Research advances of clinical applications in repairing surgery for orbital fracture / 眼科新进展

As one of the common type of ocular injuries,orbital fracture can result in enophthalmos,diplopia and infraorbital nerve injury,which affects the physiological function of eyeball.Repairing surgery for orbital fracture should be treated for reconstructing the orbital anatomical structure in case of severe enophthalmos and diplopia,or infraorbital nerve injury.Meanwhile,it's crucial to identify the suitable surgery approach and implants because of the specificity and complexity of the orbit.What a clinician expected most is the ideal prognosis obtained easily with minimal operation complication.Transconjunctival approach should be applied as one of the standard approaches for repairing surgery of orbital fracture,offering good operative field with less complications.Titanium mesh and resorbable materials are the ideal implants at present,for their high level of stable quality and plasticity.More and more applications of 3D-printed rapid prototyping technique can guide the new directions of individualization and precision of repairing surgery for orbital fracture.

Reduction of Trapdoor Type Orbital Floor Fracture with Absorbable Mesh

The orbital floor fracture of trapdoor subtype is a pure orbital fracture, linear in form and hinged medially, which allows herniation of orbital fat and ocular muscles and then entraps these contents. The goals of the reconstruction of the orbital fracture are to restore the continuity and to avoid a relapse the orbital tissue. If the reconstruction is incomplete, it may result in enophthalmos with diplopia. The indications for surgical reconstruction are the imitation of ocular muscles, the persisting diplopia, enophthalmos, large size of bony defect. There are no uniformly guidelines for the materials for orbital reconstruction. The ideal material should be biocompatible, non-carcinogenic, easily kept in position and free of any potential for disease transmission. Among the materials, the absorbable mesh is used for the orbital reconstruction recently. We used the 0.8mm thickness absorbable mesh in 11 patients with orbital floor trapdoor fracture. The displaced bony fragment was reducted and the absorbable mesh was inserted below the reducted fragment. The absorbable mesh was fixated with absorbable screw, so the mesh can support the bony fragment with cantilever effect. The results were satisfactory and no significant problem was not happened during the follow up period. Absorbable meshes are gradually resorbed and the scar that formed after resorption provides the support of the globe. Our results suggest that the orbital floor trapdoor fracture with small to moderate defects is the advisable indication of orbital reconstruction with absorbable mesh.

Clinical Analysis of Internal Orbital Fractures in Children

In order to describe the demographics, etiologic and clinical factors, and outcomes of orbital fractures in children, we have reviewed a case series of 17 patients under 18 years of age with internal orbital fractures (i.e., without involvement of the orbital rim) presenting to the Ghil hospital between March 2000 and June 2001. For 15 of the patients, we performed orbital wall reconstruction with Medpor (R) barrier sheet implantation (thickness 1mm) through transconjunctival approach under endoscopic guidance, while maintaining mere observation on the other 2 patients. There were 14 male and 3 female patients. The most common cause of fractures was accident (7 cases). Inferior wall involvement was most commonly seen, and the trapdoor type fracture was the most common. Thirteen patients had extraocular muscle restriction, 9 had nausea/vomiting and 5 had bradycardia. Diplopia of 9 patients disappeared after 43+/-23 days. Nausea/vomiting and bradycardia disappeared rapidly after surgical intervention in all cases. These results suggest that trapdoor fractures with soft tissue entrapment are the most common in pediatric orbital wall fractures, and that most of them are associated with nausea/vomiting. We suggest that early diagnosis, and prompt surgical intervention are required for those patients with oculocardiac reflex.

The Postoperative Recovery of Ocular Motility in Pediatric Blow-out Fracture

PURPOSE: To evaluate the clinical presentation, type of fracture, time of intervention and postoperative restoration of ocular motility disturbance in pediatric blow-out fracture. METHODS: The authors reviewed medical records of 30 consecutive cases which were operated for blowout fracture from January 1998 to December 2000. RESULTS: The most common cause of injury was violence (80%). The most common location of fracture was inferior wall (50%), followed by inferior-medial wall (30%). The most common type of fracture was trap door type fracture. The trap door type fracture showed much severe ocular motility disturbance preoperatively. Six cases of trap door fracture showed ocular motility restriction postoperatively. Early surgical intervention (within 5 days) resulted in a more complete return of ocular motility compared with the late intervention group (p<0.05). CONCLUSIONS: Trap door fracture was the most common type of orbital fracture in the pediatric age group. Early surgical intervention within 5 days will improve ocular motility postoperatively.