Management of simultaneous ocular elevation and depression deficit in patients after reconstruction surgery for orbital floor fracture (original) (raw)
Related papers
Journal of Oral and Maxillofacial Surgery, 2018
Purpose: We have conducted a review of the orbital fractures treated in our hospital for a period of four years. We have reviewed its several complications, and especially the relationship of postsurgical diplopia with different pre-surgical variables: age, sex, type of fracture, fracture area, coronal and sagittal diameter of the fracture, fractured floor area, time to surgery, existence of muscular herniation and muscle entrapment. Patients and methods: Fractures involving the orbital floor still remain a controversial issue in terms of surgical treatment and the time required from trauma to surgery. Surgical indications are divided into aesthetic and functional, and they greatly differ from one medical center to another. It has been observed that the variables that influence postoperative complications vary in the different studies reviewed. Post-surgical diplopia is one of the most important complications, and its relationship with pre-surgical variables has been the focus of this study. For the purpose of the present study, a bivariate and a multivariate analysis has been performed, accepting as significant the value p <0.05. Results: according to the multivariate analysis, post-surgical diplopia is only associated with trap door fractures, regardless of all other variables, especially if these fractures are operated after 48 hours. In addition, the bivariate analysis has also reported that fractures involving muscular herniation result in less diplopia and a better prognosis if operated before 48 hours. Notwithstanding, these results are not statistically significant. Conclusion: Surgery before 48 hours statistically improves fractures with real muscular entrapment, and improves (although not statistically significantly) patients with muscular herniation. INTRODUCTION: Orbital fractures account for 30 to 55% of all facial fractures (1). The most frequent etiology varies according to gender; in men, these fractures are more frequent as a result of aggression, whereas in women the most common cause is due to accidental falls. Fractures can be classified differently according to the degree of displacement
Diplopia and ocular motility in orbital blow-out fractures: 10-year retrospective study
Objective: To investigate diplopia (binocular single vision [BSV] test) and ocular motility (uniocular field of fixation [UFOF] test) characteristics in blow-out fractures of the orbit and their value in fracture management. Material and methods: Patients with isolated blow-out fractures treated from 2000 to 2010 were included. BSV scores were stratified into three categories: low BSV category (0e60); moderate BSV category (61e80), and high BSV category (81e100). UFOF scores were also divided into three categories: low score (60e240), moderate score (241e270), and high score (271e365) categories. Results: A total of 183 patients (106 surgically and 77 conservatively managed) met the inclusion criteria. There was no significant improvement in BSV postoperatively in surgically managed patients with preoperatively high BSV, whereas there was significant improvement (p < 0.05) for the high BSV category in the conservative group. Preoperative BSV was found to be significantly related (p < 0.05) to post-operative BSV, subjective diplopia outcome, follow-up time, and number of follow-up visits. However, improvement of BSV score in the surgical group was not found to be significantly correlated with subjective outcome in relation to diplopia. Preoperative UFOF score has no influence on subjective outcome in relation to diplopia. Surgical timing, approach, and choice of implant material were not found to be statistically related to final diplopia outcome, follow-up time, or number of follow-up visits. Conclusions: BSV is better correlated with diplopia outcome, follow-up time, and number of follow-up visits than is UFOF. On the basis of this study, surgical intervention would not be recommended for blow-out fracture cases with BSV score >80% for correction of diplopia alone.
Strabismus, 2013
Purpose: Superior oblique posterior tenotomy (SOPT) is a recognized surgical treatment to weaken the depressor effect of the superior oblique muscle without causing excyclotropia. We analyzed its use in the management of diplopia in downgaze due to contralateral blowout orbital fracture. Methods: We performed a retrospective case note review of patients that had undergone an SOPT as a primary surgical option in the management of diplopia in down gaze caused by contralateral blowout orbital fracture. The study covered a 17-year period from 1993 and 2010. These cases had diplopia maximal to the side of the orbital blowout. Pre-and postoperative orthoptic measurements were compared. Surgical complications were noted. Results: Five patients who fulfilled the entry criteria were identified. The mean follow-up period was 15.2 months (range 6-20 months). Preoperatively, the median jdevj was 2 prism diopters (PD) in primary position (range, 0-2) and 8 PD in downgaze (range, 2-18). At the final follow-up, the median jdevj in primary position was 0 PD (range, 0-2) and 2 PD in downgaze (range, 0-12). There were no significant differences pre-and postoperatively in both the primary position (p ¼ 0.19) or in downgaze (p ¼ 0.25) despite the large reduction in deviation size. Two patients needed a second procedure following SOPT. No patients complained of torsion, not in the primary position or in downgaze following the surgery. Conclusion: Contralateral SOPT can be a useful and simple primary treatment option for patients with moderate vertical deviations in downgaze to the same side of the orbital fracture. Larger deviations may require second surgeries. SOPT does not cause iatrogenic excyclotorsion and avoids surgery to a potentially much scarred inferior rectus area.
Extra-ocular movement restriction and diplopia following orbital fracture repair
American Journal of Otolaryngology
To report a series of patients with extra-ocular movement restriction and diplopia after orbital fracture repair, and determine the effect of timing of repair and the type of implant used. Methods: A chart review was conducted identifying all patients >18 years of age at our institution between June 2005 and June 2008 who underwent orbital fracture repair, and presented with clinically significant diplopia and extra-ocular movement restriction persisting longer than one month after repair. Data collected included timing of repair, implant used within the orbit, and need for revision. Results: Ten patients were identified with a mean time to primary orbital fracture repair at 9 days (range 1-48). Seven patients underwent revision of their orbital fracture repair with removal of the previously placed implant and replacement with non-porous 0.4 mm Supramid Foil, whereas one patient underwent lateral and inferior rectus recessions without revision of primary fracture repair. Titanium mesh was the intra-orbital implant found in all patients requiring revision of orbital fracture repair. All revisions resulted in resolution of clinically significant diplopia. Conclusions: Clinically significant diplopia and extra-ocular movement restriction is not an uncommon complication after orbital fracture repair. In our series, there was a strong association between these complications and the use of porous titanium mesh implants.
Title : Extraocular movement restriction and diplopia following orbital fracture repair 2
2017
To report a series of patients with extra-ocular movement restriction and diplopia after orbital fracture repair, and determine the effect of timing of repair and the type of implant used. Methods: A chart review was conducted identifying all patients >18 years of age at our institution between June 2005 and June 2008 who underwent orbital fracture repair, and presented with clinically significant diplopia and extra-ocular movement restriction persisting longer than one month after repair. Data collected included timing of repair, implant used within the orbit, and need for revision. Results: Ten patients were identified with a mean time to primary orbital fracture repair at 9 days (range 1-48). Seven patients underwent revision of their orbital fracture repair with removal of the previously placed implant and replacement with non-porous 0.4 mm Supramid Foil, whereas one patient underwent lateral and inferior rectus recessions without revision of primary fracture repair. Titanium mesh was the intra-orbital implant found in all patients requiring revision of orbital fracture repair. All revisions resulted in resolution of clinically significant diplopia. Conclusions: Clinically significant diplopia and extra-ocular movement restriction is not an uncommon complication after orbital fracture repair. In our series, there was a strong association between these complications and the use of porous titanium mesh implants.
Long-Term Sequelae after Surgery for Orbital Floor Fractures
Otolaryngology–Head and Neck Surgery, 1999
A surgical technique involving exact repositioning and rigid fixation is required for the reduction of fractures of the orbital floor. Even then, sequelae may be present long after the trauma. The aim of this study was to establish the frequency and type of sequelae after surgery for orbital floor fractures and to investigate the extent to which the method of surgery had any impact on the severity of the sequelae. A questionnaire was sent to all 107 patients (response rate 77%) 1 to 5 years after the injury. Further clinical data were obtained from the patients' charts. Eighty-three percent of the patients were affected by some kind of permanent sequelae in terms of sensibility, vision, and/or physical appearance. A high frequency of diplopia (36%) was related to the reconstruction of the orbital floor with a temporary “supporting” antral packing in the maxillary sinus, a technique which has now been abandoned at our department in favor of orbital restoration with sheets of poro...
Toward Management Consensus for Diplopia in Blow-Out Fractures of the Orbit
Although making a decision for the need for surgical correction of diplopia in blow-out fracture is difficult, it is logical to assume that an effective approach for management of diplopia in this type of injury should consider more than one factor. These factors include a preoperative BSV score and of the level of tissue herniation.
Delayed management of an orbital floor blow-out fracture
Beyoglu Eye Journal, 2021
A bony fracture in the orbital floor, the most common site, can lead to tissue herniation, enophthalmos, hypoglobus, or strabismic diplopia. Several surgical approaches for repair have been described in the literature. This report is a description of an illustrative case and a brief summary of the literature related to the transconjunctival approach to orbital floor fracture repair as performed by ophthalmologists. A 19-year-old female patient had fallen from a 5-meter-high fence and sustained panfacial fractures, including both orbits and the surrounding sinuses. An acute repair was performed by a maxillofacial team to stabilize the facial structure. Following neurosurgical stabilization, she was referred to ophthalmology with pronounced hypoglobus and enophthalmos, diplopia, relative afferent pupillary defect, and a slightly pale right optic nerve head. Surgery was performed under general anesthesia using the transconjunctival approach and an alloplastic implant. This approach was effective, providing excellent exposure while reducing the risks of lower eyelid retraction and surgical scars associated with the transcutaneous approach.