• Archives of Craniofacial Surgery
• /
• v.11 no.1
• /
• pp.1-6
• /
• 2010

Purpose: Many surgical approaches for reconstruction of blow out fracture have been introduced, which include subciliary incision, transconjunctival incision and transcaruncular incision. Recently endoscopic approach has been attempted. This study was intended to show the effectiveness of the approach through transconjunctival incision combined with transnasal reduction in reconstructing blow out fracture to its original position. Methods: Medical recoreds of 43 patients from March 2008 to March 2009 who underwent surgery for orbital fracture were reviewed, retrospectively. All fractures were operated through transconjuctival incision approach combined with transnasal reduction. The average follow-up period was 10.1 months. To evaluate the surgical outcomes of orbital fracture, we performed CT of the facial bone before and after the surgery. In addition, preoperative and postoperative data of enophthalmos, diplopia and the limitation of extraocular motion was assessed with physical examination. Results: Post-operative CT scan of 43 patients assured that the bone fragments of the orbital fractures were restored to their original positions. Although a few patients developed postoperative transient diplopia or impairment of ocular movement, most of the patients recovered during the follow-up period without complication. Conclusion: From this study, we were able to demonstrate the effectiveness of the transnsasal reduction technique combined with the approach through transconjunctival incision. This technique can be considered as very useful means of repairing orbital fracture. It is not only easy to perform but also it can minimize the damage to the orbital bone. Furthermore, it can restore the fracture to its original position as much as possible.

• Archives of Craniofacial Surgery
• /
• v.10 no.2
• /
• pp.86-90
• /
• 2009

Purpose: Inferior blow-out fracture is the common facial fracture. Unsatisfactory functional and aesthetic outcomes are frequent when it is treated inappropriately. If fractures are extended and reach the posterior end of orbital floor, enophthalmos frequently followed as complication. The purpose of this study was to evaluate reduction technique of extensive inferior blow-out fracture with ballooning of foley catheter through endoscopic transnasal approach and implantation of $Medpor^{(R)}$ through subciliary approach. Methods: A retrospective study was performed on 14 patients with extensive inferior blow-out fracture who underwent ballooning of foley catheter through endoscopic transnasal approach with implantation of $Medpor^{(R)}$ through subciliary approach. Patients were operated from May 2005 to November 2007. Data for 14 patients were acquired from patient's charts. Preoperative and postoperative data for enophthalmos, diplopia, limitation of extraocular motion were reviewed. Preoperative and postoperative CT scan were also checked. The patients were followed up from 4 to 18 months. Results: The enophthalmos was corrected in all patients. Among 7 patients with diplopia preoperatively, diplopia was resolved in three patients postoperatively. The diplopia persisted in four patients and two of them also had limitation of extraocular motion postoperatively. The limitation of extraocular motion occurred in seven patients preoperatively. But five patients recovered after operation immediately. These symptoms were resolved about three months after the operation. Conclusion: The ballooning of foley catheter through endoscopic transnasal approach with implantation of $Medpor^{(R)}$ through subciliary approach can be considered one of the appropriate technique for extensive inferior blowout fracture.

• Archives of Craniofacial Surgery
• /
• v.10 no.1
• /
• pp.7-13
• /
• 2009

Purpose: Endoscopic transnasal correction of the medial orbital fractures cannot be enable to confirm the reduction degree of orbital volume without imaging modalities. We have intended through this study to make a quantative analysis of preoperative orbital volume increment and the reduction degree of that after ethmoidal sinus packing by using CT scan. Methods: In this retrospective study, 22 patients were selected to evaluate the postoperative volume reduction, who took 2 CT scans which are pre- and postoperative under the same protocol. The postoperative CT scan was carried out in about 5 days after the operation with the packing inserted into ethmoidal sinus. The length of bony defect on each section was measured by PACS program and the area of defect was calculated by summing lengths on each section multiplied by the thickness of the section. When the outline of orbit on the slice is drawn manually with a cursor, PACS program measures the area automatically. Orbital volume was calculated from the sum of the area multiplied by the section thickness. Results: The mean dimension of fractured walls was $2.86{\pm}0.99cm^2$. The mean orbital volume of the unaffected orbits was $22.89{\pm}2.15cm^3$ and that of the affected orbits was $25.62{\pm}2.82cm^3$. The mean orbital volume increment of the affected orbits was $2.73{\pm}1.13cm^3$. After surgery, the mean orbital volume of the unaffected orbits was $22.46{\pm}2.73cm^3$ and the mean orbital volume decrease on the surgical side was $2.98{\pm}1.07cm^3$. The estimated correction rate was 118.30%. Conclusion: The orbital volume increment in fractured orbit showed linear correlation with the dimension of fractured area. The orbital volume changes after ethmoidal sinus packing also showed linear correlation with orbital volume increment in fractured orbit. This study showed the regressive linear correlation between the increment of orbital volume and the correction rate. To evaluate the maintenance of reduction state, we think that the further study should be done for comparative analysis of orbital volume change after removal of packing.

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