• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.2
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• pp.74-77
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• 2015

Objectives: Transpositioning of the inferior alveolar nerve to prevent injury in lower jaw has been advocated for orthognathic, pre-prosthetic and for implant placement procedures. However, the concept of infra-orbital nerve repositioning in cases of mid-face fractures remains unexplored. The infraorbital nerve may be involved in trauma to the zygomatic complex which often results in sensory disturbance of the area innervated by it. Ten patients with infraorbital nerve entrapment were treated in similar way at our maxillofacial surgery centre. Materials and Methods: In this article we are reporting three cases of zygomatico-maxillary complex fracture in which intra-operative repositioning of infra-orbital nerve into the orbital floor was done. This was done to release the nerve from fractured segments and to reduce the postoperative neural complications, to gain better access to fracture site and ease in plate fixation. This procedure also decompresses the nerve which releases it off the soft tissue entrapment caused due to trauma and the organized clot at the fractured site. Results: There was no evidence of sensory disturbance during their three month follow-up in any of the patient. Conclusion: Infraorbital nerve transposition is very effective in preventing paresthesia in patients which fracture line involving the infraorbital nerve.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.4
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• pp.292-300
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• 2004

Orbital blowout fractures are common consequence to blunt periorbital trauma. Pure orbital blowout fractures first occur at the weakest point of the orbital wall. Computed tomography(CT) is recognized to be the best imaging technique to evaluate orbital fractures. The extent and location of a blowout fractures in the CT scan were noted to have an effect on the clinical outcome. In the early posttraumatic period, the presence of significant enophthalmos is difficult to detect because of orbital edema. Early surgical intervention may improve the ultimate outcome because open reconstruction becomes more difficult if surgery is delayed. In this study, we evaluated isolated blowout fractures of the orbital floor by region-of-interest measurements from CT scans and their relationship to ophthalmologic findings. Six patients of the medial orbital wall fractures, eleven patients of the inferior orbital wall fractures, nineteen of the medial and the inferior orbital wall fractures confirmed by CT scan, were evaluated. The area of fracture and the volume of the displaced orbital tissue were determined from CT scan using linear measurements. Each of the calculated values for the area and the volume were compared with the degree of the enophthalmos, the diplopia, and the eyeball movement limitation to determine whether there was any significant relationship between them. The fracture area and the volume of the herniated orbital tissue were significantly positively correlated with the enophthalmos and the ocular motility limitation and not correlated with the diplopia. For the enophthalmos of 2mm or greater, the mean fracture area was 3.55{\pm}1.25cm^2$ and the volume of the herniated orbital tissue was $1.74{\pm}0.97cm^3$; for less than 2mm enophthalmos, $1.43{\pm}0.99cm^3$ and $0.52{\pm}0.49cm^3$, respectively. The enophthalmos of 2mm can be expected with $2.92cm^2$ of the fracture area and $1.40cm^3$ of the herniated orbital tissue. In conclusion, the enophthalmos of 2mm or more, which is a frequent indication for surgery. It can be expected when area of fracture is $2.92cm^2$ or more, or the volume of herniated orbital tissue is $1.40cm^3$ or more. And the CT scan using linear measurements has an application in the assessment of patients with blowout fractures and provides useful information in the posttraumatic evaluation of orbital fractures.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.617-622
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• 2009

Purpose: Endoscopic transnasal correction of the blowout fractures has many advantages over other techniques. But after removal of packing material, there were some patients with recurrence of preoperative symptoms. Authors tried to make a quantitative anterograde analysis of orbital volume change over whole perioperative period which might be related with recurrence of preoperative symptoms. Methods: 10 patients with pure medial wall fracture(Group I) and 10 patients with medial wall fracture combined with fracture of orbital floor(Group II) were selected to evaluate the final orbital volume change, who took 3 CT scans, pre-, postoperative and 4 months after packing removal. By multiplying cross - section area of orbit in coronal view with section thickness, orbital volume were calculated. Then, mean orbital volume increment after trauma, mean orbital volume decrement after endoscopic correction and volume increment after packing removal were found out. And we tried to find correlations between type of fracture, initial correction rate and final correction rate. Results: The mean orbital volume increment of the fractured orbits were 7.23% in group I and 13.69% in group II. After endoscopic surgery, mean orbital volume decrement were 11.0% in group I and 12.46% in group II. Mean volume increment after packing removal showed 3.10% in group I and 6.50% in group II. The initial correction rate(%) showed linear correlation with final correction rate(%) after packing removal. And there were negative linear correlation between increment percentage of orbital volume by fracture and final correction rate(%). Conclusion: Orbital volume was proved to be increasing after removal of packing or foley catheter and it was dependent upon type of fracture. Overcorrection should be done to improve the final result of orbital blowout fracture especially when there are severe fracture is present.

• Archives of Plastic Surgery
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• v.37 no.1
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• pp.99-103
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• 2010

Purpose: Blow-out fractures are reduced through transcutaneous or transconjunctival incisions. But the field of orbital surgery is difficult due to lack of visualization of fracture site, blind dissection of orbital floor, susceptibility of injury of orbital structures. In these situations, the former technique of using an antral balloon catheter has advantages over other methods for reconstruction because of its rapidity, simplicity, and inexpensiveness. Furthermore, the antral balloon catheter allows not only elevation of the orbital bone fragment but also expansion of the maxillary sinus in cases where there is a fracture of its walls. But postoperative follow-up method using computed tomography is expensive. Hence, we report a simple and inexpensive follow-up method using radiopaque dye inflation. Methods: We performed endoscopic transantral approach in 5 cases of blow-out fracture under general anesthesia. To accomplish this technique, a rigid 4 mm, 0 or 30 degree angled endoscopy was inserted into the maxillary sinus. Inflation of the catheter started gradually, with 10 to 15 mL of saline mixed radiopaque dye (saline: dye, 5 : 1) by syringe and while observing the elevation of the fracture site with endoscope until a proper contour was reached. For the maintain of the position of fractured site, 12 French urinary balloon foley catheter were used in fracture site for 7 - 10 days. Results: Postoperative assessment was performed by means of clinical and simple radiographic examination to secure the catheter under the inferior orbital wall and in the maxillary sinus. No specific complications occurred related to this procedure. Results of the surgery and follow-up in all cases were satisfactory. Conclusion: It may be a better alternative to the conventional follow-up method, with less cost and effectiveness of the catheter patency. The advantages of using the urinary balloon foley catheter with the radiopaque dye include the following : it is safe, efficacy, simple, and especially low cost. On drawback of this method is the discomfort to the patient caused by the catheter during the treatment.

• Archives of Craniofacial Surgery
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• v.10 no.1
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• pp.1-6
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• 2009

Purpose: This study presents a classification of pure medial and inferior blow-out fracture, and confirms the relationship between the types of fractures, postoperative complications and operative methods. Methods: Sixty patients were treated by transnasal endoscopic reduction with $Medpor^{(R)}$ implantation through subciliary incision and foley catheter insertion into maxillary sinus was done if there was extensive orbital floor fracture. Fractures were classified by number of coronal sections from posterior margin of fossa for lacrimal sac to orbital apex in CT. Type I is defined when the medial wall fracture is over 50% and inferior wall fracture below 50%. Type II, when below 50% medial wall fracture and over 50% floor fracture were present. If there were both over 50%, it was classified as Type III and both below 50% for Type IV. Extreme fracture involving orbital buttress was Type V and postoperative findings in all patients were examined. Results: Type I and V were most common and preoperative findings were more likely to present according to extent of inferior fracture. Diplopia remained in 2 cases after additional insertion of foley catheter, but enophthalmos over 2 mm were presented in 3 cases and diplopia in 3 cases were observed who were not treated with foley catheter. Conclusion: Postoperative complications were increased according to extent of fracture, especially buttress involvement. Additional insertion of foley catheter proved its effectiveness in decreasing postoperative complications.

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

• Archives of Craniofacial Surgery
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• v.22 no.4
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• pp.177-182
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• 2021

Background: Although prompt surgery after an orbital fracture is preferable, the actual timing of surgery in real-world settings varies. Therefore, this study investigated the outcomes of implant surgery for inferior orbital wall fractures by comparing three groups according to the time interval between the injury and surgery. Methods: A retrospective review was conducted of patients' medical charts and initial computed tomography images from 2009 to 2020. The time to treatment was chosen by patients or their guardians based on the patients' comorbidities and the physician's explanation. The patients were divided into three groups according to the time of surgery (group 1: 3-7 days, group 2: 8-14 days, group 3: 15 or more days). Data were collected on age, the time interval until surgery, the dimensions of the defect, the operation time, the follow-up period, and the postoperative paresthesia score (ranging from 0 to 10). The outcomes were evaluated using a 4-point scale: 4=good (no complications), 3=fair (no subjective symptoms), 2=poor (remaining paresthesia), and 1=very poor (strabismus and/or enophthalmos). Results: The study included 85 patients with unilateral fractures who underwent surgery from 3 to 93 days after injury. The overall score distribution of the surgical outcomes was as follows: good=63, fair=7, poor=6, and very poor=9. The three groups showed no significant differences in the transverse dimension of the injury (p=0.110) or the anteroposterior dimension (p=0.144). In groups 1, 2, and 3, the postoperative outcome scores were 3.84±0.37, 3.63±0.87, and 2.93±1.33 (p=0.083), and the percentage of patients with good outcomes was 84%, 81.25%, and 57.14%, respectively. Conclusion: Performing surgery using an artificial implant within 2 weeks of the injury showed better outcomes and fewer postoperative complications than when treatment was delayed.

• Archives of Craniofacial Surgery
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• v.10 no.2
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• pp.86-90
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• 2009

Purpose: Inferior blow-out fracture is the common facial fracture. Unsatisfactory functional and aesthetic outcomes are frequent when it is treated inappropriately. If fractures are extended and reach the posterior end of orbital floor, enophthalmos frequently followed as complication. The purpose of this study was to evaluate reduction technique of extensive inferior blow-out fracture with ballooning of foley catheter through endoscopic transnasal approach and implantation of $Medpor^{(R)}$ through subciliary approach. Methods: A retrospective study was performed on 14 patients with extensive inferior blow-out fracture who underwent ballooning of foley catheter through endoscopic transnasal approach with implantation of $Medpor^{(R)}$ through subciliary approach. Patients were operated from May 2005 to November 2007. Data for 14 patients were acquired from patient's charts. Preoperative and postoperative data for enophthalmos, diplopia, limitation of extraocular motion were reviewed. Preoperative and postoperative CT scan were also checked. The patients were followed up from 4 to 18 months. Results: The enophthalmos was corrected in all patients. Among 7 patients with diplopia preoperatively, diplopia was resolved in three patients postoperatively. The diplopia persisted in four patients and two of them also had limitation of extraocular motion postoperatively. The limitation of extraocular motion occurred in seven patients preoperatively. But five patients recovered after operation immediately. These symptoms were resolved about three months after the operation. Conclusion: The ballooning of foley catheter through endoscopic transnasal approach with implantation of $Medpor^{(R)}$ through subciliary approach can be considered one of the appropriate technique for extensive inferior blowout fracture.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.7-12
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• 2010

Purpose: 'White-eye blowout' fracture is often occur in young patients and defined as blow out fracture with little or no clinical sign of soft tissue trauma such as edema, ecchymosis, but with marked motility restrictions in vertical gaze. In this conditions, immediate operation is essential. We reported the clinical investigation study of these cases about clinical symptoms and radiologic findings and introduce our experiences about immediate operations in 'white-eye blowout' fractures. Methods: From January 2008 to December 2009, nine pediatric patients who were diagnosed as pure white-eye blowout fractures were involved this study. Patients with other facial bone fractures or with poor general medical condition were excluded. In all cases, we performed immediate operation within 48 hours. Results: All patients had diplopia, vertical gaze restriction or systemic symptoms. Six patients had nausea, vomiting and syncope caused by oculocardiac reflex. In all patients, preoperative symptoms were improved after immediate operation. There were no postoperative complications such as infection, hematoma or wound dehiscence. Conclusion: When we meet the young patients with history of periocular trauma, with little or no soft tissue trauma signs, but with marked vertical gaze restriction or general symptoms caused by oculocardiac reflex, we should immediately examine by facial bone computed tomography and refer the patient to ophthalmologist for ophthalmic evaluations. If patient is diagnosed as orbital floor fracture with entrapped muscle or soft tissue, the earlier surgical reduction get better clinical outcomes.

• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.68-71
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• 2018

Intraosseous hemangioma is an extremely rare tumor that accounts for 1% or fewer of all osseous tumors. The most common sites of its occurrence are the vertebral column and calvaria. Occurrence in a facial bone is very rare. The authors aim to report a case of the surgical treatment of intraosseous hemangioma occurring in the periorbital region, which is a very rare site of occurrence and to introduce our own experiences with the diagnosis and treatment of this condition along with a literature review. A 73-year-old male patient visited our hospital with the chief complaint of a mass touching the left orbital rim. A biopsy was performed by applying a direct incision after local anesthesia. Eventually, intraosseous hemangioma was diagnosed histologically. To fully resect the mass, the orbital floor and zygoma were exposed through a subciliary incision under general anesthesia, and then the tumor was completely eliminated. Bony defect was reconstructed by performing a seventh rib bone graft. Follow-up observation has so far been conducted for 10 months after surgery without recurrence or symptoms.