Reconstruction Of Blow-out Fractures Research Articles

“ Initial experience with augmented reality for treatment of an orbital floor fracture – A Technical Note ”

The marked developments in the fields of 3D planning and printing in the last few decades, have enabled the application of virtual surgical planning (VSP) toward personalization of surgical procedures and implants. Augmented reality superimposes digital content on the real-world reality. The aim of this technical note was to introduce the use of AR to evaluate and guide the insertion and positioning of a patient specific implant (PSI) for orbital floor blow-out fracture reconstruction. A 31-year-old, healthy male was injured and suffered from left orbital floor blow-out fracture. DICOM images of the CT scan were obtained for segmentation and for VSP, PSI design and 3D Printing. Patients’ file with the 3D objects was uploaded to AR software. The patient's left orbital floor was approached via the trans-conjunctival incision, PSI titanium plate was set in place and using AR Special head-mounted displays (HoloLens 1, Microsoft) the correct planned position of the plate was confirmed. The post-operative CT scan showed a <0.3 mm discrepancy in all axes of the plate in relation to the planned position. AR application in medicine and in maxillofacial surgery bears great potential, However, further investigation of this technology is required

Analysis of Patients With Blowout Fracture Caused by Baseball Trauma

Abstract The purpose of this study was to investigate the characteristics of blowout fractures caused by baseball trauma. The authors reviewed 337 cases of blowout fracture surgeries and included 330 eyes of 330 patients who underwent blowout fracture reconstruction between January 2017 and December 2020, in the Department of Ophthalmology at Korea university Hospital. Medical records including patient demography, trauma etiology, accompanied ocular disease, and preoperative computed tomography images were evaluated. Patients were categorized into 2 groups: a group with blowout fracture caused by baseball trauma and another group with trauma due to other causes. Two-wall blowout fracture (orbital floor fracture and medial wall fracture) was most common (63.16%) in the baseball group, followed by medial wall fracture (21.05%). In contrast, orbital floor fracture accounted for the largest proportion (42.11%) among other causes, and 2-wall blowout fracture accounted for the second largest proportion (31.83%). The most common accompanied ocular disease was traumatic hyphema and traumatic iridocyclitis (36.84%) in the baseball blowout fracture group. in contrast, subconjunctival hemorrhage was the most common ocular disease in the other-causes group (16.08%). The frequency of traumatic hyphema and irido-cyclitis was significantly different among the 2 groups (P &lt; 0.05). Distribution of blowout fracture sites and frequent ocular disease differed between baseball blowout fracture patients and other-cause blowout fracture patients.

Comparison of Blowout Fracture Sites Observed in Young and Elderly East Asians.

The purpose of this study was to investigate the distribution of blowout fracture sites among age groups and compare clinical factors that can affect the fracture site. The authors reviewed 330 cases of blowout fracture surgeries and included 226 eyes of 226 patients aged between 20 and 29 years and between 50 and 59 years who underwent blowout fracture reconstruction between January 2017 and December 2020, in the Department of Ophthalmology at Korea University Hospital.Medical records including patient demography, trauma etiology, and preoperative computed tomography image were evaluated. Ethmoidal cell septa and fracture site position were compared between the 2 age groups. The causes of injury were categorized into 3 groups: focal trauma, gross trauma, and other causes. Orbital floor fracture was the most common type (40.00%) in the young group, followed by medial wall fracture (25.33%). in contrast, medial wall fracture accounted for the largest proportion (42.11%) in the older group, and orbital floor fracture accounted for only 26.67%. The major cause of blowout fracture in young patients was focal trauma, whereas gross trauma was the most common cause in the older group. The number of ethmoidal cells was 4.19 ± 0.831 (2-6) in the young group and 3.91 ± 1.022 (2-6) in the old group (P < 0.05). Distribution of blowout fracture site differed between age groups, and these differences can be explained by cause of injury and number of ethmoidal cells.

A comparative study of porous polyethylene versus absorbable polydextro- and polylevolactic-lactide plate in reconstruction of isolated medial orbital wall fracture

Several materials for medial orbital wall reconstruction have been mentioned in the literature. Our main purpose was to investigate postoperative enophthalmos and diplopia after medial orbital wall reconstruction with polydextro- and polylevolactic (poly-L/DL) acid (P[L/DL]LA) mesh plates and porous polyethylene plates. Using a retrospective study design, we enrolled a cohort of isolated medial blowout fracture patients treated during a 58-month interval. The predictor variable was medial orbital wall reconstruction materials (P(L/DL)LA mesh plate and porous polyethylene plate. The main outcome variables included the occurrence of postoperative enophthalmos and diplopia at 1 week, 1, 3, 6, and 12 months post-surgery. Appropriate descriptive, uni- and bivariate statistics were computed, and P < 0.05 was considered significant. Three hundred-two isolated medial blowout fracture patients were included (24.5% females, 67% treated with P(L/DL)LA mesh plate). Exophthalmos measured highest in both groups 1 week after surgery and decreased steadily for 6 months postoperatively. Statistically significant differences were observed between both groups at 1 week, 1 month, and 3 months after surgery, with a higher incidence of exophthalmos observed in the P(L/DL)LA mesh plate group (P < 0.001). No significant differences were observed at 6 and 12 months after surgery. The occurrence of enophthalmos after medial blowout fracture reconstruction with P(L/DL)LA mesh plate is comparable with the use of porous polyethylene plate. Both P(L/DL)LA mesh and porous polyethylene plates are, therefore, reliable implants for medial orbital wall reconstruction.

Low-Cost, Three-Dimensionally-Printed, Anatomical Models for Optimization of Orbital Wall Reconstruction.

Orbital blowout fracture reconstruction often requires an implant, which must be shaped at the time of surgical intervention. This process is time-consuming and requires multiple placement trials, possibly risking complications. Three-dimensional printing technology has enabled health care facilities to generate custom anatomical models to which implants can be molded to precisely match orbital anatomy. The authors present their early experience with these models and their use in optimizing orbital fracture fixation. Maxillofacial computed tomographic scans from patients with orbital floor or wall fractures were prospectively obtained and digitally reconstructed. Both injured-side and mirrored unaffected-side models were produced in-house by stereolithography printing technique. Models were used as templates for molding titanium reconstruction plates, and plates were implanted to reconstruct the patients' orbital walls. Nine patients (mean age, 15.5 years) were included. Enophthalmos was present in seven patients preoperatively and resolved in six patients with surgery. All patients had excellent conformation of the implant to the fracture site on postoperative computed tomographic scan. Postoperative fracture-side orbital volumes were significantly less than preoperative, and not significantly different from unfractured-side orbital volumes. Total model preparation time was approximately 10 hours. Materials cost was at most $21. Plate bending time was approximately 60 seconds. Patient-specific orbital models can speed the shaping of orbital reconstruction implants and potentially improve surgical correction of orbital fractures. Production of these models with consumer-grade technology confers the same advantages as commercial production at a fraction of the cost and time. Therapeutic, IV.

Digital Diagnostics and Therapeutics

Information technology (IT) has much to offer for the healthcare. Healthcare IT covers a broad range of computer and technological advancement used in its environments and tools such as electronic health records (EHR), laboratory and medical imaging information systems, use of dedicated medical devices and facilitation of healthcare communication. It also supports the diagnostic ability for the healthcare members and enhance treatment deliveries reflecting patient-centered approach. However, despite vast challenges involve in the development and maintenance of these complex systems as a platform to hold enormous clinical and diagnostic information for huge number of patients, very little of these captured data are involved in the entire aspect of surgica l diagnostics and therapeutics. In most clinical situations, it merely serves for record keeping with minimal involvement in shaping the surgical workflow, perioperative clinical decision making or to enhance surgical deliveries. The aim of this presentation was to highlight our institutional experience with the utilization of various advance digital diagnostics and therapeutic software and tools for surgical management of jaw tumors and maxillofac ia l fracture reconstruction, with emphasis on orbital blowout fracture reconstruction. Bridging and personalized diagnostic procedures for therapeutic or surgical use, pre-procedural or virtual planning, image-guided surgery and perioperative surgical control and check with the use of computer technology will be highlighted in this presentation. It is hoped that this presentation could serve as sharing and learning platform for all conference delegates with regards to the revolutionary digital diagnostic and therapeutic trends in some aspect of oral and maxillofac ia l surgical procedures.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 15

Application of Three-Dimensional Printing Technology in the Orbital Blowout Fracture Reconstruction.

The aim of this study was to investigate the clinical outcomes of orbital blowout fracture repair by using the three-dimensional (3D) printing-assisted fabrication of individual titanium mesh. Clinical and radiologic data were analyzed for 12 patients with orbital floor and/or medial wall fractures. Lower eyelid incision was used to expose the fractures. Preoperative computed tomographic data were input into an imaging software to rebuild a 3D orbit and mirror the unaffected side into the affected side to replace the demolished orbit. A resin model of the reshaped orbit was generated and used to develop an individual titanium mesh for repairing the fractured orbital. The surgical results were assessed by value of enophthalmos and a comparison of preoperative and postoperative orbital volume difference. All patients had a successful treatment outcome without any complications. Clinical significant enophthalmos were not observed after treatment, and diplopia were solved within 2 weeks postoperative. No extraocular muscle limitation was observed. Postoperative computed tomography scans demonstrated appropriate positioning of titanium mesh and there was no implant displacement. The postoperative orbital volume and enophthalmos difference between the 2 eyes decreased significantly than preoperative (P < 0.001). Three-dimensional printing-assisted fabrication of individual titanium mesh is appropriate for use in orbital blowout fracture.

Does postoperative orbital volume predict postoperative globe malposition after blow-out fracture reconstruction? A 6-month clinical follow-up study

PurposeThe aim of this study was to investigate the relationship between intraorbital volume change caused by orbital fracture and globe malposition (GMP) in blow-out fracture patients undergoing surgery and to clarify the significance of different radiologically detected predictors associated with GMP.Patients and methodsA 6-month prospective follow-up study of unilateral isolated orbital fractures was designed and implemented. The main outcome variable was GMP (present or absent); the secondary outcome was orientation of GMP (horizontal or vertical). The primary predictor variable was postoperative orbital volume difference determined as the difference between the fractured and non-fractured orbit (measured in milliliter and analyzed in milliliter and percentages). The explanatory variables were gender, age, treatment delay from trauma to surgery, fracture site, horizontal depth of the fracture, fracture area, maximum vertical dislocation of the fracture, and preoperative volume difference.ResultsA total of 15 patients fulfilled the inclusion criteria and were followed for 6 months from a larger cohort. GMP was detected in 6/15 patients (40.0%). GMP was more often present in large (≥ 2.5 cm2) fractures (55.6%), in combined orbital fractures (50.0%), and in fractures with preoperative volume difference ≥ 2.5 ml (62.5%) regardless of the postoperative volume correction. Postoperatively, patients with and without GMP displayed overcorrection of orbital volume; 4.15% corresponded to 1.15 ml (with GMP) and 7.6% corresponded to 1.9 ml (without GMP).ConclusionGMP was present in large and combined orbital fractures. Clinically detectable postoperative GMP occurred despite satisfactory orbital reconstruction and overcorrection. Mild GMP, however, is not significant for the patient.

Reconstruction of Orbital Floor With Auricular Concha.

Orbital floor fractures of varying sizes commonly occur after orbital injuries and remain a serious challenge. Serious complications of such fractures include enopthalmos, restriction of extraocular movement, and diplopia. There is a dearth of literature that can be applied widely, easily, and successfully in all such situations, and therefore there is no consensus on the treatment protocol of this pathology yet. Autogenous grafts and alloplastic and allogenic materials with a wide variety of advantages and disadvantages have been discussed. The value of preoperative and postoperative ophthalmological examination should be standard of care in all orbital fracture patients. An ideal reconstructed orbital floor fracture should accelerate the restoration of orbital function with acceptable cosmetic results. Management parameters of orbital fractures such as timing of surgery, incision type, and implant materials, though widely discussed, remain controversial. In this study, 55 patients with orbital floor fractures surgically reconstructed with conchal cartilage grafts between 2008 and 2014 were retrospectively evaluated. Complications and long-time follow-up visit results have been reported with clinical and radiographic findings. The aim of this study was to present the authors' clinical experiences of reconstruction of blow-out fractures with auricular conchal graft and to evaluate the other materials available for use.

Transient Anisocoria during Medial Blowout Fracture Surgery.

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.

Delayed Superior Orbital Fissure Syndrome After Reconstruction of Blowout Fracture

The superior orbital fissure syndrome (SOFS) has been known to be a condition caused by impairment of the nerves that cross the superior orbital fissure. Traumatic SOFS is an uncommon complication which occurs usually within 48 hours after a facial injury. A 25-year-old male sustained facial trauma following an altercation. Clinical findings on presentation included swelling, ecchymosis, hyphema, subretinal hemorrhage, and mild extraocular movement limitation upon lateral gaze on his right eyelids. Facial computed tomography scan confirmed fractures of the medial walls of the right orbit and herniation of orbital soft tissue without the incarceration of medial rectus muscle. Ten days after the trauma, the operation was performed. On postoperative day 16, the patient showed ptosis of the right upper eyelid with a fixed pupil, and there was a hypoesthesia over the distribution of the right supraorbital and supratrochlear nerves. The authors diagnosed as a delayed SOFS and prescribed 4 mg of methylprednisolone q.i.d. for 30 days. After steroid therapy, extraocular movement limitations improved progressively. After 8 months, movement was completely restored. The authors experienced delayed SOFS on posttrauma day 27, and it was treated by steroid therapy. Surgical intervention is required when there is an evident etiology such as underlying hematoma or plate migration. If the reason is not clear like our case, steroid therapy can be considered as one of the options. Particularly, the authors should give special attention to the patient who has congenitally narrow superior orbital fissure, like Fujiwara et al suggested.

The Effects of Sinus Mucosal Removal during Orbital Wall Reconstruction in an Experimental Model

BACKGROUND: Various kinds of implants have been used for reconstruction of blowout fracture, but they have the possibility of infection. Although infection after orbital reconstruction is not common, it could leave serious sequelae to the patients. For this reason, some surgeons routinely removed the sinus mucosa during the repair of the blowout fracture. In this study, we evaluated the effect of mucosal removal to the healing process with implant and inflammatory reaction, using histopathologic analysis of the rabbit model. METHODS: Studies were performed with fifteen “New Zealand White Rabbits”. A 1.5 cm x 1.5 cm sized bone window was made at the maxillary sinus wall. One side of the maxilla was chosen randomly as an experimental group (n=15), and the other side became the control group (n=15). The sinus mucosa of the experimental group was totally strapped and that of control group was left intact. Bioabsorbable poly-L-lactide-conglydolida plate (Rapidorsorb, synthes) was inserted to cover the bony defects. Total maxillectomy including implant at 3 weeks, 6 weeks, and 9 weeks after implantation was conducted and composition of tissue was analyzed. The grade of inflammatory reaction, the proportion of woven bone, the amount of fibrovascular proliferation (b-FGF,CD31) and capsule thickness around the implant were assessed. RESULTS: The early inflammatory reactions around the implant were grade 1.13 (mean value, experimental group) and 2.2 (mean value, control group) in 3 weeks. Woven bone formation was more prevalent in the experimental group. Calculated area of woven bone formation was 16.27% in 3 weeks, 22.20% in 6 weeks, and 36.16% in 9 weeks. In the control group, more fibrotic connective tissue change rather than woven bone formation was observed (p=0.011) (Table 1). Also, the thickness of capsule around the implants were thinner in experimental group (p=0.04) (Table 2).Table 1: The proportion of woven bone formation (%).Table 2: Thickness of implant capsule (um).CONCLUSIONS: This study suggests that less inflammatory reaction not only stimulates formation of woven bone but also reduces the fibrosis around the absorbable implant. Therefore, removal of sinus mucosa during the orbital reconstruction can be accepted as an effective option to achieve faster bone healing process with less inflammatory reaction.

Comparison of Absorbable Mesh Plate versus Titanium-Dynamic Mesh Plate in Reconstruction of Blow-Out Fracture: An Analysis of Long-Term Outcomes.

BackgroundA blow-out fracture is one of the most common facial injuries in midface trauma. Orbital wall reconstruction is extremely important because it can cause various functional and aesthetic sequelae. Although many materials are available, there are no uniformly accepted guidelines regarding material selection for orbital wall reconstruction.MethodsFrom January 2007 to August 2012, a total of 78 patients with blow-out fractures were analyzed. 36 patients received absorbable mesh plates, and 42 patients received titanium-dynamic mesh plates. Both groups were retrospectively evaluated for therapeutic efficacy and safety according to the incidence of three different complications: enophthalmos, extraocular movement impairment, and diplopia.ResultsFor all groups (inferior wall fracture group, medial wall fractrue group, and combined inferomedial wall fracture group), there were improvements in the incidence of each complication regardless of implant types. Moreover, a significant improvement of enophthalmos occurred for both types of implants in group 1 (inferior wall fracture group). However, we found no statistically significant differences of efficacy or complication rate in every groups between both implant types.ConclusionsBoth types of implants showed good results without significant differences in long-term follow up, even though we expected the higher recurrent enophthalmos rate in patients with absorbable plate. In conclusion, both types seem to be equally effective and safe for orbital wall reconstruction. In particular, both implant types significantly improve the incidence of enophthalmos in cases of inferior orbital wall fractures.

Antiadhesive Effect of Mixed Solution of Sodium Hyaluronate and Sodium Carboxymethylcellulose After Blow-out Fracture Repair

Treatment of blow-out fractures is aimed at the prevention of permanent diplopia and cosmetically unacceptable enophthalmos. Porous polyethylene sheets are one of the most common alloplastic implants for blow-out fracture repair. Because adhesion between the porous polyethylene and the orbital soft tissue can result in restrictions of ocular motility, prevention of postoperative adhesion is important in the reconstruction of blow-out fractures. The purpose of this study was to find out the effect of the mixed solution of sodium hyaluronate and sodium carboxymethylcellulose (HACMC) on postoperative adhesion in blow-out fracture repair in an animal model.Twenty-four New Zealand white rabbits were used. An 8-mm defect was made in the maxillary sinuses including the bone and mucosa. A 10-mm porous polyethylene sheet (Medpor; Porex Surgical Inc., Newnan, GA) was inserted in to the defect. The rabbits were divided into a control group and a HACMC group. In the HACMC group, HACMC solution was instilled onto the surface of the implant and then the implant was inserted. The implants were harvested at 1, 2, 4, and 8 weeks after surgery (3 implants each period). Hematoxylin and eosin, Masson trichrome, and CD31 (platelet endothelial cell adhesion molecule-1) stains were performed for evaluation of inflammation, fibrosis, and vascularization.Inflammation appeared less severe in the HACMC group, but the difference between the 2 groups was not statistically significant. The degree of fibrosis was more severe in the control group. There were significant differences in the degree of fibrosis between the 2 groups 4 and 8 weeks after surgery (P = 0.046). The amount of vascularization was similar in both groups.The HACMC solution seemed to be effective for reducing postoperative adhesion in reconstruction of blow-out fractures in a rabbit model. Our results suggest that the application of HACMC solution could be an effective adjunct for the repair of trap-door fractures or revision of blow-out fractures.

Clinical Characteristics and Treatment of Blow-out Fracture Accompanied by Canalicular Laceration

Blow-out fracture and canalicular laceration can occur simultaneously as a result of the same trauma. Despite its importance, little research has been conducted to identify clinical characteristics or surgical techniques for repair of a blow-out fracture accompanied by canalicular laceration. The aim of this study was to evaluate the clinical characteristics, the surgical approach, and the outcomes. Thirty-four eyes of 34 patients who underwent simultaneous repair of canalicular laceration using silicone tube intubation and reconstruction of blow-out fracture were included. Medical records were retrospectively reviewed for patient demographics, nature of injury, affected canaliculus, location, and severity of blow-out fracture, associated facial bone fracture, ophthalmic diagnosis, length of follow-up period, and surgical outcome. Mean patient age was 40.0 years (range, 17-71 y). The mean follow-up was 7.3 months. Fist to the orbital area (10 patients, 29.4%) was the most common cause. There were 24 lower canalicular lacerations (70.6%), 6 upper canalicular lacerations (17.6%), and 4 upper and lower canalicular lacerations (11.8%). Isolated medial wall fractures were most common (area A4: 20/34, 58.8%). Fractures involving both the floor and medial wall and maxillo-ethmoidal strut (areas A1, A2, A3, and A4) were the second most common (6/34, 17.6%), and floor and medial wall with intact strut (areas A1, A2, and A4) were injured in 6 patients (17.6%). Pure inferior wall fractures were least frequent (areas A1 and A2: 2/34, 5.9%). The severity of the fracture was severe in most patients except for 1 linear fracture with tissue entrapment and 1 moderate medial wall fracture (32/34, 94.1%). There was lid laceration in 20 patients (58.8%). Nasal bone fracture (5/34, 14.7%) was the most common facial bone fracture. Tubes were removed at a mean of 3.3 months (range, 3-4 mo). In total, 31 patients (91.2%) achieved complete success in canalicular laceration and blow-out fracture repair. No significant complications were encountered. Fractures involving the medial wall with a lower canalicular laceration were the most common among concomitant blow-out fractures and canalicular lacerations. The severity of the fracture was most often classified as severe. Computed tomographic scan of the orbit and facial bones for identification of any additional injuries such as orbital wall and facial bone fractures should be performed in patients with canalicular laceration. To avoid disruption of the medial canthal area, repair of the canalicular laceration with silicone tube intubation was performed before reconstruction of the blow-out fracture through transconjunctival and transcaruncular approaches. Finally, the tube was fixed after blow-out fracture surgery, and these surgical orders yielded good surgical outcomes without complications.

Reconstruction of blowout fractures of medial orbital walls

To explore the classification of medial orbital blowout fractures (OBF) and the applications of reconstruction materials, to evaluate the efficacy and safety of surgical orbital reconstruction. A retrospective review of 176 cases with medial OBF between January 2008 and January 2011 was conducted, they were classified to group I (pure medial wall fracture, 85 cases) and group II (combined medial and inferior walls fractures, 91 cases). Group I was classified into 3 subgroups, Ia, Ib, and Ic, according to the fractured appearances on CT scans. Group II was classified into 2 subgroups, IIa and IIb, according to the maxillo-ethmoidal bone buttress involved in or not. The operative designs and the choice of reconstruction materials were based on the fractured classification and diplopia. Materials used for repairing included artificial bone plates, titanium meshes and wedge implants. The surgical repairs were undergone via a trans-caruncular approach when necessarily combined with an inferior fornix or lower limbus palpebralis incision. Clinical outcomes and complications were recorded including visual acuity, exophthalmometry, diplopia, hypoglobus and CT scans before and follow-up period. Group II showed more significant enophthalmos than group I (-5.1 ± 0.8 mm vs -2.7 ± 0.7 mm, P = 0.000). Both groups improved after operations (group II: -5.1 ± 0.8 mm vs. -0.7 ± 1.2 mm, P = 0.000; group I: -2.7 ± 0.7 mm vs. 0.1 ± 0.8 mm, P = 0.000). Ocular displacement was more common in group II than in group I (62% vs. 0%, P = 0.000). The hypoglobus was more common in subgroup IIb than in IIa (71% vs. 38%, χ(2) = 8.19, P = 0.004) and significantly improved after operations in subgroup IIb (71% vs. 17%, χ(2) = 38.27, P = 0.000). Diplopia was more commonly noted in group II than in group I (100% vs. 83%, P = 0.000), and was significantly relieved in both groups (group I: Z = -4.475, P = 0.000; group II: Z = -9.751, P = 0.000). Postoperative CT displayed orbital walls reconstructed satisfyingly in 92%. No one was recorded with impaired vision after operation. The important complications were aggravated or new-onset diplopia, under- or over-correction of enophthalmos and ocular superior displacement. A reconstructive operation of medial OBF with proper materials and surgical skills could be helpful for improving diplopia, enophthalmos and hypoglobus. The operations for repairing of medial OBF is efficient and safe.

Comparison of conchal cartilage graft with nasal septal cartilage graft for reconstruction of orbital floor blowout fractures

Our aim was to compare autogenous nasal septal cartilage and conchal cartilage as grafts for reconstruction of orbital blowout fractures. Twenty-two patients with blowout fractures were randomly assigned to two groups for treatment with a graft of nasal septal cartilage or conchal cartilage. Patients were evaluated for the presence of enophthalmos, diplopia, dysfunction of the infraorbital nerve, and restriction of the ocular muscles. Patients with enophthalmos of more than 2 mm were included in the study, and were followed up postoperatively at 10 days, 1 month, and 3–6 months. The patients treated with a nasal septal cartilage graft had significantly better correction of enophthalmos than those treated with conchal cartilage ( p = 0.02) after 10 days ( p = 0.02), 1 month ( p = 0.004), and 3–6 months ( p = 0.001). There was significantly less residual enophthalmos in the nasal septal graft group after 1 month (0.91 compared with 1.72 mm, p = 0.02), and after 3–6 months (1.0 compared with 2.54 mm, p = 0.008). Correction of enophthalmos was considerably better in patients who were operated on within 4 weeks of injury. We think that nasal septal cartilage is a better graft than conchal cartilage for reconstruction of blowout fractures. The time to intervention (the earlier the better) is a critical point in the correction of enophthalmos.

Reconstruction of orbit blowout fracture by hydroxyapatite composite through nasal endoscope

目的 探讨经下睑睫毛缘下皮肤切口于鼻内窥镜下经筛窦联合入路行羟基磷灰石(HA)复合体整复眶爆裂性骨折的临床效果.方法对36例患者施行下睑睫毛缘下皮肤切口与鼻内窥镜下经筛窦联合入路,将HA复合体植入骨折缺损处.结果 36例复视均好转,30例活动度完全改善,6例活动度部分改善.36例术后突出度与健眼大致对称.观察6～18月,无并发症发生.结论本术式操作简便,术后并发症少,效果良好。

Endoscopic endonasal technique of the blowout fracture of the medial orbital wall

Endoscopic endonasal surgery without the external incision could help the reconstruction of blowout fracture of the medial orbital wall. Using a rigid fiberscopic telescope, the endonasal reconstruction was performed in 12 cases of blowout fracture of the medial orbital wall, under local anesthesia. The fractured bones and the pathological changes of the ethmoid sinus were removed. The silicone plate, placed in the periosteum of orbit, filled the orbital defect. Results after endoscopic endonasal surgery in all cases were good. Endoscopic endonasal surgery without the external incision could help the reconstruction of blowout fracture of the medial orbital wall. Using a rigid fiberscopic telescope, the endonasal reconstruction was performed in 12 cases of blowout fracture of the medial orbital wall, under local anesthesia. The fractured bones and the pathological changes of the ethmoid sinus were removed. The silicone plate, placed in the periosteum of orbit, filled the orbital defect. Results after endoscopic endonasal surgery in all cases were good.

A technique for reconstruction of blow-out fractures of the medial orbital wall (case report)

A technique for reconstruction of blow-out fractures of the medial orbital wall (case report)