• Archives of Plastic Surgery
• /
• v.35 no.5
• /
• pp.553-559
• /
• 2008

Purpose: The lateral orbital wall fractures have been previously classified by some authors. As there are some limitations in applying in their own classifications, we hope to present a refined classification system of the lateral orbital wall fracture and to identify the correlation between the specific type of the fracture and clinical diagnosis. Methods: The facial bone CT scans and medical records of 78 patients with the lateral orbital wall fractures were reviewed in a retrospective manner. The classification is based on the CT scan. In type I, the fracture and its segments are away from the lateral rectus muscle and in type II, they are next to or slightly pushing the muscle in axial CT scan. In type III, the fracture segments compress and displace the longitudinal axis of the muscle or the optic nerve in axial view of CT scan. Type IV fracture includes multiple fractures found around the orbital apex or optic canal in coronal view of CT scans of the type I and type II fractures. Results: The most common fracture pattern was type I(43.6%), followed by type IV(29.5%), type II(20.5%), and type III(6.4%). As diplopia and restriction of extraocular muscles were found in type I and II fractures, severe ophthalmic complications such as superior orbital fissure syndrome, orbital apex syndrome, and traumatic optic neuropathy were found in type III and IV fractures almost exclusively. Conclusion: We propose an easy classification system of the lateral orbital wall fracture which correlates closely with ophthalmic complications and may help to make further treatment plan. In Type III and IV fractures, severe ophthalmic complications may ensue in higher rates, so early diagnosis and treatment should be performed.

• Archives of Plastic Surgery
• /
• v.41 no.5
• /
• pp.480-485
• /
• 2014

Background The objective of this article is to evaluate clinical outcomes of combined orbital floor and medial wall fracture repair using a three-dimensional pre-bent titanium implant in an East Asian population. Methods Clinical and radiologic data were analyzed for 11 patients with concomitant orbital floor and medial wall fractures. A combined transcaruncular and inferior fornix approach with lateral canthotomy was used for the exposure of fractures. An appropriate three-dimensional preformed titanium implant was selected and inserted according to the characteristics of a given defect. Results Follow-up time ranged from 2 to 6 months (median, 4.07 months). All patients had a successful treatment outcome without any complications. Clinically significant enophthalmos was not observed after treatment. Conclusions Three-dimensional pre-bent titanium implants are appropriate for use in the East Asian population, with a high success rate of anatomic restoration of the orbital volume and prevention of enophthalmos in combined orbital floor and medial wall fracture cases.

• Archives of Plastic Surgery
• /
• v.38 no.6
• /
• pp.783-790
• /
• 2011

Purpose: The zygoma (Zygomaticomaxillary) complexes make up a large portion of the orbital floor and lateral orbital walls. Zygoma fracture frequently causes the posteromedial displacement of bone fragments, and the collapse or overlapping of internal orbital walls. This process consequently can lead to the orbital volume change. The reduction of zygoma in an anterolateral direction may influence on the potential bone defect area of the internal orbital walls. Thus we performed the quantitative analysis of orbital volume change in zygoma fracture before and after operation. Methods: We conducted a retrospective study of preoperative and postoperative three-dimensional computed tomography scans in 39 patients with zygoma fractures who had not carried out orbital wall reconstruction. Orbital volume measurement was obtained through Aquarius Ver. 4.3.6 program and we compared the orbital volume change of injured orbit with that of the normal contralateral orbit. Results: The average orbital volume of normal orbit was 19.68 $cm^3$. Before the operation, the average orbital volume of injured orbit was 18.42 $cm^3$. The difference of the orbital volume between the injured orbit and the normal orbit was 1.18 $cm^3$ (6.01%) on average. After operation, the average orbital volume of injured orbit was 20.81 $cm^3$. The difference of the orbital volume between the injured orbit and the normal orbit was 1.17 $cm^3$ (5.92%) on average. Conclusion: There are considerable volume changes in zygoma fracture which did not accompany internal orbital wall fracture before and after operation. Our study reflects the change of bony frame, also that of all parts of the orbital wall, in addition to the bony defect area of orbital floor, in an isolated zygoma fracture so that it evaluates orbital volume change more accurately. Thus, the measurement of orbital volume in isolated zygoma fractures helps predict the degree of enophthalmos and decide a surgical plan.

• Archives of Craniofacial Surgery
• /
• v.10 no.2
• /
• pp.67-70
• /
• 2009

Purpose: Anatomical basis around orbit can be helpful in periorbital surgery, and there are many articles about measurement between periorbital reference points. In 1967, Jones and Evans measured the orbital wall thickness of Asian cadavers and this article has been cited more than 50 times. But there is no research in orbital thickness in Vivo. Author's idea was based on difference between live human and human cadaver. Material & Method: We conducted this study from 63 consecutive blow out fracture patients between January, 2000 to june, 2005 by collecting the bone fragments and measured the thickness of that fragment using vernia calipers. Anatomically, orbital floor is separated two area by inferior orbital fissure and we measured each area. Three areas were zone I (medial wall), zone II (medial to inferior orbital fissure) and zone III (lateral to inferior orbital fissure). Result: When the overall results were considered, the thickness of Zone I (medial wall of orbit) was average $0.131{\pm}0.006mm$ in male and $0.129{\pm}0.007mm$ in female and Zone II (medial side of orbital floor) was $0.251{\pm}0.005mm$ in male and $0.245{\pm}0.006mm$ in female, Zone III (lateral side of orbital floor) was $0.237{\pm}0.006mm$ in male and $0.226{\pm}0.006mm$ in female. There were no statistical difference between orbital wall thickness of male and female. Also, orbital wall thickness of adults measured $0.130{\pm}0.005mm$, $0.250{\pm}0.005mm$, $0.232{\pm}0.006mm$ in Zone I, Zone II, Zone III and $0.128{\pm}0.006mm$, $0.233{\pm}0.005mm$, $0.215{\pm}0.007mm$ in Zone I, Zone II, Zone III from childs, and there were no statistical difference between adult and child. Conclusion: This article is the first study about Korean orbital wall thickness, and can be helpful to periocular surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.46 no.5
• /
• pp.353-357
• /
• 2020

Fractures of the orbital floor and walls are among the most frequent maxillofacial fractures. Virtual three-dimensional (3D) planning and use of patient-specific implants (PSIs) could improve anatomic and functional outcomes in orbital reconstruction surgery. The presented case was a victim of a terrorist attack involving improvised explosive devices. This 58-year-old female suffered severe wounds caused by a single piece of metal from a bomb, shattering the left orbital floor and lateral orbital wall. Due to remaining hypotropia of the left eye compared to the right eye, late orbital floor reconstruction was carried out with a personalised 3D printed titanium implant. We concluded that this technique with PSI appears to be a viable method to correct complex orbital floor defects. Our research group noted good aesthetic and functional results one year after surgery. Due to the complexity of the surgery for a major bony defect of the orbital floor, it is important that the surgery be executed by experienced surgeons in the field of maxillofacial traumatology.

• Archives of Craniofacial Surgery
• /
• v.18 no.2
• /
• pp.128-131
• /
• 2017

With advances in diagnostic technology, radiologic diagnostic methods have been used more frequently, and physical examination may be neglected. The authors report a case of pediatric medial orbital trapdoor fracture in which the surgery was delayed because computed tomography (CT) findings did not indicate bone displacement, incarceration of rectus muscle, or soft tissue herniation. A healthy 6-year-old boy was admitted to the emergency room for right eyebrow laceration. We could not check eyeball movement or diplopia, because the patient was irritable. Thus, we performed facial CT under sedation, but there was normal CT finding. Seven days later, the patient visited our hospital due to persistent nausea and dizziness. We were able to perform a physical examination this time. Lateral gaze of right eye was limited. CT still did not show any findings suggestive of fracture, but we decided to perform exploratory surgery. We performed exploration, and found no bone displacement, but discovered entrapped soft tissue. We returned the soft tissue to its original position. The patient fully recovered six weeks later. To enable early detection and treatment, thorough physical examination and CT reading are especially needed when the patient shows poor compliance, and frequent follow-up observations are also necessary.

• Journal of Trauma and Injury
• /
• v.19 no.1
• /
• pp.89-92
• /
• 2006

Penetrating facial wounds are uncommon and are usually life threatening because of the possibility of brain damage. There are three possible pathways for penetrating the cranium through the orbit: via the orbital roof, via the superior orbital fissure, or between the optic canal and lateral wall of the orbit. Brain injuries resulting from the penetrating wounds show extensive parenchymal damage, hemorrhage, and brain edema. Transorbital penetrating wounds can lead to diverse lesions of the optical apparatus, including the eye globe, the optical nerve, and the chiasm. Moreover, intracerebral structures may be hurt, and bleeding and infection may occur. Early diagnosis and prompt debridement are the fundamental factors affecting the outcome of a penetrating facial wound. An 87-year-old man was admitted to the emergency department with a grinder impacted into the medial aspect of the right eye. On presentation, the man was fully conscious with a Glasgow Coma Scale score of 15 and complained of a visual disturbance of the right eye. Computed tomography demonstrated a right orbital medial and inferior wall fracture, a frontal bone fracture, and a contusional hemorrhage in frontal lobe of the brain. A craniotomy with hematoma removal and repair of the orbital floor was done. He showed no neurological deficits except right visual loss. This appears to be the first report of a man with a penetrating facial wound caused by a grinder, who presented with a potentially disastrous craniocerebral injury that did not lead to any serious neurological seguelae.