Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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Feasibility of navigation-assisted endoscopic transnasal optic nerve decompression for the treatment of traumatic optic neuropathy in patients with midfacial fractures

  • Taro Okui (Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine) ;
  • Tatsunori Sakamoto (Department of Otorhinolaryngology-Head and Neck Surgery, Shimane University Faculty of Medicine) ;
  • Ichiro Morikura (Department of Otorhinolaryngology-Head and Neck Surgery, Shimane University Faculty of Medicine) ;
  • Tatsuo Okui (Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine) ;
  • Kentaro Ayasaka (Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine) ;
  • Satoe Okuma (Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine) ;
  • Hiroto Tatsumi (Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine) ;
  • Takahiro Kanno (Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine)
  • Received : 2024.01.30
  • Accepted : 2024.09.23
  • Published : 2024.10.31
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Abstract

Objectives: Traumatic optic neuropathy (TON), a relatively rare condition, can cause visual functional impairment and permanent functional damage. Surgeons should be familiar with its diagnostic criteria and treatment to effectively manage cases of facial trauma with TON. We investigated the feasibility of navigation-assisted endoscopic trans-nasal optic nerve decompression (ETOND) to treat TON in maxillofacial trauma patients. Patients and Methods: We retrospectively analyzed data from the clinical investigation of four consecutive patients, two males and two females with an average age of 75 years, with midfacial fractures and TON between April 2021 and September 2023. All patients had swelling and subcutaneous periorbital hemorrhage accompanied by optic nerve canal and zygomaticomaxillary complex fractures on the affected side. Three patients had lacerations on the lateral eyebrow or upper eyelid. All patients were evaluated by an ophthalmologist for visual impairment; two patients could see hand motion at a 30 cm distance, one patient could perceive light, and one did not have any loss of visual acuity. Among the four patients, three had visual impairment immediately after the injury, and one showed delayed impairment. Results: The patients were treated with navigation-assisted ETOND conducted by an endoscopic rhinologist. Three of the ETONDs were performed along with open reduction and internal fixation (ORIF); the other ETOND was delayed. Orbital reconstruction was performed in three patients. Steroid therapy was administered to two patients, one pre-operatively and one post-operatively. The two patients with pre-operative vision loss showed improved visual acuity post-operatively, and the two patients with no pre-operative visual impairment had no vision loss associated with ORIF for their midfacial fractures. No patient had post-operative complications. Conclusion: Navigation-assisted ETOND can be performed easily by endoscopic rhinologists; and prompt examination, diagnosis, and treatment are important in patients with facial trauma and TON.

Keywords

Acknowledgement

We would like to thank all our colleagues in the Prof. Hiroaki Watanabe (Department of Acute Care Surgery, Advanced Trauma Center, Shimane University Hospital).

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