Combined Orbital Medial Wall Research Articles

Correlation between surgical timing and postoperative ocular motility in orbital blowout fractures.

The study reports the correlation between surgical timing and postoperative ocular motility in orbital blowout fractures. This was a retrospective study of 191 patients that underwent surgical repair for unilateral orbital fractures. All patients included in the study had symptomatic diplopia from the fracture. Patients were classified into one of three groups according to the time of surgery after injury: (1) Early (within 14days of surgery), (2) intermediate (between 15 and 30days), and (3) late (greater than 30days). Ocular motility was measured presurgery and at 3 and 6months postsurgery by Hess chart with calculation of the Hess area ratio (HAR%). Surgery was conducted at a mean of 24.7 ± 45.0days (range: 1-283days) postinjury. There were 120 patients in the early surgery group (surgery at 6.8 ± 3.8days), 38 in the intermediate surgery group (20.7 ± 4.1days), and 33 in the late surgery group (95.1 ± 75.0days). Overall the HAR% improved significantly from a mean of 74.2% preoperatively to 90.8% at 6months postoperatively (p < 0.01). In the early and intermediate groups, the postoperative HAR% improved significantly with all fracture regions (orbital floor, medial wall, and combined orbital medial wall and floor) (p < 0.05). However, in the late groups, the postoperative HAR% only improved significantly with orbital floor fractures. Pre- and postoperative the HAR% give objective evidence of ocular motility improvement with early orbital floor fracture repair surgery. However, observation can be deployed, as a significant improvement in ocular motility can also be achieved with reconstructive surgery conducted 30days or more after depressed floor-fragment fractures. Early intervention should be prioritized for symptomatic medial wall fractures, as late surgery does not improve motility.

Endoscopic repair of combined orbital floor and medial wall fractures involving the inferomedial strut.

To evaluate the safety, efficacy, and feasibility of an endoscopic transconjunctival inferior fornix and precaruncular approach for repair of combined orbital medial wall and floor fractures involving the inferomedial strut. A retrospective study was performed in 84 patients with combined orbital medial wall and floor fractures involving the inferomedial strut. All patients underwent surgery by endoscopic transconjunctival inferior fornix and precaruncular approach. A large polyester mesh plate was implanted to cover the fracture defect. The enophthalmos, diplopia, and surgical complications were evaluated pre- and postoperatively. Patients were followed for at least 6 months. A total of 84 patients (55 men and 29 women) with a mean age of 36.88 ± 12.95 years were included in this study. Preoperatively, all 84 patients had an enophthalmos >2 mm, and the mean exophthalmometry measurement was 11.6 ± 2.14 mm. Diplopia was presented in 33 patients. Postoperatively, good symmetry was acquired in 81 of 84 patients, with a mean improvement of 3.02 ± 0.99 mm in the enophthalmos (P < 0.05). Recovery from diplopia occurred in 32 of 33 patients. A new onset of diplopia occurred postoperatively in 13 of the remaining 51 patients, only to recover spontaneously after 1 month. One patient suffered retrobulbar hemorrhage after surgery and was cured by conservative therapy. No other serious complications occurred. The endoscopic transconjunctival inferior fornix and precaruncular approach is a promising management technique for combined orbital medial wall and floor fractures involving the inferomedial strut.

Assessment of a Consecutive Series of Orbital Floor Fracture Repairs With the Hess Area Ratio and the Use of Unsintered Hydroxyapatite Particles/Poly l-Lactide Composite Sheets for Orbital Fracture Reconstruction

The purpose of this study is to report the outcomes of a series of orbital fracture repairs, their assessment with the Hess area ratio (HAR%), and the use of unsintered hydroxyapatite (HA) implants for reconstruction. This study involved 207 consecutive unilateral orbital fractures with symptomatic diplopia that underwent surgical repair within 28 days of injury. Ocular movement was measured presurgery and at 3 and 6 months postsurgery by Hess chart with calculation of the HAR%. Surgery was conducted on 207 patients (161 males and 46 females; mean age, 27.8years) at a mean of 9.9days postinjury and with a mean follow-up of 8.6months. There were 160 patients with orbital floor fractures, 27 with medial wall fractures, and 20 with combined orbital medial wall and floor fractures, 135 of 207 patients had orbital blowout fractures, and 72 had orbital trap-door fractures. The HAR% improved significantly from a mean of 73.8% preoperatively to 92.7% postoperatively (P<.01). Orbital fractures were reconstructed with either unsintered HA particles/poly l-lactide composite sheet (133 patients), a silicone silastic sheet (47 patients), a combination of sheets (15 patients), or without an implant (12 patients). There was no significant difference in the HAR% improvement between the different implants. Very good outcomes can be achieved with early orbital floor fracture repair surgery, which can be assessed preoperatively and postoperatively by HAR%. Unsintered HA/poly l-lactide composite sheets are an effective absorbable material for orbital floor fracture reconstruction.