• 대한두개안면성형외과학회지
• /
• 제10권1호
• /
• pp.55-60
• /
• 2009

Purpose: For blowout fracture of the medial orbital wall, the goals of treatment are complete reduction of the herniated soft tissue and anatomic reconstruction of the wall without surgical complications. Surgeons frequently worry about damage to the optic nerve from the dissection, when the part over the posterior ethmoidal foramen was fractured. The authors performed small incision and inlay grafting for reconstruction of medial orbital wall fracture. Methods: Between January 2007 and April 2008, 15 out of 32 patients were included in an analysing the outcome of corrected medial orbital wall fracture. In 15 patients of posterior comminuted fracture of medial orbital wall, insertion of porous polyethylene($Medpor^{(R)}$ channel implant, Porex, USA) to ethmoidal sinus was performed in multiple layer, through the transconjunctival approach (inlay grafting). Results: In all cases, the orbital bone volume was reconstructed in its normal anatomical position. The associated ocular problems disappeared except for mild enophthalmos in 2 patients and there were no surgical complications associated with inlay grafting. Conclusion: The advantage of inlay grafting include anatomical reconstruction of the orbital wall; the avoidance of optic nerve injury; the simplicity of the procedure; and consequently, the absence of surgery-related complications. This technique is presented as one of the preferred treatments for posterior comminuted fracture of medial orbital wall.

• 대한두개안면성형외과학회지
• /
• 제10권1호
• /
• pp.23-28
• /
• 2009

Purpose: Blow out fracture can present tenderness, swelling, enophthalmos, extraoccular muscle limitation, paresthesia, diplopia according to severity of injury, so reconstruction of blow out fracture is important. Orbital soft tissue should be in orbit and defected orbital wall should be corrected by autologus tissue or alloplastic implants. Every implants have their merits and faults, every implants are used various. This study was designed to compare the sequelae of blow-out fracture repair using the alloplastic implants: micro-titanium mesh(Micro Dynamic titanium $mesh^{(R)}$, Leibinger, Germany), porous polyethylene ($Medpor^{(R)}$, Porex, USA), absorbable mesh plate(Biosorb $FX^{(R)}$ . Bionx Implants Ltd, Finland). Methods: Between January 2006 and April 2008, 52 patients were included in a retrospective study analysing the outcome of corrected inferior orbital wall fracture with various kind of implants. Implants were inserted through subciliary incision. Twenty patients were operated with micro-titanium mesh, fourteen patients with porous polyethylene and eighteen patients with absorbable mesh plate. In comparative category, enophthalmos, diplopia, range of motion of extraoccular muscle, inferior orbital nerve injury were more on frequently statistically in patients. Results: Fourteen of 18 patients underwent surgical repair to improve diplopia, 11 of 17 patients to improve parasthesia, 11 of 15 patients to improve enophthalmos, 8 of 9 patients to improve extraoccular muscle limitation. Duration of follow-up time ranged from 6 months to 12 months(mean, 7.4 months). There was no statistic difference of sequelae between micro titanium mesh and porous polyethylene and absorbable mesh plate in blowout fracture, inferior wall. Conclusion: There is no difference of sequelae between micro-titanium mesh, porous polyethylene and absorbable mesh plate in blow-out fracture, inferior wall. The other factors such as defect size, location, surgeon's technique, may influence the outcome of blow-out fracture repair.

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

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제41권2호
• /
• pp.74-77
• /
• 2015

Objectives: Transpositioning of the inferior alveolar nerve to prevent injury in lower jaw has been advocated for orthognathic, pre-prosthetic and for implant placement procedures. However, the concept of infra-orbital nerve repositioning in cases of mid-face fractures remains unexplored. The infraorbital nerve may be involved in trauma to the zygomatic complex which often results in sensory disturbance of the area innervated by it. Ten patients with infraorbital nerve entrapment were treated in similar way at our maxillofacial surgery centre. Materials and Methods: In this article we are reporting three cases of zygomatico-maxillary complex fracture in which intra-operative repositioning of infra-orbital nerve into the orbital floor was done. This was done to release the nerve from fractured segments and to reduce the postoperative neural complications, to gain better access to fracture site and ease in plate fixation. This procedure also decompresses the nerve which releases it off the soft tissue entrapment caused due to trauma and the organized clot at the fractured site. Results: There was no evidence of sensory disturbance during their three month follow-up in any of the patient. Conclusion: Infraorbital nerve transposition is very effective in preventing paresthesia in patients which fracture line involving the infraorbital nerve.

• 대한두개안면성형외과학회지
• /
• 제18권1호
• /
• pp.1-4
• /
• 2017

Frontal sinus outflow tract (FSOT) injury may occur in cases of frontal sinus fractures and nasoethmoid orbital fractures. Since the FSOT is lined with mucosa that is responsible for the path from the frontal sinus to the nasal cavity, an untreated injury may lead to complications such as mucocele formation or chronic frontal sinusitis. Therefore, evaluation of FSOT is of clinical significance, with FSOT being diagnosed mostly by computed tomography or intraoperative dye. Several options are available to surgeons when treating FSOT injury, and they need to be familiar with these options to take the proper treatment measures in order to follow the treatment principle for FSOT, which is a safe sinus, and to reduce complications. This paper aimed to examine the surrounding anatomy, diagnosis, and treatment of FSOT.

• Journal of Korean Neurosurgical Society
• /
• 제54권5호
• /
• pp.434-436
• /
• 2013

Isolated oculomotor nerve palsy (ONP) attributable to mild closed head trauma is a distinct rarity. Its diagnosis places high demands on the radiologist and the clinician. The authors describe this condition in a 36-year-old woman who slipped while walking and struck her face. Initial computed tomography did not reveal any causative cerebral and vascular lesions or orbital and cranial fractures. Enhancement and swelling of the cisternal segment of the oculomotor nerve was seen during the subacute phase on thin-sectioned contrast-enhanced magnetic resonance images. The current case received corticosteroid therapy, and then recovered fully in 13 months after injury. Possible mechanism of ONP from minor head injury is proposed and previous reports in the literature are reviewed.

• Journal of Korean Neurosurgical Society
• /
• 제55권4호
• /
• pp.222-225
• /
• 2014

Traumatic intracranial aneurysms (TICAs) are rare and are associated with high rates of morbidity and mortality. TICAs usually result from head injuries caused by traffic accidents, industrial accidents, or gunshots. We report a traumatic aneurysm of the callosomarginal artery-cortical artery junction arising from a penetrating injury by scissors. A 51-year-old woman was admitted to our hospital after suffering a penetrating injury caused by scissors. Computed tomography (CT) and CT-angiography demonstrated a right orbital roof fracture, subarachnoid hemorrhage, frontal lobe hemorrhage, intraventricular hemorrhage, and a traumatic aneurysm of the right callosomarginal artery-cortical artery junction. We trapped the traumatic aneurysm and repositioned a galeal flap. Postoperative CT showed a small infarction in the left frontal lobe. Follow-up angiography two months later showed no residual aneurysm. We suggest that an aggressive surgical intervention be performed whenever TICA is diagnosed.

• 대한두개안면성형외과학회지
• /
• 제21권5호
• /
• pp.276-282
• /
• 2020

Background: Orbital fractures are the most common pediatric facial fractures. Treatment is conservative due to the anatomical differences that make children more resilient to severe displacement or orbital volume change than adults. Although rarely, extensive fractures may result in enophthalmos, causing cosmetic problems. We aimed to establish criteria for extensive fractures that may result in enophthalmos. Methods: We retrospectively reviewed the charts of patients aged 0-15 years diagnosed with orbital fractures in our hospital from January 2010 to February 2019. Computed tomography images were used to classify the fractures into linear, trapdoor, and open-door types, and to estimate the defect size. Data on enophthalmos severity (Hertel exophthalmometry results) and fracture pattern and size at the time of injury were obtained from patients who did not undergo surgery during the follow-up and were used to identify the surgical indications for pediatric orbital fractures. Results: A total of 305 pediatric patients with pure orbital fractures were included-257 males (84.3%), 48 females (15.7%); mean age, 12.01±2.99 years. The defect size (p=0.002) and fracture type (p=0.017) were identified as the variables affecting the enophthalmometric difference between the eyes of non-operated patients. In the linear regression analysis, the variable affecting the fracture size was open-door type fracture (p<0.001). Pearson's correlation analysis demonstrated a positive correlation between the enophthalmometric difference and the bony defect size (p=0.003). Using receiver operating characteristic curve analysis, a cutoff value of 1.81 ㎠ was obtained (sensitivity, 0.543; specificity, 0.724; p=0.002). Conclusion: The incidence of enophthalmos in pediatric pure orbital fractures was found to increase with fracture size, with an even higher incidence when open-door type fracture was a cofactor. In clinical settings, pediatric orbital fractures larger than 1.81 ㎠ may be considered as extensive fractures that can result in enophthalmos and consequent cosmetic problems.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제20권4호
• /
• pp.373-378
• /
• 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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제26권6호
• /
• pp.677-680
• /
• 2000

Orbital injuries are common with facial trauma. Direct injuries to the globe are not rare but it can result in complications such as chemosis, subconjunctival hemorrhage and hyphema. Periorbital trauma or injuries to the extraocular muscles and blow-out fracture may result in lid edema, ecchymosis & ptosis and diplopia or limitation of ocular motion respectively. Indirect injuries to the optic nerve come up without any injuries but its complication is irreversible and severe such as loss of vision. The aim of this study is to review the literature on blindness or ptosis following facial trauma and present the cases of blindness after facial trauma and ptosis after mandibular fracture without specific clinical findings.