Treatment Of Orbital Blowout Fracture Research Articles

Effect of navigation endoscopy combined with three-dimensional printing technology in the treatment of orbital blowout fractures.

To explore the combined application of surgical navigation nasal endoscopy (NNE) and three-dimensional printing technology (3DPT) for the adjunctive treatment of orbital blowout fractures (OBF). Retrospective analysis was conducted on the data of patients with OBF who underwent surgical treatment at the Affiliated Eye Hospital of Nanchang University between July 2012 and November 2022. The control group consisted of patients who received traditional surgical treatment (n=43), while the new surgical group (n=52) consisted of patients who received NNE with 3DPT. The difference in therapeutic effects between the two groups was evaluated by comparing the duration of the operation, best corrected visual acuity (BCVA), enophthalmos difference, recovery rate of eye movement disorder, recovery rate of diplopia, and incidence of postoperative complications. The study included 95 cases (95 eyes), with 63 men and 32 women. The patients' age ranged from 5 to 67y (35.21±15.75y). The new surgical group and the control group exhibited no statistically significant differences in the duration of the operation, BCVA and enophthalmos difference. The recovery rates of diplopia in the new surgical group were significantly higher than those in the control group at 1mo [OR=0.03, 95%CI (0.01-0.15), P<0.0000] and 3mo [OR=0.11, 95%CI (0.03-0.36), P<0.0000] post-operation. Additionally, the recovery rates of eye movement disorders at 1 and 3mo after surgery were OR=0.08, 95%CI (0.03-0.24), P<0.0000; and OR=0.01, 95%CI (0.00-0.18), P<0.0000. The incidence of postoperative complications was lower in the new surgical group compared to the control group [OR=4.86, 95%CI (0.95-24.78), P<0.05]. The combination of NNE and 3DPT can shorten the recovery time of diplopia and eye movement disorder in patients with OBF.

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

Efficacy of endoscopic transantral versus transorbital surgical approaches in the repair of orbital blowout fractures: study protocol for a randomized controlled trial

Background: Repair of orbital blowout fractures faces a lot of complications and difficulties to restore and reconstruct the exact position of the orbital bony skeleton especially at the orbital rims, and also a difficulty in restoring the functions of the orbital soft contents such as the muscles, the globe and the lacrimal system. Methods/Design: This prospective randomized controlled trial with a two-arm, parallel-group structure evaluating the efficacy of endoscopic transantral surgical versus traditional transorbital surgical approaches in the treatment of orbital blowout fractures will be conducted at Faculty of Oral and Dental Medicine, Cairo University, Giza, Egypt. Thirty-eight patients with diplopia due to orbital blowout fracture will be recruited. All patients will undergo CT, pulse test, and forced duction test. The primary outcome measure is the diplopia resolution detected intraoperatively via forced duction test. The secondary outcomes include the enophthalmos correction, preservation of orbital floor periosteum and exacting/equalization of the injured bony level on the non-injured side. Discussion: The results of the trial will support better decision-making for surgical treatment in orbital blowout fractures. Trial registration: ClinicalTrials.gov identifier: NCT03011047 registered on January 4, 2017. Ethics: This protocol and the template informed consent form was approved by the Ethics Committee of Scientific Research, Faculty of Oral and Dental Medicine, Cairo University, Egypt (February 2017). Informed consent: Written informed consent will be obtained from all participants prior to the trial.

Surgical Treatment of Orbital Blowout Fractures: Complications and Postoperative Care Patterns.

Orbital fractures are a common result of facial trauma. Sequelae and indications for repair include enophthalmos and/or diplopia from extraocular muscle entrapment. Alloplastic implant placement with careful release of periorbital fat and extraocular muscles can effectively restore extraocular movements, orbital integrity, and anatomic volume. However, rare but devastating complications such as retrobulbar hematoma (RBH) can occur after repair, which pose a risk of permanent vision loss if not addressed emergently. For this reason, some surgeons take the precaution of admitting patients for 24-hour postoperative vision checks, while others do not. The incidence of postoperative RBH has not been previously reported and existing data are limited to case reports. Our aim was to examine national trends in postoperative management and to report the incidence of immediate postoperative complications at our institution following orbital repair. A retrospective assessment of orbital blowout fractures was undertaken to assess immediate postoperative complications including RBH. Only patients treated by a senior surgeon in the Department of Otolaryngology were included in the review. In addition, we surveyed AO North America (AONA) Craniomaxillofacial faculty to assess current trends in postoperative management. There were 80 patients treated surgically for orbital blowout fractures over a 9.5-year period. Nearly all patients were observed overnight (74%) or longer (25%) due to other trauma. Average length of stay was 17 hours for those observed overnight. There was one (1.3%) patient with RBH, who was treated and recovered without sequelae. Results of the survey indicated that a majority (64%) of responders observe postoperative patients overnight. Twenty-nine percent of responders indicated that they send patients home the same day of surgery. Performance of more than 20 orbital repairs annually significantly increased the likelihood that faculty would manage patients on an outpatient basis postoperatively (p = 0.04). For orbital blowout fractures, the number of immediate postoperative complications at our institution is low. In addition, North American trends in postoperative management of orbital blowout fractures may suggest that selected patients can be managed on an outpatient basis, which would have a positive effect on conservation of diminishing healthcare resources.

Treatment of orbital blowout fracture using porous polyethylene with embedded titanium.

The study was performed to evaluate the effectiveness and safety of porous polyethylene with embedded titanium in the repair of orbital blowout fracture. The study was designed as a prospective case series. Patients who were diagnosed with orbital blowout fracture from May 2012 to March 2013 were included in the study. A composite material of porous polyethylene and titanium mesh was used. Orbital volumes before and after surgery were measured, and the results of diplopia and ocular movement were recorded. The occurrence of diplopia was grouped and compared according to the time interval between injury and surgery. The incidence of other complications was also recorded. A total of 26 patients were involved in the study. The minimal follow-up time was 12 months. All surgeries were performed uneventfully. The orbital volume significantly decreased after the surgery, and the remission rate and the elimination rate of diplopia in 12 months were 85.7% and 47.6%, respectively. Postoperative diplopia was correlated with the time interval between injury and surgery. One patient presented with undercorrection of enophthalmos, and another patient presented with acute aggravation of diplopia and exophthalmos after surgery, which was resolved with treatment. In conclusion, porous polyethylene with embedded titanium was effective and safe in the repair of orbital blowout fracture, and studies with more subjects and longer follow-up period are recommended in future studies.

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

Long-term result of a biodegradable osteo-inductive copolymer for the treatment of orbital blowout fracture

PurposeWe have recently reconstructed the orbital wall using a bioabsorbable osteo-inductive copolymer as a support material for the bone defects in patients with orbital blowout fracture. The purpose of this study was to investigate a 2-year follow-up after implantation. Material and methodsIn order to investigate the efficacy and safety of the bioabsorbable osteo-inductive copolymer HA-P(LA/CL), hydroxyapatite-poly(l-lactide-ε-caprolactone), we measured CT density of the implanted copolymers in 7 patients at such time points as 1 week, 6 months and 2 years after surgery along with the long-term outcomes with regard to postoperative complications. ResultsFive patients in whom the intraoperative maximum width of the bone defect was less than 15 mm demonstrated the fracture types of either linear or trap-door. All patients treated with HA-P(LA/CL) copolymer indicated good bone formation with high CT density (>500) at 2 years postoperatively. In contrast, 2 patients in whom the intraoperative maximum width of the bone defect was more than 16 mm demonstrated a punched-out type fracture. Postoperative CT of the HA-P(LA/CL) copolymer showed low density (28.0 and 173.4) at 2 years postoperatively, indicative of limited bone formation. None of the cases demonstrated significant postoperative complications such as diplopia, enophthalmos, infection and extrusion of the implant material. ConclusionThe results of this study demonstrate that surgical treatment of orbital blowout fractures using bioabsorbable osteo-inductive copolymer was useful in linear and trap-door 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

Analysis of Complications After Surgical Repair of Orbital Fractures

The term "orbital blow-out fracture" is referred to as the mechanism by which an impact to the eyeball is transposed as a mechanical energy to the orbital walls, causing them to fracture. Despite a proper surgical technique, a successful anatomic reconstruction of the orbit, and an accurate follow-up, 3 complications are still frequently observed at long-term follow-up: diplopia, enophthalmos, and hypesthesia of the infraorbital nerve territory. In this retrospective study, we analyze the incidence, the specific characterization, and the potential risk factors of these 3 complications. The records of 75 patients who underwent surgical repair of isolated orbital blow-out fracture from January 2001 to December 2007 at the Maxillofacial Surgery Unit of the Novara Major Hospital were reviewed retrospectively. Patients who had other coexisting facial fractures or orbital rim involvement were excluded from this study. The mean follow-up reached 39 months (range, 6-81 months). Enophthalmos was measured by a Hertel exophthalmometer; diplopia was evaluated by an optometrist with cover test, red glass test, and Hess-Lancaster test; and hypesthesia of the infraorbital nerve territory was checked by clinical examination. The studied parameters included patient's age and sex, time interval between trauma and surgery, location of the fracture, and implant material. The χ test for nonparametric data was used, and a P value of less than 0.05 was considered statistically significant. Sex, location of the fracture, and implant material were not considered statistically significant (P > 0.05). The unique variable that influenced our data was the time interval between trauma and surgery (P > 0.05). Although the surgical technique was executed properly and the immediate postoperative recovery was uneventful, diplopia, enophthalmos, and infraorbital nerve dysfunction were the frequent complications. We stress the fact that orbital blow-out fracture is generally not considered a technically demanding procedure, but the outcome can be very disappointing; the surgical procedure must be managed very carefully by experienced surgeons to lower the high rates of these 3 common complications. However, we can report that the incidence of diplopia, enophthalmos, and infraorbital nerve dysfunction are decreased by an immediate intervention and an early surgical repair of the orbital blow-out fracture. Patients who had surgery within 2 weeks of trauma have a lower risk to develop postoperative complications; this study supports an early surgical treatment of orbital blow-out fractures, when it is indicated.

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

Update in Treatment of Orbital Blowout Fractures

Received April 6, 2011 Accepted April 19, 2011 Address for correspondence Jaehwan Kwon, MD, PhD Department of OtorhinolaryngologyHead and Neck Surgery, Maryknoll Medical Center, 12 Daecheong-dong 4-ga, Jung-gu, Busan 600-730, Korea Tel +82-51-461-2205 Fax +82-51-461-0297 E-mail entkwon@hanmail.net The orbital wall is commonly fractured and its incidence ranges from 18 to 50% of all craniofacial fractures. Numerous papers have been reported about the surgical indication, surgical timing, approach options, and reconstruction materials for orbital blowout fractures. However, there are still debates on the ideal surgical options. The choice of surgical approach and materials for reduction of orbital blowout fractures depends on the surgeon’s experience and preference. Recently, use of endoscope for blowout fractures has been popular worldwide due to its advantages over open reduction surgeries. In this review, I will discuss new techniques and concepts of the treatment of orbital blowout fractures with particular references. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:317-23

眼窩吹き抜け骨折整復術のポイント

眼窩吹き抜け骨折整復術のポイント

Surgical treatment of orbital blow-out fractures with porous high-density polyethylene implantation

目的 探讨眼眶爆裂性骨折用Medpor填充治疗的手术效果.方法 2003年9月～2006年5月经不同入路开眶术用Medpor填充治疗78例眼眶爆裂性骨折.结果 手术后对眼球内陷疗效的分析,早期治愈率92%,晚期手术治愈率72%,早期手术明显优于晚期手术;手术后对复视的疗效分析,早期手术中有效率84%,晚期手术中有效率为56%,早期手术明显优于晚期手术.结论 早期采用Medpor眶壁修补术是治疗眶壁爆裂性骨折的有效方法;术中充分松解嵌顿的眼外肌防止再粘连是消除复视的关键。

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。

Diagnosis and Treatment of Orbital Blowout Fracture

Diagnosis and Treatment of Orbital Blowout Fracture

Current concepts on the management of orbital blow-out fractures.

Surgical versus nonsurgical treatment of orbital blow-out fractures has been controversial in the past. In the 1950s it was advocated that all blow-out fractures be treated surgically based on the conception that extraocular muscles were blown out and trapped in the fracture hole, causing double vision and enophthalmos. Gradually, however, a shift to a more conservative approach occurred, probably because of the complications of surgery, the disappointing results in improvement of motility and enophthalmos, and the growing evidence of spontaneous improvement of double vision. This article analyzes the literature chronologically and blends this analysis with the results of a new anatomical approach to the human orbit. New theories on the mechanism of blow-out fractures are postulated. No longer is entrapment of muslces in a blow-out fracture held responsible for the severe motility problems; rather it is viewed as caused by a dysfunction of the entire motility apparatus in the fracture region. Consequently, conventional surgical treatment, repairing the orbital floor only, seems to have lost its theoretical foundation and a conservative approach is advocated until microsurgical techniques become more readily avaliable to treat the sequelae of blow-out fractures at their origin.