• Archives of Plastic Surgery
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• v.32 no.3
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• pp.389-392
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• 2005

A case of visual loss following cranio-maxillofacial trauma is reported. The patient had acute optic nerve injury associated with a fracture of the right zygomaticomaxillary and fronto-naso-ethmoido-orbital bone and epidural hematoma on the right temporal lobe of brain. Bony fragments compressing the optic nerve on lateral side was identified on computed tomography. Decompression of the optic nerve combined with evacuation of epidural hematoma has been performed via transfrontal craniotomy. The patient had complete recovery of visual acuity without any complications. The role of optic nerve decompression in the management of patients with traumatic optic neuropathy is discussed. Surgical indication is controversial and the procedure should be considered only within the context of the specific indication of the individual patient.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.1
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• pp.81-85
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• 2009

As panfacial fractures are involved multiple fracture, there are possibility of many pre-operative & postoperative complications. It is necessary to do exact pre-operative evaluation, appropriate operation and care, for preventing and treating these complications, especially related to optic nerve injury. The complication occurs rarely after periorbital facial bone fracture, and indirect injuries may occur as a result of impact shearing force transmitted into the optic nerve axons or to the nutrient vessels of the optic nerve. Also indirect injuries may occur after the force of impact because of vasospasm and swelling of the optic nerve within the confines of the nonexpansile optic canal. It is necessary to active evaluation and treatments involving decompression of the orbit surgically and high dose steroid therapy in relation to panfacial fracture. But sometimes this treatments are limited due to severe swelling of the face and related multiple bone fractures in the body. This case showed the delayed neuropathy, at last visual loss, in spite of megadose methylprednisolone administration. The purpose of this article is to present indirect traumatic optic neuropathy that is one of many complications in panfacial bone fracture.

• Archives of Plastic Surgery
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• v.39 no.1
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• pp.31-35
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• 2012

Background : Orbital roof fractures are frequently associated with a high energy impact to the craniofacial region, and displaced orbital roof fractures can cause ophthalmic and neurologic complications and occasionally require open surgical intervention. The purpose of this article was to investigate the clinical features and treatment outcomes of orbital root fractures combined with neurologic injuries after early reconstruction. Methods : Between January 2006 and December 2008, 45 patients with orbital roof fractures were admitted; among them, 37 patients were treated conservatively and 8 patients underwent early surgical intervention for orbital roof fractures. The type of injuries that caused the fractures, patient characteristics, associated fractures, ocular and neurological injuries, patient management, and treatment outcomes were investigated. Results : The patients underwent frontal craniotomy and free bone fragment removal, their orbital roofs were reconstructed with titanium micromesh, and associated fractures were repaired. The mean follow up period was 11 months. There were no postoperative neurologic sequelae. Postoperative computed tomography scans showed anatomically reconstructed orbital roofs. Two of the five patients with traumatic optic neuropathy achieved full visual acuity recovery, one patient showed decreased visual acuity, and the other two patients completely lost their vision due to traumatic optic neuropathy. Preoperative ophthalmic symptoms, such as proptosis, diplopia, upper eyelid ptosis, and enophthalmos were corrected. Conclusions : Early recognition and treatment of orbital roof fractures can reduce intracranial and ocular complications. A coronal flap with frontal craniotomy and orbital roof reconstruction using titanium mesh provides a versatile method and provides good functional and cosmetic results.

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