ABSTRACT The main aim of orbital fracture reconstruction is to restore the functional and aesthetic components of the eye. However, it is known that surgery for complex three-dimensional anatomy of the orbit is always a challenge. With recent advancements in technology, surgical predictability and outcomes have greatly improved. Several methods for orbital reconstruction surgery have been documented such as virtual surgical planning, intraoperative navigation, intraoperative imaging, and the use of patient-specific implant (PSI). PSI made of titanium can be designed by using a computer-aided design process and manufacturing (CAD-CAM) of CT-scan routinely used during diagnostic imaging. With precise analyses in shape and size followed by personalised implant design, the surgical precision can be alleviated further and at the same time, the surgical duration could be reduced with anticipation of better surgical outcomes. However, meticulous planning needs to be done preoperatively, with the timing of the surgery being an important factor. In the present case, pure orbital blowout fracture primarily treated with a personalised-implant solution derived from 3D-printing technology is described. Both pre-surgical and surgical workflow of this computer-assisted surgical method is elaborated. PSI for primary orbital reconstruction can be regarded as a viable alternative surgical solution including its working timeframe and adherence to the surgical protocol or algorithm.
Orbital Fractures--surgery ; Orbital Implants

PURPOSE: Blow-out fracture is one of the most common fractures in facial trauma. It is diagnosed by Computed Tomography(CT) scan, which is considered as the most effective diagnostic tool. Since, the Picture Archiving Communication System(PACS) has been provided recently to many hospitals, doctors are more familiar with imaging software of PACS. Because this software has many useful measuring tools, doctors can measure orbital structure easily and make a plan for treatment with its data. Therefore, authors intended to analyze the data of orbital structure measured with PACS imaging software and evaluate its usefulness. METHODS: The charts and CT images of 100 patients, which were 50 patients with medial wall fracture and 50 patients with floor fracture, were reviewed. Patients were selected by pre-determined criteria and their CT images were measured with image software of PACS. 'Extraocular muscle thickness', 'Defect ratio'(ratio of defect area to normal area) and 'Globe position index' were measured and analyzed statistically. RESULTS: The thickness of inferior rectus muscle and medial rectus muscle was simultaneously increased in acute-stage of blow-out fracture. The medial rectus muscle was more thickened in medial wall fracture and inferior rectus was more thickened in floor fracture, respectively. In acute blow-out fracture, globe position is exophthalmic rather than enophthalmic. Especially in floor fracture, numerical value summed up thickness of all extraocular muscle is correlated to the defect ratio and globe position index. CONCLUSION: Clinicians can decide globe position or presume defect ratio in inferior wall fracture by measurement of CT image in acute blow-out fracture using PACS.
Humans ; Orbit* ; Orbital Fractures*

PURPOSE: Blow-out fracture is one of the most common fractures in facial trauma. It is diagnosed by Computed Tomography(CT) scan, which is considered as the most effective diagnostic tool. Since, the Picture Archiving Communication System(PACS) has been provided recently to many hospitals, doctors are more familiar with imaging software of PACS. Because this software has many useful measuring tools, doctors can measure orbital structure easily and make a plan for treatment with its data. Therefore, authors intended to analyze the data of orbital structure measured with PACS imaging software and evaluate its usefulness. METHODS: The charts and CT images of 100 patients, which were 50 patients with medial wall fracture and 50 patients with floor fracture, were reviewed. Patients were selected by pre-determined criteria and their CT images were measured with image software of PACS. 'Extraocular muscle thickness', 'Defect ratio'(ratio of defect area to normal area) and 'Globe position index' were measured and analyzed statistically. RESULTS: The thickness of inferior rectus muscle and medial rectus muscle was simultaneously increased in acute-stage of blow-out fracture. The medial rectus muscle was more thickened in medial wall fracture and inferior rectus was more thickened in floor fracture, respectively. In acute blow-out fracture, globe position is exophthalmic rather than enophthalmic. Especially in floor fracture, numerical value summed up thickness of all extraocular muscle is correlated to the defect ratio and globe position index. CONCLUSION: Clinicians can decide globe position or presume defect ratio in inferior wall fracture by measurement of CT image in acute blow-out fracture using PACS.
Humans ; Orbit* ; Orbital Fractures*

No abstract available.
Orbit* ; Orbital Fractures*

No abstract available.
Maxillary Sinus* ; Orbit* ; Orbital Fractures*

PURPOSE: We compared ocular torsion rates in blow-out fracture patients before and after blowout fracture repair by analyzing mean disc foveal angles. METHODS: The study participants were divided into 2 groups: blow-out fracutre repair patients (n = 36) and controls (n = 36). We measured ocular torsion rates by analyzing mean disc foveal angle. The angle was composed of 2 imaginary horizontal lines which crossed the optic disc center and fovea. We compared statistically ocular torsion rates in blow-out fracture patients based on subsided diplopia, continued diplopia, or absence of diplopia before and after blow-out fracture repair using paired t-test. RESULTS: In the patient group, ocular torsion rates were statistically significantly decreased. In the blow-out fracture repair group with subsided diplopia, ocular torsion rates were decreased statistically from 7.74 +/- 3.48 degrees before blow-out fracture repair to 5.02 +/- 3.11 degrees after blow-out fracture repair. In the blow-out fracture repair group with continued diplopia or absence of diplopia before surgery, ocular torsion rates did not change statistically significantly from 6.36 +/- 2.80 degrees before blow-out fracture repair to 6.51 +/- 3.24 degrees after blow-out fracture repair. CONCLUSIONS: Subsided diplopia after blow-out fracture repair and ocular torsion rate changes were significantly related in blow-out fracture patients. Further research which on the correlation of intraorbital change and movement of orbital position after blow-out fracture repair with ocular torsion rates are necessary.
Diplopia* ; Humans ; Orbit ; Orbital Fractures*

The objective of this study was to ascertain the elationship between the various ocular traumas and the change of pulsatile ocular blood flow[POBF] measured with Ocular Blood Flow Tonograph[OBF Laboratories, UK Ltd.]. We tested POBF with Ocular Blood Flow Tonograph 3 times repeatedly within 48 hours after trauma in the 33 ocular trauma patients.In all the trauma eyes, heart rate[HR]and intraocular pressure[IOP]were higher and pulse amplitude [PA], pulse volume[PV], POBF were lower than in all the fellow eyes.In the hyphema group, HR, IOP, PA, PV, POBF were higher, especially IOP and OBF%S.D.were statically significant, than in non-hyphema group.In the orbital fracture group, only POBF and OBF%S.D.were higher than those of in non-fracture group. Therefore, these results show the change of POBF after various ocularinjuries in the ocular trauma patients.The further studies to follow up the serial change of POBF are necessary.
Heart ; Humans ; Hyphema ; Orbital Fractures

The purpose of this study is to compare the diagnostic accuracy and usefulness of three-dimensional CT, two-dimensional CT in case of blow-out fracture. Two-dimensional CT, three-dimensional CT images of twenty-four blow-out fracture and soft tissue incarceration. Two dimensional CT was superior to three-dimensional CT in evaluating orbital bone fracture and soft tissue incarceration. But, three-dimensional CT was more useful to identify of orbital bone fracture than two-dimensional CT in associated facial bone fracture. Coexamination with two-dimensional axial & three-dimensonal CT was useful not only in the detection of fracture but in the evaluation of soft tissue incarcerated blow-out fracture.
Facial Bones ; Fractures, Bone ; Orbit ; Orbital Fractures*

Management of posttraumatic enophthalmos can present as a challenge to the reconstructive surgeon, particularly in cases of late presentation. This article reviews the pertinent anatomy of the orbit, diagnostic modalities, indications for surgery, and surgical approaches as they relate to the treatment of posttraumatic enophthalmos. Internal orbital reconstruction has evolved to an elegant procedure incorporating various biologic or alloplastic implants, including anatomical pre-bent implants. Successful repair of late enophthalmos has been demonstrated in multiple recent studies and is likely related to the precision with which orbital anatomy can be restored.
Enophthalmos ; Orbit ; Orbital Fractures ; Orbital Implants ; Polymethacrylic Acids

Implants are used in operative reconstruction of bony defect in case of blow-out fracture. If there is a large bony defect, the thin and flexible implants can not sustain intraorbital pressure, so it may be displaced. To prevent postoperative displacement of the implant, we tried reinforcing the center of the implant, where the intraorbital pressure was focused, piling up two pieces of porous polyethylene Implants(Medpor(R)) cross- shaped. 190 patients of large blow out fracture were divided into control group(n=95) who received classic orbital wall reconstruction and study group(n=95) to whom we inserted two small pieces of Medpor(R) one by one and covered a large defect cross shaped. We compared two groups in operative time, duration of postoperative accommodation and re-operation number. Operative time was assessed as shorter in study group(16.73+/-4.24min vs 21.40+/-5.32min, p> or =0.01). Duaration of postoperative accommodation also assessed as shorter in study group (2.05+/-0.70 weeks vs 3.00+/-1.00 weeks, p> or =0.01). There was no specific difference between two groups for re- operation number (3 vs 3, p=1.00). The method to insert two small pieces of Medpor(R) one by one and covered a large defect cross shaped shows shorter operative time and duration of postoperative accommodation than the classic method inserting large one piece of Medpor(R).
Humans ; Operative Time ; Orbit ; Orbital Fractures ; Polyethylene*