Abordaje transconjuntival en comparación con abordaje subciliar para el tratamiento de fracturas orbitarias / Transconjunctival versus subciliary approach for the treatment of orbital fractures

RESUMEN: Introducción: Los abordajes transconjuntival preseptal y subciliar han sido ampliamente utilizados para el manejo quirúrgico de las fracturas orbitarias. Sin embargo, aún existe incertidumbre sobre las complicaciones asociadas a cada uno de estos abordajes. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios. Realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos seis revisiones sistemáticas que en conjunto incluyeron 21 estudios primarios, de los cuales cuatro corresponden a ensayos aleatorizados. Concluimos que el abordaje transconjuntival preseptal podría disminuir tanto la incidencia de ectropión como de un resultado estético insatisfactorio, pero la certeza de la evidencia es baja. Además, este abordaje probablemente disminuye el riesgo de complicaciones intra y postoperatorias, tales como diplopía, parestesia transitoria, equimosis, exposición escleral, laceración del plato tarsal y laceración palpebral inferior. Por otro lado, el abordaje transconjuntival podría aumentar el riesgo de entropión, pero la certeza de la evidencia también es baja.

ABSTRACT: Introduction: The preseptal transconjunctival and subciliary approach have been widely used for the surgical management of orbital fractures. However, there is still uncertainty about the complications associated with each of these approaches. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified six systematic reviews that included 21 primary studies, four of which correspond to randomized trials. We conclude that the preseptal transconjunctival approach could decrease the incidence of ectropion and an unsatisfactory aesthetic result, but the certainty of the evidence is low. Furthermore, this approach probably decreases the risk of intra and postoperative complications, such as diplopia, transient paresthesia, ecchymosis, scleral show, tarsal plate laceration and lower palpebral laceration. On the other hand, the transconjunctival approach could increase the risk of entropion, but the certainty of the evidence is also low.

Morphometric Study to Assess Dimensions of Orbital Roof and Floor In Dry Skulls

Background: The orbit is a craniofacial structure that can beaffected by a large number of congenital, traumatic, neoplastic,vascular, and endocrine disorders. Therefore, the presentstudy was conducted to assess dimensions of orbital roof andfloor in dry skulls.Materials and Methods: The present study was conducted toassess dimensions of orbital roof and floor in 55 dry skullswhich were collected from the Department of Anatomy,Teerthanker Mahaveer Medical College & Research Centre,TMU, Moradabad, Uttar Pradesh, India. Based on themorphology, skulls were differentiated into 36 male and 19female skulls. The roof length and floor length of the orbit wasmeasured. The data obtained were tabulated and analyzedusing Statistical Package for the Social Sciences, Version 21.0(SPSS, Chicago, IL). The results were considered significantwhen p < 0.05.Results: In the present study total sample size was 55 dryskulls in which 36 were male skulls and 19 were female skulls.In male mean roof length was 5.43 and in female mean rooflength was 4.65. In male mean floor length was 4.81 and infemale mean floor length was 4.76. The right mean roof lengthwas 4.22 and left mean roof length was 4.93. In right meanfloor length was 4.45 and left mean floor length was 4.86.Conclusion: Present study concluded that mean roof lengthand floor length was greater in males. The left roof and floorlength were greater than right roof length.

Tercer molar heterotópico en el reborde orbitario: Reporte de un caso y revisión de literatura / Heterotopic third molar in the orbital rim: Report of a case and literature review

Los terceros molares heterotópicos son órganos dentarios que se encuentran en un sitio anatómico fuera de lo habitual, pueden ser supernumerarios, deciduos o un diente permanente, el cual ha sido reportado en diferentes posiciones, incluyendo la región coronoidea, cavidad nasal, seno maxilar, región orbitaria, palatina, cóndilo mandibular. La etiología de la erupción heterotópica/ectópica es desconocida, aunque hay varias teorías como la discrepancia óseo-dentaria por la evolución. Los órganos dentarios heterotópicos/ectópicos son comunes en la mandíbula y en el género femenino y pueden ocurrir en ambas denticiones. Algunos terceros molares heterotópicos/ectópicos son asintomáticos durante el periodo de vida y son usualmente detectados en hallazgos clínicos y radiográficos de manera incidental. Existen casos documentados desde 1887 hasta la actualidad cuya localización es en el reborde orbitario. En el presente artículo se expone un caso clínico de una extracción quirúrgica de un tercer molar superior heterotópico en el reborde orbitario descrita bajo el protocolo de las retenciones dentales. Dicho caso fue establecido en el Hospital Regional «General Ignacio Zaragoza¼ del ISSSTE en la Ciudad de México, con el que se obtuvieron resultados favorables, fue el primer reporte de la literatura en México. Se realizó una revisión aleatoria de la literatura en páginas como PubMed, ScienceDirect y Springer, Cochrane Library y se desarrolló el reporte de caso clínico de una paciente con un tercer molar superior heterotópico ubicado en el piso de órbita derecho (AU)

Heterotopic third molars are dental organs that are in an anatomical site out of the ordinary, can be supernumerary, deciduous or a permanent tooth, which has been reported in different positions, including the coronoid region, nasal cavity, maxillary sinus, orbital region, palatal, mandibular condyle. The etiology of the heterotopic/ectopic eruption is unknown, although there are several theories such as bone-dental discrepancy due to evolution. The heterotopic/ectopic teeth are common in the jaw and in the female gender and can occur in both dentitions. Some heterotopic/ectopic third molars are asymptomatic during the lifetime and are usually found incidentally in clinical and radiographic findings. There are documented cases from 1887 to the present that its location is in the orbital rim. In the present article we present a clinical case of a surgical extraction of a third upper molar heterotopic in the orbital rim and that is described under the dental retention protocol established in the Regional Hospital «General Ignacio Zaragoza¼ of the ISSSTE in the City of Mexico, with which they obtain favorable results, first report of the literature in Mexico. A randomized review of the literature was made on pages such as PubMed, ScienceDirect and Springer, Cochrane Library and the clinical case report of a patient with a heterotopic upper third molar located on the floor of the right orbit was developed (AU)

Clinical outcome after orbital floor fracture reduction with special regard to patient's satisfaction / 中华创伤杂志(英文版)

PURPOSE@#Primary reconstruction via transconjunctival approach is a standardized treatment option for orbital floor fractures. The aim of this study was to compare the findings of specific ophthalmologic assessment with the patient's complaints after fracture reduction.@*METHODS@#A retrospective medical chart analysis was performed on patients who had undergone transconjunctival orbital floor fracture reduction for fracture therapy with resorbable foil (ethisorb sheet or polydioxanone foil). A follow-up assessment including ophthalmological evaluation regarding visual acuity (eye chart projector), binocular visual field screening (Bagolini striated glasses test) and diplopia (cover test, Hess screen test) was conducted. Additionally, a questionnaire was performed to assess patients' satisfaction.@*RESULTS@#A total of 53 patients with a mean follow-up of 23 months (ranging from 11 to 72) after surgical therapy were included. Diplopia was present preoperatively in 23 (43.4%) and reduced in follow-up examination (n = 12, 22.6%). Limitations in ocular motility reduced from 37.7% to 7.5%. The questionnaire about the patient's satisfaction revealed excellent outcomes in relation to the functional and esthetical parameters.@*CONCLUSION@#Transconjunctival approach is a safe approach for orbital fracture therapy. Postoperative diplopia is nearly never perceptible for the individual and differs to pathologic findings in the ophthalmic assessment.

Morphometry Of Orbit In South Indian Dry Skulls - Dimensions Of Orbital Roof And Floor

Background: The human orbit is a complex anatomic region. Each of its four bony walls has its own uniquefeatures and is perforated by a number of fissures and foramina that carry important nerves and blood vessels.This is an anatomical region which is of clinical & surgical interest to many disciplines like ophthalmology, oraland maxillofocial surgery and neurosurgery. This morphometric study is undertaken to provide the normalreference values of roof and floor of the orbit in south Indian population.Materials and Methods: The study was done on 200 skulls (105 males and 95 females). The length of orbital roofand floor were measured by using manual vernier caliper. All the data obtained were tabulated and analysedstatistically by computing descriptive statistics like mean, standard deviation and range. Mann-Whitney testwas done to find out the statistical significance of all parameters of orbits, with respect to gender and side (rightand left side).Results: The results showed that the length of orbital roof and floor were significantly larger in males than infemales. There were no significant differences in between the right and left side orbits.Conclusion: This study has compared the orbital roof and floor length between the genders and between the sidesof the skulls. The prior knowledge of the orbital parameters may help to restore the normal anatomy of the orbitduring maxillofacial and reconstructive surgeries.

Retrospective analysis of 79 patients with orbital floor fracture: outcomes and patient-reported satisfaction

BACKGROUND: The aim of our retrospective study is to evaluate the management of isolated orbital floor fractures considering the clinical, functional and aesthetic results according to the surgical approach and the type of materials used. METHODS: Retrospectively, clinical, radiological, surgical, and ophthalmological data from 79 patients were collected from January 2010 to December 2016. Furthermore, included patients were interrogated on functional and aesthetic satisfaction. RESULTS: The main causes of trauma were physical aggression followed by accidents. The median time between trauma and surgery was 4 days. The most common surgical approaches were the subciliary and the transconjunctival ones. Alloplastic materials were used in 75 patients. In two patients, we used a combination of two grafts. Patients experienced minor immediate complications. On follow-ups, none of our patients suffered from ocular movement restrictions. Patients treated by subciliary approach had higher risk of retractile scaring compared to other surgical approaches. In our study, patients agreed to complete a questionnaire assessing functional and aesthetic outcomes with a high satisfaction score. No association between the implant material used and the results has been assessed. CONCLUSION: This study describes the results of orbital floor reconstructions. Despite a variety of materials used and surgical approaches performed, we believe that the transconjunctival approach is the most suitable option with a high satisfaction score.

Surgical correction of severe enophthalmos caused by bullet injury.

Ballistic injuries of oral and maxillofacial region are usually fatal due to close propinquity with the vital structures. The severity of injury depends on the caliber of the weapon used and distance from which the patient is shot. The preliminary care of facial ballistic wounds strictly adheres to the basics of trauma resuscitation. Early and appropriate surgical management has proved to be influential on the final outcome and esthetic result. Treatment of facial gunshot wounds should be planned and carried out carefully to avoid esthetic complications. It takes even multiple‑staged corrections to achieve the targeted functional and esthetic treatment plan. Prevention and control of infection is one of the most important goals to achieve the success of the treatment. Herewith, we present a case of facial gunshot injury with fractures in the orbital floor, medial wall maxillary sinus, and buttress of the zygomatic bone causing deficit, which was successfully managed by surgical reconstruction.

Imaging study of maxillary sinus in normal adults using cone-beam CT / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo estimate different dimensions of maxillary sinus measured on cone-beam computerized tomography (cone-beam CT), and determine the differences in side and gender.METHODScone-beam CT image data from 200 normal adults was selected and analyzed by Invivo Dental software. The craniocaudal diameter, anteroposterior diameter, width and volume of maxillary sinus were measured as well as the thickness of the orbital floor. Statistical analysis was performed with SPSS 11.5.RESULTSThere were no statistically significant differences in the craniocaudal diameter, anteroposterior diameter, width and volume of maxillary sinus between sides (P>0.05, respectively). Significant differences were noted in the craniocaudal diameter and volume of bilateral maxillary sinus and the width of right maxillary sinus based on gender (P0.05, respectively).CONCLUSIONOur findings indicate that cone-beam CT can be used to measure different dimensions of maxillary sinus and provide imaging anatomical data for clinical treatment.

Odontogenic Keratocyst of Maxillary Premolar Region: A Case Report.

Odontogenic keratocysts (OKC) are enamel organ or dental lamina derived cysts and are not thought to be associated with any infection. They mainly occur in second and third decades of life. The purpose of this case report is to describe a rare case of OKC in a 10-year-old girl, associated with upper left unerupted maxillary first premolar. It involved maxillary sinus leading to erosion of left orbital floor. It also led to the displacement of adjacent maxillary canine and maxillary left second premolar above the unerupted maxillary left third molar. Due to the aggressive nature of the cyst, it was enucleated and followed-up.

Transoral removal of ectopic maxillary third molar situated superiorly to maxillary antrum and posteroinferiorly to the floor of orbit.

Only few cases of ectopic third molar in relation to the roof of maxillary sinus and posteroinferior to the floor of the orbit have been reported in the literature. The diagnosis is usually done by plain‑film radiography. “Caldwell‑Luc” operation or endoscopic procedures have been used for the removal of such type of ectopic tooth. We report a case of 46‑year‑old female patient who presented with pain, swelling and watering of eye due to the ectopic tooth. The trans oral removal (via “Caldwell‑Luc” operation) of the ectopic maxillary third molar situated superior to maxillary antrum and posteroinferior to the floor of orbit has been described in this case without any complication.

Visual profile of motorcycle-related ocular trauma in a tertiary hospital

Objectives@#To provide a representative data on the local profile of motorcycle-related ocular trauma seen in a tertiary hospital over a period of one year.@*Methodology@#A retrospective case review of all motorcycle-related trauma patients seen at the emergency room of the Philippine General Hospital (PGH) by the Trauma Service of the Department of Surgery and referred to the Department of Ophthalmology and Visual Sciences (DOVS) for eye injuries was conducted. Descriptive statistics were used to determine the prevalence and types of injuries, and the factors affecting these injuries. @*Results@#Thrity-four charts were reviewed; 9 (26.5%) patients had bilateral ocular involvement and 25 (73.5%) unilateral, a total of 43 eyes. The patients were mostly males in their productive age, belonged to the lower economic bracket, and came from nearby Southern Luzon provinces and the National Capital Region (NCR). Most of the injuries incurred were mild and involved the external surface of the eye. Night motorcycle driving, fair weather, and alcohol use were risks identified for motorcycle-related ocular injuries. Helmet use was the only identifiable risk indirectly correlated with severity of ocular injury. @*Conclusion@#Although majority of the ophthalmic injuries were classified as mild, and eyes involved had generally good visual potential, helmet use was the only identifiable risk associated with the severity of the ocular injury

Delayed Onset Diplopia due to Minimal Orbital Floor Fractures 16 Months Previously / 대한이비인후과학회지

Ocular symptoms related to orbital fracture occur immediately after the fracture in most cases. However, authors experienced a delayed onset diplopia occurred 16 months after orbital floor fracture. A 19-year-old man, who had right orbital floor fracture 16 months ago, presented with diplopia of upward gaze. At the time of the fracture, no surgery was performed because the fracture was minimal and there were no particular symptoms. Physical examinations revealed a minor ocular motility restriction of upward gaze, but orbital floor showed no definite interval change on computed tomography. Severe adhesion between the orbital fat tissue and orbital floor was noted intraoperatively and the adhesion was dissected. After the operation, the patient showed remarkable improvement in diplopia and restriction of the ocular motility.

Open Reduction and Internal Fixation (ORIF) of Trapdoor Orbital Floor Blowout Fracture with Absorbable Mesh Plate

PURPOSE: Trapdoor orbital blowout fracture is most common in orbital blowout fracture. Various materials have been used to reconstruct orbital floor blowout fracture. Absorbable alloplastic implants are needed because of disadvantages of nonabsorbable alloplastic materials and donor morbidity of autogenous tissue. The aim of the study is to evaluate usefulness of absorbable mesh plate as a reconstructive material for orbital blowout fractures. METHODS: From December 2008 to October 2009, 18 trapdoor orbital floor blowout fracture patients were treated using elevator fixation, depressor fixation, or elevator-depressor fixation techniques with absorbable mesh plates and screw, depending on degree of orbital floor reduction, because absorbable mesh plates are less rigid than titanium plates and other artificial substitutes. RESULTS: Among 18 patients, 5 elevator fixation, 4 depressor fixation, and 9 elevator and depressor fixation technique were performed. In all patients, postoperative computed tomographic (CT) scan showed complete reduction of orbital contents and orbital floor, and no displacement of bony fragment and mesh plate. Mean follow-up was 10 months. There were no significant intraoperative or postoperative complications. CONCLUSION: Three different techniques depending on the degree of orbital floor reduction are useful for open reduction and internal fixation of trapdoor orbital floor blowout fracture with absorbable mesh plates.

Delayed Retrobulbar Hemorrhage after Orbital Floor Reconstruction

PURPOSE: Retrobulbar hemorrhage is a rare complication followed by blepharoplasty, trauma, orbital reconstruction, and so on. Most of the cases occur within 24 hours, half of them in the first 6 hours. Some authors have reported delayed retrobulbar hemorrhage after blepharoplasty and trauma within 1 day to 9 days. However, there have been few reports of delayed retrobulbar hemorrhage resulting from the complication of orbital reconstruction. METHODS: A 22-year-old male underwent orbital floor reconstruction due to the orbital floor fracture. In 84 hours after the surgery, he complained sudden onset orbital pain and decreased visual acuity immediately after defecation. Intraocular pressure was unmeasurable due to the swelling at that time. Emergency computed tomography was performed. RESULTS: Computed tomography revealed subperiosteal hematoma on inferior orbital wall extended to the apex. Emergency decompressive surgery was performed within 1 hour. After evacuation of hematoma, orbital symptom was improved and visual acuity was restored. CONCLUSION: Delayed retrobulbar hemorrhage is rare but vision-threatening.Therefore early diagnosis and treatment of delayed retrobulbar hemorrhage is thought to be crucial. The cause of delayed hemorrhage was not clear, however, valsalva maneuver might be the cause of hemorrhage.

Immediate Operation in Pediatric White-eye Blowout Fracture

PURPOSE: 'White-eye blowout' fracture is often occur in young patients and defined as blow out fracture with little or no clinical sign of soft tissue trauma such as edema, ecchymosis, but with marked motility restrictions in vertical gaze. In this conditions, immediate operation is essential. We reported the clinical investigation study of these cases about clinical symptoms and radiologic findings and introduce our experiences about immediate operations in 'white-eye blowout' fractures. METHODS: From January 2008 to December 2009, nine pediatric patients who were diagnosed as pure white-eye blowout fractures were involved this study. Patients with other facial bone fractures or with poor general medical condition were excluded. In all cases, we performed immediate operation within 48 hours. RESULTS: All patients had diplopia, vertical gaze restriction or systemic symptoms. Six patients had nausea, vomiting and syncope caused by oculocardiac reflex. In all patients, preoperative symptoms were improved after immediate operation. There were no postoperative complications such as infection, hematoma or wound dehiscence. CONCLUSION: When we meet the young patients with history of periocular trauma, with little or no soft tissue trauma signs, but with marked vertical gaze restriction or general symptoms caused by oculocardiac reflex, we should immediately examine by facial bone computed tomography and refer the patient to ophthalmologist for ophthalmic evaluations. If patient is diagnosed as orbital floor fracture with entrapped muscle or soft tissue, the earlier surgical reduction get better clinical outcomes.

Relation between enlarged volume of medial wall and degree of enophthalmos after orbital fracture / 中华医学美学美容杂志

Objective To explore the relation between the enlargement of orbital volume and the degree of enophthalmos, and that between the enlarged volume of floor together with that of medial wall and the degree of enophthalmos. Methods A total of 17 patients of unilarteral orbital fracture were scanned by MSCT (slice width 0.625mm), who suffered late enophthalmos as a results of combination fracture of the medial wall and floor. The clinical data were collected, and input into a software named MIMICS in order to measure orbital volume, the degree of enophthalmos, the enlarged volume of medial wall, and that of orbital floor. Simple linear correlation and regression were carried out between the enlargement of orbital volume and the degree of enophthalmos. Mutiple linear correlation and regression were carried out between the enlarging volume of floor together with that of medial wall and the degree of enophthalmos. Results The equation of the enlargement of orbital volume (V) and the degree of enophthalmos (E) was E= 0.851 V-0.197 (Pearson r=0.969, P＜0.01, the 95% confidence intervals of 0.732-0.970). The standardized equation between the enlarged volume of floor together with that of medial wall and the degree of enophthalmos was E= 0.690 VF+0.413 VM-0. 086 (setpwise, entry =0.5, removal= 0. 11,P＜0.01 ); Comparing the standardized coefficients of independent variables, the outcome was bF (0.690) ＞ bM(0.413). Conclusion Significant linear correlation between the increment of the orbital volume and the degree of enophthalmos is found that 1.0 ml enlargeement in bony volume causes approximately 0.9 mm of enophthalmos; enlarged volume of floor has more powerful influence on the degree of enophthalmos than enlarged volume of medial wall, the former is 1.56 times of the latter.

The Reconstruction of the Extensive Inferior Blow-out Fracture Through Endoscopic Transnasal and Subciliary Approaches

PURPOSE: Inferior blow-out fracture is the common facial fracture. Unsatisfactory functional and aesthetic outcomes are frequent when it is treated inappropriately. If fractures are extended and reach the posterior end of orbital floor, enophthalmos frequently followed as complication. The PURPOSE of this study was to evaluate reduction technique of extensive inferior blow-out fracture with ballooning of foley catheter through endoscopic transnasal approach and implantation of Medpor(R) through subciliary approach. METHODS: A retrospective study was performed on 14 patients with extensive inferior blow-out fracture who underwent ballooning of foley catheter through endoscopic transnasal approach with implantation of Medpor(R) through subciliary approach. Patients were operated from May 2005 to November 2007. Data for 14 patients were acquired from patient's charts. Preoperative and postoperative data for enophthalmos, diplopia, limitation of extraocular motion were reviewed. Preoperative and postoperative CT scan were also checked. The patients were followed up from 4 to 18 months. RESULTS: The enophthalmos was corrected in all patients. Among 7 patients with diplopia preoperatively, diplopia was resolved in three patients postoperatively. The diplopia persisted in four patients and two of them also had limitation of extraocular motion postoperatively. The limitation of extraocular motion occurred in seven patients preoperatively. But five patients recovered after operation immediately. These symptoms were resolved about three months after the operation. CONCLUSION: The ballooning of foley catheter through endoscopic transnasal approach with implantation of Medpor(R) through subciliary approach can be considered one of the appropriate technique for extensive inferior blow- out fracture.

The Reconstruction of the Extensive Inferior Blow-out Fracture Through Endoscopic Transnasal and Subciliary Approaches

PURPOSE: Inferior blow-out fracture is the common facial fracture. Unsatisfactory functional and aesthetic outcomes are frequent when it is treated inappropriately. If fractures are extended and reach the posterior end of orbital floor, enophthalmos frequently followed as complication. The PURPOSE of this study was to evaluate reduction technique of extensive inferior blow-out fracture with ballooning of foley catheter through endoscopic transnasal approach and implantation of Medpor(R) through subciliary approach. METHODS: A retrospective study was performed on 14 patients with extensive inferior blow-out fracture who underwent ballooning of foley catheter through endoscopic transnasal approach with implantation of Medpor(R) through subciliary approach. Patients were operated from May 2005 to November 2007. Data for 14 patients were acquired from patient's charts. Preoperative and postoperative data for enophthalmos, diplopia, limitation of extraocular motion were reviewed. Preoperative and postoperative CT scan were also checked. The patients were followed up from 4 to 18 months. RESULTS: The enophthalmos was corrected in all patients. Among 7 patients with diplopia preoperatively, diplopia was resolved in three patients postoperatively. The diplopia persisted in four patients and two of them also had limitation of extraocular motion postoperatively. The limitation of extraocular motion occurred in seven patients preoperatively. But five patients recovered after operation immediately. These symptoms were resolved about three months after the operation. CONCLUSION: The ballooning of foley catheter through endoscopic transnasal approach with implantation of Medpor(R) through subciliary approach can be considered one of the appropriate technique for extensive inferior blow- out fracture.

Internal Fixation of Medpor(R) Implant for Prevention of Enophthalmos in Posteriorly Extended Orbital Floor Fracture

PURPOSE: The purpose of this study is to evaluate the effectiveness of internal fixation method of Medpor(R) implant with BioSorb(TM)FX screw which is used for prevention of enophthalmos in posteriorly extended large orbital floor fracture. METHODS: From Jun. 1997 to Dec. 2007, 21 patients who were diagnosed with posteriorly extended large orbital floor fractures were classified into two groups. One group(n=11) had undergone reduction surgery with regular Medpor(R) sheets without any fixation method, while the other group(n=10) had their Medpor(R) sheets fixed with the BioSorb(TM)FX screws. The two groups were evaluated by comparison of their enophthalmos degree and effectiveness. RESULTS: In the non-fixation group, six patients had enophthalmos preoperatively and three of them showed persistent enophthalmos postoperatively. In postoperative CT examination, displacement of Medpor(R) implant with soft tissue impaction into maxillary sinus was observed in the patients. In the screw fixation group, three patients had enophthalmos preoperatively, but none of them suffer from complication such as residual enophthalmos, soft tissue impaction, muscle entrapment or optic nerve compression postoperatively. CONCLUSION: Internal fixation method of Medpor(R) implant with BioSorb(TM)FX screw on the medial surface of orbital floor provides firm stabilization of implants and surrounding soft tissues and can be an effective option especially when postoperative implant displacement or malposition was expected.

Antibiotic Prophylaxis' Effect on Enophthalmos in Orbital Floor Fracture with Chronic Maxillary Sinusitis

PURPOSE: Orbital floor fracture has open wound to maxillary sinus and if the patient has chronic maxillary sinusitis, it may be have more risk of infection, complications. The purpose of this comparative study is to be the effectiveness of prophylactic antibiotics in orbital floor fracture with chronic maxillary sinusitis. METHODS: We studied 20 patients who diagnosed as orbital floor fracture with chronic maxillary sinusitis from march, 2005 to may, 2006. Among them 16 were male, 4 were female and age was ranged from 15 to 68, average was 42. A day before operation, Prophylactic antibiotics were used to 10 patients. Prophylactic antibiotics were not used to 10 patients. We defined control group as prophylactic antibiotics injection group a day before operation. After surgery, we confined use of same antibiotic for 7 days in both group. After 6 month from surgery, we compare the degree of enophthalmos from healthy side to legion side with hertel exopthalmometry(Inami, Japan) in control group and non-prophylactic antibiotics injection group. RESULTS: In control group, comparison of discrepancy between enophthalmic eyeball and normal eyeball with Hertel exophthalmometer was 1.1mm and non-prophylactic antibiotics injection group was 2.1mm. In independent sample t-test, control group was showed statistically significant difference with non-prophylactic antibiotics injection group(p=0.007). CONCLUSIONS: In orbital floor fracture with chronic maxillary sinusitis, bacteria in maxillary sinus can increase post-operative complication by infecting infraorbital soft tissue, and it is thought to be antibiotic prophylaxis is play a role in decrease in degree of enophthalmos. We feel the need to further study of prophylactic antibiotics in orbital floor fracture with chronic maxillary sinusitis.