Infraorbital Nerve Hypesthesia after Inferior Orbital Wall Fracture and Reconstruction Surgery

Youngje Sung; Byeong Jun Lee; Helen Lew

doi:10.3341/jkos.2017.58.4.373

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Sung, Lee, and Lew: Infraorbital Nerve Hypesthesia after Inferior Orbital Wall Fracture and Reconstruction Surgery

Original Article

J Korean Ophthalmol Soc 2017;58(4):373-379.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.4.373

Infraorbital Nerve Hypesthesia after Inferior Orbital Wall Fracture and Reconstruction Surgery

Youngje Sung, M.D.¹, Byeong Jun Lee, BD², Helen Lew, MD, PhD^1,

^¹Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea

^²CHA Medical Graduate School, Seongnam, Korea

Address reprint requests to Helen Lew, MD, PhD Department of Ophthalmology, CHA Bundang Medical Center, #59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea Tel: 82-31-780-5330, Fax: 82-31-780-5333 E-mail: eye@cha.ac.kr

Received 13 October 20161 February 2017 Accepted 18 March 2017

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 incidence of infraorbital nerve hypesthesia after inferior orbital wall fracture and reconstruction surgery and analyze the duration and factors to influence the occurence of the infraorbital nerve hypesthesia.

Methods

From March, 2001 to March, 2016, the medical records of 171 patients with isolated orbital floor fracture reconstructed with porous polyethylene or titanium mesh was analyzed retrospectively. Injury mechanism, fracture type, time interval to sur-gery, fracture size, type and thickness of implant were analyzed. Orbit computed tomography scan was performed at pre-operative and postoperative 6 weeks.

Results

Mean age was 30.4 years (male:female = 130:41). The mean time interval to surgery was 9.5 days. Incidence of in-fraorbital hypesthesia was 9.9% preoperatively, 38% in a week of surgery, 13.5% in 6 weeks and 5.8% in 6 months. Infraorbital hypesthesia lasts 20.5 weeks and the length of infraorbital canal was the only risk factor of persistent infraorbital hypesthesia.

Conclusions

Postoperative infraorbital nerve hypesthesia presents in a week in most patients. It last about 20.5 weeks, then mostly recovers in 6 months. This study will be useful to predict the clinical course of the patients with infraorbital nerve hypesthesia. Therefore, full explanation about the facial sense change is necessary for the patients with inferior orbital wall fracture.

Keywords: Inferior orbital wall fracture, Infraorbital hypesthesia, Infraorbital nerve

References

1. Renzi G, Carboni A, Perugini M. . Posttraumatic trigeminal nerve impairment: a prospective analysis of recovery patterns in a series of 103 consecutive facial fractures. J Oral Maxillofac Surg. 2004; 62:1341–6.

2. Gierloff M, Seeck NG, Springer I. . Orbital floor re-construction with resorbable polydioxanone implants. J Craniofac Surg. 2012; 23:161–4.

3. Kruschewsky Lde S, Novais T, Daltro C. . Fractured orbital wall reconstruction with an auricular cartilage graft or absorbable polyacid copolymer. J Craniofac Surg. 2011; 22:1256–9.

4. Kontio R, Suuronen R, Salonen O. . Effectiveness of operative treatment of internal orbital wall fracture with polydioxanone implant. Int J Oral Maxillofac Surg. 2001; 30:278–85.

5. Folkestad L, Granström G. . A prospective study of orbital fracture sequelae after change of surgical routines. J Oral Maxillofac Surg. 2003; 61:1038–44.

6. Al-Sukhun J, Lindqvist C. . A comparative study of 2 implants used to repair inferior orbital wall bony defects: autogenous bone graft versus bioresorbable poly-L/DL-Lactide [P(L/DL)LA 70/30] plate. J Oral Maxillofac Surg. 2006; 64:1038–48.

7. Becker ST, Terheyden H, Fabel M. . Comparison of collagen membranes and polydioxanone for reconstruction of the orbital floor after fractures. J Craniofac Surg. 2010; 21:1066–8.

8. Beck-Broichsitter BE, Acar C, Kandzia C. . Reconstruction of the orbital floor with polydioxanone: a long-term clinical survey of up to 12 years. Br J Oral Maxillofac Surg. 2015; 53:736–40.

9. Brucoli M, Arcuri F, Cavenaghi R, Benech A. . Analysis of complications after surgical repair of orbital fractures. J Craniofac Surg. 2011; 22:1387–90.

10. Cai EZ, Koh YP, Hing EC. . Computer-assisted navigational surgery improves outcomes in orbital reconstructive surgery. J Craniofac Surg. 2012; 23:1567–73.

11. Jang KH, Kim NJ, Choung HK, Khwarg SI. . Orbital wall fracture repair: the results of early and delayed surgery. J Korean Ophthalmol Soc. 2016; 57:181–7.

12. Jeon C, Shin JH, Woo KI, Kim YD. . Porous polyethylene/titanium implants in the treatment of large orbital fractures. J Korean Ophthalmol Soc. 2009; 50:1133–40.

13. Yoon JS, Chung SA, Lee SY. . Repair of large posterior inferior wall fracture using medpo (R) channel sheet implant. J Korean Ophthalmol Soc. 2006; 47:1217–24.

14. Yang PJ, Chi NC, Choi GJ. . Comparison of sugical outcome be-tween early and delayed repair of orbital wall fracture. J Korean Ophthalmol Soc. 2003; 44:1278–84.

Figure 1.

Types of inferior orbital wall fractures in the images from the orbital CT scan. I: Fracture not involving the infraorbital ca-nal (I _a: coronal view, I _b: sagittal view). II: Fracture involving infraorbital canal and medial side from the canal. III: Fracture involving infraorbital canal and temporal side from the canal. IV: Large fracture involving infraorbital canal. V: Focal trap door fracture involving infraorbital canal. CT = computed tomography.

Figure 2.

Infraorbital canal length and angle meas-urement in the sagittal view of the contralateral or-bits from the orbital computed tomography (CT) scan. The length of the infraorbital canal and the angle between the inferior orbital wall and the in-fraorbital canal were measured in the sagittal CT image that the infraorbital canal was well vi-sualized on the assumption that the orbits are symmetric.

Figure 3.

Infraorbital nerve hypesthesia after inferior orbital wall fracture repair surgery. (A) Prevalence of infraorbital nerve hypesthesia. (B) Kaplan-Meier survival analysis for infraorbital hypesthesia following orbital fracture reconstruction surgery. POD = post operative days; CI = confidence interval; D =days; W = week(s); M = months.

Figure 4.

Characteristics of the patients with infraorbital nerve hypesthesia. Early postoperative hypesthesia is a hypesthesia occurs in 10 days after reconstruction surgery. Persistent postoperative hypesthesia is a hypesthesia lasts more than 6 months. ^* p<0.05, Mann Whitney test; ^† p<0.05, Independent t-test.

Figure 5.

Analysis according to the types of inferior orbital wall fracture. (A) Inferior orbital wall fracture types in the patients. (B) Patients with infraorbital nerve hypesthesia in postoperative status. POD = post operative days; D =days; W = week(s); M = months.

Table 1.

Demographic characteristics of the patients with in-ferior orbital wall fracture

Patients	Data (n = 171)
Age (years)	30.4 ± 11.5
Sex (male:female)	130:41:00
Fracture size (cm²)	3.3 ± 1.4
Infraorbital canal length (mm)	15.85 ± 3.9
Infraorbital canal angle (°)	30.1 ± 9.6
Time of surgery after injury (days)	9.5 ± 12.7
Follow up period (weeks)	30.4 ± 54.9
Mechanism of Injury (n, %)
Assault	64 (37.4)
Fall	32 (18.7)
Sports-related injuries	32 (18.7)
Traffic accidents	10 (5.8)
Others	33 (19.3)
Types of implant (n, %)
Porous polyethylene	100 (58.5)
Porous polyethylene and titanium mesh	71 (41.5)

Values are presented as mean ± SD unless otherwise indicated.

Table 2.

Factors to influence the occurrence of early and persistent infraorbital nerve hypesthesia in the patients with inferior orbital wall fracture

Infraorbital nerve hypesthesia	Early				Persistent
Infraorbital nerve hypesthesia	B	S.E.	p-value	Exp (B)	B	S.E.	p-value	Exp (B)
Infraorbital canal length (mm)	-0.427	0.217	0.048^*	0.652	-0.423	0.195	0.030^*	0.655
Infraorbital canal angle (°)	-0.153	0.161	0.342	0.858	-0.304	0.175	0.082	0.738
Time interval to surgery (days)	0.338	0.426	0.427	1.402	-0.092	0.145	0.526	0.912
Fracture size > 2 cm²	-1.031	1.463	0.481	0.357	-7.843	7.575	0.300	0
Age (years)	0.116	0.220	0.597	1.123	-0.122	0.119	0.306	0.885
Preoperative infraorbital hypesthesia	-				-2.440	2.049	0.234	0.087
Porous polyethylene with titanium mesh					2.134	4.692	0.649	8.447
Sex					1.378	5.420	0.799	3.968
Early hypesthesia					-0.189	1.788	0.916	0.828

S.E. = standard error around the coefficient for the constant; B = coefficient for the constant in the null model; Exp (B) = exponentiation of the B coefficient, which is an odds ratio.

^* Logistic regression test.

Table 3.

Overview of previous studies on perioperative hypesthesia of the patients with inferior orbital wall fracture

	Numbers of patients	Follow up periods	Time interval from trauma to surgery	Fracture site	Implant types	Incidence (pre-oper ative)	Incidence (post-operative)	Risk factor
Jang et al. (2016)¹¹	88		-	BOF (medial, inferior)	Medpor barrier sheet	-	4.5%	-
Jeon et al. (2009)¹²	7	5.4 months	-	BOF (medial, inferior)	Porous polyethylene/tit anium	85.7%	Full recovery in last f/u	-
Yoon et al. (2006)¹³	52		15 days	BOF (medial, inferior)	Medpor channel sheet	-	23.10%	-
				Zygoma (n = 2) Orbital rim (n = 4)
Yang et al. (2003)¹⁴	83		10.1 days (Early surgery group)	BOF (medial, inferior, lateral)	Silicone plate Medpor	-	13.2% in early op	-
			28.4 days				13.3% in
			(Delayed surgery group)				delayed op
Beck-Broichsitter et al. (2015)⁸	101	6 years	5 days	BOF (n = 40) Orbital floor and midface (n = 33) Complex midfacial	PDS	-	29.7% Postop 14.8% Persistent	No significant risk factor
				(n = 25)
Gierloff et al. (2012)²	194	6 months	-	Zygomatico-maxillary Isolated floor Complex midfacial	PDS	62%	24% in POD#10 18% in 6 months	Existence of early postop (POD#14) hypesthesia
Brucoli et al. (2011)⁹	75	39 months	-	Isolated orbital BOF	Tutopatch sheet (n = 26)	-	55% Postop 29.3% Finally	Short time interval to
					Synthes (n = 13) Autologous			surgery (<2 weeks)
					calvarial bone
					graft (n = 1)
Kruschewsky et al. (2011)³	20	6 months	-	BOF (medial, inferior) Other facial fractures	Auricular cartilage graft (8) Blade absorbable s	38% vs. 42%	Postop 25 vs. 17%	-
					polyacid copolymer(12)
Folkestad and	51	12	-	Floor (51) with	Various	82%	Postop 60%	-
GranstrÖ m		months		associated facial			(70% in pure
(2003)⁵				fracture (45)			orbital fracture)

BOF = blowout fracture; f/u = follow up; op = operation; PDS = polydioxanone; Postop = postoperation; POD = postoperative day.

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