• Archives of Plastic Surgery
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• 제41권4호
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• pp.362-365
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• 2014

Background Many implants are being used for the reconstruction of orbital wall fractures. The effect of the choice of implant for the reconstruction of an orbital wall fracture on the surgical outcome is under debate. The purpose of this article is to compare the outcomes of orbital wall reconstruction of small orbital wall fractures on the basis of the implants used. Methods The authors conducted a retrospective study using electronic databases. Between March 2001 and December 2012, 461 patients with orbital wall fractures were included in this study. Among them, 431 patients in whom the fracture size was less than $300mm^2$ were analyzed. The fracture size was calculated using computed tomography scans of the orbit in the sagittal and coronal images. Cases in which the fracture size was less than $300mm^2$ were included in this study. Results One hundred and twenty-nine patients were treated with silastic sheets; 238 patients were treated with titanium meshes; and absorbable meshes were used in the case of 64 patients. Overall, 13 patients required revision, and the revision rate was 3.0%. The revision rate of the silastic sheet group was 5.4%. In the multivariable analysis, the revision rate of the group reconstructed with silastic sheets was highly statistically significant (P=0.043, odds ratio=3.65). However, other factors such as age, sex, fracture type, and fracture size were not significant. Conclusions Reconstruction of orbital wall fractures with silastic sheets may cause more complications than that with other materials such as titanium meshes and absorbable meshes.

• Archives of Plastic Surgery
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• 제40권4호
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• pp.335-340
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• 2013

Background In patients with medial orbital wall fracture, predicting the correlation between the degree of enophthalmos and the extent of fracture is essential for deciding on surgical treatment. We conducted this retrospective study to identify the correlation between the two parameters. Methods We quantitatively analyzed the correlation between the area of the bone defect and the degree of enophthalmos on computed tomography scans in 81 patients with medial orbital wall fracture who had been left untreated for more than six months. Results There was a significant linear positive correlation between the area of the medial orbital wall fracture and the degree of enophthalmos with a formula of E=0.705A+0.061 (E, the degree of enophthalmos; A, the area of bone defect) (Pearson's correlation coefficient, 0.812) (P<0.05). In addition, that there were no cases in which the degree of enophthalmos was greater than 2 mm when the area of the medial orbital wall fracture was smaller than $1.90cm^2$. Conclusions Our results indicate not only that 2 mm of enophthalmos corresponds to a bone defect area of approximately $2.75cm^2$ in patients with medial orbital wall fracture but also that the degree of enophthalmos could be quantitatively predicted based on the area of the bone defect even more than six months after trauma.

• Journal of International Society for Simulation Surgery
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• 제1권1호
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• pp.16-18
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• 2014

The orbit has a very special anatomical structure. The complex anatomical structure should be restored when we encounter the patient with orbital wall fracture. Unless these specific anatomy were reconstructed well, the patient should suffer from various complications such enophthalmos, diplopia or orbital deformity. In addition, because the patient has a his own specific orbital shape, individualized approach will be necessary. The aim of this trial is to try to restore the original orbit anatomy as possible based on the mirrored three dimensional CT images based on the computer simulation. Preoperative computed tomography (CT) data were processed for the patient and a rapid prototyping (RP) model was produced. At the same time, the uninjured side was mirrored and superimposed onto the traumatized side, to create a mirror-image of the RP model. In order to restore the missing skipped images between the cuts of CT data because of the thinness of the orbital walls, we manipulated the DICOM data for imaging the original orbital contour using the preoperatively manufactured mirror-image of the RP model. And we fabricated Titanium-Medpor to reconstruct three-dimensional orbital structure intraoperatively. This prefabricated Titanium-Medpor was then inserted onto the defected orbital wall and fixed. Three dimensional approach based on the computer simulation turned out to be very successful in this patient. Individualized approach for each patient could be an ideal way to manage the traumatic patients in near future.

• 대한두개안면성형외과학회지
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• 제13권1호
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• pp.29-35
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• 2012

Purpose: In surgical treatment of the medial orbital wall fractures, restoring the original position of the orbital wall is difficult in some cases. Under such condition, the orbital wall is often reconstructed with synthetic material, without bony reduction, which is considered to be the conventional reconstruction. The purpose of this study is to compare the outcomes of anatomical reconstruction, which restores the bony wall to the anatomical position, from that of the conventional reduction in the isolated medial orbital wall fractures. Methods: Thirty patients, who underwent reconstruction surgery for the isolated medial orbital wall fractures from March 2007 to August 2011, were reviewed retrospectively. The surgical outcomes of two groups, the conventional reconstruction group (15 patients) and the anatomical reconstruction group (15 patients), were studied in 2 measurements, a one day before and 6 months after the surgery. The changes of orbital volume were calculated by the images from a computed tomography scan and enophthalmos was measured by a Hertel exophthalmometer. Results: The orbital volume ratio was decreased by an average of 1.05% in the conventional reconstruction group, while in the anatomical reconstruction group, the ratio decreased by 5.90% (p<0.05). The changes in the Hertel scale were 0.20 mm in the conventional reconstruction group, and 0.70 mm in the anatomical reconstruction group. However, the difference in the Hertel scale was statistically insignificant (p>0.05). Conclusion: In conclusion, the anatomical reconstruction technique of the isolated medial orbital wall fracture results in a better outcome than that of the conventional reconstruction, in terms of restoring of the original orbital volume and anatomic position. Thus, it can be considered as a useful method for the isolated medial orbital wall fractures.

• Archives of Plastic Surgery
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• 제41권4호
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• pp.355-361
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• 2014

Background A blow-out fracture is one of the most common facial injuries in midface trauma. Orbital wall reconstruction is extremely important because it can cause various functional and aesthetic sequelae. Although many materials are available, there are no uniformly accepted guidelines regarding material selection for orbital wall reconstruction. Methods From January 2007 to August 2012, a total of 78 patients with blow-out fractures were analyzed. 36 patients received absorbable mesh plates, and 42 patients received titanium-dynamic mesh plates. Both groups were retrospectively evaluated for therapeutic efficacy and safety according to the incidence of three different complications: enophthalmos, extraocular movement impairment, and diplopia. Results For all groups (inferior wall fracture group, medial wall fractrue group, and combined inferomedial wall fracture group), there were improvements in the incidence of each complication regardless of implant types. Moreover, a significant improvement of enophthalmos occurred for both types of implants in group 1 (inferior wall fracture group). However, we found no statistically significant differences of efficacy or complication rate in every groups between both implant types. Conclusions Both types of implants showed good results without significant differences in long-term follow up, even though we expected the higher recurrent enophthalmos rate in patients with absorbable plate. In conclusion, both types seem to be equally effective and safe for orbital wall reconstruction. In particular, both implant types significantly improve the incidence of enophthalmos in cases of inferior orbital wall fractures.

• Archives of Plastic Surgery
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• 제34권6호
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• pp.735-740
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• 2007

Purpose: Blowout fracture is an outward fracture of the orbital wall. That usually occurs at inferior or medial wall of the orbit. The main pathophysiology is high intraocular pressure derived from impact of trauma. Among the four orbital wall, the medial wall is thinnest and most vulnerable to trauma. Many kinds of methods were introduced for correction of medial orbital wall fracture. Recently, transnasal endoscopic reconstruction methods were widely used. Endoscopic methods had many advantages. However, we experienced some cases of postoperative maxillary sinusitis. This study was planned to find out the effectiveness of middle meatal antrostomy after endoscopic reconstruction of medial orbital wall fracture. Methods: This study was retrospective analysis of 28 patients who underwent transnasal endoscopic repair of medial orbital wall fracture. The 18 male and 10 female patients were ranged from 17 to 57 years of age(mean, 30.9 years). Among 28 patients, randomly selected 17 patients underwent middle meatal antrostomy as additional procedure by the same surgeon. After at least 12 months of follow-up period, we examined the nasal symptom, endoscopic and CT findings. Results: One patient complained of nasal obstruction in middle meatal antrostomy group and four patients complained nasal symptoms in non middle meatal antrostomy group. On the endoscopic findings, three patients of non middle meatal antrostomy group had continuous nasal discharge. But middle meatal antrostomy group had no abnormal endoscopic findings. The abnormal CT finding(abnormal mucosal hypertrophy) were detected in four patient of non middle meatal antrostomy group. There were no abnormal CT findings in middle meatal antrostomy group. The data were statistically significant at comparative study. Conclusion: Authors think that the middle meatal antrostomy has some advantages as a additional procedure of endoscopic reconstruction of medial orbital wall fracture. Especially, it is good at preventing postoperative maxillary sinusitis. But, more larger group and strict application of disease entity are need for correct evaluation of middle meatal antrostomy effect.

• 대한두개안면성형외과학회지
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• 제9권2호
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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.

• Archives of Plastic Surgery
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• 제34권6호
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• pp.713-718
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• 2007

Purpose: The aim of this study is to develop and apply the critical pathway to the orbital wall fracture patients and to elucidate its effect. Methods: Critical pathway(CP) sheet and questionnaire were developed by a team approach. Critical pathway was applied to 7 orbital wall fracture patients (CP group) from April 2006 to September 2006. Length of hospitalization and cost for hospitalization of CP group were compared to those of the 10 patients who had same disease entities and treated by conventional regimen(control group). Results: Length of hospitalization in the CP group (7.20 day) were insignificantly shorter than that of control group(8.71 day). Mean cost for hospitalization of the CP group(776,398 won) were insignificantly lower than that of control group(1,028,531 won). The patients satisfaction for the explanation regarding operation procedure, therapeutic operation fee, length of hospitalization and medical personnel were all affirmative. Conclusion: Critical pathway that we developed for orbital wall fracture definitely improved the quality of treatment. Furthermore, other critical pathways should be developed for another facial trauma patients.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.879-882
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• 2011

Purpose: Superior orbital fissure syndrome is a rare neurological complex. Superior orbital fissure syndrome may result from a variety of inflammatory, infectious, neoplastic, iatrogenic, traumatic, vascular cause. The author report a patient who suffered from superior orbital fissure syndrome after inferior orbital wall reduction. Methods: A 26-year-old female suffered from inferior orbital wall fracture with inferior gaze limitation and orbital soft tissue herniation. On posttrauma 10 day, inferior orbital wall was reduced using endoscope and porous polyethylene ($Medpor^{(R)}$) was inserted. On immediate postoperation, she reported that extraocular movement was limited in almost any directions. She underwent exploration surgery to release the presence of extraocular muscle impingement. But, there was no observation of extraocular muscle impingement. On postoperative one day, high-dose steroid therapy was started to release superior orbital fissure syndrome which was defined in postoperative computed tomography. Results: After one month of high-dose steroid therapy, extraocular movement limitations improved progressively in all directions. In four months, extraocular movement recovered completely. Conclusion: Superior orbital fissure syndrome may occur after surgical procedure of orbital wall reduction. Prompt diagnosis and treatment with mega-dose corticosteroid is an effective option for avoiding disaster from compressive syndrome.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.633-638
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• 2010

Purpose: Orbital bone is one of the most complex bones in the human body. When the patient has a fracture of the orbital bone, it is difficult for the surgeon to restore the fractured orbital bone to normal anatomic curvature because the orbital bone has complex curvature. We developed a rapid prototyping model based on a mirror image of the patient's 3D-CT (3 dimensional computed tomography) for accurate reduction of the fractured orbital wall. Methods: A total of 7 cases of large orbital wall fracture recieved absorbable plate prefabrication using rapid prototyping model during surgery and had the manufactured plate inserted in the fracture site. Results: There was no significant postoperative complication. One patient had persistent diplopia, but it was resolved completely after 5 weeks. Enophthalmos was improved in all patients. Conclusion: With long term follow-up, this new method of orbital wall reduction proved to be accurate, efficient and cost-effective, and we recommend this method for difficult large orbital wall fracture operations.