Surgery on Orbital Floor Fractures

Hawes, Michael J.; Dortzbach, Richard K.

doi:10.1016/s0161-6420(83)80049-9

Cited by 244 publications

(44 citation statements)

References 4 publications

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“…Orbital fractures are common sequelae of blunt trauma to the periocular region and have been occurring more frequently because of the increasing number of traffic accidents, industrial accidents, social activities and violence [1,2]. It can be associated with various ocular and extraocular injuries, and failure of prompt recognition and treatment of these injuries may result in significant cosmetic and functional problems, such as enophthalmos, restriction in ocular motility and ocular dystopia [3].…”

Section: Introductionmentioning

confidence: 99%

An Analysis of 733 Surgically Treated Blowout Fractures

Jung

Shin

et al. 2009

Ophthalmologica

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Purpose: To evaluate current patient demographics and surgical outcomes from a large series of 733 surgically treated orbital fractures from an ophthalmologist’s perspective. Methods: We reviewed the medical records of 733 patients with orbital fracture, who were treated surgically by one of the authors at Gil Hospital, Gachon University, from May 2000 until September 2007. Data regarding patient demographics, signs and symptoms at presentation, cause of injury, nature of fracture, associated ocular and nonocular injury, surgical outcome and complications were collected. Results: Male patients outnumbered female patients, and blowout fracture occurred most frequently between the ages of 20 and 29 years (mean age 30.7 years). Violent assault was the leading cause of the fractures, followed by fall/slip and traffic accidents. Common signs and symptoms were periorbital ecchymosis, ocular motility restriction, diplopia and enophthalmos. In the pediatric group, diplopia and ocular motility restriction were the most common. Subconjunctival hemorrhage, hyphema and commotio retinae were the most commonly associated ocular injuries. As for the location of fractures, medial wall fractures were the most common, followed by fractures of the inferior wall, and both medial and inferior walls, in order. The most common type of fracture was the ‘comminuted’ one. In the pediatric group, the percentage of trapdoor-type fracture was higher than in the adult group. Forty-four percent of the patients had diplopia preoperatively and 8.7% postoperatively. The average measurement of difference in the enophthalmos (≧2 mm) patient population was improved from 2.62 (±SD 0.9) to 1.73 (±SD 1.3) after surgery. Ocular motility restriction was preoperatively noted in 297 patients (40.5%), and only 18 patients (2.5%) showed restriction after surgery. Conclusion: Young male individuals are at the highest risk for orbital fractures. There are marked differences in the clinical symptomatology and findings between pediatric and adult orbital fractures. Diplopia, enophthalmos and ocular motility restriction improved by repair of fracture.

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Section: Introductionmentioning

confidence: 99%

An Analysis of 733 Surgically Treated Blowout Fractures

Jung

Shin

et al. 2009

Ophthalmologica

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“…The apparatus from the in vitro set-up was designed on the basis of literature concerning the anatomy and physiology of the human orbit and the epidemiology of orbital floor fractures [7,8,[26][27][28][29][30][31][32]. Literature con-566 cerning the load acting on an orbital floor in normal conditions or after reconstruction was found to be scarce.…”

Section: Discussionmentioning

confidence: 99%

“…Defects of the orbital floor range in size from 1 to 4 cm 2 and enophthalmos is usually present or likely to develop when the defect is larger than half of the orbital floor or over 2.5 cm 2 in area [7,8]. An orbital floor implant used for repair of the defect should extend a few millimetres over the intact margins around the entire defect to ensure its stability [26].…”

Section: Discussionmentioning

confidence: 99%

“…The design of the apparatus was based on literature concerning the anatomy and physiology of the human orbit and the epidemiology of orbital floor fractures [7,8,[26][27][28][29][30][31]. Defect D in the perspex tray had a diameter of 2 cm, the area size of the defect thus being 3.1 cm z.…”

Section: Methodsmentioning

confidence: 99%

“…The aim of surgical intervention should be to reposition prolapsed orbital contents, to release incarcerated orbital tissue and to reconstruct the orbital floor in its correct anatomical position [5 9]. To reconstruct a large orbital floor defect and support the orbital contents the aid of an implant will frequently be needed [2,7]. For this purpose, the use of a resorbable alloplastic material presents an appealing choice.…”

Section: Introductionmentioning

confidence: 99%

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Poly (96L/4D-Lactide) implants for repair of orbital floor defects: an in vitro study of the material properties in a simulation of the human orbit

Cordewener¹,

Rozema²,

Joziasse

et al. 1995

J Mater Sci: Mater Med

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To test the mechanical and physical properties of two types of poly(96L/4D-lactide) (PLA96) implants and to evaluate their suitability for repair of large orbital floor defects, a study using an in vitro set-up was performed. Implants, 0.2 mm thick and 28 mm in diameter, were produced by either an extrusion process (type A) or by direct machining (type B) and had a molecular weight (Mw) of 64 x 103 and 146 x 103 g/mole, respectively, after y-sterilization with a dose of 25 kGy. The implants were tested over 8 weeks in an apparatus simulating the human orbit with a 3.1 cm 2 orbital floor defect under a static load corresponding to a retrobulbar pressure of 13 mm Hg as well as unloaded. Both implant types were able to counteract the applied static load without fracturing or excessive sagging. The type A implants sagged more than the type B implants (2.34-0.1 mm versus 1.0 _ 0.0 mm, p < 0.01) but retained and even increased their strength during the study whereas the type B implants showed a gradual strength-loss. In the clinical setting the observed sagging in both types would not have resulted in positional changes of the eyeball. It is concluded that with respect to the mechanical properties, both types of PLA96 implants tested are suitable for repair of large orbital floor defects.

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Bone and Cartilage Wedge Technique in Posttraumatic Enophthalmos Treatment

Lieger

Zix

Kruse

et al. 2010

Archives of Facial Plastic Surgery

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OBJECTIVE: To evaluate a new surgical method, using calvarial bone graft combined with a wedge of irradiated homologous costal cartilage, for the revision repair of posttraumatic enophthalmos. METHODS: This retrospective study was performed from January 1, 2003, through December 31, 2007. Eight patients were diagnosed as having unilateral posttraumatic enophthalmos. All the patients had previously undergone insufficient primary repair of their orbital fractures. In the revision surgery a calvarial bone graft was placed in the area of the defect using a transconjunctival approach. In combination with this technique, a wedge of irradiated rib cartilage was placed on the bone graft behind the globe. Patients were assessed preoperatively and postoperatively by ophthalmologists and maxillofacial surgeons. Standard follow-up examinations were performed at 2 and 4 weeks and at 3 and 6 months after surgery. Computed tomographic scans were obtained preoperatively and postoperatively from all patients. RESULTS: For all 8 corrected orbits, favorable cosmetic results were obtained regarding the position of the globe. The mean preoperative Hertel exophthalmometer showed a difference of 3.1 mm and 0.7 mm postoperatively. Improvement of ocular motility and reduction of diplopia were achieved in only 1 patient; in the others, motility and diplopia remained unchanged. No postoperative complications were observed. CONCLUSION: The bone and cartilage wedge technique seems to be a useful surgical technique for the cosmetic correction of posttraumatic enophthalmos.

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Surgery on Orbital Floor Fractures

Cited by 244 publications

References 4 publications

An Analysis of 733 Surgically Treated Blowout Fractures

An Analysis of 733 Surgically Treated Blowout Fractures

Poly (96L/4D-Lactide) implants for repair of orbital floor defects: an in vitro study of the material properties in a simulation of the human orbit

Bone and Cartilage Wedge Technique in Posttraumatic Enophthalmos Treatment

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