Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Early Reconstruction of Orbital Roof Fractures: Clinical Features and Treatment Outcomes

  • Kim, Jin-Woo (Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Bae, Tae-Hui (Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Kim, Woo-Seob (Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Kim, Han-Koo (Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine)
  • Received : 2011.08.05
  • Accepted : 2011.10.18
  • Published : 2012.01.15
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Abstract

Background : Orbital roof fractures are frequently associated with a high energy impact to the craniofacial region, and displaced orbital roof fractures can cause ophthalmic and neurologic complications and occasionally require open surgical intervention. The purpose of this article was to investigate the clinical features and treatment outcomes of orbital root fractures combined with neurologic injuries after early reconstruction. Methods : Between January 2006 and December 2008, 45 patients with orbital roof fractures were admitted; among them, 37 patients were treated conservatively and 8 patients underwent early surgical intervention for orbital roof fractures. The type of injuries that caused the fractures, patient characteristics, associated fractures, ocular and neurological injuries, patient management, and treatment outcomes were investigated. Results : The patients underwent frontal craniotomy and free bone fragment removal, their orbital roofs were reconstructed with titanium micromesh, and associated fractures were repaired. The mean follow up period was 11 months. There were no postoperative neurologic sequelae. Postoperative computed tomography scans showed anatomically reconstructed orbital roofs. Two of the five patients with traumatic optic neuropathy achieved full visual acuity recovery, one patient showed decreased visual acuity, and the other two patients completely lost their vision due to traumatic optic neuropathy. Preoperative ophthalmic symptoms, such as proptosis, diplopia, upper eyelid ptosis, and enophthalmos were corrected. Conclusions : Early recognition and treatment of orbital roof fractures can reduce intracranial and ocular complications. A coronal flap with frontal craniotomy and orbital roof reconstruction using titanium mesh provides a versatile method and provides good functional and cosmetic results.

Keywords

References

  1. Bolling JP, Wesley RE. Conservative treatment of orbital roof blow-in fracture. Ann Ophthalmol 1987;19:75-6.
  2. Sullivan WG. Displaced orbital roof fractures: presentation and treatment. Plast Reconstr Surg 1991;87:657-61. https://doi.org/10.1097/00006534-199104000-00008
  3. Piotrowski WP, Beck-Mannagetta J. Surgical techniques in orbital roof fractures: early treatment and results. J Craniomaxillofac Surg 1995;23:6-11. https://doi.org/10.1016/S1010-5182(05)80247-1
  4. Converse JM, Hogan VM. Open-sky approach for reduction of naso-orbital fractures: case report. Plast Reconstr Surg 1970;46:396-8. https://doi.org/10.1097/00006534-197010000-00017
  5. Haug RH, Nuveen E, Bredbenner T. An evaluation of the support provided by common internal orbital reconstruction materials. J Oral Maxillofac Surg 1999;57:564-70. https://doi.org/10.1016/S0278-2391(99)90076-9
  6. Greenwald MJ, Boston D, Pensler JM, et al. Orbital roof fractures in childhood. Ophthalmology 1989;96:491-6. https://doi.org/10.1016/S0161-6420(89)32868-5
  7. Rinna C, Rocchi G, Ventucci E, et al. Bilateral orbital roof fracture. J Craniofac Surg 2009;20:737-42. https://doi.org/10.1097/SCS.0b013e3181a2d9e4
  8. Fulcher TP, Sullivan TJ. Orbital roof fractures: management of ophthalmic complications. Ophthal Plast Reconstr Surg 2003;19:359-63. https://doi.org/10.1097/01.IOP.0000083646.20672.6B
  9. Messinger A, Radkowski MA, Greenwald MJ, et al. Orbital roof fractures in the pediatric population. Plast Reconstr Surg 1989;84:213-6. https://doi.org/10.1097/00006534-198908000-00003
  10. Kline LB, Morawetz RB, Swaid SN. Indirect injury of the optic nerve. Neurosurgery 1984;14:756-64. https://doi.org/10.1227/00006123-198406000-00021
  11. Yang WG, Chen CT, Tsay PK, et al. Outcome for traumatic optic neuropathy: surgical versus nonsurgical treatment. Ann Plast Surg 2004;52:36-42. https://doi.org/10.1097/01.sap.0000096442.82059.6d

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