• Archives of Plastic Surgery
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• v.32 no.2
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• pp.194-198
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• 2005

In many reports on the reconstruction of an orbital blowout fracture, CT(computed tomography) imaging has been used for postoperative evaluation. However, in most cases, only one plane of the CT scan was presented, which may not be sufficient for accurate evaluation. This study reviewed the CT scans presented in the related 49 articles (56 cases), and investigated our patients (150 cases) to investigate where were the most frequent unfavorable reconstructions, and to determine which planes should be presented for accurate evaluation. One plane of the CT scan was presented in 70% of the cases. On the other hand, 30% of the cases presented two planes of the CT scans. In our cases, the most prevalent sites for an unfavorable reconstruction were the posterior portion of the inferior wall, and the posterior and the inferior portion of the medial wall. In order to accurately evaluate an orbital wall reconstruction, at least two planes of a CT scan are needed. For an inferior wall evaluation, both the middle and the posterior planes of the coronal section or both the coronal and the sagittal sections are necessary. In addition, for the medial wall evaluation, both the axial and the coronal sections or both the middle and the posterior planes of the coronal section are required.

• Archives of Craniofacial Surgery
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• v.10 no.2
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• pp.67-70
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• 2009

Purpose: Anatomical basis around orbit can be helpful in periorbital surgery, and there are many articles about measurement between periorbital reference points. In 1967, Jones and Evans measured the orbital wall thickness of Asian cadavers and this article has been cited more than 50 times. But there is no research in orbital thickness in Vivo. Author's idea was based on difference between live human and human cadaver. Material & Method: We conducted this study from 63 consecutive blow out fracture patients between January, 2000 to june, 2005 by collecting the bone fragments and measured the thickness of that fragment using vernia calipers. Anatomically, orbital floor is separated two area by inferior orbital fissure and we measured each area. Three areas were zone I (medial wall), zone II (medial to inferior orbital fissure) and zone III (lateral to inferior orbital fissure). Result: When the overall results were considered, the thickness of Zone I (medial wall of orbit) was average $0.131{\pm}0.006mm$ in male and $0.129{\pm}0.007mm$ in female and Zone II (medial side of orbital floor) was $0.251{\pm}0.005mm$ in male and $0.245{\pm}0.006mm$ in female, Zone III (lateral side of orbital floor) was $0.237{\pm}0.006mm$ in male and $0.226{\pm}0.006mm$ in female. There were no statistical difference between orbital wall thickness of male and female. Also, orbital wall thickness of adults measured $0.130{\pm}0.005mm$, $0.250{\pm}0.005mm$, $0.232{\pm}0.006mm$ in Zone I, Zone II, Zone III and $0.128{\pm}0.006mm$, $0.233{\pm}0.005mm$, $0.215{\pm}0.007mm$ in Zone I, Zone II, Zone III from childs, and there were no statistical difference between adult and child. Conclusion: This article is the first study about Korean orbital wall thickness, and can be helpful to periocular surgery.

• Archives of Plastic Surgery
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• v.34 no.1
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• pp.44-51
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• 2007

Purpose: Blow-out fracture is one of the most common fractures in facial trauma. It is diagnosed by Computed Tomography(CT) scan, which is considered as the most effective diagnostic tool. Since, the Picture Archiving Communication System(PACS) has been provided recently to many hospitals, doctors are more familiar with imaging software of PACS. Because this software has many useful measuring tools, doctors can measure orbital structure easily and make a plan for treatment with its data. Therefore, authors intended to analyze the data of orbital structure measured with PACS imaging software and evaluate its usefulness. Methods: The charts and CT images of 100 patients, which were 50 patients with medial wall fracture and 50 patients with floor fracture, were reviewed. Patients were selected by pre-determined criteria and their CT images were measured with image software of PACS. 'Extraocular muscle thickness', 'Defect ratio'(ratio of defect area to normal area) and 'Globe position index' were measured and analyzed statistically. Results: The thickness of inferior rectus muscle and medial rectus muscle was simultaneously increased in acute-stage of blow-out fracture. The medial rectus muscle was more thickened in medial wall fracture and inferior rectus was more thickened in floor fracture, respectively. In acute blow-out fracture, globe position is exophthalmic rather than enophthalmic. Especially in floor fracture, numerical value summed up thickness of all extraocular muscle is correlated to the defect ratio and globe position index. Conclusion: Clinicians can decide globe position or presume defect ratio in inferior wall fracture by measurement of CT image in acute blow-out fracture using PACS.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.76-81
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• 2017

Background: A transcaruncular approach is typically used for reconstructions of medial wall fractures. However, others reported that a transconjunctival approach was conducive for securing an adequate surgical field of view. In this study, we aimed to examine the extent of repair of medial wall fracture via a transconjunctival approach. Methods: We retrospectively reviewed the medical records of 50 patients diagnosed as having medial wall fracture via preoperative computed tomography and who underwent surgery between March 2011 and February 2014. The fracture location was defined by dividing each of the anterior-posterior and superior-inferior distances into three compartments. Results: A transcaruncular approach was used in 7 patients, while the transconjunctival approach was performed in the remaining 43 patients. The transconjunctival approach enabled a relatively broad range of repair that partially included the front and back of the medial wall, and was successful in 86% of the entire study population. Conclusion: It is known that more than 50% of total cases of the medial wall fracture occur mainly in the middle-middle portion, a majority of which can be reconstructed via a transconjunctival approach. We used a transconjunctival approach in identifying the location of the fracture on image scans except for cases including the fracture of the superior portion in patients with medial wall fracture. If it is possible to identify the location of the fracture, a transconjunctival approach would be an useful method for the reconstruction in that it causes no damages to the lacrimal system and is useful in confirming the overall status of the floor.

• Archives of Plastic Surgery
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• v.41 no.6
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• pp.686-692
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• 2014

Background Restoring orbital volume in large blowout fractures is still a technically challenge to the orbital surgeon. In this study, we restored the orbital wall using the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses, and we compared the surgical outcome to that of a conventional transorbital method. Methods A retrospective review of all patients with pure unilateral blowout fractures between March 2007 and March 2013 was conducted. 150 patients were classified into two groups according to the surgical method: conventional transorbital method (group A, 75 patients, control group), and the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses (group B, 75 patients, experimental group). Each group was subdivided depending on fracture location: group I (inferior wall), group IM (inferomedial wall), and group M (medial wall). The surgical results were assessed by the Hertel scale and a comparison of preoperative and postoperative orbital volume ratio (OVR) values. Results In the volumetric analysis, the OVR decreased more by the experimental groups than each corresponding control groups (P<0.05). Upon ophthalmic examination, neither the differences among the groups in the perioperative Hertel scale nor the preoperative and postoperative Hertel scales were statistically significant (P>0.05). Conclusions Our surgical results suggest that orbital volume was more effectively restored by the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses than the conventional method, regardless of the type of fracture.

• Archives of Craniofacial Surgery
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• v.21 no.2
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• pp.99-105
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• 2020

Background: Due to the different handling properties of unsintered hydroxyapatite particles/poly-L-lactic acid (uHA/PLLA) and polycaprolactone (PCL), we compared the surgical outcomes and the postoperative implantation accuracy between uHA/PLLA and PCL meshes in orbital fracture repair. Methods: Patients undergoing orbital wall reconstruction with PCL and uHA/PLLA mesh, between 2017 and 2019, were investigated retrospectively. The anatomical accuracy of the implant in bony defect replacement and the functional outcomes such as diplopia, ocular motility, and enophthalmos were evaluated. Results: No restriction of eye movement was reported in any patient (n= 30 for each group), 6 months postoperatively. In the PCL group, no patient showed diplopia or enophthalmos, while the uHA/PLLA group showed two patients with diplopia and one with enophthalmos. Excellent anatomical accuracy of implants was observed in 27 and 22 patients of the PCL and uHA/PLLA groups, respectively. However, this study showed that there were neither any significant differences in the surgical outcomes like diplopia and enophthalmos nor any complications with the two well-known implants. Conclusion: PCL implants and uHA/PLLA implants are safe and have similar levels of complications and surgical outcomes in orbital wall reconstruction.

• Archives of Craniofacial Surgery
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• v.10 no.1
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• pp.1-6
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• 2009

Purpose: This study presents a classification of pure medial and inferior blow-out fracture, and confirms the relationship between the types of fractures, postoperative complications and operative methods. Methods: Sixty patients were treated by transnasal endoscopic reduction with $Medpor^{(R)}$ implantation through subciliary incision and foley catheter insertion into maxillary sinus was done if there was extensive orbital floor fracture. Fractures were classified by number of coronal sections from posterior margin of fossa for lacrimal sac to orbital apex in CT. Type I is defined when the medial wall fracture is over 50% and inferior wall fracture below 50%. Type II, when below 50% medial wall fracture and over 50% floor fracture were present. If there were both over 50%, it was classified as Type III and both below 50% for Type IV. Extreme fracture involving orbital buttress was Type V and postoperative findings in all patients were examined. Results: Type I and V were most common and preoperative findings were more likely to present according to extent of inferior fracture. Diplopia remained in 2 cases after additional insertion of foley catheter, but enophthalmos over 2 mm were presented in 3 cases and diplopia in 3 cases were observed who were not treated with foley catheter. Conclusion: Postoperative complications were increased according to extent of fracture, especially buttress involvement. Additional insertion of foley catheter proved its effectiveness in decreasing postoperative complications.

• Journal of International Society for Simulation Surgery
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• v.3 no.2
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• pp.80-83
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• 2016

A 37-year-old male was assaulted and complained of severe periorbital swelling. Physical examination revealed that there were limitation of eyeball movement on upper gaze, diplopia, and hypoesthesia on the infraorbital nerve innervating region. Three-dimensional (3D) computed tomography (CT) of facial bone exhibited the fracture of orbital floor accompanying the significant amount of orbital contents' herniation extending to the far posterior part. To recover the orbital volume and restore orbital floor without threatening the optic nerve, preoperative simplified simulation was applied. The posterior margin of the fractured orbit was delineated with simulation technique using cross-linkage between the coronal and sagittal sections based on the referential axial view of the CT scans. Dissection, reduction of orbital contents, and insertion of the absorbable mesh plate molded after the prefabricated template by the simulation technique was performed. Extensive orbital floor defect was successfully reconstructed and there were no serious complications. The purpose of this report is to emphasize the necessity of preoperative simulation in case of restoring the extensive orbital floor defect.

• The Journal of the Korean dental association
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• v.54 no.10
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• pp.799-810
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• 2016

Orbital fractures have a significant portion in facial bone trauma. The important thing in treatment of orbital fractures is variable depending on the patient. Reconstruction of orbital wall demands an understanding of the anatomy and function of the orbit, including the orbital tissues, and the approacheds, materials, and methods available.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.675-679
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• 2008

Purpose: In the orbital floor fracture, sensory impairment due to the damage of the infraorbital nerve is one of the most common symptom and complication. In this report, we have the assumption that tailoring of $medpor^{(R)}$ for decompression may have correlations to the damage and regeneration of the nerve. Methods: Among patients who had open reduction for pure orbital floor fracture in our hospital from March 2005 to March 2008, we selected 80 cases. In 40 cases, we inserted tailored $medpor^{(R)}$, and in other 40 cases, non-tailored $medpor^{(R)}$ was inserted. Patient's reports were obtained and analyzed, and the pin-prick test and the 2-point discrimination test on the infraorbital nerve regions were done for testing the sensory impairments. Results: The results show that the patients who adopted sculpture of $medpor^{(R)}$ showed higher tendency of recovery of sensory impairments in the patient's subjective report, static touch sensation, static two point discrimination using. And in postoperative 3 months, there are statistically significant recovery of sensory symptoms, signs and the result of sensory tests. Conclusion: From these results, tailored $medpor^{(R)}$ in reconstruction of orbital wall fracture may improve recovery of sensory impairments for decreasing of compression of infraorbital nerve.