• Archives of Craniofacial Surgery
• /
• v.16 no.2
• /
• pp.53-57
• /
• 2015

Background: Surgical outcomes after orbital wall decompression have focused on the degree of exophthalmos and intraocular pressure. The aim of this research was to evaluate intraorbital volume using computed tomography (CT) images following two-wall decompression using a combined subcilliary and endoscopic approaches. Methods: A retrospective review was performed for all patients who had undergone the two-wall decompression method. The pre/postoperative CT images were used to evaluate changes in intraocular volume. Intraocular pressure was evaluated using applanation tonometry. Surgical details are discussed within the body of text. Results: Two-wall decompression thru the medial wall and floor was associated with an average intraorbital volume change of $7.3cm^3$, with maximal accommodation up to $13cm^3$. Changes in intraocular pressures were not statistically significant. Conclusion: Two-wall decompression was effective in accommodation of up to $13cm^3$ of soft tissue herniation. There was no statistically significant association between changes in volume to pressure.

• Archives of Craniofacial Surgery
• /
• v.19 no.4
• /
• pp.264-269
• /
• 2018

Background: Orbital resorbable mesh plates are adequate to use for isolated floor and medial wall fractures with an intact bony buttress, but are not recommended to use for large orbital wall fractures that need load bearing support. The author previously reported an orbital wall restoring surgery that restored the orbital floor to its prior position through the transnasal approach and maintained temporary extraorbital support with a balloon in the maxillary sinus. Extraorbital support could reduce the load applied on the orbital implants in orbital wall restoring surgery and the use of resorbable implants was considered appropriate for the author's orbital wall restoring technique. Methods: A retrospective review was conducted of 31 patients with pure unilateral orbital floor fractures between May 2014 and May 2018. The patients underwent transnasal restoration of the orbital floor through insertion of a resorbable mesh plate and maintenance of temporary balloon support. The surgical results were evaluated by the Hertel scale and a comparison of preoperative and postoperative orbital volume ratio (OVR) values. Results: The OVR decreased significantly, by an average of 6.01% (p<0.05) and the preoperative and postoperative Hertel scale measurements decreased by an average of 0.34 mm with statistical significance (p<0.05). No complications such as buckling or sagging of the implant occurred among the 31 patients. Conclusion: The use of resorbable mesh plate in orbital floor restoration surgery is an effective and safe technique that can reduce implant deformation or complications deriving from the residual permanent implant.

• The Korean Journal of Cytopathology
• /
• v.8 no.1
• /
• pp.98-102
• /
• 1997

Sinonasal undifferentiated carcinoma(SNUC) is a distinct, relatively rare neoplasm arising in the nasal cavity and paranasal sinuses composed of undifferentiated epithelial cells and clinically characterized by a fulminant course. We report a case of SNUC in a 56-year old man who have had bilateral neck masses since one month ago before coming to our hospital. The paranasal computed tomography showed soft mass density in the left maxillary sinus and the nasal cavity with bone destruction in the anterior medial and the inferior maxillary sinus wall. This mass was extruded into the left orbital wall. Biopsy of the nasal mass and fine needle aspiration(FNA) of the neck mass were done. FNA revealed medium-sized neoplastic cells forming clusters or individually dispersed. Nuclei were round to oval, slightly to moderately pleomorphic, and hyperchromatic. Chromatin was finely granular, but occasionally was coarsely granular. Nucleoli varied from large to inconspicuous and the cytoplasm was scanty.

• Journal of the Korean Medical Association
• /
• v.61 no.12
• /
• pp.740-748
• /
• 2018

Posttraumatic facial deformities (PTFDs) are very difficult to correct, and if they do occur, their impact can be devastating. It may sometimes be impossible for patients to return to normal life. The aim of surgical treatment is to restore the deformed bone structure and soft tissue to create symmetry between the affected side and the opposite side. In the process of managing PTFD, correcting enophthalmos is one of the most challenging aspects for surgeons because of difficulties in overcoming the scar tissue and danger of injuring to the optic nerve. In this article, surgical options for reconstruction of the medial wall, floor, lateral wall, and roof of the orbit are described. To optimize aesthetic improvement, additional cosmetic procedures such as facial contouring surgery, blepharoplasty and rhinoplasty can be used. Plastic surgeons should join emergency trauma teams to implement an overall treatment plan containing rational strategies to avoid or minimize PTFD.

• Korean Journal of Radiology
• /
• v.1 no.3
• /
• pp.162-164
• /
• 2000

Malignant transformation of teratoma in the anterior mediastinum is rare; the mass usually has a long history and is seen in older patients. We report a case of teratoma with malignant transformation in the anterior mediastinum, complicated by rupture. CT revealed a lobulated, inhomogeneous cystic mass with a fat component and wall calcifications. The lateral wall was disrupted and consolidation in the adjacent left upper lobe was noted, suggesting rupture. A heterogeneously enhanced solid portion, obliterating the fat plane between the mass and the great vessels was present in the medial aspect of the mass, and pathologic examination demonstrated the presence of adenocarcinoma.

• Archives of Plastic Surgery
• /
• v.34 no.5
• /
• pp.599-604
• /
• 2007

Purpose: Blowout fractures of the orbit are common sequelae to blunt facial trauma and now increasing in number due to automobile accidents, violence and industrial disasters. There are some reports of diagnosis and treatment of this fracture, but detailed data provided in overall aspects are very few. We analysed extensive data to provide guide line of blowout fracture patients care. Methods: We retrospectively studied 387 orbital blowout fracture patients who had been followed up at least 3-6 months. Their hospital records were reviewed according to causes, fracture site, operation methods, and follow up results, etc. Results: The ratio of males to females was 7 : 3 and fractures were most often seen in the 20-29 age group. 180(47%) patients had medial orbital wall fractures, 155(40%) patients had floor fractures and 52(13%) patients had a combination of orbital floor and medial wall fractures. The highest associated bone fracture was the nasal bone(37%). The open reduction was done in the 324 patients(83.7%) and insertion materials were used in the 249 patients(77%). Total 45 patients(14%) complained of residual diplopia and 26 patients(8%) kept mild enophthalmos. 24 patients(7%) showed some restriction of extraocular muscle movements. Conclusion: We broadly surveyed the information of blow out fracture patients and believe that this study provides important prognostic information that can be of benefit to both patient and surgeon during preoperative counseling and postoperative analysis of orbital blowout fractures.

• Journal of Korean Neurosurgical Society
• /
• v.63 no.2
• /
• pp.210-217
• /
• 2020

Objective : To analyze the accuracy of iliac screws using freehand technique performed by the same surgeon. We also analyzed how the breach of iliac screws was related to the clinical symptoms resulting in revision surgery. Methods : From January 2009 to November 2015, 100 patients (193 iliac screws) were analyzed using postoperative computed tomography scans. The breaches were classified based on the superior, inferior, lateral, and medial iliac wall violation by the screw. According to the length of screw extrusion, the classification grades were as follows : grade 1, screw extrusion <1 cm; grade II, 1 cm ≤ screw extrusion <2 cm; grade III, 2 cm ≤ screw extrusion <3 cm; and grade IV, 3 cm ≤ screw extrusion. We also reviewed the revision surgery associated with iliac screw misplacement. Results : Of the 193 inserted screws, 169 were correctly located and 24 were misplaced screws. There were eight grade I, six grade II, six grade III, and four grade IV screw breaches, and 11, 8, 2, and 3 screws violated the medial, lateral, superior, and inferior walls, respectively. Four revision surgeries were performed for the grade III or IV iliac screw breaches in the lateral or inferior direction with respect to its related symptoms. Conclusion : In iliac screw placement, 12.4% breaches developed. Although most breaches were not problematic, symptomatic violations (2.1%) could result in revision surgery. Notably, the surgeon should keep in mind that lateral or inferior wall breaches longer than 2 cm can be risky and should be avoided.

• 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.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
• /
• v.14 no.1
• /
• pp.17-26
• /
• 1984

The purpose of this study was radiographic analysis of the morphology of maxillary sinus in adolescents and adults. In order to analize the morphology of maxillary sinus in view point of anteroposterior width of medial wall, vertical distance between antral floor and nasal floor level, anterior extension, distance between antral floor and maxillary 1st molar apex, and types of lower border of maxillary sinus, specialized maxillary projection and periapical view with paralleling technique was taken. The author examined orthopantomograms and intraoral standard views taken from 400 adolescents and adults ranged 15-65 year-old. The obtained results were as follows: 1. The antero-posterior width of medial wall of maxillary sinus was 32.80mm in 15-19 year-old group, 33.86㎜ in 20-24 year-old group, 34.09㎜ in 25-29 year-old group, and 33.67㎜ in 30-65 year-old group, and the left maxillary sinus was somewhat smaller than the right. 2. The vertical distance between antral floor and nasal floor level was 8.49㎜ in 15-19 year-old group, 9.05㎜ in 20-24 year-old group, 8.95㎜ in 25-29 year-old group, and 8.32㎜ in 30-65 year-old group. 3. The order of anterior extension of maxillary sinus were distal half of canine, mesial half of canine, mesial half of 1st premolar, and distal half of 1st premolar. 4. The distance between antral floor and maxillary 1st molar were 4.36㎜ in 15-19 year-old group, 4.77㎜ in 20-24 year-old group, 3.58㎜ in 25-29 year-old group, and 2.33㎜ in 30-65 year-old group. 5. The order of the types of lower border of maxillary sinus were entire downward type, close type, partially downward type, waving type, separating type, and indistinct. In the types of antral floor, there was a tendency to increase the seperating type with age.

• Archives of Plastic Surgery
• /
• v.46 no.5
• /
• pp.421-425
• /
• 2019

Background The endoscopic transnasal approach is widely used for reconstructing the medial orbital wall by filling it with a silicone sheet or Merocel, but this technique has the disadvantage of retaining the packing for a long time. To overcome this drawback, a method of positioning an absorbable plate in the orbit has been introduced, but there is a risk of defect recurrence after the plate is absorbed. Here, the authors report the results of a novel surgical technique of placing a nonabsorbable titanium mesh with porous polyethylene into the orbit through the endoscopic transnasal approach. Methods Fourteen patients underwent surgery using the endoscopic transnasal approach. Preoperative computed tomography (CT) was used to calculate the size of the bone defect due to the fracture, and the titanium mesh was designed to be shorter than the anteroposterior length of the defect and longer than its height. The titanium mesh was inserted into the orbit under an endoscopic view. The authors then confirmed that the titanium mesh supported the orbital contents by pressing the eyeball and finished the operation. Immediately after surgery, CT results were evaluated. Results Postoperative CT scans confirmed that the titanium mesh was well-inserted and in the correct position. All patients were discharged without any complications. Conclusions We obtained satisfactory results by inserting a titanium mesh with porous polyethylene into the orbit via the transnasal approach endoscopically.