Incidence of diplopia after division and reattachment of the inferior oblique muscle during orbital fracture repair

Alameddine, Raafat; Tsao, Jeffrey Z.; Ko, Audrey C.; Lee, Bradford W.; Kikkawa, Don O.; Korn, Bobby S.

doi:10.1016/j.jcms.2018.05.026

Cited by 7 publications

(16 citation statements)

References 12 publications

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“…Seventeen and 23 patients had right and left orbital wall fractures, respectively. The mean follow-up visit was 9 ± 3.47 months (range, [6][7][8][9][10][11][12][13][14][15][16][17]. Patients showed enophthalmos of -1.46 ± 0.25 (range, -5 to 3) mm compared with the normal side.…”

Section: Resultsmentioning

confidence: 99%

“…Detaching IOM permits a thorough examination of the fracture site on the inner aspects of the orbital wall and the application of an appropriately preshaped or L-shaped fabricated implant to restore the lost natural curve of the orbital wall. 9 , 12 Moreover, reattachment following IO detachment facilitated great surgical results. We reported satisfactory surgical outcomes following combined orbital wall fractures with IO reattachment.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, when the extent of the fracture is large, surgery should be performed with the goal of overcorrection by approximately 1 mm in comparison with the fellow eye. 9,12 Diplopia occurred in patients with IOM weakening. No factors related to diplopia were discovered in this study; however, we found important factors associated with IOM weakening, such as preoperative strabismus and preoperative EOM limitation.…”

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confidence: 99%

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Clinical Results According to Inferior Oblique Manipulation in Patients with Inferomedial Blowout Fracture Involving the Orbital Strut

Park

Choi

2022

OPTH

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Background: Detachment of the inferior oblique muscle may be necessary under certain circumstances to repair a large inferomedial orbital fracture involving the orbital strut. This study aimed to evaluate the outcomes of patients who underwent surgeries with and without inferior oblique muscle reattachment after its detachment to repair the orbital wall fractures. Methods: Forty patients who underwent repair of combined floor and medial orbital wall fracture involving the orbital strut at a single tertiary institution between January 2014 and December 2020 were reviewed. Groups 1 and 2 comprised 20 patients each, who underwent surgery with inferior oblique muscle detachment without and with reattachment, respectively, and were followed up for at least 6 months postoperatively. Enophthalmos, Goldmann diplopia test, alignment test, ocular motility test, and orbital inferomedial angle ratio were the outcome measures. Results: Statistically significant improvement was observed in ocular motility, diplopia, and enophthalmos postoperatively at the 1and 6-month follow-up (p < 0.01). The mean postoperative inferomedial angle ratio (102.28 ± 10.62%) was improved significantly compared with the preoperative inferomedial angle ratio (115.61 ± 4.38%) (p = 0.004) in all patients. After surgery, inferior oblique muscle underaction was observed in seven and six patients in groups 1 and 2, respectively, which was associated with preoperative extraocular movement limitation and strabismus. Two patients showed diplopia in both groups at the last follow-up; they had inferior oblique muscle underaction but no enophthalmos. Conclusion: Orbital fracture repair with or without inferior oblique muscle reattachment was clinically effective and safe; however, patients with preoperative strabismus and extraocular motility limitation should be informed of the increased risk of postoperative complications.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical Results According to Inferior Oblique Manipulation in Patients with Inferomedial Blowout Fracture Involving the Orbital Strut

Park

Choi

2022

OPTH

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“…14 However, other reports of intentional IO disinsertion followed by muscle reposition within the orbit showed no lasting postoperative motility deficits or diplopia. 1,15 The IO is often regarded as a forgiving muscle and may be less likely to elicit diplopia when injured, compared with other EOMs.…”

Section: Discussionmentioning

confidence: 99%

“…Disinsertion of the inferior oblique (IO) during orbital surgery is a wellestablished technique to improve visualization and access to the orbital floor and medial wall. 1,2 Diplopia is less common in these cases, despite techniques ranging from re-suturing the cut muscle, to simply repositing the muscle in the orbit without additional fixation. 1 Herein, the authors present a case of IO transection and repair during a complex facial fracture repair.…”

Section: Introductionmentioning

confidence: 99%

Inferior Oblique Entrapment After Orbital Fracture With Transection and Repair

Tooley

Levine

Godfrey

et al. 2020

Craniomaxillofacial Trauma & Reconstruction

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Extraocular muscle (EOM) entrapment with resulting reduction in motility and diplopia is a known complication of orbital fractures. Less commonly, transection of the EOMs due to trauma, iatrogenic injury, or intentional myotomy may lead to persistent diplopia. The inferior oblique (IO) is often encountered during orbital surgery along the medial wall and floor, and may be disinserted to aid in visualization. The authors present a case of IO entrapment which occurred during zygomaticomaxillary fracture reduction. Intraoperatively, an IO transection was performed and the muscle was reattached within the orbit. Postoperatively, the patient did not develop diplopia or motility disruption. This technique may provide a useful solution to an unusual problem during orbital fracture repair.

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