Management of persistent diplopia after surgical repair of orbital fractures

Loba, Piotr; Kozakiewicz, Marcin; Nowakowska, Olimpia; Omulecki, Wojciech; Broniarczyk-Loba, Anna

doi:10.1016/j.jaapos.2012.08.007

Cited by 23 publications

(16 citation statements)

References 25 publications

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“…Two weeks are enough for the orbital hematoma and edema to subside or reduce and to prepare the patient for surgery Kwon et al divided orbital floor fractures into anterior, posterior and anteroposterior 12 . But there is a very large dispersion of functional results, 8.7-67%, especially in the persistence of postoperative diplopia 5,7,[13][14][15][16][17] . Worth noting is the contribution of CT-guided surgery, leading to the complete disappearance of postoperative diplopia.…”

Section: Discussionmentioning

confidence: 99%

Indications for repositioning of blow-out fractures of the orbital floor based on new objective criteria - tissue protrusion volumometry

Kovář¹,

Voldrich²,

Voska³

et al. 2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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a Background and Aim. The otolaryngologist often meets with fractures of the orbital floor. The most serious complication is diplopia, arising as a result of herniation of the orbital contents, with or without fixation of the inferior rectus muscle. The aim of our work was to create a mathematical model to calculate the volume of prolapsed soft tissue of the orbit in blow-out fractures, as a factor in deciding on the need for surgical treatment. Patients and Methods. In a retrospective study (2007)(2008)(2009)(2010)(2011)(2012)(2013), we evaluated 80 patients with blow-out fractures, divided into two equal groups: 40 conservatively treated and 40 surgically treated patients. We created the model by measuring the fracture lines and herniation of the orbital soft tissues in the coronal and sagittal sections from CT images, equivalent to half the volume of a rotating ellipsoid. Results. According to the proposed model, posterior and anterior fractures with a prolapse volume above 500 mm 3 , and anteroposterior fractures with a volume over 1400 mm 3 , are indicated for surgery. Conclusion. The volume of prolapsed soft tissue relative to the location of the fracture is the main indicator for selecting the best treatment procedure immediately after injury.

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Section: Discussionmentioning

confidence: 99%

Indications for repositioning of blow-out fractures of the orbital floor based on new objective criteria - tissue protrusion volumometry

Kovář¹,

Voldrich²,

Voska³

et al. 2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…The goal is to achieve a useful field of binocular single vision in the straight-ahead direction, not in the entire field of gaze. 92 In case of orbital soft tissue scarring, the usual doseeffect rules cannot be applied (e.g., 1.5 degrees change of gaze/ mm recession or resection of a healthy rectus muscle). In our own experience, 17% of patients perceived diplopia after orbital reconstruction necessitating subsequent strabismus surgery.…”

Section: Functional Rehabilitation By Orbital Soft Tissue Surgerymentioning

confidence: 99%

Orbital Reconstruction: Prefabricated Implants, Data Transfer, and Revision Surgery

et al. 2014

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External impact to the orbit may cause a blowout or zygomatico-maxillary fractures. Diagnosis and treatment of orbital wall fractures are based on both physical examination and computed tomography scan of the orbit. Injuries of the orbit often require a reconstruction of its orbital walls. Using computer-assisted techniques, anatomically preformed orbital implants, and intraoperative imaging offers precise and predictable results of orbital reconstructions. Secondary reconstruction of the orbital cavity is challenging due to fractures healed in malposition, defects, scarring, and lack of anatomic landmarks, and should be avoided by precise primary reconstruction. The development of preformed orbital implants based on topographical analysis of the orbital cavity was a milestone for the improvement of primary orbital reconstruction.

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“…Potential complications following the orbital floor fracture repair may include incomplete correction of preoperative enophthalmos and diplopia, as well as induction of the globe dystopia, eyelid malposition, or optic nerve injury [3]. Residual diplopia is regarded as the most common post-treatment complication of orbital bone fracture reduction [4,5].…”

Section: Introductionmentioning

confidence: 99%

Management of simultaneous ocular elevation and depression deficit in patients after reconstruction surgery for orbital floor fracture

Loba

Ordon

2020

Graefes Arch Clin Exp Ophthalmol

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Purpose To present and examine the results of surgical correction of simultaneous ocular elevation and depression deficit in patients who underwent reconstruction surgery for orbital floor fracture. Methods A retrospective analysis of medical records of patients who had undergone surgical correction for diplopia associated with orbital fracture which persisted after orbital reconstruction surgery. All patients underwent orthoptic evaluation before surgery and postoperatively with various times of follow-up. Results Eight cases of blow-out fracture of the orbital floor were identified. Surgical plan varied from case to case. It included thorough revision of inferior rectus/oblique complex with or without recession of the former or flap tear repair and additional procedures. Postoperatively 4 patients (50%) were diplopia free, 3 (37.5%) presented diplopia in extreme upgaze and 1 (12.5%) in mid-upgaze and adduction. None of the patients reported diplopia in the primary position neither downgaze. Conclusion Diplopia persisting after reconstructive surgery of a fractured orbital floor may be corrected surgically. Our results suggest that at least two surgical procedures are necessary to achieve satisfying outcomes. Contralateral inferior rectus recession combined with superior oblique recession and superior rectus posterior fixation appears to be effective procedures for use.

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Management of persistent diplopia after surgical repair of orbital fractures

Cited by 23 publications

References 25 publications

Indications for repositioning of blow-out fractures of the orbital floor based on new objective criteria - tissue protrusion volumometry

Indications for repositioning of blow-out fractures of the orbital floor based on new objective criteria - tissue protrusion volumometry

Orbital Reconstruction: Prefabricated Implants, Data Transfer, and Revision Surgery

Management of simultaneous ocular elevation and depression deficit in patients after reconstruction surgery for orbital floor fracture

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