• Archives of Plastic Surgery
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• v.35 no.6
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• pp.675-679
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• 2008

Purpose: In the orbital floor fracture, sensory impairment due to the damage of the infraorbital nerve is one of the most common symptom and complication. In this report, we have the assumption that tailoring of $medpor^{(R)}$ for decompression may have correlations to the damage and regeneration of the nerve. Methods: Among patients who had open reduction for pure orbital floor fracture in our hospital from March 2005 to March 2008, we selected 80 cases. In 40 cases, we inserted tailored $medpor^{(R)}$, and in other 40 cases, non-tailored $medpor^{(R)}$ was inserted. Patient's reports were obtained and analyzed, and the pin-prick test and the 2-point discrimination test on the infraorbital nerve regions were done for testing the sensory impairments. Results: The results show that the patients who adopted sculpture of $medpor^{(R)}$ showed higher tendency of recovery of sensory impairments in the patient's subjective report, static touch sensation, static two point discrimination using. And in postoperative 3 months, there are statistically significant recovery of sensory symptoms, signs and the result of sensory tests. Conclusion: From these results, tailored $medpor^{(R)}$ in reconstruction of orbital wall fracture may improve recovery of sensory impairments for decreasing of compression of infraorbital nerve.

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

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

• 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.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.42.1-42.5
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• 2018

Background: Fractures of the orbital wall are mainly caused by traffic accidents, assaults, and falls and generally occur in men aged between 20 and 40 years. Complications that may occur after an orbital fracture include diplopia and decreased visual acuity due to changes in orbital volume, ocular depression due to changes in orbital floor height, and exophthalmos. If surgery is delayed too long, tissue adhesion will occur, making it difficult to improve ophthalmologic symptoms. Thus, early diagnosis and treatment are important. Fractures of the superior orbital wall are often accompanied by skull fractures. Most of these patients are unable to perform an early ocular evaluation due to neurosurgery and treatment. These patients are more likely to show tissue adhesion, making it difficult to properly dissect the tissue for wall reconstruction during surgery. Case presentation: This report details a case of superior orbital wall reconstruction using superior orbital rim osteotomy in a patient with a superior orbital wall fracture involving severe tissue adhesion. Three months after reconstruction, there were no significant complications. Conclusion: In a patient with a superior orbital wall fracture, our procedure is helpful in securing the visual field and in delamination of the surrounding tissue.

• 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.39 no.3
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• pp.204-208
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• 2012

Background : Isolated pure blowout fractures are clinically important because they are the main cause of serious complications such as diplopia and limitation of extraocular movement. Many reports have described the incidence of blowout fractures associated with diplopia and limitation of extraocular movement; however, no studies have statistically analyzed this relationship. The purpose of this study was to demonstrate the correlation between the location of isolated pure blowout fractures and orbital symptoms such as diplopia and limitation of extraocular movement. Methods : We enrolled a total of 354 patients who had been diagnosed with isolated pure blowout fractures, based on computed tomography, from June 2008 to November 2011. Medical records were reviewed, and the prevalence of extraocular movement limitations and diplopia were determined. Results : There were 14 patients with extraocular movement limitation and 58 patients complained of diplopia. Extraocular movement limitation was associated with the following findings, in decreasing order of frequency: floor fracture (7.1%), extended fracture (3.6%), and medial wall (1.7%). However, there was no significant difference among the types of fractures (P=0.60). Diplopia was more commonly associated with floor fractures (21.4%) and extended type fractures (23.6%) than medial wall fractures (10.4%). The difference was statistically significant (Bonferroni-corrected chi-squared test P<0.016). Conclusions : Data indicate that extended type fractures and orbital floor fractures tend to cause diplopia more commonly than medial wall fractures. However, extraocular movement limitation was not found to be dependent on the location of the orbital wall fracture.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.633-638
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• 2010

Purpose: Orbital bone is one of the most complex bones in the human body. When the patient has a fracture of the orbital bone, it is difficult for the surgeon to restore the fractured orbital bone to normal anatomic curvature because the orbital bone has complex curvature. We developed a rapid prototyping model based on a mirror image of the patient's 3D-CT (3 dimensional computed tomography) for accurate reduction of the fractured orbital wall. Methods: A total of 7 cases of large orbital wall fracture recieved absorbable plate prefabrication using rapid prototyping model during surgery and had the manufactured plate inserted in the fracture site. Results: There was no significant postoperative complication. One patient had persistent diplopia, but it was resolved completely after 5 weeks. Enophthalmos was improved in all patients. Conclusion: With long term follow-up, this new method of orbital wall reduction proved to be accurate, efficient and cost-effective, and we recommend this method for difficult large orbital wall fracture operations.

• Archives of Craniofacial Surgery
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• v.19 no.2
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• pp.108-113
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• 2018

Background: The aim of our retrospective study is to evaluate the management of isolated orbital floor fractures considering the clinical, functional and aesthetic results according to the surgical approach and the type of materials used. Methods: Retrospectively, clinical, radiological, surgical, and ophthalmological data from 79 patients were collected from January 2010 to December 2016. Furthermore, included patients were interrogated on functional and aesthetic satisfaction. Results: The main causes of trauma were physical aggression followed by accidents. The median time between trauma and surgery was 4 days. The most common surgical approaches were the subciliary and the transconjunctival ones. Alloplastic materials were used in 75 patients. In two patients, we used a combination of two grafts. Patients experienced minor immediate complications. On follow-ups, none of our patients suffered from ocular movement restrictions. Patients treated by subciliary approach had higher risk of retractile scaring compared to other surgical approaches. In our study, patients agreed to complete a questionnaire assessing functional and aesthetic outcomes with a high satisfaction score. No association between the implant material used and the results has been assessed. Conclusion: This study describes the results of orbital floor reconstructions. Despite a variety of materials used and surgical approaches performed, we believe that the transconjunctival approach is the most suitable option with a high satisfaction score.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.11 no.1
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• pp.261-266
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• 1989

This study was undertaken to compare those 4 most commonly used incisions for exposure of fractures of the infraorbital rim and the orbital floor. The patient's age ranged from 19 to 67 years, the majority being in the 2nd decade. There were 17males and 1 female. Three orbital rim, 5 lower eyelid, 7 subciliary and 3 combined conjunctival-lateral canthotomy incisions were reviewed. Following points were the summury of author's experience. 1. The average scar following any of four incisions is barely noticeable. 2. Adequate fracture exposure was achieved with lower eyelid, orbital rim, subciliary and combined conjunctival-lateral canthotomy incisions. 3. One transient ectropion following subciliary incision occurred in 29-years old man with prolonged postoperative eyelid edema.