Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
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A useful additional medial subbrow approach for the treatment of medial orbital wall fracture with subciliary technique

  • Kim, Seung Min (Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine) ;
  • Kim, Cheol Keun (Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine) ;
  • Jo, Dong In (Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine) ;
  • Lee, Myung Chul (Department of Plastic and Reconstructive Surgery, Konkuk University Seoul Hospital, Konkuk University School of Medicine) ;
  • Kim, Ji Nam (Department of Plastic and Reconstructive Surgery, Konkuk University Seoul Hospital, Konkuk University School of Medicine) ;
  • Choi, Hyun Gon (Department of Plastic and Reconstructive Surgery, Konkuk University Seoul Hospital, Konkuk University School of Medicine) ;
  • Shin, Dong Hyeok (Department of Plastic and Reconstructive Surgery, Konkuk University Seoul Hospital, Konkuk University School of Medicine) ;
  • Kim, Soon Heum (Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine)
  • Received : 2019.04.10
  • Accepted : 2019.04.20
  • Published : 2019.04.20
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Abstract

Background: To date, a variety of surgical approaches have been used to reconstruct the medial orbital wall fracture. Still however, there is still a controversy as to their applicability because of postoperative scars, injury of anatomical structures and limited visual fields. The purpose of this study was to introduce a useful additional medial subbrow approach for better reduction and securement more accurate implant pocket of medial orbital wall fracture with the subciliary technique. Methods: We had performed our technique for a total of 14 patients with medial orbital wall fracture at our medical institution between January 2016 and July 2017. All fractures were operated through subciliary technique combined with the additional medial subbrow approach. They underwent subciliary approach accompanied by medial wall dissection using a Louisville elevator through the slit incision of the medial subbrow procedure. This facilitated visualization of the medial wall fracture site and helped to ensure a more accurate pocket for implant insertion. Results: Postoperative outcomes showed sufficient coverage without displacement. Twelve cases of preoperative diplopia improved to two cases of postoperative diplopia. More than 2 mm enophthalmos was 14 cases preoperatively, improving to 0 case postoperatively. Without damage such as major vessels or extraocular muscles, enophthalmos was corrected and there was no restriction of eyeball motion. Conclusion: Our ancillary procedure was useful in dissecting the medial wall, and it was a safe method as to cause no significant complications in our clinical series. Also, there is an only nonvisible postoperative scar. Therefore, it is a recommendable surgical modality for medial orbital wall fracture.

Keywords

References

  1. Chou C, Kuo YR, Chen CC, Lai CS, Lin SD, Huang SH, et al. Medial orbital wall reconstruction with porous polyethylene by using a transconjunctival approach with a caruncular extension. Ann Plast Surg 2017;78(3 Suppl 2):S89-94. https://doi.org/10.1097/SAP.0000000000001012
  2. Mullins JB, Holds JB, Branham GH, Thomas JR. Complications of the transconjunctival approach: a review of 400 cases. Arch Otolaryngol Head Neck Surg 1997;123:385-8. https://doi.org/10.1001/archoto.123.4.385
  3. Kim YH, Park Y, Chung KJ. Considerations for the management of medial orbital wall blowout fracture. Arch Plast Surg 2016;43:229-36. https://doi.org/10.5999/aps.2016.43.3.229
  4. Lee W, Kang DH, Oh SA, Lee SW. Transnasal reduction of blow out fracture with transconjunctival approach. J Korean Cleft Palate Craniofac Assoc 2010;11:1-6.
  5. Purnell CA, Vaca EE, Ellis MF. Orbital fracture reconstruction using prebent, anatomic titanium plates: technical tips to avoid complications. J Craniofac Surg 2018;29:e515-7. https://doi.org/10.1097/SCS.0000000000004563
  6. Chen CT, Huang F, Chen YR. Management of posttraumatic enophthalmos. Chang Gung Med J 2006;29:251-61.
  7. Nam SB, Kim KH, Choi SJ, Lee MW, Bae YC. The postoperative results of endoscopic transnasal approach to blowout fractures. J Korean Cleft Palate Craniofac Assoc 2007;8:59-64.
  8. Sanno T, Tahara S, Nomura T, Hashikawa K. Endoscopic endonasal reduction for blowout fracture of the medial orbital wall. Plast Reconstr Surg 2003;112:1228-37. https://doi.org/10.1097/01.PRS.0000080723.29129.64
  9. Wang S, Lv J, Xue L, Xi Z, Zheng H, Wang R. Anatomic study and clinical significance of extended endonasal anterior skull base surgery. Neurol India 2014;62:525-31. https://doi.org/10.4103/0028-3886.144451
  10. Choi WK, Kang DH, Oh SA. Anatomical reconstruction of the medial orbital wall fracture. Arch Craniofac Surg 2012;13:29-35. https://doi.org/10.7181/acfs.2012.13.1.29
  11. Baumann A, Ewers R. Transcaruncular approach for reconstruction of medial orbital wall fracture. Int J Oral Maxillofac Surg 2000;29:264-7. https://doi.org/10.1016/S0901-5027(00)80025-9
  12. Lim JH, Kim TG, Lee JH, Kim YH. Inlay grafting for the treatment of the posterior comminuted fracture of medial orbital wall. J Korean Cleft Palate Craniofac Assoc 2009;10:55-60.
  13. Shi W, Jia R, Li Z, He D, Fan X. 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
  14. Strong EB, Kim KK, Diaz RC. Endoscopic approach to orbital blowout fracture repair. Otolaryngol Head Neck Surg 2004;131:683-95. https://doi.org/10.1016/j.otohns.2004.05.017
  15. Fernandes R, Fattahi T, Steinberg B, Schare H. Endoscopic repair of isolated orbital floor fracture with implant placement. J Oral Maxillofac Surg 2007;65:1449-53. https://doi.org/10.1016/j.joms.2006.10.080
  16. Jeon SY, Kwon JH, Kim JP, Ahn SK, Park JJ, Hur DG, et al. Endoscopic intranasal reduction of the orbit in isolated blowout fractures. Acta Otolaryngol Suppl 2007;127:102-9. https://doi.org/10.1080/03655230701624962
  17. Kakibuchi M, Fukazawa K, Fukuda K, Yamada N, Matsuda K, Kawai 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
  18. Choi SJ, Oh HC, Nam SB, Kang CU, Bae YC. The reconstruction of the extensive inferior blow-out fracture through endoscopic transnasal and subciliary approaches. J Korean Cleft Palate Craniofac Assoc 2009;10:86-90.
  19. Eitzen JP, Elsas FJ. Strabismus following endoscopic intranasal sinus surgery. J Pediatr Ophthalmol Strabismus 1991;28:168-70. https://doi.org/10.3928/0191-3913-19910501-13
  20. Hamra ST. Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconstr Surg 1995;96:354-62. https://doi.org/10.1097/00006534-199508000-00014
  21. Shorr N, Baylis HI, Goldberg RA, Perry JD. Transcaruncular approach to the medial orbit and orbital apex. Ophthalmology 2000;107:1459-63. https://doi.org/10.1016/S0161-6420(00)00241-4