Repair of Inferomedial Orbital Wall Fractures with Bony Strut Loss by Overlapping Absorbable Copolymer

Ah Young Choi; Su Youn Park; Koung Hoon Kook

doi:10.3341/jkos.2013.54.9.1315

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Choi, Park, and Kook: Repair of Inferomedial Orbital Wall Fractures with Bony Strut Loss by Overlapping Absorbable Copolymer

Original Article

J Korean Ophthalmol Soc 2013;54(9):1315-1320.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.9.1315

Repair of Inferomedial Orbital Wall Fractures with Bony Strut Loss by Overlapping Absorbable Copolymer

Ah Young Choi, MD, Su Youn Park, MD, Koung Hoon Kook, MD, PhD

Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea

Address reprint requests to Koung Hoon Kook, MD, PhD Department of Ophthalmology, Ajou University School of Medicine, #164 Worldcup-ro, Yeongtong-gu, Suwon 443-380, Korea Tel: 82-31-219-5260, Fax: 82-31-219-5259 E-mail: drkook@ajou.ac.kr

∗ This study was presented as a narration at the 108th Annual Meeting of the Korean Ophthalmological Society 2012.

Received 22 February 201318 April 2013 Accepted 27 June 2013

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

To report the results of surgical repairing of inferomedial orbital wall fractures accompanied with loss of bony strut by an overlapping method using Resorb X^® plates (poly(D,L)-lactic acid).

Methods

To repair inferomedial orbital wall fractures with loss of bony strut, we bent the medial aspect of the plate for floor fracture according to the anatomical structure and then inserted the floor implant, which was supported by anterior, posteri-or and lateral margins of the floor fracture. Then, the medial implant, which was supported by the bent medial edge of the floor implant, was inserted. Postoperatively, we analyzed the outcomes of 21 patients regarding postoperative enoph-thalmos, limitation of eye movement (LOM) and diplopia. The diagonal lengths of the orbit in the operated side were com-pared with the non-traumatized side based on the coronal view of the postoperative CT scans to determine the success or failure of the reconstruction.

Results

The average postoperative enophthalmic value was 0.5 mm, and no significant differences between the orbital di-agonal lengths of the operated and non-operated eyes were observed. The LOM shown in 7 out of 8 patients was com-pletely resolved during the postoperative follow-up period. All patients with diplopia, including one patient who showed par-tial remission of LOM, experienced complete symptom resolution. No other complications related to the implant were recorded.

Conclusions

Inferomedial orbital wall fractures with the loss of bony strut can be successfully repaired by the overlapping method using Resorb X^® implants.

Keywords: Bony strut, Inferomedial orbital wall fracture, Orbital implant, Overlapping method

References

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Figure 1.

(A) Schematic drawing of overlapping method for repairing of floor and medial wall fractures with loss of bony strut. (B), (C) Note the bended portion of floor implant to support the medial implant instead of the bony strut.

Figure 2.

The maximal diagonal lengths of the orbit in the op-erated and non-operated eye were measured from the point of supero-lateral orbital edge to the bony strut.

Figure 3.

Preoperative and post operative computed tomography images for repair of a combined infero-medial orbital wall fracture with loss of bony strut by an overlapping method. (A) Preoperative coronal view (B) Preoperative axial view (C) Postoperative coro-nal view. Note the similar size of the “box-shaped” orbit in both eyes (D) Postoperative axial view.

Table 1.

Demographic data of patients

	Sex	Age (year)	Dur*(day)	F/U^†(month)	Diplopia		LOM^∏		Enophthalmos (mm)		Diagonal length of orbit (mm)
	Sex	Age (year)	Dur*(day)	F/U^†(month)	Pre^‡	Post^§	Pre^‡	Post^§	Pre^‡	Post^§	Operated	Contralateral
1	F	25	19	22	‐	‐	‐	‐	0.5	1.0	37.44	37.73
2	F	29	11	18	+	‐	‐	‐	1.0	0.0	36.46	36.26
3	M	50	31	7	‐	‐	‐	‐	2.5	1.5	36.26	36.21
4	M	14	58	10	‐	‐	‐	‐	2.0	0.0	36.15	36.18
5	M	36	24	1	+	‐	‐	‐	2.0	0.5	42.64	42.61
6	M	30	0	2	+	‐	Mod	‐	0.5	1.0	38.94	38.67
7	M	16	21	21	‐	‐	‐	‐	2.0	0.5	38.94	38.67
8	M	51	106	1	‐	‐	‐	‐	2.0	0.0	35.00	34.94
9	F	28	24	3	‐	‐	Mod	‐	2.0	1.0	35.00	34.95
10	F	19	16	3	+	‐	Mild	‐	2.0	0.0	35.54	35.59
11	M	60	9	4	‐	‐	Mod	‐	2.0	0.0	34.63	34.70
12	M	24	19	18	‐	‐	‐	‐	1.0	1.0	36.15	36.65
13	M	32	31	9	+	‐	‐	‐	0.0	0.0	33.14	33.77
14	M	16	20	3	‐	‐	‐	‐	2.0	0.0	34.61	34.27
15	M	32	4	7	+	‐	Sev	Mild	1.0	1.0	36.25	36.47
16	M	10	18	5	+	‐	‐	‐	0.5	0.5	36.02	36.04
17	M	37	17	1	‐	‐	‐	‐	3.0	1.5	38.63	38.48
18	M	22	23	2	‐	‐	‐	‐	1.5	0.0	36.24	36.05
19	M	27	16	12	+	‐	Mod	‐	1.0	0.0	34.63	34.81
20	M	19	23	4	+	‐	Sev	‐	1.5	0.0	35.36	35.58
21	F	53	23	2	+	‐	Mild	‐	1.5	1.0	34.47	34.33
Mean	n	30.0	24.4	7.4					1.5	0.5	36.31	36.33

^* Duration from trauma to operation;

^† Duration of postoperative follow-up;

^‡ Preoperative;

^§ Postoperative;

^∏ Light target is held directly in front of subject's eye as the patient is asked to look as far as possible in the corresponding directions (Sev: light reflex (LR) falls inside pupil, Mod: LR falls near to pupil margin between limbus and pupil margin, Mild: LR falls near to limbus between limbus and pupil margin).

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