• Archives of Plastic Surgery
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• v.37 no.1
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• pp.99-103
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• 2010

Purpose: Blow-out fractures are reduced through transcutaneous or transconjunctival incisions. But the field of orbital surgery is difficult due to lack of visualization of fracture site, blind dissection of orbital floor, susceptibility of injury of orbital structures. In these situations, the former technique of using an antral balloon catheter has advantages over other methods for reconstruction because of its rapidity, simplicity, and inexpensiveness. Furthermore, the antral balloon catheter allows not only elevation of the orbital bone fragment but also expansion of the maxillary sinus in cases where there is a fracture of its walls. But postoperative follow-up method using computed tomography is expensive. Hence, we report a simple and inexpensive follow-up method using radiopaque dye inflation. Methods: We performed endoscopic transantral approach in 5 cases of blow-out fracture under general anesthesia. To accomplish this technique, a rigid 4 mm, 0 or 30 degree angled endoscopy was inserted into the maxillary sinus. Inflation of the catheter started gradually, with 10 to 15 mL of saline mixed radiopaque dye (saline: dye, 5 : 1) by syringe and while observing the elevation of the fracture site with endoscope until a proper contour was reached. For the maintain of the position of fractured site, 12 French urinary balloon foley catheter were used in fracture site for 7 - 10 days. Results: Postoperative assessment was performed by means of clinical and simple radiographic examination to secure the catheter under the inferior orbital wall and in the maxillary sinus. No specific complications occurred related to this procedure. Results of the surgery and follow-up in all cases were satisfactory. Conclusion: It may be a better alternative to the conventional follow-up method, with less cost and effectiveness of the catheter patency. The advantages of using the urinary balloon foley catheter with the radiopaque dye include the following : it is safe, efficacy, simple, and especially low cost. On drawback of this method is the discomfort to the patient caused by the catheter during the treatment.

• Archives of Craniofacial Surgery
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• v.17 no.3
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• pp.154-157
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• 2016

Transient anisocoria is rare during blowout fracture reconstruction. We report a case of transient anisocoria occurring during medial blowout fracture reconstruction and review the relevant literature. A 54-year-old woman was struck in the face and was admitted for a medial blowout fracture of the left eye. During the operation, persistent bleeding occurred. To control this bleeding, a 1% lidocaine solution with 1:200,000 epinephrine was applied to the orbital wall with cotton pledgets. In total, 40 mL of local anesthetic was used for the duration of the operation. After approximately three hours of the surgery, the ipsilateral pupil was observed to be dilated, with sluggish response to light. By 3 hours after the operation, the mydriasis had resolved with normal light reflex. In conclusion, neurological and ophthalmologic evaluation must be performed prior to blowout fracture surgery. Preoperative ophthalmic evaluation is simple and essential in ruling out any preexisting neurologic condition. Moreover, surgeons must be aware of the fact that excessive injection of lidocaine with epinephrine for hemostasis during orbital wall surgery can result in intraoperative anisocoria. Anisocoria-related situations must be addressed in a proficient manner through sufficient understanding of the mechanism controlling the pupillary response to various stimuli.

• Archives of Craniofacial Surgery
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• v.17 no.3
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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.

• Journal of Trauma and Injury
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• v.19 no.1
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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.

• Archives of Plastic Surgery
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• v.42 no.2
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• pp.247-249
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• 2015

• Proceedings of the KSME Conference
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• 2003.04a
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• pp.670-677
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• 2003

Although Gas Tungsten Arc Welding (GTAW or TIG welding) is considered as high quality and precision welding process, it also has demerit of low melting rate. Narrow-gap TIG welding which has narrow joint width reduces the groove volume remarkably, so it could be shorten the welding time and decrease the overall shrinkage in heavy wall pipe welding. Generally Narrow-gap TIG welding is used as orbital welding process, it is important to select the optimum conditions for the automatic control welding This paper looks at the application and metallurgical properties on Narrow-gap TIG welding joint of heavy wall large austenitic stainless steel pipe to determine the deposition efficiency, the resultant shrinkage and fracture toughness. The fracture toughness depends slightly on the welding heat input.

• Archives of Craniofacial Surgery
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• v.16 no.1
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• pp.35-38
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• 2015

Alloplastic implants have been used to repair orbital wall fractures in most cases. Orbital hemorrhage is a rare complication of these implants and has been reported rarely in Korea. The purpose of this article is to report a late complication case focusing on their etiology and management. A 20-year-old male patient underwent open reduction with Medpor (porous polyethylene) insertion for bilateral orbital floor fractures. The initial symptom occurred with proptosis in the right side as well as vertical dystopia, which had started 4 days earlier, 8 months after surgery. Any trauma history after the surgery was not present. We performed an exploration and removal of hematoma with Medpor titanium meshed alloplastic implant. A case of delayed orbital hematoma following alloplastic implant insertion was identified. It occurred within the pseudocapsule of the implant. One week after surgery, overall symptoms improved successfully, and no complications were reported during the 11-month follow-up period. Although rare, orbital hemorrhage is a potential complication of alloplastic orbital floor implants, which may present many years after surgery. As in the case presented, delayed hematoma should be included in the differential diagnosis of late proptosis or orbital dystopia.

• Archives of Craniofacial Surgery
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• v.22 no.4
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• pp.177-182
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• 2021

Background: Although prompt surgery after an orbital fracture is preferable, the actual timing of surgery in real-world settings varies. Therefore, this study investigated the outcomes of implant surgery for inferior orbital wall fractures by comparing three groups according to the time interval between the injury and surgery. Methods: A retrospective review was conducted of patients' medical charts and initial computed tomography images from 2009 to 2020. The time to treatment was chosen by patients or their guardians based on the patients' comorbidities and the physician's explanation. The patients were divided into three groups according to the time of surgery (group 1: 3-7 days, group 2: 8-14 days, group 3: 15 or more days). Data were collected on age, the time interval until surgery, the dimensions of the defect, the operation time, the follow-up period, and the postoperative paresthesia score (ranging from 0 to 10). The outcomes were evaluated using a 4-point scale: 4=good (no complications), 3=fair (no subjective symptoms), 2=poor (remaining paresthesia), and 1=very poor (strabismus and/or enophthalmos). Results: The study included 85 patients with unilateral fractures who underwent surgery from 3 to 93 days after injury. The overall score distribution of the surgical outcomes was as follows: good=63, fair=7, poor=6, and very poor=9. The three groups showed no significant differences in the transverse dimension of the injury (p=0.110) or the anteroposterior dimension (p=0.144). In groups 1, 2, and 3, the postoperative outcome scores were 3.84±0.37, 3.63±0.87, and 2.93±1.33 (p=0.083), and the percentage of patients with good outcomes was 84%, 81.25%, and 57.14%, respectively. Conclusion: Performing surgery using an artificial implant within 2 weeks of the injury showed better outcomes and fewer postoperative complications than when treatment was delayed.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.3
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• pp.312-316
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• 1999

When the external force was applied to the orbit the most thin area might be displaced. These were usually orbital floor and/or medial wall of orbit. Among these cases some who showed the entrapment of the muscle between the fractured fragments needed the surgical treatment. We had operated 4 cases of the "blow-out" fracture via subciliary approach. The entrapped muscles were freed from fragments and the bony defect was restored with micro-titanium mesh. Mean follow-up periods was 15 months and there were no complication observed.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.428-431
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• 2009

Purpose: Blow out fracture resulting from facial trauma is of high frequency among facial bone fractures, and can cause severe complications. So, proper management and close observation after operation are needed. So far, Computed tomography has been the best choice in the evalution following orbit wall reconstruction. However, cost - effectiveness, accessibility to patients and hazard of radiation exposure of computed tomography require supplementary measure for the evaluation following orbit wall reconstruction. This study was performed to describe the effectiveness of ultrasonography in the evalution following orbit wall reconstruction. Methods: A retrospective study was performed on 40 patients who underwent orbit wall reconstruction from June, 2008 to July, 2008. The patients' ages ranged from 13 to 65 years (mean 27.5 years), and this group was compsoed of 27 male and 13 female patients. The follow up period ranged from 2 weeks to 28 weeks (mean 11weeks). Preoperatively, all fractures were diagnosed using computed tomography. Ultrasonography for all cases, and computed tomography for 2 cases were performed for evaluation following orbit wall reconstruction. Results: Reduction of herniated orbital soft tissue and orbit implant was identified by using ultrasonography in 38 cases out of 40 cases. In other cases which we could not identify the orbit implant, computed tomography was performed. Con clusion: Compared to computed tomography, ultrasonography is simple, inexpensive and convenient method. Ultrasonography can be used as supplementary measure to computed tomography in the evaluation following orbit wall reconstruction for elective patients.