Repair Of Orbital Floor Fractures Research Articles

Repair of orbital floor fracture with titanic web

目的 评估钛网在爆裂性眶底骨折并缺损病例进行修复中的应用.方法 2004年1月～2005年4月收治的爆裂性眶底骨折患者12例,采用眶下缘微小切口入路,进行钛网填充修补.结果 本组手术均为一期愈合,术后6月X线及CT检查,结果显示,钛网未见移位,临床检查无排斥反应、眼球下陷,复视得到矫治.结论 钛网适合于眶底缺损的修复,优于常规填充材料。

Repair of Orbital Floor Fractures With SupraFOIL Smooth Nylon Foil

Repair of Orbital Floor Fractures With SupraFOIL Smooth Nylon Foil

Rounding of the Inferior Rectus Muscle as a Predictor of Enophthalmos in Orbital Floor Fractures

In spite of established indications for early operative repair of orbital floor fractures 7-10% of patients treated nonoperatively develop enophthalmos. Clearly further indications for repair are required to prevent these post-injury complications. Rounding of the inferior rectus muscle on coronal computerized tomography (CT) scan results from a loss of soft tissue and bony support and may therefore be predictive of late enophthalmos.A four-year institutional review was conducted to identify patients with orbital floor fractures that had been treated nonoperatively. Patients were recruited for late clinical follow-up (mean 30 months) where clinically significant enophthalmos and diplopia were measured. Clinical results were correlated with measurements of the height-to-width ratio of the inferior rectus muscle on CT scans by a blinded examiner. Eighteen of 78 patients were available for late follow-up. Sixteen patients had no enophthalmos whereas 2 patients had enophthalmos. The inferior rectus height-to-width ratios measured in the unaffected orbits were statistically similar between the two groups. There was a significantly increased height-to-width ratio exceeding 1.00 in the affected orbit when the enophthalmos group was compared to the no enophthalmos group.A height-to-width ratio of the inferior rectus muscle on coronal CT scan of greater than or equal to 1.00 is predictive of late enophthalmos.

Porous Polyethylene Implants in Orbital Floor Reconstruction

Various alloplastic materials are used in orbital wall reconstruction. This study investigated the outcome of patients treated with porous polyethylene sheet implants in the reconstruction of orbital floor fracture. Twenty-one patients who underwent orbital reconstructions using 0.85-mm porous polyethylene sheets for the repair of orbital floor fracture were included. A transconjunctival approach was used in all patients. The mean duration of postoperative follow-up was 29.7 +/- 12.3 months. Postoperatively, results and complications such as infection and implant extrusion were followed-up on the first day, the first week, monthly for the first 3 months and then every 3-6 months thereafter. All 21 patients had symptomatic diplopia before surgery. The diplopia resolved in 14 patients and improved in seven patients within the first month after surgery. All patients except one were free from diplopia at follow-up periods exceeding 6 months. Preoperative enophthalmos resolved in four of seven patients and improved in three. None of the patients developed orbital infection, implant exposure or migration, worsening diplopia, infraorbital anesthesia or loss of vision during follow-up. The study demonstrated that porous polyethylene implants in the repair of orbital wall fractures had good results with few complications.

A Case of Acute Orbital Abscess following Repair of Orbital wall Fracture with Alloplastic Implant

Purpose: To report a case of acute orbital abscess after MedporⓇ implantation for orbital floor fracture repair. Case summary: A 15-year-old boy who was punched in the right orbit visited our clinic because of diplopia. An orbital CT scan demonstrated a fracture of the right orbital floor. At surgery, a Medpor sheet was placed over the orbital floor defect. Over the first three days, clinical improvement was gradual, but at four days postoperatively, depression of the right eye was restricted, and lower lid edema and proptosis was present in the right eye. At eight days postoperatively, the orbital CT scan showed a large cystic mass surrounding the Medpor sheet and fine needle aspiration cytology showed a number of inflammatory cells. Because systemic antibiotics were ineffective, the MedpoⓇ sheet and the cystic mass were removed through a transconjunctival approach to the orbit. A culture of the removed MedporⓇ sheet grew Staphylococcus aureus and signs of inflammatory cells in the tissue were present. After removal of the abscess, most clinical symptoms showed improvement except for the remaining depression of the right eye. Conclusions: Symptoms of eye movement restriction, lower lid edema, and proptosis may be uncommon after orbital floor fracture repair but can occur. We should also consider the possibility of abscess formation due to infection of the implant and emphasize the importance of prompt diagnosis and treatment of such a case.

Combined Inferior and Medial Surgical Approaches and Overlapping Thin Implants for Orbital Floor and Medial Wall Fractures

To evaluate the clinical outcome of combined orbital floor and medial wall fracture repair using overlapping thin implants. A retrospective chart review was conducted on 19 fracture repairs performed by one surgeon using thin overlapping implants inserted through transcaruncular and inferior fornix incisions. Nineteen combined medial wall and floor fractures were repaired in 18 patients (14 male, 4 female). The median age was 37 years (range, 13-60 years). The median trauma-to-surgery interval was 9 days (range, 1 day to 6 years). Two overlapped implants (0.2-0.4 mm) were used in 12 fracture repairs, and 3 overlapped implants (0.2-0.3 mm) were used in 7 fracture repairs. Materials included prepunched nylon foil in 18 fractures and, in one fracture, high-density polyethylene. Follow-up time ranged from 1 month to 53 months (median, 7 months). No complications occurred during the postoperative follow-up period. Clinically significant enophthalmos was not observed after treatment. The repair of combined orbital floor and medial wall fractures using thin overlapping implants inserted through transcaruncular and inferior transconjunctival incisions is a safe, effective, and cosmetically sensitive surgical technique.

Individually preformed titanium mesh implants for a true-to-original repair of orbital fractures

The purpose of this investigation is to present the results using preoperatively-formed titanium mesh implants for a true-to-original primary repair of extensive orbital floor and medial wall fractures. Individually preformed implants were used to repair extensive orbital floor injuries in 19 patients at the University Hospital, Freiburg. The form of the orbital floor and walls was analysed by preoperative diagnostic CT scan data. The form of the virtual reconstructed orbit was transformed into a model of the orbital cavity by a template machine. Postoperative imaging by or CT scan verified the exact 3D reconstruction of the orbital cavity ‘true to original’. None of the patients demonstrated diplopia or enophthalmos postoperatively. Using individually preformed titanium mesh implants, the accuracy of the 3D orbital reconstruction was within a range of 1 mm. The reconstruction using preformed implants proved to be less time consuming, more precise and less invasive, compared to ‘free hand’ efforts, for the repair of orbital injuries using titanium mesh and calvarial grafts.

Porous Polyethylene Implants in Orbital Floor Reconstruction

Background/Purpose: Various alloplastic materials are used in orbital wall reconstruction. This study investigated the outcome of patients treated with porous polyethylene sheet implants in the reconstruction of orbital floor fracture. Methods: Twenty-one patients who underwent orbital reconstructions using 0.85-mm porous polyethylene sheets for the repair of orbital floor fracture were included. A transconjunctival approach was used in all patients. The mean duration of postoperative follow-up was 29.7 ± 12.3 months. Postoperatively, results and complications such as infection and implant extrusion were followed-up on the first day, the first week, monthly for the first 3 months and then every 3–6 months thereafter. Results: All 21 patients had symptomatic diplopia before surgery. The diplopia resolved in 14 patients and improved in seven patients within the first month after surgery. All patients except one were free from diplopia at follow-up periods exceeding 6 months. Preoperative enophthalmos resolved in four of seven patients and improved in three. None of the patients developed orbital infection, implant exposure or migration, worsening diplopia, infraorbital anesthesia or loss of vision during follow-up. Conclusion: The study demonstrated that porous polyethylene implants in the repair of orbital wall fractures had good results with few complications. [J Formos Med Assoc 2007;106(1):51–57]

An unusual late complication of orbital floor fracture repair

An unusual late complication of orbital floor fracture repair

Endoscopic Repair of Orbital Floor Fractures: Computed Tomographic Analysis Using a Cadaveric Model

To determine the efficiency (and accuracy) of endoscopic repair versus transconjunctival repair for orbital floor fractures in a cadaveric model. In nine fresh cadavers, a standardized technique created orbital floor fractures. One orbit was repaired using an endoscopic transantral approach, whereas the other was repaired using a standard transconjunctival approach. Commercially available implants were used for floor reconstruction. A validated computed tomographic volumetric analysis of the orbits was performed at three time points: prefracture, postfracture, and postrepair. Student's t-test analyzed the percentage of volume change in the prefracture and postrepair stages for each approach. The percentage of change between the prefracture and postrepair states was not statistically significant for transconjunctival (p = .834) or endoscopic (p = .366) repair. The average differences between transconjunctival repair and endoscopic repair were not statistically significant (p = .732). This study objectively confirms the efficiency of the endoscopic repair of orbital floor fractures when compared with traditional techniques in the cadaveric model.

Inflammatory nasal polyps: an unusual late complication of Silastic sheet repair of orbital floor fracture

Silastic implants are very widely used in surgical practice and are considered to be relatively inert. They do however present with complications, including infection, local foreign body inflammatory response,calcification, migration and failure of repair of the defect, which sometimes may necessitate explantation. Head and neck implants do present a special case, as complications can cause obstruction and disruption of function in small cavities. A pertinent history, clinical review and computed tomography scan are usually invaluable in obtaining a diagnosis. We present a rare case of migrated Silastic orbital sheet, presenting as a nasal polyp and causing maxillary antral pain and infection. A detailed search of the medical literature revealed no other such case.

Use of Enophthalmic Implants in the Repair of Orbital Floor Fractures

Introduction: High-density porous polyethylene (Medpor®) enophthalmic implants are used in patients with the sunken socket syndrome to augment the orbital volume. We have used them to improve enophthalmos and hypoglobus in the repair of large long-standing orbital floor fractures. This is the first report of enophthalmic wedge implants being used in seeing eyes to improve function and cosmesis. Materials and methods: Four patients had large long-standing orbital floor fractures with subsequent enlargement/expansion of the orbital volume. Indications for surgical intervention were enophthalmos (> 2 mm), hypoglobus (> 2 mm) and diplopia in primary position and downgaze. A transconjunctival approach was used to access the orbital floor and a Medpor® enophthalmic wedge implant was placed postero-inferiorly to the globe and periosteum. Results: Patients were followed up for a minimum of 4 to 6 months post-operatively with no complications noted. All patients achieved a good cosmetic and functional result post-operatively with resolution of their enophthalmos and hypoglobus. Diplopia in primary position was corrected with only mild residual diplopia present in extreme up-gaze. Conclusion: We have found enophthalmic implants useful in the surgical repair of symptomatic long-standing orbital floor fractures.

Case Peport, Chronic Subperiosteal Hematic Cyst Formation Twelve Years After Orbital Fracture Repair with Alloplastic Orbital Floor Implant

An 89-year-old female patient with a history of a left orbital floor fracture repair with synthetic implant 12 years prior, presented with a three-week history of blurry vision, inferior conjunctival chemosis and proptosis of the left eye. CT scan revealed a well-circumscribed subperiosteal lesion with superior elevation of the orbital floor implant. The patient underwent transconjunctival orbital surgery with removal of the implant and drainage of the subperiosteal hemorrhagic cyst. The patient had an uncomplicated postoperative course, with resolution of the proptosis, chemosis, and return of normal vision. This case represents an unusual late complication of orbital fracture repair with associated reduced visual acuity.

Endoscopic endonasal or transmaxillary repair of orbital floor fracture: a study of 88 patients treated in our department.

Objective—Endoscopic repairs of orbital floor fractures performed in our department were reviewed and postoperative outcomes were assessed.Material and Methods—The subjects comprised 88 patients who underwent surgery between 1991 and 2001, 14 of whom had trapdoor fractures. Endoscopic repair was performed when diplopia did not improve after 1 week of conservative treatment. Fractures were repaired via endonasal or transmaxillary routes and fixed with a urinary bladder catheter.Results—The postoperative course was evaluated on the basis of change in diplopia. After surgery, diplopia resolved in 79.5% of patients but remained, especially on upward gaze, in 20.5% of patients. Residual diplopia was more common in patients with trapdoor fracture.Conclusions—Endoscopic endonasal and transmaxillary repairs were effective and less invasive methods for freeing orbital tissues trapped by fragments of fractured bone and for restoring smooth ocular movements. However, suspected trapdoor fractures should be repaired within 1 week after injury in order to prevent fibrosis from developing in orbital tissues owing to entrapment by bone fragments.

Endoscopically assisted repair of orbital floor fractures.

Chen C-T, Chen Y-R Plast Reconstr Surg. 2001;108:2011-2018 Traditionally, orbital floor fractures are repaired with standard transcutaneous or transconjunctival approaches. Complications such as ex...

Post-traumatic orbital floor reconstruction with nasoseptal cartilage in children

Objective: Repair of orbital floor fractures may require the placement of a graft or implant. Both autogenous and alloplastic materials have been used for this purpose. This article reports the use of nasal septal cartilage for the repair of orbital floor defect secondary to blunt facial trauma in children. Methods: Three children with disruption of the orbital floor after facial trauma were included in this prospective review. All children underwent open reduction with rigid fixation of the facial fractures and reconstruction of the orbital floor with nasoseptal cartilage. Results: All of the cases were successfully treated by restoration of the orbital floor continuity. On follow-up clinical examination, one patient had persistent mild enophthalmus. Conclusions: Nasal septal cartilage is a readily accessible autogenous material with minimal donor site morbidity, and should be considered when an autogenous orbital implant is needed for the repair of a traumatic orbital floor defect.

Repair of orbital floor fractures with bioactive glass implants

Purpose: The ideal management of orbital floor fractures has been highly controversial. Many implants, both autogenous and alloplastic, have been used to span the defects. This study evaluated the use of bioactive glass implants (BAG-implant, S53P4; Abmin Technologies Ltd, Turku, Finland) for the repair of orbital floor defects caused by blunt facial trauma. Patients and Methods: This retrospective review of 36 patients was carried out from 1995 to 1999. All patients were diagnosed with an orbital floor fracture or a large orbital blowout fracture. The BAG-implant was placed over the defect, using a subciliary or transconjunctival approach. No screw fixation was used when the implant was the correct size. Follow-up examination was done at 1 and 3 months after surgery. Twenty-eight (82%) of the patients were also seen at one-year follow-up (21 men and 7 women). Results: The implants did not cause a foreign body reaction in the bone or soft tissue. There was no sign of resorption or infection, nor postoperative extrusion, hemorrhage, or displacement of the implant. Diplopia was seen preoperatively in 17 cases (61%) and postoperatively in 5 cases (18%). In 1 patient, the implant was removed 3 months after operation because of diplopia. Infraorbital nerve paresthesia was seen preoperatively in 9 patients (32%) and postoperatively in 5 patients (18%). The functional and cosmetic results were good at the 1-year follow-up. Conclusion: The BAG-implant is a well-tolerated material in orbital floor reconstruction. It provides a favorable environment for an uncomplicated healing process because it is bioactive and biocompatible and because it causes new bone formation. © 2001 American Association of Oral and Maxillofacial Surgeons

Endoscopically Assisted Repair of Orbital Floor Fractures

Endoscopically Assisted Repair of Orbital Floor Fractures

Endoscopically assisted repair of orbital floor fractures.

Traditionally, orbital floor fractures are repaired with standard transcutaneous or transconjunctival approaches. Complications such as external scarring, eyelid edema, ectropion, entropion, and granuloma formation have been associated with these open lid techniques. The endoscope has been used to assist in orbital floor exploration, to reduce entrapped orbital tissue, and to identify the posterior shelf for implant placement. However, an open lid incision is inevitable when implant placement is necessary. We present our experiences in repairing orbital floor fractures using transantral endoscopy without open lid incision.A 0-degree, 4-mm endoscope was placed through a 2 x 1.5-cm2 maxillary antrostomy to dissect the sinus roof. The endoscope was used to assist in the reduction of the floor fractures and prolapsed orbital tissue into the orbital cavity, if present. The orbital floor defect was reconstructed with titanium mesh or Medpor through the antrostomy under endoscopic control. This technique was applied to nine patients who had orbital floor fractures. Two of the patients had zygomatico-orbital fractures, whereas the rest had isolated orbital floor fractures. Three patients received Medpor reconstruction and the remaining six underwent titanium mesh reconstruction. The patients were followed up for 10 months on average. The enophthalmos was corrected in all patients but one, who suffered from mild enophthalmos because of uncorrected orbital medial wall fractures. Diplopia occurred in three patients preoperatively, which was resolved in two of them and improved in the other postoperatively. There have been no complications apart from transient anesthesia in the dermatome of the infraorbital nerve. The technique successfully reconstructed the orbital floor defects, minimized ocular globe manipulation, and eliminated a lower eyelid incision.

Discussion

For the most part, orbital floor fracture repair can be successfully accomplished with alloplastic implants or autogenous grafts using a variety of surgical exposures. The goal of such surgery is to restore the eye to its preoperative status. Unfortunately, there are always a few patients in whom this does not seem possible.