Combined orbital fractures: Surgical strategy of sequential repair

Title
Combined orbital fractures: Surgical strategy of sequential repair
Author(s)
김용하허수원김성은정규진이준호김태곤
Keywords
titanium; adolescent; adult; aged; Article; comminuted inferomedial strut; computer assisted tomography; diplopia; enophthalmos; exophthalmometry; extraocular muscle; eye examination; female; human; major clinical study; male; maxillary sinus; operation duration; orbit; orbit fracture; orbit reconstruction; orbital floor implant; periosteum elevator; retrospective study; surgical approach; surgical mesh
Issue Date
201507
Citation
Archives of Plastic Surgery, v.42, no.4, pp.424 - 430
Abstract
Background Reconstruction of combined orbital floor and medial wall fractures with a comminuted inferomedial strut (IMS) is challenging and requires careful practice. We present our surgical strategy and postoperative outcomes. Methods We divided 74 patients who underwent the reconstruction of the orbital floor and medial wall concomitantly into a comminuted IMS group (41 patients) and non-comminuted IMS group (33 patients). In the comminuted IMS group, we first reconstructed the floor stably and then the medial wall by using separate implant pieces. In the non-comminuted IMS group, we reconstructed the floor and the medial wall with a single large implant. Results In the follow-up of 6 to 65 months, most patients with diplopia improved in the first-week except one, who eventually improved at 1 year. All patients with an EOM limitation improved during the first month of follow-up. Enophthalmos (displacement, 2 mm) was observed in two patients. The orbit volume measured on the CT scans was statistically significantly restored in both groups. No complications related to the surgery were observed. Conclusions We recommend the reconstruction of orbit walls in the comminuted IMS group by using the following surgical strategy: usage of multiple pieces of rigid implants instead of one large implant, sequential repair first of the floor and then of the medial wall, and a focus on the reconstruction of key areas. Our strategy of step-by-step reconstruction has the benefits of easy repair, less surgical trauma, and minimal stress to the surgeon. ? 2015 The Korean Society of Plastic and Reconstructive Surgeons.
URI
http://hdl.handle.net/YU.REPOSITORY/31526http://dx.doi.org/10.5999/aps.2015.42.4.424
ISSN
2234-6163
Appears in Collections:
의과대학 > 성형외과학교실 > Articles
의과대학 > 영상의학과학교실 > Articles
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