Archives of Plastic Surgery

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

DOI QR Code

Mapping the Posterior Ledge and Optic Foramen in Orbital Floor Blowout Fractures

  • Yu Cong Wong (Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore) ;
  • Doreen S.L. Goh (Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore) ;
  • Celine S.Y. Yoong (Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore) ;
  • Cowan Ho (Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore) ;
  • Elijah Z. Cai (Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, National University Health Systems) ;
  • Angela Hing (Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore) ;
  • Hanjing Lee (Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, National University Health Systems) ;
  • Vigneswaran Nallathamby (Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, Ng Teng Fong General Hospital) ;
  • Yan L. Yap (Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, National University Health Systems) ;
  • Jane Lim (Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, National University Health Systems) ;
  • Sundar Gangadhara (Department of Ophthalmology, Division of Orbit and Oculofacial Surgery, National University Hospital) ;
  • Thiam C. Lim (Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore)
  • Received : 2022.06.11
  • Accepted : 2023.02.07
  • Published : 2023.07.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background The posterior ledge (PL) is a vital structure that supports the implant posteriorly during orbital floor reconstruction. This study describes a technique for mapping the PL in relation to the infraorbital margin (IM) in patients with orbital floor blowout fractures. This study establishes the location of the optic foramen in relation to the PL. Methods Facial computed tomography (FCT) scans of 67 consecutive patients with isolated orbital floor blowout fractures were analyzed using Osirix. Planes of reference for orbital fractures, a standardized technique for performing measurements on FCT, was used. Viewed coronally, the orbit was divided into seven equal sagittal slices (L1 laterally to L7 medially) with reference to the midorbital plane. The distances of PL from IM and location of optic foramen were determined. Results The greatest distance to PL is found at L5 (median: 30.1 mm, range: 13.5-37.1 mm). The median and ranges for each slice are as follows: L1 (median: 0.0 mm, range: 0.0-19.9 mm), L2 (median: 0.0 mm, range: 0.0-21.5 mm), L3 (median: 15.8 mm, range: 0.0-31.7 mm), L4 (median: 26.1 mm, range: 0.0-34.0 mm), L5 (median: 30.1 mm, range: 13.5-37.1 mm), L6 (median: 29.0 mm, range: 0.0-36.3 mm), L7 (median: 20.8 mm, range: 0.0-39.2 mm). The median distance of the optic foramen from IM is 43.7 mm (range: 37.0- 49.1) at L7.

Keywords

References

  1. Gunarajah DR, Samman N. Biomaterials for repair of orbital floor blowout fractures: a systematic review. J Oral Maxillofac Surg 2013;71(03):550-570 https://doi.org/10.1016/j.joms.2012.10.029
  2. Boyette JR, Pemberton JD, Bonilla-Velez J. Management of orbital fractures: challenges and solutions. Clin Ophthalmol 2015;9:2127-2137 https://doi.org/10.2147/OPTH.S80463
  3. Bly RA, Chang S-H, Cudejkova M, Liu JJ, Moe KS. Computer-guided orbital reconstruction to improve outcomes. JAMA Facial Plast Surg 2013;15(02):113-120 https://doi.org/10.1001/jamafacial.2013.316
  4. Liu S, Chen Y, Song J, Tian Y, Xia C, Li Y. Optic canal location by computed tomography. J Craniofac Surg 2013;24(01):284-286 https://doi.org/10.1097/SCS.0b013e31827102ee
  5. Nicholson DH, Guzak SV. Visual loss complicating repair of orbital floor fractures. Plast Reconstr Surg 1972;49(03):356
  6. Kozakiewicz M, Olbrzymek L, Stefanczyk L, et al. Radio-opaque polyethylene for personalized craniomaxillofacial implants. Clin Oral Investig 2017;21(05):1853-1859 https://doi.org/10.1007/s00784-016-1978-x
  7. OsiriX User Manual. Accessed December 12, 2021 at: https://www.osirix-viewer.com/osirix/osirix-user-manual/
  8. Cai EZ, Chong XT, Ong WL, et al. Planes of reference for orbital fractures: a technique for reproducible measurements of the orbit on computed tomography scans. J Craniofac Surg 2018;29(07):1817-1820 https://doi.org/10.1097/SCS.0000000000005021
  9. Cheng Y, Leow WK, Lim TC (2012). Automatic identification of Frankfurt plane and mid-sagittal plane of skull. 2012 IEEE Workshop on the Applications of Computer Vision (WACV) Doi:10.1109/wacv.2012.6162994
  10. Kunz C, Audige L, Cornelius CP, Buitrago-Tellez CH, Rudderman R, Prein J. The Comprehensive AOCMF Classification System: orbital fractures - level 3 tutorial. Craniomaxillofac Trauma Reconstr 2014;7(Suppl 1):S092-S102 https://doi.org/10.1055/s-0034-1389562
  11. Kim HS, Jeong EC. Orbital floor fracture. Arch Craniofac Surg 2016;17(03):111-118 https://doi.org/10.7181/acfs.2016.17.3.111
  12. Harris GJ. Avoiding complications in the repair of orbital floor fractures. JAMA Facial Plast Surg 2014;16(04):290-295 https://doi.org/10.1001/jamafacial.2014.56
  13. Gooris PJJ, Muller BS, Dubois L, et al. Finding the ledge: sagittal analysis of bony landmarks of the orbit. J Oral Maxillofac Surg 2017;75(12):2613-2627 https://doi.org/10.1016/j.joms.2017.07.156
  14. Essig H, Dressel L, Rana M, et al. Precision of posttraumatic primary orbital reconstruction using individually bent titanium mesh with and without navigation: a retrospective study. Head Face Med 2013;9(01):18
  15. Ploder O, Klug C, Backfrieder W, Voracek M, Czerny C, Tschabitscher M. 2D- and 3D-based measurements of orbital floor fractures from CT scans. J Craniomaxillofac Surg 2002;30(03):153-159 https://doi.org/10.1054/jcms.2002.0296
  16. Manchio JV, Sati S, Rosman DA, Bryan DJ, Lee GM, Weinzweig J. Role of sagittal reformatted computed tomographic images in the evaluation of orbital floor fractures. J Craniofac Surg 2010;21(04):1153-1157 https://doi.org/10.1097/SCS.0b013e3181e433e5
  17. O'Hare TH. Blow-out fractures: a review. J Emerg Med 1991;9(04):253-263 https://doi.org/10.1016/0736-4679(91)90422-C
  18. Rontal E, Rontal M, Guilford FT. Surgical anatomy of the orbit. Ann Otol Rhinol Laryngol 1979;88(3 Pt 1):382-386 https://doi.org/10.1177/000348947908800315
  19. Mohamed A, Nankivil D, Pesala V, Taneja M. The precision of ophthalmic biometry using calipers. Can J Ophthalmol 2013;48(06):506-511 https://doi.org/10.1016/j.jcjo.2013.07.007
  20. Gilliland GD, Gilliland G, Fincher T, Harrington J, Gilliland JM. Assessment of biomechanics of orbital fracture: a study in goats and implications for oculoplastic surgery in humans. Am J Ophthalmol 2005;140(05):868-876 https://doi.org/10.1016/j.ajo.2005.05.030
  21. Dubois L, Jansen J, Schreurs R, et al. Predictability in orbital reconstruction: a human cadaver study. Part I: endoscopic-assisted orbital reconstruction. J Craniomaxillofac Surg 2015;43(10):2034-2041 https://doi.org/10.1016/j.jcms.2015.07.019
  22. Turvey TA, Golden BA. Orbital anatomy for the surgeon. Oral Maxillofac Surg Clin North Am 2012;24(04):525-536 https://doi.org/10.1016/j.coms.2012.08.003
  23. Danko I, Haug RH. An experimental investigation of the safe distance for internal orbital dissection. J Oral Maxillofac Surg 1998;56(06):749-752 https://doi.org/10.1016/S0278-2391(98)90812-6