Blow-out fractures usually occur at the weakest point of orbital wall such as medial wall or orbital floor. The operative treatment of blow-out fracture involve restoration of intra-orbital soft tissue and bony structural integrity. The surgical reduction of medial blow-out fracture are mainly transcutaneous, transnasal and transconjunctival approaches. The conventional methods has several disadvantages, such as external scar, narrow operative field and injury of neurovascular bundle. But medial transconjunctival approach has advantages such as minimal scar, short operative time and relative safety. We experinced 26 cases of medial blow-out fracture using medial transconjunctival approach from June 2001 to May 2003. Preoperatively 21 cases showed diplopia and 14 cases showed enophthalmos. In postoperative complications, diplopia were 2 cases, enophthalmos was 1 case, anterior displacement of implant were 2 cases, conjunctival scar were 2 cases and injury of caruncle was 1 case. We report the medial transconjunctival approach that was effective treatment for medial blow-out fracture without specific complications.
Cicatrix ; Diplopia ; Enophthalmos ; Operative Time ; Orbit ; Orbital Fractures* ; Postoperative Complications

BACKGROUND: Poly-L-lactide materials combined with hydroxyapatite (u-HA /PLLA) have been developed to overcome the drawbacks of absorbable materials, such as radiolucency and comparably less implant strength. This study was designed to evaluate the usefulness of u-HA/PLLA material in the repair of orbital medial wall defects. METHODS: This study included 10 patients with pure medial wall blow-out fractures. The plain radiographs were taken preoperatively, immediately after, and 2 months after surgery. The computed tomography scans were performed preoperatively and 2 months after surgery. Patients were evaluated for ease of manipulation, implant immobility, rigidity and complications with radiologic studies. RESULTS: None of the patients had postoperative complications, such as infection or enophthalmos. The u-HA/PLLA implants had adequate rigidity, durability, and stable position on follow-up radiographic studies. On average, implants were thawed 3.4 times and required 14 minutes of handling time. CONCLUSION: The u-HA/PLLA implants are safe and reliable for reconstruction of orbital medial wall in terms of rigidity, immobility, radiopacity, and cost-effectiveness. These thin yet rigid implants can be useful where wide periosteal dissection is difficult due to defect location or size. Since the u-HA/PLLA material is difficult to manipulate, these implants are not suitable for use in complex 3-dimensional defects.
Absorbable Implants ; Durapatite* ; Enophthalmos ; Follow-Up Studies ; Humans ; Orbit* ; Orbital Fractures ; Orbital Implants ; Postoperative Complications

The recommended treatment of blow-out fracture varies greatly according to the operators. In addition, the implants used to span the orbital bony defect in blow-out fracture are various. Titanium is widely used for orthopaedic device for its good structural stability, excellent strength, eternal quality, high biocompatability, little risk of infection, malleability and easy fixation for operation. We had repaired inferior orbital wall fracture with Titanium mesh on 7 patients with large orbital inferior wall fracture in the posterior orbit in the last 2 years. All 7 patients showed improvements in extraocular ovements and the reduction of diplopia over 6 months. But one patient had persistent enophthalmos, and 2 patients complained of infraorbital numbness. For the reconstruction of orbital fracture, especially inferior wall in the posterior orbit, Titanium mesh may served as a good alloplastic implant without serious postoperative complications.
Diplopia ; Enophthalmos ; Fractures, Bone* ; Humans ; Hypesthesia ; Orbit* ; Orbital Fractures ; Postoperative Complications ; Titanium*

PURPOSE: This study presents a classification of pure medial and inferior blow-out fracture, and confirms the relationship between the types of fractures, postoperative complications and operative methods. METHODS: Sixty patients were treated by transnasal endoscopic reduction with Medpor(R) implantation through subciliary incision and foley catheter insertion into maxillary sinus was done if there was extensive orbital floor fracture. Fractures were classified by number of coronal sections from posterior margin of fossa for lacrimal sac to orbital apex in CT. Type I is defined when the medial wall fracture is over 50% and inferior wall fracture below 50%. Type II, when below 50% medial wall fracture and over 50% floor fracture were present. If there were both over 50%, it was classified as Type III and both below 50% for Type IV. Extreme fracture involving orbital buttress was Type V and postoperative findings in all patients were examined. RESULTS: Type I and V were most common and preoperative findings were more likely to present according to extent of inferior fracture. Diplopia remained in 2 cases after additional insertion of foley catheter, but enophthalmos over 2 mm were presented in 3 cases and diplopia in 3 cases were observed who were not treated with foley catheter. CONCLUSION: Postoperative complications were increased according to extent of fracture, especially buttress involvement. Additional insertion of foley catheter proved its effectiveness in decreasing postoperative complications.
Catheters ; Diplopia ; Endoscopy ; Enophthalmos ; Floors and Floorcoverings ; Humans ; Maxillary Sinus ; Orbit ; Orbital Fractures ; Postoperative Complications

PURPOSE: The inferior orbital wall is the most vulnerable to injury and inadequate reconstruction of inferior orbital fracture result in postoperative complications include enophthalmos, ocular dystopia and diplopia. Although the anatomical reconstruction of the inferior orbital wall is necessary to prevent these complications, the complexity of inferior orbital wall makes it difficult. We fabricated and remodeled the titanium micro-mesh plate for the anatomical reconstruction of inferior orbital wall. METHODS: Twenty-nine patients with inferior orbital wall blow-out fracture were operated and twelve of them presented large extensive fracture. We intraoperatively fabricated and remodeled the Titanium-micro mesh to angulated lazy S shape similar to contralateral uninjured orbit. The preoperative and postoperative facial CT scan verified the 3-dimensional and anatomical reconstruction of the fractures. The mean follow-up was 19.7 months and postoperative complications was evaluated. RESULTS: All cases showed the exact anatomical reconstruction, but there were minor complications in two cases. one patient had postoperative diplopia until 3months after surgery and the other patient had persistent enophthalmos(2mm), but no further surgical correction was required. CONCLUSION: The comprehensive understanding of orbital convexity is the most important factor for anatomical reconstruction of inferior orbital fracture. We could prevent postoperative complications after inferior orbital wall reconstruction by intraoperative fabrication and anatomical remodeling of Titanium micro-mesh.
Diplopia ; Enophthalmos ; Follow-Up Studies ; Humans ; Orbit ; Orbital Fractures ; Postoperative Complications ; Titanium

PURPOSE: The inferior orbital wall is the most vulnerable to injury and inadequate reconstruction of inferior orbital fracture result in postoperative complications include enophthalmos, ocular dystopia and diplopia. Although the anatomical reconstruction of the inferior orbital wall is necessary to prevent these complications, the complexity of inferior orbital wall makes it difficult. We fabricated and remodeled the titanium micro-mesh plate for the anatomical reconstruction of inferior orbital wall. METHODS: Twenty-nine patients with inferior orbital wall blow-out fracture were operated and twelve of them presented large extensive fracture. We intraoperatively fabricated and remodeled the Titanium-micro mesh to angulated lazy S shape similar to contralateral uninjured orbit. The preoperative and postoperative facial CT scan verified the 3-dimensional and anatomical reconstruction of the fractures. The mean follow-up was 19.7 months and postoperative complications was evaluated. RESULTS: All cases showed the exact anatomical reconstruction, but there were minor complications in two cases. one patient had postoperative diplopia until 3months after surgery and the other patient had persistent enophthalmos(2mm), but no further surgical correction was required. CONCLUSION: The comprehensive understanding of orbital convexity is the most important factor for anatomical reconstruction of inferior orbital fracture. We could prevent postoperative complications after inferior orbital wall reconstruction by intraoperative fabrication and anatomical remodeling of Titanium micro-mesh.
Diplopia ; Enophthalmos ; Follow-Up Studies ; Humans ; Orbit ; Orbital Fractures ; Postoperative Complications ; Titanium

From April 1989 to April 1993, 85 patients with orbital fractures were analysed. Among them, 10 patients were repaired surgically. Orbital fractures occured most frequently between the aga of 11 and 40 years. The main causes of injury were violence(41%), traffic accident (27%) and falldown injury (19%). Medial wall fractures were most common, followed by fractures of inferior wall, superior wall in order. In combined wall fracture, medial and inferior wall fracture was most frequent. The associated symptoms and signs of orbital fracture were lid laceration (32%), diplopia (29%). orbital edema(27%). traumatic iridocyclitis(22%). The subciliary approach was used for repair of the fracture. Early surgical intervention was done within 10 days in all cases. The insertion of Lyodura was performed in 9 patients. and calvarian bone graft was fashioned and placed over the defect in 1 patient. Insufficient correction of enophthalmos in 1 patient, lower eye lid retraction in 1 patient, residual diplopia in far upgaze in 2 patients were encountered as postoperative complications.
Accidents, Traffic ; Diplopia ; Enophthalmos ; Humans ; Lacerations ; Orbit* ; Orbital Fractures* ; Postoperative Complications ; Transplants

PURPOSE: The operative treatment for blow-out fracture involves restoration of intra-orbital soft tissue and bony structural integrity. There are several methods for reconstruction of inferior blow out fracture. We report reduction of inferior blow-out fracture with urinary balloon catheter in comparison with Medpor(R) using group to complication rate. METHODS: A retrospective study was performed on 67 patients who underwent inferior orbital blow-out fracture reconstruction with Medpor(R) implant or urinary balloon catheter following between 2003 and 2006. Hospital records were reviewed especially for preoperative and postoperative enophthalmos, diplopia, extraocular muscle movement limitations, and hypoesthesia between Medpor(R) implant group and balloon catheter using group. RESULTS: There was no significant statistical difference between both groups on incidence of postoperative complications of enophthalmos, diplopia, extraocular muscle movement limitations, and hypoesthesia. Postoperative infection, ectropion were absent in both groups. CONCLUSION: The use of urinary balloon catheter is simple, fast and inexpensive. Urinary balloon catheter is an alternative and reliable use for reduction of inferior orbital blow-out fracture.
Catheters* ; Diplopia ; Ectropion ; Enophthalmos ; Hospital Records ; Humans ; Hypesthesia ; Incidence ; Orbit ; Orbital Fractures* ; Postoperative Complications ; Retrospective Studies

OBJECTIVETo evaluate the effective of transconjunctival approach in treating orbitozygomatic complex fractures.

METHODSFifty-four transconjunctival incisions were applied to correct enophthalmos and face collapse in 46 patients who suffered by orbitozygomatic complex fractures. All operative procedures were performed with an additional lateral canthotomy (5-10 mm) and 43 of them with gingivobuccal sulcus incisions simultaneously. The infraorbital rim and lateral orbital wall were stabilized with titanium plates. Titanium nets were used to reconstruct the comminuted orbit floor fractures.

RESULTSThe bilateral zygomaticas of 46 cases with orbitozygomatic complex fractures were basically symmetric, and the eyeball positions were reset anatomically. The treatment effectiveness were satisfactory. There were no obvious postoperative complications, except one corneal epithelium stripped on the right side and one overtime swelling of conjunctiva which cured after relevant treatments.

CONCLUSIONThe transconjunctival approach has good exposure to the orbital floor without visible scar and injury to facial nerve branches, it is a preferable procedure to reconstruct orbitozygomatic fractures.

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