Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Orbital Wall Restoring Surgery in Pure Blowout Fractures

  • Lim, Nam Kyu (Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine) ;
  • Kang, Dong Hee (Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine) ;
  • Oh, Sang Ah (Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine) ;
  • Gu, Ja Hea (Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine)
  • Received : 2014.05.09
  • Accepted : 2014.06.24
  • Published : 2014.11.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background Restoring orbital volume in large blowout fractures is still a technically challenge to the orbital surgeon. In this study, we restored the orbital wall using the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses, and we compared the surgical outcome to that of a conventional transorbital method. Methods A retrospective review of all patients with pure unilateral blowout fractures between March 2007 and March 2013 was conducted. 150 patients were classified into two groups according to the surgical method: conventional transorbital method (group A, 75 patients, control group), and the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses (group B, 75 patients, experimental group). Each group was subdivided depending on fracture location: group I (inferior wall), group IM (inferomedial wall), and group M (medial wall). The surgical results were assessed by the Hertel scale and a comparison of preoperative and postoperative orbital volume ratio (OVR) values. Results In the volumetric analysis, the OVR decreased more by the experimental groups than each corresponding control groups (P<0.05). Upon ophthalmic examination, neither the differences among the groups in the perioperative Hertel scale nor the preoperative and postoperative Hertel scales were statistically significant (P>0.05). Conclusions Our surgical results suggest that orbital volume was more effectively restored by the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses than the conventional method, regardless of the type of fracture.

Keywords

References

  1. Rodriguez ED, Dorafshar AH, Manson PN. Facial fractures. In: Neligan PC, editor. Plastic surgery: volume 3. Philadelphia: Elsevier Saunders; 2013. p.53-7.
  2. Kakibuchi M, Fukazawa K, Fukuda K, et al. Combination of transconjunctival and endonasal-transantral approach in the repair of blowout fractures involving the orbital floor. Br J Plast Surg 2004;57:37-44. https://doi.org/10.1016/j.bjps.2003.10.006
  3. Farwell DG, Strong EB. Endoscopic repair of orbital floor fractures. Facial Plast Surg Clin North Am 2006;14:11-6. https://doi.org/10.1016/j.fsc.2005.11.001
  4. Shi W, Jia R, Li Z, et al. Combination of transorbital and endoscopic transnasal approaches to repair orbital medial wall and floor fractures. J Craniofac Surg 2012;23:71-4. https://doi.org/10.1097/SCS.0b013e318240c88e
  5. Cho RI, Davies BW. Combined orbital floor and medial wall fractures involving the inferomedial strut: repair technique and case series using preshaped porous polyethylene/titanium implants. Craniomaxillofac Trauma Reconstr 2013;6:161-70. https://doi.org/10.1055/s-0033-1343785
  6. Oh SA, Aum JH, Kang DH, et al. Change of the orbital volume ratio in pure blow-out fractures depending on fracture location. J Craniofac Surg 2013;24:1083-7. https://doi.org/10.1097/SCS.0b013e31828b6c2d
  7. Musch DC, Frueh BR, Landis JR. The reliability of Hertel exophthalmometry. Observer variation between physician and lay readers. Ophthalmology 1985;92:1177-80. https://doi.org/10.1016/S0161-6420(85)33880-0
  8. Andrades P, Hernandez D, Falguera MI, et al. Degrees of tolerance in post-traumatic orbital volume correction: the role of prefabricated mesh. J Oral Maxillofac Surg 2009;67:2404-11. https://doi.org/10.1016/j.joms.2008.11.024

Cited by

  1. Considerations for the Management of Medial Orbital Wall Blowout Fracture vol.43, pp.3, 2014, https://doi.org/10.5999/aps.2016.43.3.229
  2. Application of Rapid Prototyping Technique and Intraoperative Navigation System for the Repair and Reconstruction of Orbital Wall Fractures vol.17, pp.3, 2014, https://doi.org/10.7181/acfs.2016.17.3.146
  3. Reconstruction of Medial Orbital Wall Fractures without Subperiosteal Dissection: The "Push-Out" Technique vol.44, pp.6, 2014, https://doi.org/10.5999/aps.2017.01319
  4. A Reduction Technique for Depressed Medial Maxillary Fractures : vol.29, pp.4, 2014, https://doi.org/10.1097/scs.0000000000004413
  5. Orbital wall restoring surgery with resorbable mesh plate vol.19, pp.4, 2018, https://doi.org/10.7181/acfs.2018.01956
  6. Choroidal volume changes following blow-out fracture repair vol.39, pp.9, 2014, https://doi.org/10.1007/s10792-018-1033-9
  7. Orbital wall restoring surgery with primary orbital wall fragments in blowout fracture vol.20, pp.6, 2014, https://doi.org/10.7181/acfs.2019.00724
  8. Orbital wall restoration with primary bone fragments in complex orbital fractures: A preliminary study vol.21, pp.3, 2020, https://doi.org/10.7181/acfs.2020.00101
  9. Application of nasal septal cartilage in a combined transorbital and transnasal approach for orbital wall reconstruction vol.48, pp.2, 2021, https://doi.org/10.5999/aps.2020.01312