Simultaneous Transconjunctival and Transantral Approach for Repair of Blowout Fracture by using Medpor Orbital Implant

Surgical approaches to blowout fracture have been made through a skin inci-sion in the lower eyelid placed just below the eyelashes[a subciliary pproach], a conjunctival approach, a transantral approach, or a combined approach. Authors repaired the orbital floor fracture through the transconjunctival and transantral approaches simultaneously in 4 patients confirmed orbital floor fracture on CT scan from April to September 1998. Transconjunctival approach could avoid ectropion, lower eyelid retraction and transantral endoscopic orbital floor exploration could allow precise determination of fracture size, location, and replacement of prolapsed tissue and placement of implant over the bony defect. So it was possible to repair with a minimal size of implant and could avoid the complications caused by a too large implant in the posteriorly located orbital floor fracture.

Repair of Telecanthus with Titanium Miniplate in Blepharophimosis Syndrome

Telecanthus in congenital blepharophimosis has traditionally been repaired with conventional methods such as medial canthal tendon tucking and transnasal wiring.We report 2 cases of patients with telecanthus who underwent repair with titanium miniplate. After the anterior limb of medial canthal tendon was dissected, its insertion site was drilled and a titanium miniplate was fixed with screws.The dissected medial canthal tendon was fixed with 4-0 mersilene to a miniplate hole.After the surgery, we obtained a mean decrease of 11 mmin intermedial canthal distance and no complications except scar in incision site. We believe that this procedure has advantages such as short operation time, precise placement of the medial canthal tendon.For these reasons, it seems to be an excellent alternative to transnasal wiring, but considers this operation because of scar in incision site.

Lipogranuloma in the Upper Lids

The author experienced a case of paraffinoma in a 64-year-old woman who complained of nontender hard masses of both upper lids causing difficulties of eye opening and ptosis and had undergone injection of foreign material into zygomatic areas 20 years ago for cosmesis. Excisional biopsy showed multiple irregular shaped vacuoles with perivacuolar dense fibrotic rim and chronic inflammatory cell infiltration in interstitium. These findings were consistent with lipogranuloma[paraffinoma].

Vaporization of Orbital Lymphangioma with Ultrapulse CO2 Laser

Orbital lymphangioma is a benign vascular hamartoma that may be found in the conjunctiva, eyelids, orbit, or elsewhere in the head and neck region. Deep lymphangiomatous lesions are classically characterized by acute onset of a fulminant proptosis resulting from spontaneous hemorrhage within the orbit. Complete surgical excision is often difficult because of the infiltrative nature of the tumor. Moreover, because of the hemorrhagic and friable nature of the tumor, conventional surgical techniques are frequently complicated by bleeding. We treated a case of pathologically-proven orbital lymphangioma with the ultrapulse CO2 laser. The ultrapulse CO2 laser permits a precise form of treatment with the ultimate form of hemostasis[tissue vaporization], resulting in minimal trauma, edema, and scarring, and thus offers a safe alternative to surgical excision of this lesion. The ultrapulse CO2 laser is an best ideal instrument for subtotal excision of this lesion because of its hemostatic cutting-vaporizing actions.

Surgical Treatment of Thyroid-related Upper Eyelid Retraction

Lid retraction is one of the most common problems in Grave's disease. Many techniques for correction of the upper eyelid retraction have been described.The authors performed surgeries for correction of upper lid retraction by means of transconjunctival and transcutaneous recession of the aponeurosis of the levator muscle and Muller's muscle. From March 1997 to June 1999, 8 patients underwent for unilateral upper lid retraction through transcutaneous approaches and 6 patients through transconjunctival approaches.Transcutaneous and transcon-junctival approaches were effective when the recession was 1.54 mm, and 2.43 mm, respectively for every millimeter of correction for retraction desired.Two approaches were safe and efficacious and could be used for all degrees of eyelid retraction, but transcutaneous approach was thought to be more appropriate for severe eyelid retraction and blephraplasty simultaneously than transconjunctival approach.

Clinical Effect of Porous Polyethylene (Medpor(r))Orbital Implant

Porous polyethylene (Medpor(r))implant offers several advantages over other implant materials. Its porosity allows fibrovascular ingrowth which promotes host integration, prevents migration and reduces the likelihood of opportunistic infections. The authors used the porous polyethylene (Medpor(r)) as a central orbital implant in 36 eyes of the 36 patients. They underwent enucleation (17 cases), evisceration (16 cases), and a secondary implantation (1 cases)between November 1997 and June 1999. A mean follow-up period was 8.9 months (range, 3 to 17 months). There were 5 cases of implant exposure and 4 cases of superior sulcus deformity. There were no infection of implant, implant migration, or extrusion of motility coupling post. Postoperatively, all sockets showed good to excellent motility of prosthesis. Porous polyethylene (Medpor(r))can be used successfully as an orbital implant in anophthalmic socket surgery. Its advantages over other similar implants include a significantly lower material cost and the ability to suture the extraocular muscles directly to it without the need for a covering material such as fascia or sclera.

Treatment of Lagophthalmos with Gold Weight Implantation

When an eye is exposed to the air due to lagophthalmos caused by facial nerve paralysis, exposure keratitis, conjunctivitis and corneal damages occur. Artificial tears, soft contact lens, ophthalmic ointments, and tarsorrhaphy have been used for treatment of lagophthalmos to relieve exposure keratopathy. But these trials have little continuity and comfortability and have many cosmetic problems, so that the results have not been satisfactory. We obtained good results by implantation of Gold weight in the upper lid for the treatment of lagophthalmos with complications in 7 cases. In conclusion, the author believes that Gold weight implantation will be a good therapeutic modality for treatment of lagophthalmos.

Treatment of Lagophthalmos with Gold Weight Implantation

When an eye is exposed to the air due to lagophthalmos caused by facial nerve paralysis, exposure keratitis, conjunctivitis and corneal damages occur. Artificial tears, soft contact lens, ophthalmic ointments, and tarsorrhaphy have been used for treatment of lagophthalmos to relieve exposure keratopathy. But these trials have little continuity and comfortability and have many cosmetic problems, so that the results have not been satisfactory. We obtained good results by implantation of Gold weight in the upper lid for the treatment of lagophthalmos with complications in 7 cases. In conclusion, the author believes that Gold weight implantation will be a good therapeutic modality for treatment of lagophthalmos.

Prediction of Late Enophthalmos by Volumetric Analysis of Blowout Fractures using Orbital CT

The purpose of this study was to determine whether orbital volume assessment by CT could provide additional information for the initial evaluation of orbital blowout fractures and guide optimal treatment. The medical records of 26 patients with orbital blowout fractures, either surgically or conservatively managed, were retrospectively reviewed. Orbital volumetric analysis was then determined from digitized CT scans. Fracture-related volume expansion relative to the unaffected fellow orbit was correlated with degree of enophthalmos. Early Hertel's measurements[4 weeks] were obtained in 13 nonrepaired fractures and in 3 of 13 surgically repaired patients[late presentation;16 patients]. When seen at more than 4 weeks, 4[80%] of 5 patients with> OR =13% orbital volume expansion manifested significant enophthalmos[>2 mm] compared with 2[18.2%] of 11 patients with<13% orbital expansion[p<0.01]. CT measurements of orbital volume can predict the final degree of late enophthalmos and may facilitate the planning of surgical intervention.

A Case of Subperiosteal Orbital Hematoma in Patient with Ethmoid and Maxillary Sinusitis

Subperiosteal hematoma of the orbit is uncommon and mostly caused by trauma or some general diseases such as leukemia, hemophilia, and scurvy. Subperiosteal yhematoma associated with sinusitis which is not related to trauma and general diseases, however, is extremely rare. The authors report a case of subperiosteal hematoma of the orbit in 22-year-old man without a history of trauma and general diseases. He had proptosis, and sudden decreased visual acuity. Clinical features, and computerized tomography established the diagnosis of subperiosteal orbital hematoma secondary to ethmoid and maxillary sinusities. We could make definitive diagnosis by needle aspiration of blood using 18-gauge needle with a 10ml syringe at our OPD. To avoid complications such as compressive neuropathy, central retinal occlusion, and recurrence of hematoma, we managed it successfully by evacuation of blood and thermal cauterization to bleeding areas of periosteum, or bone.

Malignant Melanoma of the Lacrimal Sac

Malignant melanoma of the lacrimal sac is extremely rare. To our knowledge, there have been 17 cases of malignant melanoma of the lacrimal sacreported in the literature and no case has been reported in Korea. The authors have experienced a 56 year-old male patient complaining of epiphora and mass in the medial canthal and neck areas for two month duration in the left eye. Excisional biopsy showed typical malignant melanoma which was treated with radiation therapy. Metastasis occurred in spinal cord during follow-up period. Although malignant melanoma of lacrimal sac is very rare, it should be considered in differential diagnosis of a growing tumor in the lacrimal sac.

Infected Hydorx yapatite Implant by Pseudomonas Aeroginosa

The hydroxyapatite orbital implant has been known to be a biocompatible and nontoxic implant with good fibrovascular ingrowth, few postoperative complications, and excellent prosthesis motility. The complications after implantation of hydroxyapatite were included peg extrusion, implant exposure, conjunctival dehiscene, granulation tissue overgrowth, and infection of implant. Infected hydroxyapatite implants are, to date, rare. When they occur, implant removal has been the only successful treatment modality. Infection of hydroxyapatite implant occurred in 37months after surgery on conjuctival culture. Pseudomonas aeruginosa was identified as a causative microorganism. To our knowledge, this is the first report of complications with the latest infected hydroxyapatite after implantation of hydroxyapatite. The case also unique because causative microorganism is Pseudomonas aeroginosa instead of Staphylococcus aureus. Persistent conjunctival inflammation postoperatively despite using systemic and topical antimicrobial drops, persist orbital discomfort, discharge, conjunctival dehiscence and the development of a pyogenic grauloma after hydroxyapatite implant should be suspected possibility of hydroxyapatite implant infection.