Treatment Of Blowout Fracture Research Articles

Analysis on the complications of Medpor repairment for the orbital blowout fracture

Objective To analyze the complications after orbital reconstruction with Medpor repairment for the treatment of orbital blowout fracture. Methods The data of 18 patients with complications after orbital reconstruction with Medpor were analyzed retrospectively. Results All cases were unilateral orbital blowout fracture.The visual acuity decreased significantly in 1 case, residual diplopia occurred in 5 cases, endophthalmos was undercorrection in 5 cases, eyeball deviation occurred in 2 cases, zygomatic cheek occurred in 2 cases, secondary dacryocystitis occurred in 2 cases and eyelid ectropion occurred in 1 case. The causes of postoperative complications of orbital reconstruction with Medpor repairment for orbital blowout fracture were related to the degrees of fracture injury process, location, operation time, doctor’s surgical techniques and experience. Conclusion The complications can be reduced or be avoided and the success rate of the operation will be improved with standardized surgical approach, timely detection and treatment measures. Key words: Fracture, blowout, orbital; Medpor; Surgery, repairment; Cause, complication

Clinical application of self-developed fracture reduction fixator in the treatment of severe blow-out orbital floor fracture

Objective To investigate how to effectively reposit and fix the displaced tissues of severe blow-out orbital floor fracture.Methods The self-developed fracture reduction fixators were applied to nine cases of orbital floor fracture by maxillary sinus route.Results The operation method was simple,and the good curative effects were obtained in all patients,such as fracture reduction,no tissue incarceration,diplopia eliminated or even disappeared,enophthalmos less than 2 mm.Conclusion The self-developed fracture reduction fixator is a reasonable and effective approach in the treatment of severe blow-out orbital floor fracture. Key words: Fracture, blow-out, orbital floor; Operation; Fixator, reduction, fracture

Surgical treatment of orbital blow-out fracture

Objective To evaluate the effect of implantation surgery for orbital reconstruction.Methods Twenty-four cases with the orbital blow-out fracture treated by Hydroxyapatite complex or Medpor implantation surgery were reviewed and summarized,and their surgical effects were analyzed.Results The enophthalmos and diplopia completely disappeared in 20 cases,relieved in 4 cases.There were no infection or extrusion of Hydroxyapatite complex or Medpor implant.Conclusion Surgery is the majoy method of treating orbital blow-out fracture,the operative skill,timing and implant are key points for successful operation. Key words: Fracture, orbital, blow-out ; Enophthalmos ; Diplopia; Sugery

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.

Treatment of orbital blowout fracture by CT image navigation assisted nasal endoscope

Objective To study the curative effect of CT image navigation assisted nasal endoscope in the treatment of orbital blowout fracture.Method To perform CT image navigation assisted nasal endoscope reduction surgery on 23 patients(23 eyes) with clear surgical indieations of orbital blowout fractures,and observe the effect of the surgery.Results Follow up 23 patients(23 eyes) for 3 months to 1 year after the operation,the data shown that 19 patients( 19 eyes) were cured,4 patients(4 eyes) were improved,the invalid was 0,the improvement rate was 100％ and cure rate was 82.6％.Conclusion CT image navigation assisted nasal endoscopy is a good and effective method in the treatment of orbit blowout fracture Key words: Navigation; Nasal endoscopic; Fracture orbital wall, blowout

Application of medpor surgical implant combined with medical biomaterials glue for treatment of orbital blowout fracture

Objective To observe the clinical efficacy of using Medpor surgical implant combined with medical biomaterials glue to treat orbital blowout fracture. Methods Retrospective analysis was taken in 26 patients with orbital fracture from the year of 2007 to 2010 by examination of CT scan, the endophthalmos, diplopia and ocular movement before and after operation. After six months we evaluated the clinical efficacy. Results Twenty-five eyes of endophthalmos recovered after operations. After six month twenty-one patients had improved eye sight without diplopia, diplopia of three patients improved obviously. All patients had no adverse reaction from Medpor. The vision of these eyes elevated with different degrees. Conclusions For the patients of orbital trauma, early diagnoses is very important. If patients have endophthalmos and diplopia, the plerosis operation must be done as early as possible. The way of the operation is to use Medpor transplantation combined with medical biomaterials glue to fracture bone. Training of ocular movement immediately after the operation is an efficacious clinical therapy. Key words: orbital fracture; Medpor surgical implant; bipmaterials glue, medical

Resorbable Mesh Plate in the Treatment of Blow-out Fracture Might Cause Gaze Restriction

Selection of the material for the reconstruction of orbital floor defects is controversial. There are both autogenous and alloplastic materials, each having its own benefits and disadvantages. Resorbable mesh plate is one of the alloplastic implants. Although it has many advantages, the considerable complication related to the mesh is local inflammatory reaction along the infraorbital rim.We present a patient treated using resorbable mesh plate for the orbital floor fracture, in whom gaze restriction in the eye movements was detected because of some fibrotic bands passing through holes of the resorbable mesh.

Reduction surgeries for delayed cases with isolated blowout fractures

To show the effectiveness of endoscopic reduction surgeries for delayed cases with blowout fractures, and to determine the cause of persisting diplopia based on surgical findings. Retrospective study. Between 1997 and 2006, 114 patients with isolated blowout fractures underwent surgery. In 6 of 114 patients, there were delayed cases in which over 3 months had elapsed since the initial trauma. For persisting diplopia, surgeries were performed using an endoscopic endonasal approach. Adhesion between the protruded periorbita and the paranasal sinus mucosa was remarkable in the delayed cases. Dissection of the adhesion and removal of the bone fragments were performed. The ocular motility improvement was confirmed by intraoperative eye traction tests. Postoperatively, diplopia disappeared in five patients. Endoscopic reduction surgeries for delayed cases are available in the treatment of blowout fractures. The main cause of diplopia was determined to be the adhesion.

Endoscopic versus external repair of orbital blowout fractures

This study evaluates the usefulness of endoscopic repair compared to external repair in the treatment of blowout fracture (BOF) of the orbit. This retrospective study comprised 100 patients who had had surgical repair of orbital BOF since 1992. Forty-eight of the 100 had undergone endoscopic repair, 48 patients had had external repair, and four patients underwent surgery that combined the two approaches. The two basic approaches were evaluated and compared with respect to technique, results and complications. Endoscopically, transnasal and transantral approaches had been used for reduction and support of fractured medial and inferior walls, respectively. In the external approach, various transorbital incisions were made and the fractured wall was repaired with alloplastic or autologous materials. Complete or partial resolution of preoperative diplopia was achieved in 94% of the endoscopic group and 83% of the external group (NS). Enophthalmos was improved in 89% of the endoscopic group and 76% of the external group (NS). Though the endoscopic group had no significant complications, the external group had ectropions, significant facial scars, extrusion of inserted Medpor, and intra-orbital hematoma. Endoscopic repair appears to be a safe and effective technique for the treatment of BOF of the orbit.

Blow-out fractures in children: six years’ experience

To present and analyze our experience in treating blow-out fractures in children, over a 6-year period. The study was retrospective with 16 consecutive cases of blow-out fractures in children aged 5 to 15 years. All patients presented with impairment of eye motility and diplopia together with radiological findings. Treatment included fracture reduction, release of entrapped periorbital soft tissues, and placement of an alloplastic membrane on the orbital floor. Fractures were linear in 11 cases (trapdoor) and severe or comminuted in 5 cases. Clinical symptoms subsided in all cases. Complete recovery of eye motility was achieved after surgical procedure in 13 cases; 2 patients presented late but had full recovery, and 1 patient, 4 years postoperatively, still had slight motility impairment. Surgical treatment of blow-out fractures, including periorbital tissue release and placement of a membrane lining on the orbital floor, presented satisfactory results in our cases.

Sugrical treatment of orbital blow-out fractures

目的 研究眼眶爆裂性骨折整复术中应用Medpor的疗效.方法 对135例眼眶爆裂性骨折手术:眶内壁骨折患者采用内眦皮肤切口及结膜切口入路,眼眶下壁骨折,及下壁合并内壁骨折术中采用下睑缘或下穹隆手术切口入眶,将嵌顿于眼眶骨折处的下直肌、内直肌及其他软组织游离至眶内,插入修剪塑形后的Medpor板.结果 术后眼球突出度较术前提高1.5～5.0 mm,同对侧正常眼相比为-2～+2 mm(即内陷或突出2 mm之间),外观上基本同受伤前相似,术后1月后复视消除103例(76.30%),术后3月复视消除128例(94.81%).结论 及时实施眼眶爆裂性骨折整复术合并Medpor板植入可有效矫正眼球内陷及复视。

Endonasal endoscopic reduction of blowout fractures of the medial orbital wall

Purpose: This article describes the endonasal endoscopic reduction (EER) of blowout fractures (BOFs) of the medial orbital walls and reports the clinical results. Patients and Methods: Sixteen patients who underwent EER for a BOF of the medial orbital wall were analyzed. The surgical indications for treatment were diplopia, limitation of eye movements, and significant enophthalmos. They were followed-up for at least 3 months after the surgery. Surgical techniques, surgical results, and postoperative complications were reviewed. Results: There were no significant intraoperative or postoperative complications. Fourteen patients showed complete resolution of symptoms after the surgery. One patient, who had persistent diplopia and remaining enophthalmos, underwent medial wall reconstruction with a Medpor surgical implant (Porex Surgical Inc, College Park, GA) by a transorbital approach. Another patient, who had residual enophthalmos, had correction of enophthalmos after insertion of a Medpor implant. Both patients are now symptom-free. Conclusion: The results indicate that EER is a safe and effective technique for the treatment of BOFs of the medial orbital wall. © 2000 American Association of Oral and Maxillofacial Surgeons.

A comprehensive computerized clinical record for head and neck malignancy

This study evaluates the usefulness of endoscopic repair compared to external repair in the treatment of blowout fracture (BOF) of the orbit.This retrospective study comprised 100 patients who had had surgical repair of orbital BOF since 1992. Forty-eight of the 100 had undergone endoscopic repair, 48 patients had had external repair, and four patients underwent surgery that combined the two approaches. The two basic approaches were evaluated and compared with respect to technique, results and complications.Endoscopically, transnasal and transantral approaches had been used for reduction and support of fractured medial and inferior walls, respectively. In the external approach, various transorbital incisions were made and the fractured wall was repaired with alloplastic or autologous materials. Complete or partial resolution of preoperative diplopia was achieved in 94% of the endoscopic group and 83% of the external group (NS). Enophthalmos was improved in 89% of the endoscopic group and 76% of the external group (NS). Though the endoscopic group had no significant complications, the external group had ectropions, significant facial scars, extrusion of inserted Medpor, and intra-orbital hematoma.Endoscopic repair appears to be a safe and effective technique for the treatment of BOF of the orbit.