OBJECTIVE: To discuss the clinical features and treatment methods for simple orbital blowout fracture. METHOD: Retrospective analysis of the CT images of 16 orbital blowout fracture case, and identification of the sites, degree, patterns and features of fractures. Among the 16 cases, 2 cases adopted conservative treatment; 11 cases gained a reduction of orbital fracture through endoscopic transnasal surgery; the other 3 patients choosed endoscopic transnasal surgery and Caldwell-Luc operations. RESULT: Among 16 diplopia cases, 13 cases were completely cured, and 3 patients' vision were significantly improved. Among 11 enophthalmos cases, 10 patients were cured, and the effect of the other one was not satisfied. Among the 15 eye movement disorder cases, 13 patients' eye movement gained a full recovery, and the other 2 cases were nearly normal. All patients' vision were improved in different extents, and no one got a complication. CONCLUSION Computerized Tomography is helpful to the diagnosis of simple orbital blowout fracture. Caldwell-Luc operation with transnasal endoscope is an effective method for the treatment of orbital fractures.
Diplopia ; etiology ; Endoscopy ; Enophthalmos ; etiology ; Humans ; Orbital Fractures ; complications ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed

Enophthalmos ; etiology ; surgery ; Humans ; Orbital Fractures ; complications ; surgery ; Polyethylenes ; Prostheses and Implants ; Reconstructive Surgical Procedures ; methods ; Surgery, Computer-Assisted

OBJECTIVETo study and compare the operative results of the early and late treatment of orbital blow-out fracture.

METHODSOrbital blow-out fractures were reconstructed and repositioned. Three dimensional measurements, CT scanning, diplopia analysis, Medpor filling of the orbit were used for the operation and the study. The operative results were compared between 15 cases of early and 16 cases of late reconstruction of blow-out fracture.

RESULTSIn the early treatment group, there were 8 cases of diplopia, 15 cases of orbital invagination and 10 cases of disesthesia of the infraorbital nerve. After surgery, diplopia was corrected in 7 cases; invagination was corrected in all the 15 cases; disesthesia of the infraorbital nerve was corrected in 8 cases. In the late treatment group, there were 10 cases of diplopia, 16 cases of orbital invagination and 9 cases of disesthesia of the infraorbital nerve. After surgery, diplopia was corrected in 3 cases, unimproved in 4 cases, aggravated in 2 cases. 5 of them received reoperation of extraocular muscle for diplopia. Orbital invagination was uncorrected in 3 cases. 2 of them were re-operated on. Disesthesia of the infraorbital nerve was unimproved in 2 cases. By comparing the operation results, of the two groups using FISHER accuracy inspection, the significant difference was only in the correction of the double visions (chi 2 = 4.865, P < 0.05).

CONCLUSIONEarly operation for orbital blow-out fracture is easier, with better results, fewer complications and reoperations than the late operation.

Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Orbital Fractures ; surgery ; Postoperative Complications ; epidemiology ; Reconstructive Surgical Procedures ; methods ; Time Factors

OBJECTIVE: To study surgical techniques and clinical applications of the intranasal endoscopic combined middle meatus and expand prelacrimal recess-maxillary ainus approach for orbital fracture treatment. METHOD: A retrospective clinical analysis of 3 patients whose admitted for orbital floor fractures or medial wall fractures operated by the intranasal endoscopic middle meatus with expand prelacrimal recess-maxillary ainus approach surgical treatment was studied, and the treatment effects and the postoperative complications were analyzed. RESULT: All patients had been followed up for 6 to 12 months. All cases of diplopia symptom were disappeared, enophthalmos were totally corrected, no cases of complication were found. CONCLUSION Endonasal endoscopic combined middle meatus and expand prelacrimal recess-maxillary ainus approach for orbital fracture treatment have great and clear view. This approach with less tissue damage and high therapeutic effect makes the cost lower than other methods and complications will be decreased as well, it has a great advantage in the orbital fracture treatment.
Diplopia ; etiology ; therapy ; Endoscopy ; Enophthalmos ; etiology ; therapy ; Humans ; Maxillary Sinus ; surgery ; Nose ; Ophthalmologic Surgical Procedures ; methods ; Orbital Fractures ; complications ; surgery ; Postoperative Complications ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies

OBJECTIVEFor reconstruction of secondary orbit-zygomatic deformities after severe malar fracture.

METHODSWe made shaped segments in orbito-zygoma region using lamella osteotomy, rearranged inferior and lateral orbital segment with inner and upper movement, and fixed the zygomatic fragment in new place with lateral and upward movement. Pre and post operative measurements including Hetel measurement and the angle between orbital horizontal level with bilateral tragus linkage(A-OT) have been done.

RESULTSIn our 22 cases list, lateral and inferior orbital segment was moved to upper and inner direction with 8.1 mm in average, while zygomatic fragent was lift 9.2 mm and pushed 1.5 mm in average. In average 6.5 months follow-up, good facial contour were maintained in most of our list and no obvious relapse was occurred.

CONCLUSIONSLamella osteotomy with separated segments movement was benefit to most of secondary deformities in orbito-zygoma displace.

Adolescent ; Adult ; Craniofacial Abnormalities ; etiology ; surgery ; Humans ; Male ; Middle Aged ; Orbit ; abnormalities ; surgery ; Orbital Fractures ; complications ; Osteotomy ; methods ; Young Adult ; Zygoma ; abnormalities ; surgery

BACKGROUND: One of the main concerns in orbital blowout fracture repair is a narrow operation field, due mainly to the innate complex three dimensions of the orbit; however, a deep location and extensive area of the fracture and soft tissue edema can also cause concern. Swelling of the orbital contents progresses as the operation continues. Mannitol has been used empirically in glaucoma, cerebral hemorrhage, and orbital compartment syndrome for decompression. The authors adopted mannitol for the control of intraorbital edema and pressure in orbital blowout fracture repair. METHODS: This prospective study included 108 consecutive patients who were treated for a pure blowout fracture from January 2007 to October 2012. For group I, mannitol was administered during the operation. Under general anesthesia, all patients underwent surgery by open reduction and insertion of an absorbable mesh implant. The authors compared postoperative complications, the reoperation rate, operation time, and surgical field improvement between the two groups. RESULTS: In patients who received intraoperative administration of mannitol, the reoperation rate and operation time were decreased; however, the difference was not statistically significant. The total postoperative complication rates did not differ. Panel assessment for the intraoperative surgical field video recordings showed significantly improved vision in group I. CONCLUSIONS: For six years, mannitol proved itself an effective, reliable, and safe adjunctive drug in the repair of orbital blowout fractures. With its rapid onset and short duration of action, mannitol could be one of the best methods for obtaining a wider surgical field in blowout fracture defects.
Anesthesia, General ; Cerebral Hemorrhage ; Compartment Syndromes ; Decompression ; Edema ; General Surgery ; Glaucoma ; Humans ; Intraoperative Complications ; Mannitol* ; Methods ; Orbit* ; Orbital Fractures ; Postoperative Complications ; Prospective Studies ; Reoperation ; Video Recording ; Vision, Ocular

OBJECTIVETo evaluate the efficiency of individually fabricated titanium mesh to correct enophthalmos following orbital fracture by using computer-assisted navigation system.

METHODSForty- nine patients with unilateral orbital fracture were divided into navigation group (25 cases) and non-navigation group (24 cases). All patients underwent orbital reconstruction to correct post-traumatic enophthalmos with individually fabricated titanium mesh. The bilateral global projection and the orbital volumn were measured preoperatively and postoperatively. The depth of titanium mesh was measured postoperatively.

RESULTSStatistical analysis demonstrated the global projection at the affected side increased by (3.35 ± 1.46) mm in navigation group and by (2.25 ± 1.14) mm in non- navigation group postoperatively, and there was a significant difference between the two groups (P < 0.05). The orbital volumn at the affected side decreased by (5.94 ± 2.20) ml in navigation group and by (4.21 ± 2.18) ml in non-navigation group, and there was a significant difference between the two groups (P < 0.05). The depth of titanium was (31.95±2.97) mm in navigation group and (29.27±2.72) mm in non-navigation group, and the values between the two groups differed significantly (P < 0.05).

CONCLUSIONSThe use of computer-assisted navigation for the orbital wall reconstruction with individually fabricated titanium mesh can protect the optic nerve reliably and achieve satisfactory results.

Enophthalmos ; etiology ; surgery ; Eye Injuries ; Humans ; Orbit ; Orbital Fractures ; complications ; Prostheses and Implants ; Reconstructive Surgical Procedures ; Surgery, Computer-Assisted ; Surgical Mesh ; Titanium

We report four unusual cases of upper eyelid retraction following periorbital trauma. Four previously healthy patients were evaluated for unilateral upper eyelid retraction following periorbital trauma. A 31-year-old man (Case 1) and a 24-year-old man (Case 2) presented with left upper eyelid retraction which developed after blow-out fractures, a 44-year-old woman (Case 3) presented with left upper eyelid retraction secondary to a periorbital contusion that occurred one week prior, and a 56-year-old man (Case 4) presented with left upper eyelid retraction that developed 1 month after a lower canalicular laceration was sustained during a traffic accident. The authors performed a thyroid function test and orbital computed tomography (CT) in all cases. Thyroid function was normal in all patients, CT showed an adhesion of the superior rectus muscle and superior oblique muscle in the first case and diffuse thickening of the superior rectus muscle and levator complex in the third case. CT showed no specific findings in the second or fourth cases. Upper eyelid retraction due to superior complex adhesion can be considered one of the complications of periorbital trauma.
Accidents, Traffic ; Adult ; Eye Injuries/*complications/surgery ; Eyelid Diseases/*etiology/radiography ; Female ; Humans ; Lacerations/complications/surgery ; Lacrimal Apparatus/*injuries ; Male ; Middle Aged ; Oculomotor Muscles ; Orbital Fractures/*complications/surgery ; Tomography, X-Ray Computed

OBJECTIVETo summarize the experiences in the treatment of complicated orbital fractures.

METHODSA total of 89 patients with complicated orbital fractures treated in Department of Oral and Maxillofacial Surgery, China Medical University from January 2005 to January 2010 were retrospectively reviewed. The classification of these cases included naso-orbital-ethmoid fracture, frontal orbital fracture and orbitozygomatic fracture. All patients were followed up for 6 - 36 months.

RESULTSThe orbital frame was repaired or reconstructed in these patients. The function of lacrimal pathways was improved. All the patients and the physicians were satisfied with the surgical effects. However, recurrence of deformity after endophthalmas correction was found in several cases.

CONCLUSIONSThe experiences, comprehensive management of complicated orbital fractures by team approaches, concluded from this study could be expanded. There are still challenges in the treatment of complicated orbital fractures, such as severe endophthalmas deformity, recurrence of endophthalmas deformity and malunion of complicated orbital fracture.

Adolescent ; Adult ; Aged ; Enophthalmos ; etiology ; surgery ; Ethmoid Bone ; injuries ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Nasal Bone ; injuries ; surgery ; Orbital Fractures ; complications ; surgery ; Reconstructive Surgical Procedures ; Retrospective Studies ; Skull Fractures ; complications ; surgery ; Young Adult ; Zygomatic Fractures ; complications ; surgery

Alloplastic implants are known to be inert for many years, though complications are infrequently reported many years after their insertion. We report the case of a patient who had undergone a blow-out fracture repair five years before the discovery of a hematic cyst. He had been free of symptoms for the first five years after his orbital floor repair but then developed pain on eyeball movement and persistent vertical diplopia, which finally led to surgical intervention. At surgery, a hematic cyst was found to have formed around the implanted silastic plate. When alloplastic material is used in orbital fracture repair, we should be alert for late complications which may occur many years after surgery.
Adult ; Biocompatible Materials ; *Blood ; Bone Cysts/diagnosis/*etiology ; Humans ; Male ; Orbital Diseases/diagnosis/*etiology ; Orbital Fractures/diagnosis/*surgery ; Postoperative Complications ; Prostheses and Implants/*adverse effects ; Reoperation ; Silicone Elastomers/*adverse effects ; Tomography, X-Ray Computed