Research progress of finite element method in the biomechanics of the orbit / 国际眼科杂志(Guoji Yanke Zazhi)

The finite element method(FEM)is a widely employed mathematical technique in mechanical research that divides an object into discrete and interacting finite elements. Medically, finite element analysis(FEA)enables the simulation of biomechanical experiments that are challenging to conduct. Orbital surgery poses significant challenges to ophthalmologists due to its inherent difficulty and steep learning curve. FEM enables the simulation and analysis of the mechanical properties of orbital tissue, offering a novel approach for diagnosing and treating orbital-related diseases. With technological advancements, FEM has significantly matured in the diagnosis and treatment of orbital diseases, becoming a popular area of research in orbital biomechanics. This paper reviewed the latest advancements in orbital FEM, encompassing the development of orbital FEA models, simulation of orbital structure, and its application in orbital-related diseases. Additionally, the limitations of FEM and future research directions are also discussed. As a digital tool for auxiliary diagnosis and treatment, orbital FEA will progressively unlock its potential for diagnosing and treating orbital diseases alongside technological advancements.

Clinical profile and visual outcome in patients with traumatic optic neuropathy

Purpose: To analyze the visual outcome in patients with traumatic optic neuropathy (TON) with respect to different treatment modalities, to study the correlation of initial visual loss with the final visual outcome, and to find out the predictor of final visual outcome in patients with indirect TON. Methods: A retrospective analysis of 36 eyes with TON was done. Data on clinical profile, including demographics, mode of trauma, best corrected visual acuity (BCVA), pupillary reflex examination, and anterior and posterior segment examination, was collected. Presence and location of orbital and cranial fractures were identified from computed tomography scan. Visual outcomes following steroid therapy, optic nerve (ON) decompression, and in untreated patients were analyzed. Pre? and post?treatment BCVA were divided into three groups based on logarithm of the minimum angle of resolution (logMAR) as follows: group A: 3, group B: 2.9–1.3, and group C<1.3. BCVA values at follow?up visits were taken as the primary outcome measure. Association between various risk factors and final visual outcome in patients with indirect TON was also analyzed. Results: Out of 34 patients whose 36 eyes were studied, three (8.8%) patients were females and 31 (91.2%) patients were males. Most common mode of trauma was road traffic accident (RTA; 91.2%), which was followed by fall (8.8%) and assault (2.9%). Pre? and post?treatment BCVA values of 36 eyes were compared, and improvement in BCVA after treatment was found to be statistically significant. Also, 28.6% of patients with presenting BCVA of no light perception showed improvement compared to 94.1% and 100% in groups B and C, respectively. Orbital wall fractures were seen in 80.5% (n = 29) of the patients, with lateral wall fracture being the most common (58.3%) followed by medial wall (33.3%), roof (27.7%), floor (27.7%), and optic strut (5%). Conclusion: Baseline BCVA had significant association with final vision improvement. Lateral wall fracture was the most common fracture associated with indirect TON. Patients treated with high?dose corticosteroids, irrespective of the time of presentation, had a better visual outcome

Complicaciones postoperatorias en fractura de órbita: experiencia en el Hospital del Trabajador de Santiago

Objetivo: Describir la experiencia del equipo de cirugía maxilofacial del Hospital del Trabajador en el manejo de las fracturas de órbita. Materiales y Método: Estudio retrospectivo de 42 pacientes consecutivos operados por fractura de órbita en el Servicio de Cirugía Maxilofacial del Hospital del Trabajador entre enero de 2016 y diciembre de 2017. Se tabularon datos demográficos, información del trauma, tipo de fractura, fracturas asociadas, tratamiento y seguimiento. Resultado: De los 42 pacientes, la mayoría eran hombres (73,8%) con edad promedio de 40 ± 12,24 años. Los principales síntomas al ingreso fueron equimosis (64,3%), edema periocular (54,8%), hemorragia subconjuntival (33,3%) y diplopía (26,2%). La pared orbitaria más frecuentemente afectada fue el piso de la órbita (85,7%). Las fracturas se presentaron de forma aislada en 35,7% de los casos y asociada a otra fractura de la cara en 64,3%. Post cirugía, la tasa de complicación fue de 16,7%, producto de diplopía y enoftalmos leves que solo requirieron tratamientos conservadores para su resolución. Discusión: La baja tasa de complicaciones se debe a la experiencia del equipo médico con un seguimiento a largo plazo, la medición de volúmenes orbitarios, imagenología intraoperatoria, utilización de malla prefabricada y asistencia endoscópica. Conclusiones: Un adecuado diagnóstico y evaluación son fundamentales para el tratamiento de la fractura de órbita. Los datos demográficos, las características de las fracturas y las complicaciones descritas fueron muy similares a lo reportado por otras experiencias, mientras que la tasa de complicaciones fue menor.

Aim: To describe the experience of the Maxillofacial Surgical team of Hospital del Trabajador de Santiago in the management of orbital fractures. Materials and Methods: Retrospective study of 42 patients operated consecutively between January of 2016 and November of 2017 at Hospital del Trabajador de Santiago by the Maxillofacial Surgery team due to orbital fracture. The demographic data was tabulated and then a comparison between isolated and combined orbital fractures was made. Results: Of 42 patients most were men (73.8%) with an average age of 40±12.24 years. At admission the main symptoms were ecchymosis (64.3%), periorbital edema (54.8%), subconjunctival hemorrhage (33.3%) and diplopia (26.2%). The most frequently affected orbital wall was the floor (85.7%). Isolated fractures accounted for 35.7% of the cases and those associated with other facial fractures for 64.3%. The postoperative complication rate was 16.7% due to diplopia and enophthalmos. Both complications were mild and only required conservative management. Discussion: The low complication rate might be due to the experience of the surgical team in the management of orbital fractures, long-term following, orbital volume measurements, intraoperative imaging, the use of prefabricated mesh and endoscopic guidance. Conclusión: An adequate diagnosis and evaluation are fundamental for orbital fracture treatment. Demographic data, fracture characteristics and the complications described were similar to those reported by other studies, while the rate of complications was lower than those experiences.

Patient-Specific Implant for Primary Orbital Reconstruction: A Case Report

ABSTRACT @#The main aim of orbital fracture reconstruction is to restore the functional and aesthetic components of the eye. However, it is known that surgery for complex three-dimensional anatomy of the orbit is always a challenge. With recent advancements in technology, surgical predictability and outcomes have greatly improved. Several methods for orbital reconstruction surgery have been documented such as virtual surgical planning, intraoperative navigation, intraoperative imaging, and the use of patient-specific implant (PSI). PSI made of titanium can be designed by using a computer-aided design process and manufacturing (CAD-CAM) of CT-scan routinely used during diagnostic imaging. With precise analyses in shape and size followed by personalised implant design, the surgical precision can be alleviated further and at the same time, the surgical duration could be reduced with anticipation of better surgical outcomes. However, meticulous planning needs to be done preoperatively, with the timing of the surgery being an important factor. In the present case, pure orbital blowout fracture primarily treated with a personalised-implant solution derived from 3D-printing technology is described. Both pre-surgical and surgical workflow of this computer-assisted surgical method is elaborated. PSI for primary orbital reconstruction can be regarded as a viable alternative surgical solution including its working timeframe and adherence to the surgical protocol or algorithm.

Treatment of infraorbital nerve injury after orbital fracture with Triamcinolone acetonide combined with rat nerve growth factor / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical efficacy of local application of triamcinolone acetonide combined with mouse nerve growth factor in the treatment of infraorbital nerve injury after infraorbital wall fracture.METHODS: Forty-three patients(43 eyes)with infraorbital wall fractures who underwent infraorbital wall fracture revision from April 2020 to February 2021 at the Affiliated Eye Hospital of Nanchang University were prospectively analyzed. Patients were randomly divided into two groups, in which 20 patients(20 eyes)in the experimental group had gelatin sponges infiltrated with triamcinolone acetonide and mouse nerve growth factor placed on the nerve injury intraoperatively; 23 patients(23 eyes)in the control group had no special treatment intraoperatively. At 6mo postoperative follow-up, the results of quantitative sensory testing(two-point localization, nociception, and touch)were compared between the affected and healthy lower lid areas, and the results were reported in an asymmetry index(AI).RESULTS: Baseline results showed no significant differences between the two groups in terms of gender, age, time of injury, and preoperative sensory testing between the two groups(all <i>P</i>>0.05). The AI values of two-point localization sensation, tactile sensation, and pain sensation in both groups were higher at 1wk after surgery than before surgery(all <i>P</i><0.05), and the symptoms of sensory impairment were aggravated, with different degrees of improvement at 1mo after surgery and statistically significant differences in pain sensation at 3mo after surgery(<i>P</i><0.05), and two-point localization sensation, tactile sensation, and pain sensation were significantly improved at 6mo after surgery than before treatment(all <i>P</i><0.01). At 1mo after surgery, the differences in two-point localization sensation and pain sensation in the test group were statistically significant compared with the control group(<i>t</i>=-2.082,-2.143; <i>P</i>=0.044, 0.038). At 3mo after surgery, there was a statistically significant difference in nociception in the test group compared to the control group(<i>t</i>=-2.118, <i>P</i>=0.04). At 6mo after surgery, there was no statistically significant difference in quantitative sensory testing between the two groups(<i>P </i>>0.05).CONCLUSION: Local application of triamcinolone acetonide combined with mouse nerve growth factor for the treatment of infraorbital nerve injury after infraorbital wall fracture was effective in early internal recovery and superior to the group without special intraoperative treatment.

Reconstrucción de Fracturas Orbitarias Utilizando Tecnología Digital Tridimensional: Una forma de Optimizar Resultados

RESUMEN: La reconstrucción de las paredes orbitarias fracturadas es compleja debido a la gran cantidad de parámetros volumétricos que posee. Una restitución inadecuada de ellas habitualmente está asociada a secuelas postquirúrgicas en el paciente. El contar con herramientas que optimicen la restitución de la forma anatómica de la órbita en su reconstrucción es de vital importancia, y la utilización de nuevas tecnologías ha permitido mejorar los resultados quirúrgicos, tanto anatómicos como funcionales. El objetivo de este artículo es mostrar dos herramientas quirúrgicas que permiten optimizar los resultados terapéuticos en pacientes con fractura de órbita, que son el modelo estereolitográfico con imagen en espejo y la tomografía computada intraoperatoria. Se presentan las características de estas herramientas, su utilización en tres casos de pacientes con fractura orbitaria y los resultados obtenidos en el post operatorio.

ABSTRACT: The reconstruction of fractured orbital walls is complex due to the many volumetric parameters involved. An inadequate restitution of these walls may be associated with postsurgical sequelae in the patient. Is vitally important to count with tools that optimize the restitution of the orbit's anatomic shape during its reconstruction, and the use of new technologies has allowed the improvement of the surgical results, both anatomical and functional. The aim of this article is to show two surgical tools that allow to optimize the therapeutic results in patients with orbital fracture, which are stereolithographic models with mirror image technique, and intraoperative computed tomography. Their characteristics, their use in three cases of patients with orbital fractures, and the postoperative results are shown.

Neumomediastino secundario a fractura aislada de piso de órbita / Pneumomediastinum secondary to isolated fracture of orbit floorx

Resumen Introducción: El neumomediastino se define como la presencia de aire o gas dentro de los planos fasciales del mediastino. Por lo general, es un fenómeno secundario a perforaciones traumáticas del tracto aerodigestivo. El neumomediastino secundario a una fractura orbitaria es un evento raro. Se asocia a complicaciones potencialmente mortales como el neumotórax, el neumopericardio y la mediastinitis. Objetivo: Describir un caso de neumomediastino secundario a una fractura aislada de piso orbitario y su manejo médico-quirúrgico. Caso clínico: Paciente de sexo femenino de 42 años que sufre traumatismo en regiones facial, cervical y torácica desarrollando secundariamente un enfisema subcutáneo panfacial y un neumomediastino, el cual se resuelve exitosamente. Discusión: El neumomediastino secundario a una fractura aislada de piso orbitario es un evento muy raro. El aire puede descender a lo largo de los espacios fasciales hasta el mediastino. En este sentido, sonarse la nariz es un factor de riesgo para desarrollar esta pa-tología. Conclusión: Ocurrido un trauma maxilofacial puede presentarse enfisemas de espacios profundos de la cabeza, cuello e incluso el mediastino.

Introduction: Pneumomediastinum is defined as the presence of air or gas within the fascial planes of the mediastinum. It is usually a phenomenon secondary to traumatic perforations of the aerodigestive tract. Pneumomediastinum secondary to an orbital fracture is a rare event. And it is related to life-threatening complications such as pneumothorax, pneumopericardium and mediastinitis. Aim: To describe a case of pneumomediastinum secondary to an isolated orbital floor fracture and its medical-surgical management. Clinical case: A 42-year-old female patient who suffers trauma to the facial, cervical and thoracic regions, secondary development of a subcutaneous panfacial emphysema and pneumomediastinum, which resolves successfully. Discussion: Pneumomediastinum following an isolated orbital floor fracture is a very rare event. The air can descend along the fascial spaces to the mediastinum. In this sense, blowing your nose is a risk factor to develop this pathology. Conclusion: After a maxillofacial trauma, emphysema of the deep spaces of the head, neck and even the mediastinum can occur

Application of computer navigation technique in the treatment of complex orbital fractures / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the efficacy and utility of computer navigation technique in the treatment of complex orbital fracture.<p>METHODS: A retrospective review of 19 patients with complex orbital fractures were conducted. They underwent the reconstructive surgery assisted by image-data-based computer navigation. The pre- and postoperative data of enophthalmos, eyeball movement, diplopia, infraorbital numbness, and orbit CT image were recorded and analyzed. <p>RESULTS: The processes of pre-operation planning and intraoperative navigation were successful. During the 6 to 18mo postoperative follow-up, enophthalmos was completely corrected in 14 cases, while 5 patients had slight residual enophthalmos. Eyeball movement restriction was completely corrected in 7 cases, and was also improved in 3 cases. Diplopia was disappeared in 10 patients and improved in 2 patients, but still maintained in 1 patient postoperatively. Infraobital numbness was found in 4 cases, and dissappeared in 6mo postoperatively. No serious complications such as optic nerve lesion and vision loss were observed. Postoperative CT scans demonstrated that the fractures were corrected in all cases. The accuracies of the surgeries were satisfying. <p>CONCLUSION: Computer navigation system is a safe and effictive technique in assisting diorthosis in complex orbital fracture.

Using Computed Tomography: Predictive Factors for Recovery Time in Patients with Orbital Fracture with Diplopia

PURPOSE: To identify predictive factors for recovery time in patients with orbital fracture with diplopia through analysis of preoperative and postoperative computed tomography (CT) images and postoperative recovery time. METHODS: We retrospectively analyzed CT findings-preoperative: fracture size, type of fracture, fracture site, extraocular muscle (EOM) swelling, EOM and soft tissue injury, and the amount of soft tissue herniation; post-operative: degree of enophthalmos, and diplopia recovery period in 379 patients who underwent surgical treatment for orbital fracture between March 2006 and December 2015. RESULTS: The average postoperative follow-up period was 556.2 ± 59.5 days, and the mean duration of recovery was 23.9 ± 42.5 (range, 3–186) days. The recovery time of diplopia was significantly increased with the following preoperative CT findings: fracture size (small and medium < large) (p = 0.049), type of fracture (linear < hinge < comminuted, trap-door) (p < 0.01), fracture site (inferior < medial and both) (p < 0.01), EOM and soft tissue injury (prolapse and torsion, muscle entrapment, kinked muscle) (p < 0.01), and the amount of soft tissue herniation (small and medium < large) (p < 0.001). The mechanism of injury, sex, age, and the degree of enophthalmos were not related to the length of the diplopia recovery period. CONCLUSIONS: The length of diplopia recovery could be predicted by CT findings.

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.

Management of Orbital Blowout Fractures: ENT Surgeon's Perspective

Treatment of orbtical blow-out fracture by surgical or conservative therapy: A retrospective study of 90 cases / 实用口腔医学杂志

Objective: To compare the effects of surgical and conservative therapy in the treatment of orbital blow-out fracture. Methods: 90 cases of obital blow-out fracture were treated by surgical(n = 40) and conservative(n = 50) trerapy respectively, the patients were fllowed up for 12 months. The treatment outcome was retrospectively analysed. Results: Of the 40 patients managed surgically 39 were with complete follow up data, 19 had diplopia in peripheral gaze before surgery, 13 (33％) had at 3-month and 12 (31％) had at 6-month follow-up. 31 had enophthalmus before surgery and 3(8％) had at 3-month and 6-month follow-up. Of the 50 patients managed conservatively 26 were with complete follow-up data, 11 had diplopia in peripheral gaze initially, 9(35％) had at 3-month and 8(31％) had at 6-month follow-up. 15 had enophthalmus initially and 13(50％) had at 3-month and 6-month followup. Conclusion: Surgical therapy is more effective for the treatment of enophthalmus. The effects tend to be stable 3 months after treatment, the ratio of diplopia in peripheral gaze after treatment by the 2 treatments is similar(about 30％ of the total cases).

Effect on enophthalmos between different edge point repairment after orbital wall fracture repair surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the importance between several edge points repair through enophthalmos study after orbital wall fracture repair surgery. <p>METHODS: The date of 23 eyes of 23 cases with medial-inferior orbital wall fracture with enophthalmos were collected and analyzed retrospectively. All cases underwent orbital fracture surgery, the follow-up time was 3mo. After surgery, the degree of enophthalmos was within 2mm. The repair of bony buttress, exterior margin of inferior orbital wall, and superior margin of medial orbital wall after surgery were analyzed. <p>RESULTS: In these well-recoverd patients, repair rate between bony buttress(100%), exterior margin of inferior orbital wall(43%)and superior margin of medial orbital wall(83%)were different. <p>CONCLUSION: The repair of bony buttress was most important for surgery. Analysis between surgical efficacy and edge points repair is valuable for surgical operation and risk control.

Application of 3D printing orbit and surgical implant for orbital blowout fracture surgical operation planning and teaching / 眼科新进展

Objective To explore the possibility of three-dimensional orbit replications for clinic and teaching of orbital blowout fracture surgical operation.Methods The orbital CT DICOM format data from 10 patients with orbital floor fractures were selected between November 2016 and January 2017 from Wendeng Osteopath Hospital.Thresholding technique,region growing technique,edit mask technique and multiple slice edit technique were used in sequence by Mimics software.And 3D replications were printed by Object 500 3D printer.The sizes of the replications were measured.The model of orbital blowout fracture and surgical implant model were simulated by senior orbital surgeon.Results In the 10 cases,male was 5 cases,and female was 5 eyes.The 3 D replications of the orbits were successfully designed and printed.The sizes of the 3D replications were basically consistent with those of patients' orbits,and there was no statistical difference (all P ＞ O.05).Under operation room surgery simulation environment,the orbital fracture surgical repair operation was demonstrated to the resident by the senior surgeon,3D printing orbital blowout fracture model can be successfully used to simulate the operation and teaching demonstration.Conclusion 3D printing orbital blowout fracture model can restore the true orbital injury and orbital anatomic details,provides the design operation of stereoscopic model for the physician,which has positive significance to understand the scope and surgery teaching simulation of orbital blowout fracture.

Application of bone grafts from chin of the mandible in the reconstruction of orbital fracture / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the clinical effects of bone graft from the mandible in repairing orbital floor defects.</p><p><b>METHODS</b>Bone grafts from the mandible were used to treat 11 cases of orbital floor defects and followed up for 6-12 months.</p><p><b>RESULTS</b>The surgical incisions healed primarily in all 11 patients. The orbital floor structure was restored. No vision loss, limited eye movement, implant infection, or resorption were observed postoperatively, and no complications occurred in the supply area.</p><p><b>CONCLUSIONS</b>Bone grafts from the mandible were an ideal material to repair orbital floor defects.</p>

Effect of pre-shaped titanium mesh implantation on the prognosis of patients with orbital fractures / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the effectiveness and safety of 3D printing pre-shaped titanium mesh in the repair of orbital fracture compared with the conventional titanium mesh. <p>METHODS: The clinical data of 72 eyes of 72 patients who received surgery for orbital fracture from June 2015 to March 2016 in our department were retrospectively analyzed.All patients were divided into two groups, including pre-shaped titanium mesh implantation group(observation group), 40 cases, conventional titanium mesh implantation group(control group), 32 cases. The control group was treated by physicians according to the experience of manual bending and shaping titanium mesh implantation ipsilateral orbital pad,when the observation group by the physicians directly in the pre-shaped titanium mesh of 3D printing. The eyeball exophthalmos, eye movement and diplopia were evaluated in the next 1, 3 and 6mo after the operation, and we compared the differences between the two methods at different time points and the differences of the indexes between the two materials at the same time point. <p>RESULTS: The cure rate of the observation group and the control group about eyeball exophthalmos values was 84% and 59%, the difference of the two groups was statistically significant(<i>P</i><0.05). The cure rates of diplopia of the two groups were 80% and 70% without significant difference(<i>P</i>>0.05). The cure rate of limited ocular movement of observation group was 73%, that of control group was 66%, there was no statistical significance(P>0.05). During the follow-up period, there was no infection in the two groups, no titanium mesh shift, extrusion, deformation and rejection or other complications. <p>CONCLUSION: Pre-shaped titanium mesh shaping orbital implantation with no need for shaping the mesh in the operation, can shorten the operation time, make accurate reconstruction of orbital wall, reduce complications and improve the curative effect.

Late Complication of a Silicone Implant Thirty Years after Orbital Fracture Reconstruction

Alloplastic materials used for orbital fracture reconstruction can induce complications, such as infection, migration, extrusion, intraorbital hemorrhage, and residual diplopia. Silicone is one of the alloplastic materials that has been widely used for decades. The author reports a rare case of spontaneous extrusion of a silicone implant that was used for orbital fracture reconstruction 30 years earlier. A 50-year-old man was admitted to the emergency room for an exposed substance in the lower eyelid area of the left eye, which began as a palpable hard nodule a week earlier. The exposed material was considered to be implant used for previous surgery. Under general anesthesia, the implant and parts of the fibrous capsule tissue were removed. Several factors hinder the diagnosis of implant extrusions that occur a long period after the surgery. So, surgeons must be aware that complications with implants can still arise several decades following orbital fracture reconstruction, even without specific causes.

Late Complication of a Silicone Implant Thirty Years after Orbital Fracture Reconstruction

Alloplastic materials used for orbital fracture reconstruction can induce complications, such as infection, migration, extrusion, intraorbital hemorrhage, and residual diplopia. Silicone is one of the alloplastic materials that has been widely used for decades. The author reports a rare case of spontaneous extrusion of a silicone implant that was used for orbital fracture reconstruction 30 years earlier. A 50-year-old man was admitted to the emergency room for an exposed substance in the lower eyelid area of the left eye, which began as a palpable hard nodule a week earlier. The exposed material was considered to be implant used for previous surgery. Under general anesthesia, the implant and parts of the fibrous capsule tissue were removed. Several factors hinder the diagnosis of implant extrusions that occur a long period after the surgery. So, surgeons must be aware that complications with implants can still arise several decades following orbital fracture reconstruction, even without specific causes.

Usefulness of a Transconjunctival Approach in the Reconstruction of the Medial Blow-Out Wall Fracture

BACKGROUND: A transcaruncular approach is typically used for reconstructions of medial wall fractures. However, others reported that a transconjunctival approach was conducive for securing an adequate surgical field of view. In this study, we aimed to examine the extent of repair of medial wall fracture via a transconjunctival approach. METHODS: We retrospectively reviewed the medical records of 50 patients diagnosed as having medial wall fracture via preoperative computed tomography and who underwent surgery between March 2011 and February 2014. The fracture location was defined by dividing each of the anterior-posterior and superior-inferior distances into three compartments. RESULTS: A transcaruncular approach was used in 7 patients, while the transconjunctival approach was performed in the remaining 43 patients. The transconjunctival approach enabled a relatively broad range of repair that partially included the front and back of the medial wall, and was successful in 86% of the entire study population. CONCLUSION: It is known that more than 50% of total cases of the medial wall fracture occur mainly in the middle-middle portion, a majority of which can be reconstructed via a transconjunctival approach. We used a transconjunctival approach in identifying the location of the fracture on image scans except for cases including the fracture of the superior portion in patients with medial wall fracture. If it is possible to identify the location of the fracture, a transconjunctival approach would be an useful method for the reconstruction in that it causes no damages to the lacrimal system and is useful in confirming the overall status of the floor.