A retrospective study to compare the treatment outcomes with and without surgical navigation for fracture of the orbital wall / 中华创伤杂志(英文版)

PURPOSE@#To evaluate the outcomes with and without aid of a computer-assisted surgical navigation system (CASNS) for treatment of unilateral orbital wall fracture (OWF).@*METHODS@#Patients who came to our hospital for repairing unilateral traumatic OWF from 2014 to 2017 were included in this study. The patients were divided into the navigation group who accepted orbital wall reconstruction aided by CASNS and the conventional group. We evaluated the surgical precision in the navigation group by analyzing the difference between actual postoperative computed tomography data and preoperative virtual surgical plan through color order ratios. We also compared the duration of surgery, enophthalmos correction, restoration of orbital volumes, and improvement of clinical symptoms in both groups systemically. Quantitative data were presented as mean ± SD. Significance was determined by the two-sample t-test using SPSS Version 19.0 A p < 0.05 was considered statistically significant.@*RESULTS@#Seventy patients with unilateral OWF were included in the study cohort. The mean difference between preoperative virtual planning and actual reconstruction outcome was (0.869 ± 0.472) mm, which means the reconstruction result could match the navigation planning accurately. The mean duration of surgery in the navigation group was shorter than it is in the control group, but not significantly. Discrepancies between the reconstructed and unaffected orbital-cavity volume and eyeball projection in the navigation group were significantly less than that in the conventional group. One patient had remnant diplopia and two patients had enophthalmos after surgery in the navigation group; two patients had postoperative diplopia and four patients had postoperative enophthalmos in the conventional group.@*CONCLUSION@#Compare with the conventional treatment for OWF, the use of CASNS can provide a significantly better surgical precision, greater improvements in orbital-cavity volume and eyeball projection, and better clinical results, without increasing the duration of surgery.

Factors Affecting Persistent Diplopia after Surgical Repair of Isolated Inferior Orbital Wall Fracture

PURPOSE: To investigate factors affecting persistent diplopia after surgical repair of isolated inferior orbital wall fractures. METHODS: Thirty-three patients who underwent surgical repair of isolated inferior orbital wall fractures in Inha University Hospital Ophthalmology Department from 2014 to 2017 were enrolled in this study. The authors examined facial computed tomography, diplopia, extraocular muscle movement, and Hertel's exophthalmometer before and 6 months after surgery. The diplopia which was not recovered even at 6 months postoperatively was defined as persistent diplopia. Multivariable logistic regression analyses were performed on parameters that were found to be related to persistent diplopia using univariable logistic regression analyses. RESULTS: Univariable regression analysis showed that preoperative ocular motility limitation, preoperative diplopia, the type of fracture, the number of contacts with the fracture site and extraocular muscle (EOM), and EOM tenting were associated with persistent postoperative diplopia. Multivariable regression analysis using the previously mentioned five parameters showed 28.3-fold and 17.4-fold greater probabilities of diplopia after surgery in preoperative diplopia and EOM tenting, respectively (p = 0.023). CONCLUSIONS: Preoperative diplopia and EOM tenting were associated with persistent postoperative diplopia. These parameters were predictors of persistent diplopia in eyes with isolated inferior orbital wall fractures.

Analysis of soldiers' orbital wall fracture surgical treatment in General Hospital of Northen Theater Command / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical characteristics and surgical treatment fororbital wall fracture of soldiers. <p>METHODS: This study choose 58 soldiers(58 eyes)who had surgical treatments for orbital wall fracture in our hospital from January 1st, 2015 to December 31st, 2018. Their demographic characteristics, causes of injury, fracture sites, preoperative and postoperative visual acuity, eye movement, eye prominence, and operative conditions were recorded and statistically analyzed. The patients were followed up for 6mo after treatment. <p>RESULTS: All patients in 58 cases of orbital wall fractures were male. The <i>P</i>50 age of them was 21, and most of them were 20-29 years old(78%). 45 cases(78%)were injured at work, in which boxing injury and impingement injury were the main causes(74%). Simple medial orbital wall, inferior wall and both of the medial and inferior wall fractures were the common types(91%). The visual acuity of all the patients did not change significantly after operation comparing with preoperative visual acuity. According to the clinical data of postoperative CT and postoperative follow up, no implant displacement, infection or other serious complications appeared. Eye movement disorder of 33 patients were improved. Abnormal suborbital perception of 7 patients disappeared. And enophthalmos of 3 patients were corrected. <p>CONCLUSION: Young male soldiers are the main population of orbital wall fracture. It is of great significance to improve the protection in daily training. Surgical treatment for orbital wall fractures has significant therapeutic effect. Furthermore, it is very necessary for primary hospital to develop basic diagnosis and treatment.

Clinical study of Medpor Titan implantation for orbital blowout fracture with nasal endoscopy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of reconstruction of orbital blowout fracture by conjunctival incision combined with Medpor Titan implantation under nasal endoscopy. <p>METHODS: Sixteen patients(16 eyes)diagnosed with orbital blowout fracture, include medial fractures, floor fractures and extended fractures, were performed reconstruction by transconjunctival approach with implant material- Medpor Titan under nasal endoscopic-assisted; observation of postoperative visual acuity, eyeball protrusion, extraocular movement limitations, diplopia, orbital CT, occurrence of implanted material rejection was taken. <p>RESULTS: A 3-month follow-up was performed and the therapeutic efficacies of anatomic and functional recovery were evaluated. No further vision loss or infection occurred postoperatively. In the 16 patients, the average postoperative observation was 3mo, enophthalmos were fully corrected, diplopia disappeared. Orbital(CT)did not reveal implant displacement and rejection postoperatively. <p>CONCLUSION: Endoscopic-assisted reconstruction of orbital blowout fracture by conjunctival incision combined with Medpor Titan implantation is a safe and effective surgical method with the characteristics of with direct operation, clear range of fracture exposure and safe and reliable operation, not only restores the patient's visual function and appearance, but also reduces the incidence of complications, avoiding postoperative facial scar.

The Effect of Intraoperative Exophthalmometric Values on Enophthalmos Correction in Inferior Orbital Wall Reconstruction

PURPOSE: To measure the enophthalmos corrective effect after inferior orbital wall reconstruction, we compared preoperative and intraoperative exophthalmometric values with postoperative exophthalmometric values. METHODS: From January 2014 to April 2016, 60 eyes of 60 patients who underwent surgery for inferior orbital wall fracture were included. In Group 1, the exophthalmometric value was measured before surgery, during the operation, and 6 months after surgery using the Naugle exophthalmometer. In Group 2, the value was measured before surgery and 6 months after surgery using the Hertel exophthalmometer. The thickness of implants was determined by preoperative exophthalmometric values and overcorrection of 0.5 mm was performed in Group 1 patients with relatively large fractures. RESULTS: The mean age of the patients was 32.4 years in Group 1 and 34.3 years in Group 2. The mean duration between injury and surgery was 4.2 weeks in Group 1 and 2.3 weeks in Group 2. There was no statistically significant difference between preoperative exophthalmometric values in Group 1 (−1.78 ± 0.31 mm) and Group 2 (−1.81 ± 0.26 mm), but postoperative exophthalmometric values between Group 1 (−0.25 ± 0.78 mm) and Group 2 (−0.53 ± 0.46 mm) were statistically different (p = 0.034). CONCLUSIONS: The exophthalmometric values and wall fracture size are important factors for determining implant thickness of inferior orbital wall reconstruction. Intraoperative measurement of exophthalmometric values should be considered in inferior orbital wall reconstruction for enophthalmos correction.

Infraorbital Nerve Hypesthesia after Inferior Orbital Wall Fracture and Reconstruction Surgery

PURPOSE: To report the incidence of infraorbital nerve hypesthesia after inferior orbital wall fracture and reconstruction surgery and analyze the duration and factors to influence the occurence of the infraorbital nerve hypesthesia. METHODS: From March, 2001 to March, 2016, the medical records of 171 patients with isolated orbital floor fracture reconstructed with porous polyethylene or titanium mesh was analyzed retrospectively. Injury mechanism, fracture type, time interval to surgery, fracture size, type and thickness of implant were analyzed. Orbit computed tomography scan was performed at preoperative and postoperative 6 weeks. RESULTS: Mean age was 30.4 years (male:female = 130:41). The mean time interval to surgery was 9.5 days. Incidence of infraorbital hypesthesia was 9.9% preoperatively, 38% in a week of surgery, 13.5% in 6 weeks and 5.8% in 6 months. Infraorbital hypesthesia lasts 20.5 weeks and the length of infraorbital canal was the only risk factor of persistent infraorbital hypesthesia. CONCLUSIONS: Postoperative infraorbital nerve hypesthesia presents in a week in most patients. It last about 20.5 weeks, then mostly recovers in 6 months. This study will be useful to predict the clinical course of the patients with infraorbital nerve hypesthesia. Therefore, full explanation about the facial sense change is necessary for the patients with inferior orbital wall fracture.

Eyeball Displacement into Ethmoid Sinus with Good Visual Restoration

PURPOSE: To report a case of eyeball displacement into the ethmoid sinus followed by early surgical intervention and good visual recovery. CASE SUMMARY: A 46-year-old female visited our hospital after she injured the right side of her face. Her visual acuity could not be measured and computed tomography revealed displacement of the right eyeball into the ethmoid sinus, as well as right medial orbital wall fracture and rupture of the right medial rectus muscle. She underwent surgical reduction of the herniated eyeball and surgical correction of the medial orbital wall fracture within 20 hours after the accident. Eighteen months after the surgery, visual acuity of the right eye improved from light perception to 20/28, and her color vision and visual field of the right eye improved to normal range. CONCLUSIONS: Displacement of the eyeball in the orbital wall fracture is very rare, and eyeball displacement into the ethmoid sinus is even rarer. We achieved good visual outcome through early surgical intervention. The early anatomical reduction of the displacement and wall fracture may promote improved final visual outcome in other similar cases.

Orbital Wall Fracture Repair: The Results of Early and Delayed Surgery

PURPOSE: To investigate the surgical results of early and delayed repair of orbital wall fracture after multiple subgrouping of patients by time between the operation and injury. METHODS: Eighty-eight eyes of 88 patients who underwent orbital wall fracture repair from January 2002 to December 2014 and who were followed up for more than 3 months postoperatively were included in this study. We divided the 88 patients into three groups: Early surgery group (surgery within 2 weeks after the injury), slightly delayed surgery group (surgery between 3 weeks and 2 months after the injury), delayed surgery group (surgery after 2 months of the injury). Preoperative and postoperative ocular motility, diplopia, and the degree of enophthalmos were analyzed retrospectively. RESULTS: The early surgery group consisted of 30 eyes; slightly delayed surgery group, 42 eyes; and delayed surgery group, 16 eyes. The mean duration between injury and surgery was 8.6 +/- 22.5 weeks in all patients, 1.5 +/- 0.5 weeks in the early surgery group, 3.5 +/- 1.3 weeks in the slightly delayed surgery group, and 35.3 +/- 44.7 weeks in the delayed surgery group. All patients were followed up for a mean of 12.9 +/- 10.8 weeks. Gaze limitation in all directions showed improvement in all groups, with the most shown in up gaze limitation. There were no significant differences in the degree of improvement between preoperative and postoperative gaze limitation among the three groups. Enophthalmos improved as well, without any significant differences among the three groups. CONCLUSIONS: Improvement in ocular motility limitation and enophthalmos after orbital wall fracture repair did not vary significantly according to the duration between the surgery and injury. Therefore, surgical repairment even for old orbital fractures may successfully treat enophthalmos or diplopia and relieve symptoms.

Endoscopic Transnasal versus Transcaruncular Reconstruction in Isolated Medial Orbital Wall Fractures

PURPOSE: To compare 2 surgical techniques, endoscopic transnasal reconstruction and transcaruncular reconstruction in isolated medial orbital wall fractures. METHODS: This study included 79 isolated medial orbital wall fracture patients from January 2011 to December 2012 of Department of Ophthalmology, Inha University Hospital. The authors compared computed tomographic scans, diplopia, extraocular muscle (EOM) movements, and Hertel's exophthalmometer exams pre- and post-surgery. Thirty-five patients received endoscopic transnasal reconstruction and 44 received transcaruncular reconstruction. RESULTS: The 2 surgical methods showed no significant differences in primary gaze diplopia (p = 0.50), restriction of EOM movements (p = 0.48), remaining enophthalmos of more than 2 mm (p = 0.99), and improvement in enophthalmos (p = 0.07) when compared 6 months after surgery. Statistically significant differences were observed in peripheral diplopia (p = 0.04) 6 months after surgery. CONCLUSIONS: The 2 surgical methods present similar effectiveness in postoperative primary gaze diplopia, EOM restriction, and enophthalmos. With respect to postoperative peripheral diplopia, endoscopic transnasal reconstruction method showed advantages. The surgical method should be selected by comparing advantages and disadvantages.

Outcomes of Isolated Medial Orbital Wall Fracture Reconstructions

PURPOSE: To evaluate surgical results after the reconstruction of isolated medial orbital wall fractures. METHODS: We performed a retrospective chart review of patients with isolated medial orbital wall fractures who underwent reconstruction using the transcaruncular approach from March 2012 to October 2013. Computed tomography (CT) was performed before and after surgery. Postoperative follow-ups were conducted at 1 week, 1 month, and 3 months. Diplopia, ocular motility, postoperative complication, and exophthalmometry were recorded at each follow-up visit. Preoperative and postoperative enophthalmos was quantified using Hertel exophthalmometry and a quantitative method for the area of the circular sector under the chord (CA)/orbital area (OA) ratio at the CT scan. Patients were divided into either the incomplete or complete reduction groups based on the degree of reduction observed on postoperative CT. RESULTS: We evaluated 55 patients (42 males, 13 females) with an average age of 36 years. Five of 55 patients with preoperative enophthalmos of more than 2 mm obtained good symmetry after surgery. Diplopia at primary gaze was resolved in 9 of 9 patients and 2 patients had residual diplopia on lateral gaze. The difference of exophthalmometry and CA-to OA ratio between before and after reconstruction was not significantly changed in either the incomplete or complete groups. CONCLUSIONS: Enophthalmos and diplopia were well corrected in all subjects. If reduction was successfully performed in the anterior portion of medial orbital wall fracture, clinically significant enophthalmos might be preventable even if complete reduction was not obtained.

Repair of Inferomedial Orbital Wall Fractures with Bony Strut Loss by Overlapping Absorbable Copolymer

PURPOSE: To report the results of surgical repairing of inferomedial orbital wall fractures accompanied with loss of bony strut by an overlapping method using Resorb X(R) plates (poly(D,L)-lactic acid). METHODS: To repair inferomedial orbital wall fractures with loss of bony strut, we bent the medial aspect of the plate for floor fracture according to the anatomical structure and then inserted the floor implant, which was supported by anterior, posterior and lateral margins of the floor fracture. Then, the medial implant, which was supported by the bent medial edge of the floor implant, was inserted. Postoperatively, we analyzed the outcomes of 21 patients regarding postoperative enophthalmos, limitation of eye movement (LOM) and diplopia. The diagonal lengths of the orbit in the operated side were compared with the non-traumatized side based on the coronal view of the postoperative CT scans to determine the success or failure of the reconstruction. RESULTS: The average postoperative enophthalmic value was 0.5 mm, and no significant differences between the orbital diagonal lengths of the operated and non-operated eyes were observed. The LOM shown in 7 out of 8 patients was completely resolved during the postoperative follow-up period. All patients with diplopia, including one patient who showed partial remission of LOM, experienced complete symptom resolution. No other complications related to the implant were recorded. CONCLUSIONS: Inferomedial orbital wall fractures with the loss of bony strut can be successfully repaired by the overlapping method using Resorb X(R) implants.

Degree of enophthalmos according to the extent of orbital wall fracture and volume of herniated orbital tissue

INTRODUCTION: The enlargement and deformation of the orbit give rise to a visible enophthalmos. As a consequence, a disturbance of eye motility together with double images is likely to occur. This study examined the degree of enophthalmos according to the extent of orbital wall fracture and volume of herniated orbital tissue in blowout fractures of the medial and inferior orbital wall. MATERIALS AND METHODS: This study was performed on patients diagnosed with medial and inferior orbital wall fractures at the Department of Oral and maxillofacial surgery, Chonbuk National University Hospital from 2007 to 2009. The patients' age, gender, etiology of fracture and degree of enophthalmos were investigated. The changes in the degree of enophthalomos, diplopia and ocular motility restriction after operation were examined. RESULTS: The degree of enophthalomos increased with increasing extent of orbital wall fracture and volume of herniated orbital tissue. CONCLUSION: Whether to perform the operation is decided after measuring the extent of the orbital wall fracture and volume of herniated orbital tissue using computed tomography (CT), time for the decision of operation can be shortened. This can cause a decrease in the complications of orbital wall fractures.

Chronic Maxillary Sinusitis Occurred after Reconstruction of Inferior Orbital Wall Fracture / 대한이비인후과학회지

A 27-year-old man presented with symptoms of chronic postnasal drip and nasal obstruction, which had begun one year earlier. He had undergone an ophthalmologic operation due to inferior orbital wall fracture 12 years ago. During physical examination, mucopurulent discharge was observed from the right middle meatus. On the paranasal sinus computed tomography, a sheet-like foreign material was observed inside the right maxillary sinus and haziness was found in the right maxillary, ethmoid, and frontal sinuses. Endoscopic sinus surgery was performed and a silastic sheet, which had been inserted during previous surgery, was removed. After surgery, the patient's symptoms disappeared gradually. We report a case of maxillary sinusitis that occurred after orbital wall reconstruction with a silastic sheet and discuss about the efficacy of the silastic implant.

A Clinical Feature of the Patients of Orbital Wall Fracture With Diplopia

PURPOSE: To analyze the clinical features of orbital wall fracture with diplopia between the surgical treatment group and the conservative treatment group. METHODS: The study comprised of 109 eyes of 109 patients with orbital wall fracture and diplopia. The patients were divided into two groups: the surgical treatment group (59 cases) and the conservative treatment group (50 cases). The groups were analyzed retrospectively according to age, gender, cause, CT, the period and severity of diplopia, and enophthalmos with time. RESULTS: In the conservative treatment group, 38 cases (64.4%) had medial wall fracture, and the average fracture size was 26alpha of the inferior wall and 33% of the medial wall. In addition, at the first visit, the patients showed diplopia within 45.5 degrees, and diplopia disappeared completely within 17 days on average (57 cases, 96.6%). In the group that underwent the reconstruction of orbital wall fracture, 27 cases (54.0%) had inferior wall fracture, and the average fracture size was 41% of the inferior wall and 35% of the medial wall. Additionally, in the first visit, the patients showed diplopia within 20.3 degrees. The muscle incarceration occurred in 12 cases (24%). In the surgical treatment group, diplopia disappeared completely within 30 days on average (45 cases, 90.0%). CONCLUSION: In the group of conservative treatment, they showed diplopia within 45.5 degrees at the first visit. Diplopia disappeared completely within 17 days on average (57 cases, 96.6%). In the group of surgical treatment, they showed diplopia within 20.3 degrees at the first visit. Diplopia disappeared completely within 30 days on average (45 cases, 90.0%).

Long-Term Results of Reconstruction of Orbital Wall Fracture With Resorbable Copolymer Mesh

PURPOSE: This study examined the postoperative long-term results of the reconstruction of orbital wall fracture using Macropore(R). METHODS: The long-term results for 10 patients who were diagnosed with orbital wall fracture and received the repair of orbital wall fracture using Macropore(R), were examined postoperatively after an average of 23.5 months. RESULTS: The mean difference in orbital volume between the fractured orbit and the unaffected orbit after an average of 23.5 months postoperatively was 1.01+/-0.70 cm3 (4.75+/-2.92%), which slightly increased compared to 0.70+/-0.52 cm3 (3.26+/-2.10%) immediately after the operation, although the difference was not statistically significant (p-value=0.190). At the last follow-up, the shape of Macropore(R) was not observed in 3 out of the 10 patients, and intense ossification was observed at the site of fracture in 6 patients. At the last follow-up, one patient showed 1.5 mm enophthalmos, and the other patients did not show the occurrence of diplopia or the progress of enophthalmos. CONCLUSIONS: According to the long-term results of the reconstruction of orbital wall fracture, Macropore(R) is considered an implant that produces a safe and satisfactory effect without notable complications.

Results of Reconstruction of Orbital Wall Fracture With Bioresorbable Plate

PURPOSE: To investigate the long-term results and complications of orbital wall fracture reconstruction using the bioabsorbable orbital implant, Macropore(R) orbital floor liner. METHODS: This retrospective study included patients who underwent the reconstruction of an orbital wall fracture using Macropore(R) orbital floor liner and completed a postoperative follow-up longer than 6 months. The enophthalmic values as well as the data of ocular movement and diplopia was collected from the medical records of each patient and analyzed. RESULTS: A total of 35 patients were evaluated with an average follow-up period of 14.0 months. The average enophthalmic value of 29 patients, whose reconstruction was primarily indicated from enophthalmic tissue, was 0.90 mm at the last follow-up. No significant progression of enophthalmos was observed at postoperative 12, 18 and 24 months when compared with the enophthalmic value at postoperative 6 months. All 15 patients who have had the limitation of ocular movement or diplopia preoperatively resolved completely or improved to the degree that no clinically significant limitation or diplopia further existed. No complications such as dislocation of implant, infection, and aggravation of ocular limitation were observed during the follow-up period. CONCLUSIONS: Macropore(R) orbital floor liner may be regarded as a useful implant in reconstruction of orbital wall fracture with no significant implant-related complications during its absorption.

A Case of Pseudo-Duane's Retraction Syndrome With Old Medial Orbital Wall Fracture

We report a case of pseudo-Duane's retraction syndrome with entrapment of the medial rectus muscle in an old medial orbital wall fracture presenting identical clinical symptoms as Duane's retraction syndrome. A 15-year-old boy presented with persistent limited right eye movement since a young age. Examination showed marked limited abduction, mildly limited adduction, and globe retraction accompanied by narrowing of the palpebral fissure during attempted adduction in the right eye. He showed a right esotropia of 16 prism diopters and his head turned slightly to the right. A slight enophthalmos was noted in his right eye. A computed tomography scan demonstrated entrapment of the medial rectus muscle and surrounding tissues in an old medial orbital wall fracture. A forced duction test revealed a marked restriction of abduction in the right eye. A 5 mm recession of the right medial rectus muscle was performed. Postoperatively, the patient's head turn and esotropia in the primary position were successfully corrected, but there was still some limitations to his ocular movement. The importance of several tests such as the forced duction test and an imaging study should be emphasized in making a diagnosis for limitation of eye movement.

Inlay Grafting for the Treatment of the Posterior Comminuted Fracture of Medial Orbital Wall

PURPOSE: For blowout fracture of the medial orbital wall, the goals of treatment are complete reduction of the herniated soft tissue and anatomic reconstruction of the wall without surgical complications. Surgeons frequently worry about damage to the optic nerve from the dissection, when the part over the posterior ethmoidal foramen was fractured. The authors performed small incision and inlay grafting for reconstruction of medial orbital wall fracture. METHODS: Between January 2007 and April 2008, 15 out of 32 patients were included in an analysing the outcome of corrected medial orbital wall fracture. In 15 patients of posterior comminuted fracture of medial orbital wall, insertion of porous polyethylene(Medpor(R) channel implant, Porex, USA) to ethmoidal sinus was performed in multiple layer, through the transconjunctival approach (inlay grafting). RESULTS: In all cases, the orbital bone volume was reconstructed in its normal anatomical position. The associated ocular problems disappeared except for mild enophthalmos in 2 patients and there were no surgical complications associated with inlay grafting. CONCLUSION: The advantage of inlay grafting include anatomical reconstruction of the orbital wall; the avoidance of optic nerve injury; the simplicity of the procedure; and consequently, the absence of surgery-related complications. This technique is presented as one of the preferred treatments for posterior comminuted fracture of medial orbital wall.

Classification of the Lateral Orbital Wall Fracture and Its Clinical Significance

PURPOSE: The lateral orbital wall fractures have been previously classified by some authors. As there are some limitations in applying in their own classifications, we hope to present a refined classification system of the lateral orbital wall fracture and to identify the correlation between the specific type of the fracture and clinical diagnosis. METHODS: The facial bone CT scans and medical records of 78 patients with the lateral orbital wall fractures were reviewed in a retrospective manner. The classification is based on the CT scan. In type I, the fracture and its segments are away from the lateral rectus muscle and in type II, they are next to or slightly pushing the muscle in axial CT scan. In type III, the fracture segments compress and displace the longitudinal axis of the muscle or the optic nerve in axial view of CT scan. Type IV fracture includes multiple fractures found around the orbital apex or optic canal in coronal view of CT scans of the type I and type II fractures. RESULTS: The most common fracture pattern was type I(43.6%), followed by type IV(29.5%), type II(20.5%), and type III(6.4%). As diplopia and restriction of extraocular muscles were found in type I and II fractures, severe ophthalmic complications such as superior orbital fissure syndrome, orbital apex syndrome, and traumatic optic neuropathy were found in type III and IV fractures almost exclusively. CONCLUSION: We propose an easy classification system of the lateral orbital wall fracture which correlates closely with ophthalmic complications and may help to make further treatment plan. In Type III and IV fractures, severe ophthalmic complications may ensue in higher rates, so early diagnosis and treatment should be performed.

Advantage of Middle Meatal Antrostomy in Transnasal Endoscopic Reconstruction of Medial Orbital Blow-out Fracture

PURPOSE: Blowout fracture is an outward fracture of the orbital wall. That usually occurs at inferior or medial wall of the orbit. The main pathophysiology is high intraocular pressure derived from impact of trauma. Among the four orbital wall, the medial wall is thinnest and most vulnerable to trauma. Many kinds of methods were introduced for correction of medial orbital wall fracture. Recently, transnasal endoscopic reconstruction methods were widely used. Endoscopic methods had many advantages. However, we experienced some cases of postoperative maxillary sinusitis. This study was planned to find out the effectiveness of middle meatal antrostomy after endoscopic reconstruction of medial orbital wall fracture. METHODS: This study was retrospective analysis of 28 patients who underwent transnasal endoscopic repair of medial orbital wall fracture. The 18 male and 10 female patients were ranged from 17 to 57 years of age(mean, 30.9 years). Among 28 patients, randomly selected 17 patients underwent middle meatal antrostomy as additional procedure by the same surgeon. After at least 12 months of follow-up period, we examined the nasal symptom, endoscopic and CT findings. RESULTS: One patient complained of nasal obstruction in middle meatal antrostomy group and four patients complained nasal symptoms in non middle meatal antrostomy group. On the endoscopic findings, three patients of non middle meatal antrostomy group had continuous nasal discharge. But middle meatal antrostomy group had no abnormal endoscopic findings. The abnormal CT finding(abnormal mucosal hypertrophy) were detected in four patient of non middle meatal antrostomy group. There were no abnormal CT findings in middle meatal antrostomy group. The data were statistically significant at comparative study. CONCLUSION: Authors think that the middle meatal antrostomy has some advantages as a additional procedure of endoscopic reconstruction of medial orbital wall fracture. Especially, it is good at preventing post- operative maxillary sinusitis. But, more larger group and strict application of disease entity are need for correct evaluation of middle meatal antrostomy effect.