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Min and Mi: Reconstruction of Isolated Medial Orbital Wall Fracture Using a Transcaruncular Approach
Original Article

J Korean Ophthalmol Soc 2009;50(1):1-7.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.1.1

Reconstruction of Isolated Medial Orbital Wall Fracture Using a Transcaruncular Approach

Cheol Bae Min, M.D, Sun Kwak Mi, M.D

Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea

Address reprint requests to Mi Sun Kwak, MD Department of Ophthalmology, Daegu Fatima Hospital #576-31 Sinam-dong, Dong-gu, Daegu 701-600, Korea Tel: 82-53-940-7140, Fax: 82-53-940-7149, E-mail: mskwak66@hotmail.com

Received 7 October 2008       Accepted 2 June 2008

Copyright © 2009 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We present our results in the reconstruction of medial orbital wall fractures using a transcaruncular approach.

Methods

Forty-five patients with isolated medial orbital wall fractures underwent reconstruction by transcaruncular approach in our clinic between May 2003 and October 2007, and were followed up for 6 months or more.

Results

Thirty-three males and 12 females were included in this study, with a mean age of 34.9 years. The most common indication for reconstruction were large sized fractures more than 50%. Operations were performed at a mean 11.9 days after trauma. Among 18 patients who had diplopia before the operation, 16 (89%) patients had symptom relief or improvement, and in the 2 patients where diplopia persisted, it did not in primary and down gaze and offered no difficulties in daily activities. Among 34 patients who had enophthalmos before the operation, most (n=30) of the patients had minimal enophthalmos not more than 2 mm, 4 patients had enophthalmos that exceeded 2 mm.

Conclusions

Transcaruncular approach in reconstruction of isolated medial orbital wall fracture shows more satisfying functional and cosmetic results and can be preferred to isolated medial orbital wall fracture.

Keywords: Diplopia, Enophthalmos, Medial wall fracture, Transcaruncular approach

References

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Figure 1.
Transcaruncular approach in the reconstruction of medial orbital wall fracture; (A) Traction suture in the upper & lower episclera with 6-0 black silk. (B) Conjunctival incision is made with Ellman cautery between the caruncle and semilunar fold. (C) Transcaruncular dissection through the avascluar plane deep to the caruncle in a direction toward the posterior lacrimal crest with straight scissors. (D) The periosteal incision posterior to the posterior lacrimal crest using Ellman cautery. (E) Subperiosteal dissection and herniated orbital soft tissue reduction using malleable retractor and periosteal elevator. (F) Herniated orbital soft tissue is completely reduced and wide exposure of entire fracture site. (G) Medpor® barrier sheet placed to sufficiently cover the defect. (H) Conjuctival wound repairing with continuous suture using 6-0 vicryl.
jkos-50-1f1.tif
Figure 2.
(A) Preoperative CT scan of the patient who has medial orbital wall fracture and muscle displacement into ethmoid sinus. (B) Postoperative CT scan of the same patient. Reconstruction of the wall was done by Medpor® barrier sheet (white arrow).
jkos-50-1f2.tif
Table 1.
Demographic characteristics of patients
Age (years) Male Female Total
11-20 7 2 9
21-30 10 1 11
31-40 7 5 12
41-50 5 0 5
51-60 2 1 3
61-70 2 3 5
Total 33 12 45
Table 2.
Causes of fracture
No. of patients (%)
Assault 23 (51)
Traffic accident 11 (24)
Sports 8 (18)
Slip down 3 (7)
Total 45 (100)
Table 3.
Indications for fracture repair
No. of patients (%)
Large fracture > 50% (L) 15 (33)
Enophthalmos ≥ 2 mm (E) 4 (9)
Clinically significant diplopia (D)∗ 2 (4)
E+L 13 (29)
D+L 5 (11)
D+E 3 (7)
D+E+L 3 (7)
Total 45 (100)

∗ D=diplopia within 30° of primary gaze.

Table 4.
Preoperative and postoperative values of enophthalmos measured by Naugle exophthalmometry
Degree of enophthalmos (mm) No. of patients (%)
Preoperative Postoperative
E∗=0 11 (24) 20 (44)
E<1 0 (0) 3 (7)
1≤ E<2 11 (24) 18 (41)
2≤ E<3 17 (39) 2 (4)
3≤ E 6 (13) 2 (4)
Total 45 (100) 45 (100)

∗ E=enophthalmos.

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