PURPOSE: Primary reconstruction via transconjunctival approach is a standardized treatment option for orbital floor fractures. The aim of this study was to compare the findings of specific ophthalmologic assessment with the patient's complaints after fracture reduction. METHODS: A retrospective medical chart analysis was performed on patients who had undergone transconjunctival orbital floor fracture reduction for fracture therapy with resorbable foil (ethisorb sheet or polydioxanone foil). A follow-up assessment including ophthalmological evaluation regarding visual acuity (eye chart projector), binocular visual field screening (Bagolini striated glasses test) and diplopia (cover test, Hess screen test) was conducted. Additionally, a questionnaire was performed to assess patients' satisfaction. RESULTS: A total of 53 patients with a mean follow-up of 23 months (ranging from 11 to 72) after surgical therapy were included. Diplopia was present preoperatively in 23 (43.4%) and reduced in follow-up examination (n = 12, 22.6%). Limitations in ocular motility reduced from 37.7% to 7.5%. The questionnaire about the patient's satisfaction revealed excellent outcomes in relation to the functional and esthetical parameters. CONCLUSION Transconjunctival approach is a safe approach for orbital fracture therapy. Postoperative diplopia is nearly never perceptible for the individual and differs to pathologic findings in the ophthalmic assessment.
Cohort Studies ; Diplopia ; diagnosis ; etiology ; Follow-Up Studies ; Fracture Fixation ; methods ; Orbital Fractures ; complications ; physiopathology ; psychology ; surgery ; Outcome Assessment (Health Care) ; Patient Satisfaction ; Polydioxanone ; administration & dosage ; Polyglycolic Acid ; administration & dosage ; Retrospective Studies ; Surveys and Questionnaires ; Treatment Outcome ; Visual Acuity ; Visual Fields

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

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

Traumatic rupture of the superior oblique muscle is rare. We report a case of a 54-year-old man injured by the metal hook of a hanger, resulting in a rupture of the superior oblique muscle tendon. He complained of torsional diplopia when in the primary position. The distal margin of the superior oblique muscle was reattached to sclera 5 and 9 mm apart from the medial insertion of the superior rectus muscle. One week after the operation, torsional diplopia disappeared. However, a 4-prism diopter ipsilateral hypertropia was observed. Three months later, hypertropia gradually increased to 20 prism dioptors and the second operation was done to correct vertical diplopia.
Diplopia/etiology/physiopathology/surgery ; Eye Injuries/complications/*diagnosis/surgery ; *Eye Movements ; Humans ; Male ; Middle Aged ; Oculomotor Muscles/*injuries/physiopathology/surgery ; Ophthalmologic Surgical Procedures/*methods ; Strabismus/etiology/physiopathology/surgery ; Tendon Injuries/complications/*diagnosis/surgery

Diplopia ; etiology ; Fracture Fixation ; adverse effects ; methods ; Humans ; Orbital Fractures ; diagnosis ; diagnostic imaging ; surgery ; Orbital Implants ; Tomography, X-Ray Computed

Diplopia ; etiology ; Enophthalmos ; etiology ; Exophthalmos ; etiology ; Facial Nerve Injuries ; etiology ; Hemorrhage ; etiology ; Humans ; Intraoperative Complications ; etiology ; prevention & control ; Orbit ; blood supply ; surgery ; Orbital Fractures ; surgery ; Postoperative Complications ; etiology ; prevention & control ; Reconstructive Surgical Procedures ; adverse effects ; Reflex, Trigeminocardiac ; Vision, Low ; etiology

A case of acquired Brown syndrome caused by surgical repair of medial orbital wall fracture is reported in the present paper. A 23-year-old man presented at the hospital with right periorbital trauma. Although the patient did not complain of any diplopia, the imaging study revealed a blow-out fracture of the medial orbital wall. Surgical repair with a calvarial bone autograft was performed at the department of plastic surgery. The patient was referred to the ophthalmologic department due to diplopia that newly developed after surgery. The prism cover test at distant fixation showed hypotropia of the right eye, which was 4 prism diopters (PD) in primary gaze, 20 PD in left gaze, while orthophoric in right gaze. Eye movement of the right eye was markedly limited on elevation in adduction with normal elevation in abduction with intorsion in the right eye present. Forced duction test of the right eye showed restricted elevation in adduction. Computerized tomography scan of the orbits showed the right superior oblique muscle was entrapped between the autografted bone fragment and posterior margin of the fracture. When repairing medial orbital wall fracture that causes Brown syndrome, surgeons should always be careful of entrapment of the superior oblique muscle if the implant is inserted without identifying the superior and posterior margin of the orbital fracture site.
Bone Transplantation/*adverse effects ; Diplopia/etiology ; Humans ; Male ; Ocular Motility Disorders/*etiology/radiography ; Ophthalmologic Surgical Procedures/*adverse effects ; Orbital Fractures/*surgery ; Tomography, X-Ray Computed ; Transplantation, Autologous ; Young Adult

A 51-year old man presented with vertical and torsional diplopia after reduction of a blowout fracture at another hospital one year ago. He had no anormalies of head position and 14 prism diopters (PD) right hypertropia (RHT) in the primary position. In upgaze no vertical deviation was found, and hyperdeviation on downgaze was 35PD. Bielschowsky head tilt test showed a negative response. Distinct superior oblique (SO) and inferior rectus (IR) underaction of the right eye was noted but IO overaction was mild on the ocular version test. Double Maddox rod test (DMRT) revealed 10-degree extorsion, but fundus extorsion was minimal in the right eye.Thin-section coronal CT scan showed that there was no fracture line on the anterior orbital floor, but a fracture remained on the posterior orbital floor. Also, the anterior part of the right inferior oblique muscle was vertically reoriented and the medial portion of the inferior oblique muscle was not traced on the coronal CT scan. The patient underwent 14 mm right IO recession and 3 mm right IR resection. One month after the surgery, his vertical and torsional diplopia were eliminated in the primary position.
Constriction, Pathologic/complications/etiology/physiopathology/radiography ; Diplopia/etiology ; Humans ; Male ; Middle Aged ; Muscular Diseases/complications/etiology/*physiopathology/*radiography ; Oculomotor Muscles/*physiopathology/*radiography/surgery ; Orbital Fractures/*complications ; *Tomography, X-Ray Computed

Simulated Brown syndrome is a term applied to a myriad of disorders that cause a Brown syndrome-like motility. We encountered a case of acquired simulated Brown syndrome in a 41-year-old man following surgical repair of fractures of both medial orbital walls. He suffered from diplopia in primary gaze, associated with hypotropia of the affected eye. We performed an ipsilateral recession of the left inferior rectus muscle as a single-stage intraoperative adjustment procedure under topical anesthesia, rather than the direct approach to the superior oblique tendon. Postoperatively, the patient was asymptomatic in all diagnostic gaze positions.
Adult ; Anesthesia, Local ; Diplopia/*etiology/surgery ; Eye Movements ; Humans ; Male ; Ocular Motility Disorders/*etiology/radiography/surgery ; Oculomotor Muscles/surgery ; Ophthalmologic Surgical Procedures ; Orbital Fractures/radiography/*surgery ; *Postoperative Complications ; Strabismus/etiology/surgery ; Tomography, X-Ray Computed ; Vision, Binocular

A 28-year-old female presented with a palpable mass lesion on the superonasal aspect of her right globe and she had a progressive diplopia. She had a scleral encircling surgery with a Miragel explant (MIRA, Waltham, Mass, USA) for the tractional retinal detachment associated with pars planitis 9 years previously. On examination, she revealed restricted eye movements of her right eye. The magnetic resonance imaging documented a swelling of the Miragel explant that mimicked a periorbital mass lesion. The Miragel explant was removed and fragmentation of the explant was found intraoperatively. The removed Miragel explant was examined by a scanning electron microscopy, and this demonstrated a disintergrated and swollen structural composition of the Miragel explant. Postoperatively, her extraocular movement was almost restored and the retina remained well attached. Alterations in the structural composition of the Miragel explant results in an excessive swelling that causes a restriction of the extraocular movement, and this can mimick a periorbital mass lesion.
Adult ; Diplopia/*etiology ; Female ; Granuloma, Plasma Cell, Orbital/*etiology ; Humans ; Magnetic Resonance Imaging ; Polyhydroxyethyl Methacrylate/*adverse effects/*analogs & derivatives ; Retinal Detachment/surgery ; Scleral Buckling/*adverse effects ; Visual Fields