Timing of operation for blowout fractures with extraocular muscle entrapment

Sugamata, Akira; Yoshizawa, Naoki; Shimanaka, Kosuke

doi:10.3109/2000656x.2013.779581

Cited by 11 publications

(16 citation statements)

References 22 publications

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“…In extreme cases patients with entrapment can experience bradycardia, nausea, and syncope when attempting extraocular movements (the oculocardiac reflex), and immediate operative reduction with release of the entrapped muscle is of immediate importance. [15][16][17][24][25][26] The most common indication for repair is correction of enophthalmos, resulting from the loss of support of the orbital floor. A small amount of hypophthalmos can be tolerated both cosmetically and functionally; however, the degree of floor loss that does require repair is often debated.…”

Section: Orbital Floor Fracturesmentioning

confidence: 99%

Orbital Trauma

Lozada

Cleveland

Smith

2019

Seminars in Plastic Surgery

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The orbit is contained within a complex bony architecture with overlying soft tissue that involves many important anatomical structures. Orbital trauma is a frequent cause of damage to these structures. The authors review the literature on reconstructive techniques focusing on fractures of the orbital rim, orbital roof, orbital floor, medial orbital wall, and naso-orbito-ethmoid complex. A thorough literature review was conducted using PubMed analyzing articles relevant to the subject matter. Various search terms were used to identify articles regarding orbital trauma presentation, diagnosis, management, as well as postoperative complications. Articles were examined by all authors and pertinent information was gleaned for the purpose of generating this review. Orbital trauma can result in a wide variety of complications in form and function. Not all orbital fractures require operative repair. However, bony disruption can cause enophthalmos, hypophthalmos, telecanthus, epiphora, cerebrospinal fluid leaks, orbital hematoma, and even blindness to name a few. Timing of operative repair as well as reconstructive method is dictated by the patient's individual presentation. Successful fracture management requires a detailed understanding of the anatomy and pathophysiology to ensure restoration of the patients' preoperative state. Orbital trauma encompasses a wide variety of mechanisms of injury and resulting fracture patterns. A variety of surgical approaches to the orbit exist as has been discussed allowing the surgeon access to all area of interest. Regardless of the fracture complexity, the principles of atraumatic technique, anatomic reduction, and stable fixation apply in all cases.

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Section: Orbital Floor Fracturesmentioning

confidence: 99%

Orbital Trauma

Lozada

Cleveland

Smith

2019

Seminars in Plastic Surgery

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“…5 Most published cases appear to affect young adults in their late teens and 20's. [6][7][8][9][10][11][12][13][14][15] The oldest patient with confirmed extraocular muscle entrapment found in our literature review was 53 years old. 16 Similarly, we had 3 patients who were in their twenties and 2 patients aged 58 and 62, which to our knowledge represents the oldest patients with confirmed extraocular muscle entrapment.…”

Section: Discussionmentioning

confidence: 73%

Adult Orbital Fractures with Extraocular Muscle Entrapment

Hakim

Huang

Mojtahed³

et al. 2021

FACE

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Orbital fractures with entrapment are well described in children but occur less frequently in adults. The true incidence, natural history, and ideal timing of surgical intervention of adult orbital fractures with entrapment are unknown. A single institution, retrospective chart review of 5 adult patients with orbital fractures with entrapment who underwent surgical intervention and had at least 1 follow up visit was performed. Ages ranged from 21 to 62 years old (mean = 37.6). Timing between initial presentation and surgery ranged from 14 to 62 hours (mean = 34.8). Intra-operatively, all patients had clinical entrapment of extraocular muscles and underwent surgical release followed by orbital implant reconstruction. Follow up ranged from 1 week to 1 year (mean = 16 weeks). Three of 5 patients had significant improvement of extraocular movements at their last follow up. Two patients had residual exotropia and difficulty with adduction; one was a unique case with medial rectus transection which has not been previously described. It is important that clinical suspicion for entrapment remains high in orbital fractures even in adult populations. Based on current literature, early surgical intervention is recommended for adult patients with entrapment even in the absence of oculocardiac reflex.

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“…Generally, it should be performed immediately in patients with ocular motility limitation and diplopia due to the entrapment of extraocular muscles confirmed by orbital CT scan. Otherwise, the surgery should be performed approximately 2 weeks after the onset of trauma (20,21), when traumatic edema and hematoma have basically disappeared and tissue adhesion haven't significantly formed yet. Thus, it is easy to separate and reposit those intraorbital soft tissues that herniate into the paranasal sinus, and the surgical outcome is better than that performed immediately after trauma.…”

Section: Discussionmentioning

confidence: 99%

Repair of unilateral combined orbital floor and medial wall fracture using two titanium mesh plates: a modified technique

et al. 2021

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Background: Compared to isolated orbital wall fracture, combined orbital floor and medial wall fractures are more likely to be required surgical correction due to a higher possibility of complications. However, it remains a challenge to repair concomitant orbital fracture using a one-piece implant due to the complex anatomic structures of the orbit. Aiming to reduce surgical difficulties and enhance therapeutic effects, we repaired unilateral combined orbital floor and medial wall fractures using two separated modified titanium mesh plates in this study.Methods: A retrospective study was conducted on 21 consecutive patients who presented with unilateral combined orbital floor and medial wall fractures in Tianjin Medical University General Hospital between November 2010 and January 2016. The orbital fractures were repaired with two separated titanium mesh plates. The corner at the transition zone area between the orbital floor and the medial wall was reconstructed simultaneously through a combined transcaruncular and inferior subciliary approach with lateral canthotomy.The pre-and post-operative functions and aesthetic results were evaluated.Results: Preoperatively, all patients presented with 3.5-6.5 mm enophthalmos, five patients presented with diplopia with ocular motility limitation in injured eyes, and six patients presented with hypoglobus ranging from 1.5 to 3.5 mm. Orbital floor and medial wall fractures of all patients were successfully repaired with two separated titanium mesh plates. Postoperatively, enophthalmos was improved in all patients, which was less than 2 mm on the last follow-up day. Hypoglobus was disappeared in all six patients postoperatively. Diplopia was resolved in five patients within 3 months post operation, and was reduced in one patient.Conclusions: In cases of unilateral concomitant orbital floor and medial wall fractures, two titanium mesh plates implantation is a safe and effective procedure. It is worthwhile to take the technique into account when the key points to consider when applying this method include reconstruction of the special orbital shape and the complete return reposition of prolapsed intraorbital soft tissues were intended.

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Timing of operation for blowout fractures with extraocular muscle entrapment

Cited by 11 publications

References 22 publications

Orbital Trauma

Orbital Trauma

Adult Orbital Fractures with Extraocular Muscle Entrapment

Repair of unilateral combined orbital floor and medial wall fracture using two titanium mesh plates: a modified technique

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