Outcomes of Isolated Medial Orbital Wall Fracture Reconstructions

Jung Hee In; Sun Young Jang; Youn Joo Choi; Hye Sun Choi; Jae Woo Jang; Sung Joo Kim

doi:10.3341/jkos.2014.55.11.1589

Journal List > J Korean Ophthalmol Soc > v.55(11) > 1009825

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

In, Jang, Choi, Choi, Jang, and Kim: Outcomes of Isolated Medial Orbital Wall Fracture Reconstructions

Original Article

J Korean Ophthalmol Soc 2014;55(11):1589-1594.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.11.1589

Outcomes of Isolated Medial Orbital Wall Fracture Reconstructions

Jung Hee In, MD¹, Sun Young Jang, MD¹, Youn Joo Choi, MD², Hye Sun Choi, MD³, Jae Woo Jang, MD³, Sung Joo Kim, MD³

¹Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

²Department of Ophthalmology, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

³Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea

Address reprint requests to Sun Young Jang, MD, Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, #170 Jomaru-ro, Wonmi-gu, Bucheon 420-767, Korea, Tel: 82-32-621-6718, Fax: 82-32-621-5018, E-mail: ysyat01@naver.com

Received 18 April 2014 Revised 27 May 2014 Accepted 3 October 2014

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 evaluate surgical results after the reconstruction of isolated medial orbital wall fractures.

Methods

We performed a retrospective chart review of patients with isolated medial orbital wall fractures who underwent reconstruction using the transcaruncular approach from March 2012 to October 2013. Computed tomography (CT) was performed before and after surgery. Postoperative follow-ups were conducted at 1 week, 1 month, and 3 months. Diplopia, ocular motility, postoperative complication, and exophthalmometry were recorded at each follow-up visit. Preoperative and postoperative enophthalmos was quantified using Hertel exophthalmometry and a quantitative method for the area of the circular sector under the chord (CA)/orbital area (OA) ratio at the CT scan. Patients were divided into either the incomplete or complete reduction groups based on the degree of reduction observed on postoperative CT.

Results

We evaluated 55 patients (42 males, 13 females) with an average age of 36 years. Five of 55 patients with preoperative enophthalmos of more than 2 mm obtained good symmetry after surgery. Diplopia at primary gaze was resolved in 9 of 9 patients and 2 patients had residual diplopia on lateral gaze. The difference of exophthalmometry and CA-to OA ratio between before and after reconstruction was not significantly changed in either the incomplete or complete groups.

Conclusions

Enophthalmos and diplopia were well corrected in all subjects. If reduction was successfully performed in the anterior portion of medial orbital wall fracture, clinically significant enophthalmos might be preventable even if complete reduction was not obtained.

Keywords: Enophthalmos, Isolated medial orbital wall fracture, Surgical outcome

References

1. Mathog RH. Management of orbital blow-out fractures. Otolaryngol Clin North Am. 1991; 24:79–91.

2. Dulley B, Fells P. Long-term follow up of orbital blowout fracture-with or without surgery. Mod Probl Ophthalmol. 1975; 14:467–70.

3. Jin HR, Shin SO, Choo MJ, Choi YS. Relationship between the extent of fracture and the degree of enophthalmos in isolated blowout fractures of the medial orbital wall. J Oral Maxillofac Surg. 2000; 58:617–20.

4. Thiagarajah C, Kersten RC. Medial wall fracture: an update. Craniomaxillofac Trauma Reconstr. 2009; 2:135–9.

5. Nowinski D, Messo E, Hedlund A. Treatment of orbital fractures: evaluation of surgical techniques and materials for reconstruction. J Craniofac Surg. 2010; 21:1033–7.

6. Lee CS, Yoon JS, Lee SY. Combined transconjunctival and transcaruncular approach for repair of large medial orbital wall fractures. Arch Ophthalmol. 2009; 127:291–6.

7. Mun GH, Song YH, Bang SI. Endoscopically assisted transconjunctival approach in orbital medial wall fractures. Ann Plast Surg. 2002; 49:337–43.

8. Wu W, Yan W, Cannon PS, Jiang AC. Endoscopic transethmoidal and transconjunctival inferior fornix approaches for repairing the combined medial wall and orbital floor blowout fractures. J Craniofac Surg. 2011; 22:537–42.

9. Wu W, Jing W, Selva D, et al. Endoscopic transcaruncular repair of large medial orbital wall fractures near the orbital apex. Ophthalmology. 2013; 120:404–9.

10. Musch DC, Frueh BR, Landis JR. The reliability of Hertel exophthalmometry. Observer variation between physician and lay readers. Ophthalmology. 1985; 92:1177–80.

11. Campi I, Vannucchi GM, Minetti AM, et al. A quantitative method for assessing the degree of axial proptosis in relation to orbital tissue involvement in Graves’ orbitopathy. Ophthalmology. 2013; 120:1092–8.

12. Manson PN, Grivas A, Rosenbaum A, et al. Studies on enophthalmos: II. The measurement of orbital injuries and their treatment by quantitative computed tomography. Plast Reconstr Surg. 1986; 77:203–14.

13. Manson PN, Clifford CM, Su CT, et al. Mechanisms of global support and posttraumatic enophthalmos: I. The anatomy of the ligament sling and its relation to intramuscular cone orbital fat. Plast Reconstr Surg. 1986; 77:193–202.

14. Lee CS, Yoon JS, Lee SY. Combined transconjunctival and transcaruncular approach for repair of large medial orbital wall fractures. Arch Ophthalmol. 2009; 127:291–6.

Figure 1.

Measurements of orbital parameters on axial computed tomography. CA = cord area; OA = oribital area; R = radius. A: Medial wall of the ethmoidal lamina papyracea; B, C: The point of intersecting the globe with the triangle; D: Lateral anterior zygomatic emergence; H₁: Height of orbital triangle; H₂: Height of triangle; α: The triangle.

Figure 2.

Group 1: incomplete reduction (blow out fracture at med. Wall, Lt.). (A) Preoperative axial CT image. (B) Postoperative axial CT image.

Figure 3.

Group 2: complete reduction (blow out fracture at med. Wall, Rt.). (A) Preoperative axial CT image. (B) Postoperative axial CT image: orbital soft-tissue herniation is decreased.

Table 1.

Patients demographics

Age (years)	Male	Female	Total
<10	1	0	1
10-20	8	0	8
20-30	11	3	14
30-40	11	2	13
40-50	5	1	6
50-60	5	3	8
60-70	1	1	2
>70	0	3	3
Total	42	13	55

Table 2.

Causes of fracture

Causes	No. of patients (%)
Assault	20 (36.4)
Slip down	17 (30.9)
Sports	7 (12.7)
Other causes	6 (10.9)
Traffic accident	5 (9)
Total	55 (100)

Table 3.

Enophthalmos improvement 3 months after surgery

Patients	N	Preoperative exophthalmometry	Postoperative exophthalmometry	Improvement in exophthalmometry
All	55	12.91 ± 2.696	13.33 ± 2.510	0.55 ± 0.959
≥2 mm enophthalmos	5	12.40 ± 3.578	13.80 ± 1.789	1.80 ± 1.924
<2 mm enophthalmos	50	12.96 ± 2.634	13.28 ± 2.580	0.42 ± 0.731

Values are presented as mean ± SD unless otherwise indicated.

Table 4.

Preoperative and posoperative values of enophthalmos measured by exophthalmometry

		Preoperative enophthalmos (mm)					Postoperative enophthalmos (mm)				Total
		E = 0	E < 1	1 ≤ E < 2	2 ≤ E < 3	E ≥ 3	E = 0	E < 1	1 ≤ E < 2	E ≥ 2	Total
Incomplete	Count (%)	22 (81.5)	0 (0)	3 (11.1)	1 (3.7)	1 (3.7)	22 (81.5)	0 (0)	2 (3.6)	3 (5.5)	27 (100)
Complete	Count (%)	23 (82.1)	0 (0)	2 (7.1)	3 (10.7)	0 (0)	19 (67.9)	0 (0)	8 (14.5)	1 (1.8)	28 (100)
Total	Count (%)	45 (81.8)	0 (0)	5 (9.1)	4 (7.3)	1 (1.8)	41 (74.5)	0 (0)	10 (18.2)	4 (7.3)	55 (100)

E = exophthalmometry.

Table 5.

Preoperative and posoperative values of enophthalmos measured by CA-to-OA ratio

		Preoperative enophthalmos				Postoperative enophthalmos				Total
		R < 0.20	0.20 ≤ R < 0.30	0.30 ≤R < 0.40	R ≥ 0.40	R <0.20	0.20 ≤R < 0.30	0.30 ≤R < 0.40	R ≥ 0.40	Total
Incomplete	Count (%)	2 (7.4)	10 (37)	13 (48.1)	2 (7.4)	0 (0)	14 (51.8)	11 (40.9)	2 (7.4)	27 (100)
Complete	Count (%)	2 (7.1)	11 (39.3)	11 (39.3)	4 (14.3)	1 (3.6)	8 (28.5)	16 (57.2)	3 (10.8)	28 (100)
Total	Count (%)	4 (7.3)	21 (38.1)	24 (43.7)	6 (10.8)	1 (1.8)	22 (40)	24 (43.6)	5 (9.0)	55 (100)

R: CA-to-OA ratio.

CA = cord area; OA = oribital area.

TOOLS

Similar articles