Orbital wall restoring surgery with primary orbital wall fragments in blowout fracture

Most orbital surgeons believe that it's difficult to restore the primary orbital wall to its previous position and that the orbital wall is so thin that cannot be firmly its primary position. Therefore, orbital wall fractures generally have been reconstructed by replacing the bony defect with a synthetic implant. Although synthetic implants have sufficient strength to maintain their shape and position in the orbital cavity, replacement surgery has some drawbacks due to the residual permanent implants. In previous studies, the author has reported an orbital wall restoring technique in which the primary orbital wall fragment was restored to its prior position through a combination of the transorbital and transantral approaches. Simple straight and curved elevators were introduced transnasally to restore the orbital wall and to maintain temporary extraorbital support in the maxillary and ethmoid sinus. A transconjunctival approach provided sufficient space for implant insertion, while the transnasal approach enabled restoration of the herniated soft tissue back into the orbit. Fracture defect was reduced by restoring the primary orbital wall fragment to its primary position, making it possible to use relatively small size implant, furthermore, extraorbital support from both sinuses decreased the incidence of implant displacement. The author could recreate a natural shape of the orbit with the patient's own orbital bone fragments with this dual approach and effectively restored the orbital volume and shape. This procedure has the advantages for retrieving the orbital contents and restoring the primary orbital wall to its prior position.

The Reliability of the Transconjunctival Approach for Orbital Exposure: Measurement of Positional Changes in the Lower Eyelid

BACKGROUND: Lower eyelid incisions are widely used for the orbital approach in periorbital trauma and aesthetic surgery. In general, the subciliary approach is known to cause disposition of the lower eyelid by scarring the anterior lamella in some cases. On the other hand, many surgeons believe that a transconjunctival approach usually does not result in such complications and is a reliable method. We measured positional changes in the lower eyelid in blowout fracture repair since entropion is one of the most serious complications of the transconjunctival orbital approach. METHODS: To measure the positional changes in the lower eyelids, we analyzed preoperative and postoperative photographs over various time intervals. In the analysis of the photographs, marginal reflex distance 2 (MRD2) and eyelash angle were used as an index of eyelid position. Statistical analyses were performed to identify the significance in the positional changes. All patients underwent orbital reconstruction through a transconjunctival incision by a single plastic surgeon. RESULTS: In 42 blowout fracture patients, there was no statistical significant difference in the MRD2 and eyelash angle. Furthermore, there were no clinical complications, such as infection, hematoma, bleeding, or implant protrusion, during the follow-up periods. CONCLUSION: The advantages of the transconjunctival approach for orbital access include minimal scarring and a lower risk of eyelid displacement compared with other approaches. Based on these results, we recommend the transconjunctival approach for orbital exposure as a safe and reliable method.

Usefulness of Fibrin Glue in Transantral Orbital Floor Fracture Repair Using Bioresorbable Panel / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the advantages and limitations of using fibrin glue for securing bioresorbable panels to reconstruct the fractured orbital floor by transantral approach. SUBJECTS AND METHOD: A retrospective study was conducted from July 2009 to July 2015 in 35 patients with pure orbital floor fractures. Nineteen patients underwent reduction surgery for inserting the bioresorbable panel and 16 patients underwent reduction surgery using fibrin glue for securing the bioresorbable panel via a transantral approach. In both groups, a chart review of preoperative and postoperative ocular symptoms, operation records, and complications was conducted. RESULTS: There was no significant difference between two groups in the demographic data of patients. Comparing the surgical outcomes between two groups, diplopia and mean discrepancy between fractured bone chip and intact orbital floor based on computed tomography scans showed much better results in the group that used bioresorbable panel secured by fibrin glue than in the bioresorbable only group. Furthermore, we carried out revision operations in six cases in the bioresorbable panel only group, where we found that the main cause of fracture to be the dislocation of bioresorbable panel. On the other hand, in the bioresorbable panel secured by the fibrin glue group, there were no reoperation and postsurgical complications. CONCLUSION: During the course of the study, we sensed orbital floor fracture repair using bioresorbable panel secured by fibrin glue via a transantral approach as an easy and effective technique with good postoperative results, and minimal implant related complications. This novel procedure is recommended as a surgical option for the reduction of orbital floor fractures, especially in large and posterior fractures.

Transient Anisocoria during Medial Blowout Fracture Surgery

Transient anisocoria is rare during blowout fracture reconstruction. We report a case of transient anisocoria occurring during medial blowout fracture reconstruction and review the relevant literature. A 54-year-old woman was struck in the face and was admitted for a medial blowout fracture of the left eye. During the operation, persistent bleeding occurred. To control this bleeding, a 1% lidocaine solution with 1:200,000 epinephrine was applied to the orbital wall with cotton pledgets. In total, 40 mL of local anesthetic was used for the duration of the operation. After approximately three hours of the surgery, the ipsilateral pupil was observed to be dilated, with sluggish response to light. By 3 hours after the operation, the mydriasis had resolved with normal light reflex. In conclusion, neurological and ophthalmologic evaluation must be performed prior to blowout fracture surgery. Preoperative ophthalmic evaluation is simple and essential in ruling out any preexisting neurologic condition. Moreover, surgeons must be aware of the fact that excessive injection of lidocaine with epinephrine for hemostasis during orbital wall surgery can result in intraoperative anisocoria. Anisocoria-related situations must be addressed in a proficient manner through sufficient understanding of the mechanism controlling the pupillary response to various stimuli.

Comparison of Diplopia and Ocular Torsion Rate in Blow-Out Fracture Patients

PURPOSE: We compared ocular torsion rates in blow-out fracture patients before and after blowout fracture repair by analyzing mean disc foveal angles. METHODS: The study participants were divided into 2 groups: blow-out fracutre repair patients (n = 36) and controls (n = 36). We measured ocular torsion rates by analyzing mean disc foveal angle. The angle was composed of 2 imaginary horizontal lines which crossed the optic disc center and fovea. We compared statistically ocular torsion rates in blow-out fracture patients based on subsided diplopia, continued diplopia, or absence of diplopia before and after blow-out fracture repair using paired t-test. RESULTS: In the patient group, ocular torsion rates were statistically significantly decreased. In the blow-out fracture repair group with subsided diplopia, ocular torsion rates were decreased statistically from 7.74 +/- 3.48 degrees before blow-out fracture repair to 5.02 +/- 3.11 degrees after blow-out fracture repair. In the blow-out fracture repair group with continued diplopia or absence of diplopia before surgery, ocular torsion rates did not change statistically significantly from 6.36 +/- 2.80 degrees before blow-out fracture repair to 6.51 +/- 3.24 degrees after blow-out fracture repair. CONCLUSIONS: Subsided diplopia after blow-out fracture repair and ocular torsion rate changes were significantly related in blow-out fracture patients. Further research which on the correlation of intraorbital change and movement of orbital position after blow-out fracture repair with ocular torsion rates are necessary.

Inferior Blow-Out Fracture Reduction Using Two Urinary Balloon Catheters

BACKGROUND: The reduction of orbital blowout fracture primarily aims to normalize the extra-ocular movement by returning the herniated orbital soft tissue into the original position, and to prevent enophthalmos by normalizing the orbital cavity volume. We introduce a balloon catheter-assisted orbital floor reduction technique. METHODS: A retrospective review was performed for all patients with orbital floor fracture who underwent the technique described in the main body of this text. Medical records were reviewed for demographic data, clinical presentation and course, degree of enophthalmos, intraorbital volume on computed tomography scan, and postoperative outcomes. The enophthalmos and intraorbital volume of the injured site were compared to the uninjured eye and orbit. RESULTS: The review identified 14 patients (11 male, 3 female). The mean preoperative difference in en-exopthalmos was 2.13 mm, while the mean orbital volume was 116%. The mean postoperative difference in en-exophthalmos had improved to 0.61 mm with a mean orbital volume of 101.85%. At the time of catheter removal at 10 days, three patients experienced diplopia (n=1), extra-ocular movement disorder (1), or enophthalmos (1). All of these had resolved by the 6-month follow-up visit. CONCLUSION: Balloon catheter-assisted reduction of the orbital floor fractures was associated with improvements in intraorbital volume and enopthalmos in the 14 patients. Notable complications included diplopia, enophthalmos, and limited extra-ocular movement, all of which were transient in the early postoperative period and had resolved by 6-month follow up.

2 Cases of Reduction of Orbital Floor Fracture Using Fibrin Glue for Securing Bioresorbable Panel

Many surgical methods for the reconstruction of orbital floor fractures have been reported, and theseinclude transorbital, transantral and transnasal endoscopic approaches, among others. The choice of surgical approach and materials for the reduction of orbital blowout fractures depends on the surgeon's experience and preference. For the cases of large orbital floor fractures, reduction has beenperformed most frequently through the transantral approach, and the herniated orbital tissue generally has been supported by asilastic block, silastic tube or urethral balloon catheter. However, the transantral approach has significant drawbacks that includethe requirement of removal surgery, displacement of materials, and inflammation of the maxillary sinus. To overcome these negative effects, the authors used fibrin glue tosecure the reduction through the transantral approach in two cases of patients with orbital floor fractures.

Clinical Significance of Orbital Inferiomedial Blow Out Fracture

BACKGROUND: The incidence of blow out fractures is increasing and the techniques of diagnosis and treatment have been recently evolving. Despite its clinical significance, there has been no study on orbital inferiomedial blow out fractures. Therefore, this study was designed to investigate the clinical significance of treatment of orbital inferiomedial blow out fractures. METHODS: A retrospective review of fifty-seven patients who could be followed up for at least 1 year after surgical reconstruction of pure inferiomedial blow out fracture was undertaken. The transconjunctival approach was performed in all cases. The onlay technique was used in 32 patients and the inlay/sheet method was used in 25 patients. We evaluated the clinical outcomes using the chi-square test. RESULTS: In the group using the onlay technique, postoperative diplopia and enophthalmos were observed in 14 cases and 3 cases, respectively. Of these, 5 cases and 3 cases lasted for more than 6 months, respectively. In the group using the inlay/sheet method, postoperative diplopia was observed in 9 cases, but there were no cases of enophthalmos. Among the 9 diplopia cases, 4 lasted for more than 6 months. CONCLUSION: Postoperative diplopia and enophthalmos were increased after treatment of inferiomedial blow out fractures compared to isolated medial (0.6%, 0.3%) or inferior (1.8%, 0.6%) blow out fractures. Therefore, careful dissection is necessary not to injure the inferior oblique muscle to decrease the incidence of postoperative diplopia. Moreover, the inlay/sheet method is an effective option for reconstruction of inferiomedial blow out fractures.

Modified Direct W-incision with Silicone Sheet to Minimize Operation Scar in Reconstruction of Mild to Moderate Symptomatic Medial Orbital Wall Fracture

BACKGROUND: For reconstruction of the mild to moderate medial orbital wall fractures, various surgical approaches have been used. Prior existing W-shaped incision was a direct local approach through a 3 cm incision on the superior medial orbital area with a titanium mesh implant. In this study, the authors modified W-shaped incision and reconstructed the defect with silastic sheet to improve the result and the postoperative scar. METHODS: This study included 20 patients who had mild to moderate size of medial wall defect and therefore relatively suitable for reconstruction with silastic sheets from July, 2009 to December, 2011. A modified W-shaped skin incision approximately 1.2 to 1.5 cm in length was made along the superior medial orbital rim from approximately 1 cm medial to the medial canthus to the lower border of the medial eyebrow. The angles of the limbs of the W ranged from 150 to 160 degrees. RESULTS: By using soft flexible silastic sheet, the authors reduced the incision from 3 to 1.5 cm, and by widening the angle of the W limbs, scars were more effectively hided in the relaxed skin tension line. Scar assessment was done with modified patient and observer scar assessment scale and mean score from patients was 2.08 and mean score from observers was 2.12. CONCLUSION: Although this method will not be suitable for every case, it can be a consistent method to obtain the surgical goal in treatment of mild to moderate blowout fractures of the medial orbital wall.

A Case of Ptosis Blowout Fracture of the Inferior Orbital Wall / 대한이비인후과학회지

Blow out fractures occur in many patients who suffer from blunt trauma in the face. The typical signs and symptoms are diplopia, limited eye movement and enophthalmos. Upper eyelid ptosis is a relatively rare symptom caused by blowout fracture, where traumatic ptosis accounts for only 1-9%. The etiology is usually the result of a direct levator muscle injury due to eyelid trauma. Sometimes traumatic blepharoptosis occurs due to ischemic damage to the superior branch of the oculomotor nerve. Generally, blepharoptosis caused by blow out fracture is treated with conservative treatment unless there is some evidence of bone impingement. The authors report one case of blepharoptosis caused by blow out fracture, which was treated successfully.

Anatomical Reconstruction of the Medial Orbital Wall Fracture

PURPOSE: In surgical treatment of the medial orbital wall fractures, restoring the original position of the orbital wall is difficult in some cases. Under such condition, the orbital wall is often reconstructed with synthetic material, without bony reduction, which is considered to be the conventional reconstruction. The purpose of this study is to compare the outcomes of anatomical reconstruction, which restores the bony wall to the anatomical position, from that of the conventional reduction in the isolated medial orbital wall fractures. METHODS: Thirty patients, who underwent reconstruction surgery for the isolated medial orbital wall fractures from March 2007 to August 2011, were reviewed retrospectively. The surgical outcomes of two groups, the conventional reconstruction group (15 patients) and the anatomical reconstruction group (15 patients), were studied in 2 measurements, a one day before and 6 months after the surgery. The changes of orbital volume were calculated by the images from a computed tomography scan and enophthalmos was measured by a Hertel exophthalmometer. RESULTS: The orbital volume ratio was decreased by an average of 1.05% in the conventional reconstruction group, while in the anatomical reconstruction group, the ratio decreased by 5.90% (p0.05). CONCLUSION: In conclusion, the anatomical reconstruction technique of the isolated medial orbital wall fracture results in a better outcome than that of the conventional reconstruction, in terms of restoring of the original orbital volume and anatomic position. Thus, it can be considered as a useful method for the isolated medial orbital wall fractures.

Anatomical Reconstruction of the Medial Orbital Wall Fracture

PURPOSE: In surgical treatment of the medial orbital wall fractures, restoring the original position of the orbital wall is difficult in some cases. Under such condition, the orbital wall is often reconstructed with synthetic material, without bony reduction, which is considered to be the conventional reconstruction. The purpose of this study is to compare the outcomes of anatomical reconstruction, which restores the bony wall to the anatomical position, from that of the conventional reduction in the isolated medial orbital wall fractures. METHODS: Thirty patients, who underwent reconstruction surgery for the isolated medial orbital wall fractures from March 2007 to August 2011, were reviewed retrospectively. The surgical outcomes of two groups, the conventional reconstruction group (15 patients) and the anatomical reconstruction group (15 patients), were studied in 2 measurements, a one day before and 6 months after the surgery. The changes of orbital volume were calculated by the images from a computed tomography scan and enophthalmos was measured by a Hertel exophthalmometer. RESULTS: The orbital volume ratio was decreased by an average of 1.05% in the conventional reconstruction group, while in the anatomical reconstruction group, the ratio decreased by 5.90% (p0.05). CONCLUSION: In conclusion, the anatomical reconstruction technique of the isolated medial orbital wall fracture results in a better outcome than that of the conventional reconstruction, in terms of restoring of the original orbital volume and anatomic position. Thus, it can be considered as a useful method for the isolated medial orbital wall fractures.

Endoscopic Endonasal Reduction of Medial Blow Out Fracture Using Nasopore Forte(R) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Before the introduction of transnasal endoscopic sinus surgery, transorbital approach with an external incision used to be one of the representative reconstructive surgical repairing method of blow out fracture. The important advantages of transnasal endoscopic technique are magnified direct visualization and easy accessibility to the medial orbital wall. Nasopore Forte(R) is a slowly absorbable material and provides excellent durability. The purpose of this study is to evaluate outcomes of endoscopic endonasal reduction (EER) of medial blow out fracture using Nasopore Forte(R). SUBJECTS AND METHOD: A retrospective study was performed on 26 patients with medial blowout fracture who had undergone EER using Nasopore Forte(R) from January to December of 2010 at our clinic. A review of medical records included demographic data, preoperative ocular symptoms and signs, and surgical outcomes including postoperative symptom improvement and complications. RESULTS: Of 26 patients, 5 had persistent diplopia, 5 enophthalmos, and 3 both diplopia and enophthalmos preoperatively. Seventeen patients were asymptomatic, but had large defects with the mean defect size of 2.4 cm2. Postoperative computed tomography scan showed excellent (22) to good (4) reduction. Preoperative symptoms were resolved in all of 13 symptomatic patients and there was no enophthalmos during the follow-up period. No significant complications including sinusitis or synechia were found. CONCLUSION: EER is a highly effective and safe procedure for the reduction of medial blow out fracture. Nasopore Forte(R) is easy to handle and can be tailored to individual defects, and is useful for securing the reduction and preventing adhesion after EER.

Orbital Floor Reconstruction Using Endoscope and Selected Urethral Balloon Catheter

PURPOSE: Blow-out fractures can be reduced using various methods. The orbital reconstruction technique using a balloon under endoscopic control has advantages over other methods. However, this method has some problems too, such as postoperative follow-up, management of the balloon catheter, and reduction of the posterior orbital floor. Thus, we developed a simple, effective method for orbital floor reduction that involves molding and shaping the antral balloon catheter. METHODS: A 0, 30, or 70degrees, 4-mm endoscope was placed though a two-point, 5-mm maxillary antrostomy. The balloon catheter is placed directly at the orbital apex to reconstruct the anterior shelf(spherical shape), while it is turned in a U-shape towards the anterior maxilla for the posterior shelf(elliptical shape). Orbital floor defects, compound or comminuted fractures are reconstructed with alloplastic materials through an open lid incision under the endoscopic control. RESULTS: This technique was applied to ten patients with orbital floor fractures: five anterior shelf and five posterior shelf fracture, respectively. Four of the patients had zygomatico-orbital fractures, while the rest had isolated orbital floor fractures. Two patients were given porous polyethylene implants(Synpor(R)) and three underwent reconstruction with a resorbable mesh plate. No complication associated with this technique was identified. CONCLUSION: The freestyle placement and selection of a urinary balloon catheter under endoscopic control and the preoperative estimation of the volume enhanced the stabilization of the orbital contour. This method improves the adaptation of the orbital floor without the risk of injuring the surrounding orbital contents, dissecting blindly, or using sharp traction. One drawback of this method is the patient's discomfort from the catheter during treatment.

Prognosis and Clinical Features of Orbital Wall Fracture in Preschool Children

PURPOSE: To evaluate the clinical aspects associated with the preoperative and postoperative state of blow-out fractures in preschool children. METHODS: The authors of the present study retrospectively reviewed 11 cases of blow-out fracture repaired by orbital reconstruction. RESULTS: The most common cause of fracture was a traffic accident (45%); there were 7 cases (63%) of inferior wall fracture and 7 cases (63%) of trapdoor-type fracture. All patients with trapdoor-type fractures had nausea and vomiting. After the operation, the majority of patients (88%) had mild ocular motility restriction and diplopia. CONCLUSIONS: In preschool children, systemic symptoms such as nausea and vomiting presented frequently. In addition, complications such as restriction in ocular movement and diplopia often developed postoperatively.

Nerve Injuries after the Operations of Orbital Blow-out Fracture

PURPOSE: In accordance with the increasing number of accidents caused by various reasons and recently developed fine diagnostic skills, the incidence of orbital blow-out fracture cases is increasing. As it causes complications, such as diplopia and enophthalmos, surgical reduction is commonly required. This article reports a retrospective series of 5 blow-out fracture cases that had unusual nerve injuries after reduction operations. We represents the clinical experiences about treatment process and follow-up. METHODS: From January 2000 to August 2009, we treated total 705 blow-out fracture patients. Among them, there were 5 patients(0.71%) who suffered from postoperative neurologic complications. In all patients, the surgery was performed with open reduction with insertion of Medpor(R). Clinical symptoms and signs were a little different from each other. RESULTS: In case 1, the diagnosis was oculomotor nerve palsy. The diagnosis of the case 2 was superior orbital fissure syndrome, case 3 was abducens nerve palsy, and case 4 was idiopathic supraorbital nerve injury. The last case 5 was diagnosed as optic neuropathy. Most of the causes were extended fracture, especially accompanied with medial and inferomedial orbital blow-out fracture. Extensive dissection and eyeball swelling, and over-retraction by assistants were also one of the causes. Immediately, we performed reexploration procedure to remove hematomas, decompress and check the incarceration. After that, we checked VEP(visual evoked potential), visual field test, electromyogram. With ophthalmologic test and follow-up CT, we can rule out the orbital apex syndrome. We gave Salon(R)(methylprednisolone, Hanlim pharmaceuticals) 500 mg twice a day for 3 days and let them bed rest. After that, we were tapering the high dose steroid with Methylon(R)(methylprednisolon 4 mg, Kunwha pharmaceuticals) 20 mg three times a day. Usually, it takes 1.2 months to recover from the nerve injury. CONCLUSION: According to the extent of nerve injury after the surgery of orbital blow-out fracture, the clinical symptoms were different. The most important point is to decide quickly whether the optic nerve injury occurred or not. Therefore, it is necess is to diagnose the nerve injury immediately, perform reexploration for decompression and use corticosteroid adequately. In other words, the early diagnosis and treatment is most important.

Treatment of Severe Blepharoptosis after Blow Out Fracture

PURPOSE: Blepharoptosis can result from either congenital or acquired causes. Blow out fracture or facial bone fracture including blow out fracture can be one of the causes. Authors experienced 3 cases of severe blepharoptosis after blow out fracture treated only with observation after reduction of associated fracture. METHODS: Reconstruction of orbital wall was conducted on all cases diagnosed as blow out fracture using 3 dimensional computed tomography, and conservative treatment was done on accompanying severe blepharoptosis. RESULTS: At the time of injury, all cases showed severe blepharoptosis requiring frontalis muscle transfer for correction. But blepharoptosis was recovered in an average of 18 weeks without any surgical procedure except reconstruction of orbital wall. CONCLUSION: Once Blepharoptosis occurred after blow out fracture, thorough evaluation must be done at first. If definitive cause of blepahroptisis cannot be found as authors' cases, injury of oculomotor nerve may result in blepharoptosis. So, as for blepharoptosis after blow out fracture, conservative treatment following reconstruction of fractured orbital wall can be one of good management.

A Case of Acquired Brown Syndrome after Surgical Repair of a Medial Orbital Wall Fracture

A case of acquired Brown syndrome caused by surgical repair of medial orbital wall fracture is reported in the present paper. A 23-year-old man presented at the hospital with right periorbital trauma. Although the patient did not complain of any diplopia, the imaging study revealed a blow-out fracture of the medial orbital wall. Surgical repair with a calvarial bone autograft was performed at the department of plastic surgery. The patient was referred to the ophthalmologic department due to diplopia that newly developed after surgery. The prism cover test at distant fixation showed hypotropia of the right eye, which was 4 prism diopters (PD) in primary gaze, 20 PD in left gaze, while orthophoric in right gaze. Eye movement of the right eye was markedly limited on elevation in adduction with normal elevation in abduction with intorsion in the right eye present. Forced duction test of the right eye showed restricted elevation in adduction. Computerized tomography scan of the orbits showed the right superior oblique muscle was entrapped between the autografted bone fragment and posterior margin of the fracture. When repairing medial orbital wall fracture that causes Brown syndrome, surgeons should always be careful of entrapment of the superior oblique muscle if the implant is inserted without identifying the superior and posterior margin of the orbital fracture site.

Reconstruction of the Orbital Floor Fracture using the Antral Balloon Catheter with Radiopaque Dye

PURPOSE: Blow-out fractures are reduced through transcutaneous or transconjunctival incisions. But the field of orbital surgery is difficult due to lack of visualization of fracture site, blind dissection of orbital floor, susceptibility of injury of orbital structures. In these situations, the former technique of using an antral balloon catheter has advantages over other methods for reconstruction because of its rapidity, simplicity, and inexpensiveness. Furthermore, the antral balloon catheter allows not only elevation of the orbital bone fragment but also expansion of the maxillary sinus in cases where there is a fracture of its walls. But postoperative follow-up method using computed tomography is expensive. Hence, we report a simple and inexpensive follow-up method using radiopaque dye inflation. METHODS: We performed endoscopic transantral approach in 5 cases of blow-out fracture under general anesthesia. To accomplish this technique, a rigid 4 mm, 0 or 30 degree angled endoscopy was inserted into the maxillary sinus. Inflation of the catheter started gradually, with 10 to 15 mL of saline mixed radiopaque dye (saline: dye, 5 : 1) by syringe and while observing the elevation of the fracture site with endoscope until a proper contour was reached. For the maintain of the position of fractured site, 12 French urinary balloon foley catheter were used in fracture site for 7 - 10 days. RESULTS: Postoperative assessment was performed by means of clinical and simple radiographic examination to secure the catheter under the inferior orbital wall and in the maxillary sinus. No specific complications occurred related to this procedure. Results of the surgery and follow-up in all cases were satisfactory. CONCLUSION: It may be a better alternative to the conventional follow-up method, with less cost and effectiveness of the catheter patency. The advantages of using the urinary balloon foley catheter with the radiopaque dye include the following : it is safe, efficacy, simple, and especially low cost. On drawback of this method is the discomfort to the patient caused by the catheter during the treatment.

Clinico-Radiologic Findings of Entrapped Inferior Oblique Muscle in a Fracture of the Orbital Floor

A 51-year old man presented with vertical and torsional diplopia after reduction of a blowout fracture at another hospital one year ago. He had no anormalies of head position and 14 prism diopters (PD) right hypertropia (RHT) in the primary position. In upgaze no vertical deviation was found, and hyperdeviation on downgaze was 35PD. Bielschowsky head tilt test showed a negative response. Distinct superior oblique (SO) and inferior rectus (IR) underaction of the right eye was noted but IO overaction was mild on the ocular version test. Double Maddox rod test (DMRT) revealed 10-degree extorsion, but fundus extorsion was minimal in the right eye.Thin-section coronal CT scan showed that there was no fracture line on the anterior orbital floor, but a fracture remained on the posterior orbital floor. Also, the anterior part of the right inferior oblique muscle was vertically reoriented and the medial portion of the inferior oblique muscle was not traced on the coronal CT scan. The patient underwent 14 mm right IO recession and 3 mm right IR resection. One month after the surgery, his vertical and torsional diplopia were eliminated in the primary position.