상으로 인해 안구운동 검사상 안검연의 중심부를 통과하지 못하는 심한 내전장애 소견을 보였으며 편위각은 40 프리즘디옵터의 외사시를 나타내었다. 전산화 단층촬영상 좌측의 안와 내측벽의 손상으로 안와 지방의 노출과 좌측 내직근이 손상된 소견을 볼 수 있었다. 안구의 심한 외측 편위와 지속적인 복시는 안과적 수술을 시행하여 교정하였다.

• 대한두개안면성형외과학회지
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• 제16권2호
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• pp.53-57
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• 2015

Background: Surgical outcomes after orbital wall decompression have focused on the degree of exophthalmos and intraocular pressure. The aim of this research was to evaluate intraorbital volume using computed tomography (CT) images following two-wall decompression using a combined subcilliary and endoscopic approaches. Methods: A retrospective review was performed for all patients who had undergone the two-wall decompression method. The pre/postoperative CT images were used to evaluate changes in intraocular volume. Intraocular pressure was evaluated using applanation tonometry. Surgical details are discussed within the body of text. Results: Two-wall decompression thru the medial wall and floor was associated with an average intraorbital volume change of $7.3cm^3$, with maximal accommodation up to $13cm^3$. Changes in intraocular pressures were not statistically significant. Conclusion: Two-wall decompression was effective in accommodation of up to $13cm^3$ of soft tissue herniation. There was no statistically significant association between changes in volume to pressure.

• Archives of Plastic Surgery
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• 제46권5호
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• pp.421-425
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• 2019

Background The endoscopic transnasal approach is widely used for reconstructing the medial orbital wall by filling it with a silicone sheet or Merocel, but this technique has the disadvantage of retaining the packing for a long time. To overcome this drawback, a method of positioning an absorbable plate in the orbit has been introduced, but there is a risk of defect recurrence after the plate is absorbed. Here, the authors report the results of a novel surgical technique of placing a nonabsorbable titanium mesh with porous polyethylene into the orbit through the endoscopic transnasal approach. Methods Fourteen patients underwent surgery using the endoscopic transnasal approach. Preoperative computed tomography (CT) was used to calculate the size of the bone defect due to the fracture, and the titanium mesh was designed to be shorter than the anteroposterior length of the defect and longer than its height. The titanium mesh was inserted into the orbit under an endoscopic view. The authors then confirmed that the titanium mesh supported the orbital contents by pressing the eyeball and finished the operation. Immediately after surgery, CT results were evaluated. Results Postoperative CT scans confirmed that the titanium mesh was well-inserted and in the correct position. All patients were discharged without any complications. Conclusions We obtained satisfactory results by inserting a titanium mesh with porous polyethylene into the orbit via the transnasal approach endoscopically.