• Archives of Craniofacial Surgery
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• v.21 no.4
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• pp.219-224
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• 2020

Background: Repair of the orbital floor following trauma or tumor removal remains a challenge because of its complex three-dimensional shape. The purpose of the present study is to understand normal orbital floor anatomy by investigating its differences across four groups (Caucasian American and East Asian, males and females) via facial bone computed tomography (CT). Methods: A total of 48 orbits in 24 patients between 20 and 60 years of age were evaluated. Although most patients underwent CT scanning following trauma, the orbital walls were intact in all patients. Linear and angular measurements of the orbital floor were obtained from CT images. Results: Orbital floor width, length, angle between the orbital floor and medial wall, and distance from the inferior orbital rim to the lowest point of the orbital floor did not show a statistically significant difference between groups. Angles made by the infraorbital rim, the lowest point of the floor, and the anterior border of the infraorbital fissure were statistically significantly wider in East Asian females than in male groups. The floor depth in East Asian females was significantly smaller compared to all the other groups. Conclusion: East Asian female population had smaller curvature and depth of an orbital floor than the other groups, which means racial and sex-related differences should be considered in the orbital floor reconstruction.

• Archives of Plastic Surgery
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• v.39 no.1
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• pp.31-35
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• 2012

Background : Orbital roof fractures are frequently associated with a high energy impact to the craniofacial region, and displaced orbital roof fractures can cause ophthalmic and neurologic complications and occasionally require open surgical intervention. The purpose of this article was to investigate the clinical features and treatment outcomes of orbital root fractures combined with neurologic injuries after early reconstruction. Methods : Between January 2006 and December 2008, 45 patients with orbital roof fractures were admitted; among them, 37 patients were treated conservatively and 8 patients underwent early surgical intervention for orbital roof fractures. The type of injuries that caused the fractures, patient characteristics, associated fractures, ocular and neurological injuries, patient management, and treatment outcomes were investigated. Results : The patients underwent frontal craniotomy and free bone fragment removal, their orbital roofs were reconstructed with titanium micromesh, and associated fractures were repaired. The mean follow up period was 11 months. There were no postoperative neurologic sequelae. Postoperative computed tomography scans showed anatomically reconstructed orbital roofs. Two of the five patients with traumatic optic neuropathy achieved full visual acuity recovery, one patient showed decreased visual acuity, and the other two patients completely lost their vision due to traumatic optic neuropathy. Preoperative ophthalmic symptoms, such as proptosis, diplopia, upper eyelid ptosis, and enophthalmos were corrected. Conclusions : Early recognition and treatment of orbital roof fractures can reduce intracranial and ocular complications. A coronal flap with frontal craniotomy and orbital roof reconstruction using titanium mesh provides a versatile method and provides good functional and cosmetic results.

• Archives of Craniofacial Surgery
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• v.13 no.1
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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 Craniofacial Surgery
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• v.23 no.6
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• pp.262-268
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• 2022

Background: To compare the sensory change and recovery of infraorbital area associated with zygomaticomaxillary and orbital floor fractures and their recoveries and investigate the factors that affect them. Methods: We retrospectively reviewed 652 patients diagnosed with zygomaticomaxillary (n= 430) or orbital floor (n= 222) fractures in a single center between January 2016 and January 2021. Patient data, including age, sex, medical history, injury mechanism, Knight and North classification (in zygomaticomaxillary fracture cases), injury indication for surgery (in orbital floor cases), combined injury, sensory change, and recovery period, were reviewed. The chi-square test was used for statistical analysis. Results: Orbital floor fractures occurred more frequently in younger patients than zygomaticomaxillary fractures (p< 0.001). High-energy injuries were more likely to be associated with zygomaticomaxillary fractures (p< 0.001), whereas low-energy injuries were more likely to be associated with orbital floor fractures (p< 0.001). The sensory changes associated with orbital floor and zygomaticomaxillary fractures were not significantly different (p= 0.773). Sensory recovery was more rapid and better after orbital floor than after zygomaticomaxillary fractures; however, the difference was not significantly different. Additionally, the low-energy group showed a higher incidence of sensory changes than the high-energy group, but the difference was not statistically significant (p= 0.512). Permanent sensory changes were more frequent in the high-energy group, the difference was statistically significant (p= 0.043). Conclusion: The study found no significant difference in the incidence of sensory changes associated with orbital floor and zygomaticomaxillary fractures. In case of orbital floor fractures and high-energy injuries, the risk of permanent sensory impairment should be considered.

• Journal of Mechanical Science and Technology
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• v.20 no.2
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• pp.177-184
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• 2006

An orbital design method of the formation initialization based on the relative orbital element method is presented. It firstly constructed the relative motion equation of the satellite formation flying in terms of the leader and followers' orbital elements. Then the equation was simplified when the orbit eccentricity of the leader satellite was small. And according to the satellites' mission, a general design method for the relative trajectory was proposed. The advantage of this method is that one can get a very simple analytical formula of each follower satellite's orbital elements when the orbital eccentricity of the leader satellite is zero. The simulation results show that the method is effective.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.3
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• pp.356-359
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• 2000

Superior orbital fissure syndrome is characterized by ophthalmoplegia, ptosis of the eye, reflex dilation of the pupil, and anesthesia of the upper eyelid and forehead. This syndrome may be the result of craniofacial fractures as well as neoplasms of the retrobulbar space, hematomas in the orbital muscle cone and retrobulbar space, and hematoma and infection of the cavernous sinus. A case of superior orbital fissure syndrome is described.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.617-622
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• 2009

Purpose: Endoscopic transnasal correction of the blowout fractures has many advantages over other techniques. But after removal of packing material, there were some patients with recurrence of preoperative symptoms. Authors tried to make a quantitative anterograde analysis of orbital volume change over whole perioperative period which might be related with recurrence of preoperative symptoms. Methods: 10 patients with pure medial wall fracture(Group I) and 10 patients with medial wall fracture combined with fracture of orbital floor(Group II) were selected to evaluate the final orbital volume change, who took 3 CT scans, pre-, postoperative and 4 months after packing removal. By multiplying cross - section area of orbit in coronal view with section thickness, orbital volume were calculated. Then, mean orbital volume increment after trauma, mean orbital volume decrement after endoscopic correction and volume increment after packing removal were found out. And we tried to find correlations between type of fracture, initial correction rate and final correction rate. Results: The mean orbital volume increment of the fractured orbits were 7.23% in group I and 13.69% in group II. After endoscopic surgery, mean orbital volume decrement were 11.0% in group I and 12.46% in group II. Mean volume increment after packing removal showed 3.10% in group I and 6.50% in group II. The initial correction rate(%) showed linear correlation with final correction rate(%) after packing removal. And there were negative linear correlation between increment percentage of orbital volume by fracture and final correction rate(%). Conclusion: Orbital volume was proved to be increasing after removal of packing or foley catheter and it was dependent upon type of fracture. Overcorrection should be done to improve the final result of orbital blowout fracture especially when there are severe fracture is present.

• Journal of Korean Neurosurgical Society
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• v.46 no.1
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• pp.77-80
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• 2009

Orbital solitary fibrous tumor (SFT) is a rare tumor originating from the mesenchyme. We describe the clinical presentations, radiological and operative findings, and pathological features of a patient with orbital SFT. The patient was a 46-year-old female who presented with progressive proptosis advanced for 20 months. On ophthalmological examination, no visual impairment was detected, but left eye was found to be obviously protruded on exophthalmometry. Orbital magnetic resonance imaging showed a 2.5 ${\times}$ 2 ${\times}$ 2 cm, intensely enhanced mass in the left orbit, which compressed the eyeball forward and the optic nerve downward. The patient underwent frontal craniotomy with superior orbitotomy and gross total resection was performed for the tumor. The histopathological diagnosis including immunohistochemistry was a SFT. After the surgery, proptosis was markedly relieved without visual impairment. Although orbital SFT is extremely rare, it should be considered in the differential diagnosis of orbital tumors. Clinical presentations such as painless proptosis and CD34 immunoreactivity play a significant role in differentiating orbital SFT from other spindle-cell neoplasms of the orbit.

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.552-556
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• 2006

Purpose: As the use of computed tomographic scanning spread, the diagnosis of blow-out fractures of the medial orbital wall increased. Conventionally, the surgery of blow-out fractures in medial orbital wall was performed by various approaches with external incision or endoscopic approach. Although the field of orbital surgery has progressed significantly during the last decade, accurate realignment and replacement of component is difficult due to lack of visualization of the fracture site, blind dissection of the orbital wall, and difficulty in insertion of implant. In order to overcome these shortcomings, we explored the use of endoscopic transnasal approach together with subciliary approach. Methods: The entrapped periorbital tissues in the ethmoid sinus were completely reduced endoscopically, and the bone defect of medial orbital wall was reconstructed with $Medpor^{(R)}$ insertion via subciliary approach. This technique was applied to 13 patients who had medial orbital wall fracture. Results: The patients were followed-up for 3 to 24 months with an average of 9 months. The postoperative courses were satisfactory in all cases. Conclusion: The conjunction of endoscopic transnasal and subciliary approach technique seems to produce good results in medial orbital wall fracture.

• Archives of Craniofacial Surgery
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• v.20 no.4
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• pp.274-278
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• 2019

Orbital tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrimal gland, periosteum, or bones of the orbital wall. We present a case of orbital tuberculosis on the lower eyelid. An 18-year-old woman with no underlying disease visited our clinic for evaluation of an oval nodule ($1.5{\times}1.2cm$) on the right lower eyelid. Incision and drainage without biopsy was performed 2 months ago in ophthalmology department, but the periorbital mass had deteriorated, as the patient had erythematous swelling, tenderness, and cervical lymphadenopathy. Visual acuity was normal; there were no signs of proptosis, diplopia, or ophthalmoplegia. Computed tomography revealed a small abscess cavity without bony involvement. We performed an excision and biopsy through a percutaneous incision under local anesthesia. Histological examination revealed a granuloma and was diagnosed as orbital tuberculosis. The patient was additionally treated with anti-tuberculosis therapy for 6 months and recovered without complication or recurrence by 7 months. Orbital tuberculosis occurs in patients with or without associated pulmonary tuberculosis, and should be considered as a differential diagnosis in patients with inflammatory orbital disease and an orbital mass. If recurrence occurs despite adequate initial treatment, we recommend an additional examination and excisional biopsy.