Medial Rectus Muscle Entrapment Research Articles

Polyester Urethane Implants for Orbital Trapdoor Fracture Repair in Children

The objective of this study was to present the surgical and clinical outcomes of polyester urethane implants in orbital trapdoor fracture repair in children. This is the first study reporting on the use of polyester urethane implants to repair orbital fractures. A retrospective review was performed of children with orbital trapdoor fracture who underwent surgical repair in the authors' medical center over 6years. The trapdoor fracture diagnosis was based on clinical and computed topographic findings. Eight patients with trapdoor fracture were identified. All cases were repaired by polyester urethane implant placement. Patients' mean age was 13.5years and mean follow-up was 13.6months. All patients had orbital floor fractures. Two fractures also involved the medial wall. Seven patients had inferior rectus muscle entrapment and 1 had medial rectus muscle entrapment. Three patients had residual diplopia on extreme upgaze after the surgical repair. No patient had enophthalmos or infraorbital paresthesia at the end of follow-up. No postoperative complications associated with the used material were reported. The polyester urethane implant is a reliable, safe, inexpensive, and effective implant for trapdoor fracture repair in children. It can serve as a promising alternative to implants fabricated from other synthetic materials for orbital floor fracture repair.

Pseudo-Duane’s Retraction Syndrome Associated with Medial Wall Trapdoor Orbital Fracture

Trapdoor orbital fractures are uncommon and tend to occur in children and young adults. Medial orbital wall fractures with associated incarceration of the medial rectus muscle have been reported as the most common cause of pseudo-Duane’s retraction syndrome. We report a case of a 10-year-old patient with isolated medial wall trapdoor orbital fracture with right medial rectus muscle entrapment visible on the CT scan. The patient complained of nausea and vomiting especially with abduction of the right eye and showed signs of pseudo-Duane’s syndrome. It was satisfactorily resolved via a transcaruncular approach.

Endonasal endoscopic surgery in treatment of medial recus muscle entrapment: the management and effectiveness

Objective:To explore the indications , surgery method and effect for the treatment of medial rectus muscle entrapment with endoscopic surgery.Method: Eight medial rectus muscle entrapment patients were enrolled in this study,3 cases underwent obital medial wall fracture reposition and medial rectus muscle adhesion decomposition surgery through endonasal endoscope,and 5 cases received obital medial wall fracture reposition surgery with endoscope through nasal cavity and lacrimal caruncle conjunctival incision. Result:The diplopia disappeared and eyeball abduction function recovered in 6 cases of medial rectus muscle entrapment patients within 2 months,and 1 case with each surgery had mild diplopia and eyeball incomplete abduction left.Conclusion:Adopting endonasal endoscopic surgery or dual approaches surgery with endonasal endoscopic and transcaruncular surgery were ideal methods for medial rectus muscle entrapment diseases.Surgery with endoscope has the characteristics of clear field and less damage.The surgery should be performed whithin 3 weeks, and the entrapment of medial rectus muscle can be resoved effectively.

Transient Exotropia after Open Reduction of a Naso-Ethmoidal-Orbital Fracture.

Transient Exotropia after Open Reduction of a Naso-Ethmoidal-Orbital Fracture.

A Case of Pediatric Medial-Orbital Wall Fracture with Extraocular Muscle Entrapment

Purpose: To report a case of pediatric medial wall blowout fracture with entrapment of medial rectus muscle which can be easily misdiagnosed as a cerebral lesion. Case summary: A 16-year-old male visited our clinic with headache, severe restriction of his right eye movement, and diplopia after a head injury due to falling occurring 1 day before evaluation. The patient was inebriated at the time of the accident and could not recall the event but occipital hematoma was palpable. Periorbital ecchymosis or edema was not observed with minimal soft tissue injury except mild conjunctival injection on slit-lamp examination. The patient had an 18 prism diopter exodeviation at primary position and severe medial and mild lateral gaze limitation in his right eye. Brain magnetic resonance imaging (MRI) showed no specific cerebral findings although trapdoor orbital medial wall fracture with incarceration of soft tissue and medial rectus muscle at the medial wall fracture site of his right eye was observed. Within 48 hours from the first evaluation, the blowout fracture was repaired and 50 days postoperatively, right eye gaze limitation and diplopia were nearly recovered. Conclusions: A case of pediatric blowout fracture with uncertain injury location, periocular ecchymosis, or edema absent could be misdiagnosed as a cerebral lesion. If a pediatric patient is experiencing gaze limitation, diplopia, nausea, or vomiting after trauma, neurological examination as well as evaluation for blowout fracture should be performed. J Korean Ophthalmol Soc 2015;56(6):961-966

The White-Eyed Medial Blowout Fracture

The pediatric white-eyed blowout fracture with entrapment of the inferior rectus muscle is well recognized as an easily missed injury with significant morbidity if left untreated. A series of five isolated medial orbital blowout fractures with medial rectus muscle entrapment is described. The purpose of this study was to define this injury pattern and its clinical outcome. A retrospective review of the presentation, management, and clinical outcomes of identified cases was conducted. Early exploration and release of the entrapped muscle combined with implant reconstruction of the medial orbital wall within 2 weeks resulted in complete resolution of diplopia and full recovery of extraocular movements. Delayed treatment and release of the soft tissues without orbital wall reconstruction were associated with restricted gaze and diplopia. Similar outcomes were confirmed on analysis of other reported cases. Orbital floor blowout fractures in the pediatric population have a high incidence of muscle entrapment that must be recognized and treated early to avoid muscle necrosis and permanent ocular restriction from fibrosis. Medial orbital wall fractures with entrapment are rare, but early recognition and operative release of the entrapped muscles result in better outcomes.

Endoscopically assisted reconstruction of orbital medial wall fractures.

Traditional surgical approaches to orbital medial wall fractures are either direct extraocular skin incisions or indirect bicoronal flap. However, these methods can leave remarkable orbital scars or scalp alopecia with the possible associated complications. A minimally invasive endoscopic technique with the assistance of a 2.7-mm, 30-degree telescope through a medial transconjunctival incision has been successfully used to reconstruct the orbital medial wall fractures. This technique was applied to four patients who had orbital medial wall fractures. Three patients also had concomitant orbital floor fractures. The other had associated superior orbital fissure syndrome. All patients were presented with limited eye movement, positive forced duction test, horizontal diplopia, and enophthalmos (3 mm to 6 mm) preoperatively. The entrapped periorbital tissues in the ethmoid sinus were completely reduced endoscopically. The bone defect of orbital medial wall was reconstructed with autogenous rib bone grafts under endoscopic control. The patients were followed up for 8 to 16 months with an average of 11 months. Three patients recovered completely without any residual eye symptoms after intervention. Clinically significant residual enophthalmos of 3 mm occurred in the patient with the superior orbital fissure syndrome. His eye movement limitation caused by entrapment of medial rectus muscle was relieved postoperatively. There was no donor-site morbidity or any complications related to the endoscopically assisted procedure. Endoscopically assisted medial transconjunctival approach to the orbital medial wall fractures is an excellent adjunct for the exposure and complete reduction of herniated periorbital tissue and bony reconstruction of the medial orbital wall.

Medial Orbital Wall Fractures

Medial wall fractures are often overlooked during routine radiographic examination and rarely develop complications. We present complications associated with medial wall fracture in six cases. Complications from medial rectus muscle entrapment include restricted and painful abduction, pseudo-sixth-nerve paresis and pseudo-Duane's-retraction syndrome. Massive orbital emphysema, in one case, was responsible for temporary loss of vision prior to definitive treatment. Two patients developed severe enophthalmos secondary to the medial wall fractures. We suggest that orbital exploration is indicated for painful or limited ocular motility, significant diplopia, severe orbital emphysema, or severe enophthalmos. An inferior approach to the medial wall through the lower eyelid provides good exposure and minimal cosmetic deformity. Postoperative complications included transient paresis of the medial rectus muscle, residual motility disturbance, and residual enophthalmos.

Medial orbital blow‐out fracture: A case report

A case report of orbital blow-out fracture with medial rectus muscle entrapment is described. Over one-third of the patients with blow-out fractures of the orbital floor also sustain medial wall injury. Five previous case reports of medial entrapment are reviewed. The mechanism of injury is hydraulic, and the medial muscle incarceration in the fracture may produce an orbital retraction syndrome. Exploratory surgery is recommended through an external orbito-ethmoid approach.

Medial orbital wall fracture with rectus entrapment.

Two cases of medial orbital fracture with medial rectus muscle entrapment are reported, one a bona fide blowout fracture. Review of the literature reveals six previous cases. Clinically, patients complain of diplopia with lateral gaze and forced duction tests confirm medial rectus entrapment. Radiographic confirmation is best obtained with hypocycloidal tomography. Surgical therapy is indicated for diplopia or enophthalmus.

Isolated Blowout Fracture of the Medial Orbital Wall with Medial Rectus Muscle Entrapment

Isolated Blowout Fracture of the Medial Orbital Wall with Medial Rectus Muscle Entrapment