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Objective To present the changing of the parameters of orbital volume after endoscopic transethmoid medial orbital wall decompression combined with the endoscopic transethmoid intraconal fat-removal orbital decompression in thyroid associated ophthalmopathy (TAO).Methods A retrospective chart was reviewed in 11 patients (20 eyes) receiving orbital decompression for the treatment of exophthalmos secondary to TAO from September 2014 to August 2015. All patients diagnosed TAO were in stable and inactive phase at least for 6 months. High-resolution computed tomography (HRCT) scan were performed in all patients before and 3-month after surgery. CT scan of orbit and computer-aided measurement software were used to measure the exophthalmos. Changing of the parameters of orbital volume were recorded for analysis its relationship with the amount of proptosis reduction.Results The exophthalmos was signiifcantly decreased after surgery. Medial rectus volume, fat volume and orbital volume were larger postoperatively. The changing of rectus volume and fat volume both had negative correlationship with the amount of proptosis.Conclusions The thickening of medial rectus 3-month postoperative may due to the removing of medial wall of orbit during the surgery. The stimulation of the surgery may be another reason. The changing of rectus volume and fat volume both had negative correlationship with the amount of proptosis.
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PURPOSE: To compare the orbital volume calculated from various slice thickness facial computed tomography scans using a semi-automated computer program. METHODS: Axial and coronal scans of 2, 2.5, 3 mm slice thickness facial computed tomography scans were used to measure the orbital volume. The cross-sectional area was determined from each slice using a semi-automated computer program (MATLAB 2009a®, MathWorks, Inc., Natick, MA, USA), and then the volume was calculated from serial reconstruction of the cross sections. RESULTS: The measured value in the 2 mm images was 33.14 ± 2.37 cm³ in the right orbit and 34.32 ± 2.60 cm³ in the left orbit for the axial scans, and 35.54 ± 3.58 cm³ in the right orbit and 34.96 ± 4.05 cm³ in the left orbit for the coronal scans. In the 2.5 mm images, the values were 33.28 ± 3.35 cm³ in the right orbit and 33.73 ± 4.10 cm³ in the left orbit for the axial scans, and 35.24 ± 3.98 cm³ in the right orbit and 35.10 ± 3.93 cm³ in the left orbit for the coronal scans. In the 3 mm images, the values were 33.23 ± 2.70 cm³ in the right orbit and 33.39 ± 2.69 cm³ in the left orbit for the axial scans, and 33.20 ± 3.64 cm³ in the right orbit and 32.95 ± 3.45 cm³ in the left orbit for the coronal scans. In the 3 mm image, there was not a significant difference in the calculated volume between the axial and coronal scans (p(3mm) = 0.62). CONCLUSIONS: Because there is no difference in the results of the orbital volumetric measurements between three other slice thicknesses in the axial scan, using axial scan images with a computer program that semi-automatically calculates orbital volume is useful. In addition, the volume measured by thick slice images has more reproducibility than the volume measured by thin slice images.
Subject(s)
OrbitABSTRACT
The stereo-structure of the orbit is affected by several orbital diseases, e.g. congenital orbital dysplasia, orbital fracture, and intraorbital tumor. The three-dimensional (3D) reconstruction technique serves as a practical tool in diagnosis, surgical planning, and outcome prediction of plastic and reconstructive surgery. In our study, the morphologic features of the Mongolianadult orbit were described by 11 anatomic parameters using a 3D reconstruction technique and quantitative morphometry. The morphologic parameters of orbit such as bony orbital volume, orbital foramen area and orbital rim perimeter were measured on 3D models using this technique. Three-dimensional (3D) reconstruction based on high-resolution spiral computed tomography (CT) scans has been used for more than 10 years to reveal the anatomic location and morphologic features of orbital abnormalities and plays a important role in diagnosis, surgicalplanning, and outcome prediction. The findings of the study would allow for quantification of the orbital features of Mongolian adults and provide parameters for preoperative planning and prediction of postoperative outcome.
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PURPOSE: To investigate the clinical results of patients who have undergone simultaneous dermo-fat graft and insertion of orbital implants in patients who are unable to put on an ocular prosthesis due to severe conjunctival sac contracture or large orbital implant exposure. METHODS: A retrospective analysis was performed of patients who underwent dermo-fat graft simultaneously with orbital implant insertion for replacement of the conjunctival sac from 2007 to 2012. Eight eyes were enrolled in this study and all patients were followed up for phthisis bulbi or implant exposure. RESULTS: Among the eight eyes, five eyes (62.5%) that were diagnosed with orbital implant exposure underwent orbital implant exchange and dermo-fat graft, and two eyes (25%) were anophthalmic enophthalmic patients and underwent secondary orbital implant insertion and dermo-fat graft. One patient (12.5%) underwent orbital implant insertion and dermo-fat graft simultaneously during the evisceration operation. We followed the progress for 46.3 months. For seven out of eight eyes, the results of the wound healing process were successful. One patient underwent removal and reinsertion of the orbital implant with dermo-fat graft, and the wound in this case healed well. However, after five months, dermo-fat re-graft was performed for orbital implant re-exposure and it was not exposed thereafter. Overall cosmetic appearance was satisfactory in each patient, and all patients were able to comfortably retain a prosthesis. CONCLUSIONS: We found that undergoing dermo-fat graft simultaneously when performing orbital implant insertion is effective for replacement of the conjunctival sac and orbital volume.
Subject(s)
Humans , Anophthalmos , Contracture , Eye, Artificial , Orbit , Orbital Implants , Prostheses and Implants , Retrospective Studies , Transplants , Wound Healing , Wounds and InjuriesABSTRACT
PURPOSE: To measure the orbital volume from facial CT scans using a semi-automatic computer program. METHODS: Axial and coronal slices of 35 facial CT scans were used to measure the orbital volume. The cross-sectional area was determined from each slice using a semi-automated computer program (MATLAB 2009a). Next, the orbital volume was calculated from serial reconstruction of the cross-sections. RESULTS: The measured value in males was 26.34 +/- 3.09 cm3 in the right orbit and 26.30 +/- 3.21 cm3 in the left orbit from axial scans, and 26.58 +/- 2.76 cm3 in the right orbit and 26.59 +/- 2.75 cm3 in the left orbit from coronal scans. In females, the values were 23.84 +/- 2.29 cm3 in the right orbit and 23.89 +/- 2.33 cm3 in the left orbit from axial scans, and 24.06 +/- 2.90 cm3 in the right orbit and 24.10 +/- 2.82 cm3 in the left orbit from coronal scans. There was high positive correlation (r = +0.832, p = 0.0001) in measured orbital volume between axial and coronal scans. CONCLUSIONS: The orbital volume measurement from facial CT scans using a semi-automatic computer program is very useful. This method should prove useful in further studies examining the correlation of orbital volume variation in many ophthalmologic disorders.
Subject(s)
Female , Humans , Male , Orbit , Tomography, X-Ray ComputedABSTRACT
PURPOSE: The zygoma(Zygomaticomaxillary) complexes make up a large portion of the orbital floor and lateral orbital walls. Zygoma fracture frequently causes the posteromedial displacement of bone fragments, and the collapse or overlapping of internal orbital walls. This process consequently can lead to the orbital volume change. The reduction of zygoma in an anterolateral direction may influence on the potential bone defect area of the internal orbital walls. Thus we performed the quantitative analysis of orbital volume change in zygoma fracture before and after operation. METHODS: We conducted a retrospective study of preoperative and postoperative three-dimensional computed tomography scans in 39 patients with zygoma fractures who had not carried out orbital wall reconstruction. Orbital volume measurement was obtained through Aquarius Ver. 4.3.6 program and we compared the orbital volume change of injured orbit with that of the normal contralateral orbit. RESULTS: The average orbital volume of normal orbit was 19.68cm3. Before the operation, the average orbital volume of injured orbit was 18.42cm3. The difference of the orbital volume between the injured orbit and the normal orbit was 1.18cm3(6.01%) on average. After operation, the average orbital volume of injured orbit was 20.81cm3. The difference of the orbital volume between the injured orbit and the normal orbit was 1.17cm3(5.92%) on average. CONCLUSION: There are considerable volume changes in zygoma fracture which did not accompany internal orbital wall fracture before and after operation. Our study reflects the change of bony frame, also that of all parts of the orbital wall, in addition to the bony defect area of orbital floor, in an isolated zygoma fracture so that it evaluates orbital volume change more accurately. Thus, the measurement of orbital volume in isolated zygoma fractures helps predict the degree of enophthalmos and decide a surgical plan.
Subject(s)
Humans , Displacement, Psychological , Enophthalmos , Floors and Floorcoverings , Orbit , Retrospective Studies , ZygomaABSTRACT
Objective To explore the relation between the enlargement of orbital volume and the degree of enophthalmos, and that between the enlarged volume of floor together with that of medial wall and the degree of enophthalmos. Methods A total of 17 patients of unilarteral orbital fracture were scanned by MSCT (slice width 0.625mm), who suffered late enophthalmos as a results of combination fracture of the medial wall and floor. The clinical data were collected, and input into a software named MIMICS in order to measure orbital volume, the degree of enophthalmos, the enlarged volume of medial wall, and that of orbital floor. Simple linear correlation and regression were carried out between the enlargement of orbital volume and the degree of enophthalmos. Mutiple linear correlation and regression were carried out between the enlarging volume of floor together with that of medial wall and the degree of enophthalmos. Results The equation of the enlargement of orbital volume (V) and the degree of enophthalmos (E) was E= 0.851 V-0.197 (Pearson r=0.969, P＜0.01, the 95% confidence intervals of 0.732-0.970). The standardized equation between the enlarged volume of floor together with that of medial wall and the degree of enophthalmos was E= 0.690 VF+0.413 VM-0. 086 (setpwise, entry =0.5, removal= 0. 11,P＜0.01 ); Comparing the standardized coefficients of independent variables, the outcome was bF (0.690) ＞ bM(0.413). Conclusion Significant linear correlation between the increment of the orbital volume and the degree of enophthalmos is found that 1.0 ml enlargeement in bony volume causes approximately 0.9 mm of enophthalmos; enlarged volume of floor has more powerful influence on the degree of enophthalmos than enlarged volume of medial wall, the former is 1.56 times of the latter.
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PURPOSE: Endoscopic transnasal correction of the blowout fractures has many advantages over other techniques. But after removal of packing material, there were some patients with recurrence of preoperative symptoms. Authors tried to make a quantitative anterograde analysis of orbital volume change over whole perioperative period which might be related with recurrence of preoperative symptoms. METHODS: 10 patients with pure medial wall fracture(Group I) and 10 patients with medial wall fracture combined with fracture of orbital floor(Group II) were selected to evaluate the final orbital volume change with 3 CT scans, preoperatively, postoperatively and 4 months after packing removal. By multiplying cross-section area of orbit in coronal view with section thickness, orbital volume were calculated. Then, mean orbital volume increment after trauma, mean orbital volume decrement after endoscopic correction and volume increment after packing removal were found out. And we tried to find correlations between type of fracture, initial correction rate and final correction rate. RESULTS: The mean orbital volume increase of the fractured orbits were 7.23% in group I and 13.69% in group II. After endoscopic surgery, mean orbital volume decrease were 11.0% in group I and 12.46% in group II. Mean volume increase after packing removal showed 3.10% in group I and 6.50% in group II. The initial correction rate(%) showed linear correlation with final correction rate(%) after packing removal. And there were negative linear correlation between increment percentage of orbital volume by fracture and final correction rate(%). CONCLUSION: Orbital volume was proved to be increasing after removal of packing or foley catheter and it was dependent upon type of fracture. Overcorrection should be done to improve the final result of orbital blowout fracture especially when severe fracture is present.
Subject(s)
Humans , Catheters , Endoscopy , Orbit , Orbital Fractures , Perioperative Period , RecurrenceABSTRACT
PURPOSE: To evaluate the early effect of orbital reconstruction with MacroPore(R) by assessment of orbital volume through orbital computed tomography (CT) in cases of orbital wall fracture METHODS: We performed orbital reconstruction with MacroPore(R) in patients with orbital wall fracture smaller than 3 cmx2 cm. Orbital CT was done preoperatively and 6 months postoperatively. We then evaluated the results by measuring the orbital volume through Rapidia 2.8 program. RESULTS: The study comprised 14 patients. The site of fracture was the medial wall in one patient, inferior in seven, and both medial and inferior in six patients. The site of insertion of MacroPore(R) was the medial wall in one patient, inferior in 12, and both medial and inferior walls in one. The mean volume of the affected orbit before operation was 20.23+/-2.78 cm3, that of the unaffected orbit was 18.27+/-2.24 cm3 (p-value=0.000), and the mean volume of the affected orbit after operation was 19.06+/-2.57 cm3, that of the unaffected orbit was 18.06+/-2.24 cm3 (p-value=0.000). The mean enophthalmos before operation was 1.00+/-0.62mm, and after operation was 0.64+/-0.46 mm. The mean difference of orbital volume between the affected and the unaffected orbits before operation was 1.96+/-0.33 cm3, and 1.00+/-0.87 cm3 after operation (p-value=0.000). The mean volume of the affected orbit before operation was 20.23+/-2.77 cm3, and 19.06+/-2.57 cm3 after operation (p-value=0.000). Each cubic centimeter decrement in volume caused a 0.67+/-0.68 mm mean decrease of enophthalmos. CONCLUSIONS: We concluded that MacroPore(R) was safe orbital implant and effective in decreasing the orbital volume at early orbital reconstruction in cases of orbital wall fracture smaller than 3 cmx2 cm through a comparison of orbital volume before and after operation.
Subject(s)
Humans , Enophthalmos , Orbit , Orbital ImplantsABSTRACT
PURPOSE: To evaluate the effect on the growth rate of orbital volume of those who received enucleation or evisceration with or without implants, according to different sizes and operation periods. METHODS: The subjects comprised 47 patients who had previously undergone evisceration or enucleation. The volumes of both anophthalmic and normal orbit were measured from CT scans of patients and compared. The relationship between the orbital volume growth rate and the operation at young age with different size implants or operation without implants was evaluated. RESULTS: Five groups, divided by age at operation, were evaluated. Four groups comprising under 12 years of age, had a significant delay in orbital volume growth development (p<0.05). Three groups, divided by size of implants, were evaluated and 17 mm or smaller sized orbital implants showed significant orbital volume growth retardation (p<0.05) CONCLUSIONS: The effect of early enucleation on orbital volume growth should be considered in patients younger than 12 years old. Furthermore, during the operation, implants with sizes larger than 18mm should be used to prevent the retardation of orbital volume growth.
Subject(s)
Child , Humans , Anophthalmos , Orbit , Orbital Implants , Tomography, X-Ray ComputedABSTRACT
PURPOSES: To measure orbital volumes in normal adults using computed tomography to help make proper diagnoses and treatments of orbital diseases. METHODS: Among the patients who had CT scan taken between July 1995 and March 2001, we evaluated the scan results of 142 orbits in 112 adults over the age of 20 years with no pathology in the orbit. The anterior and posterior borders were defined as the zygomatico-frontal suture and the optic canal, respectively. We summed up the area according to the serial coronal views covering the whole orbit, calculated the volume of the whole orbit mathematically and compared the volume between the left and right eyes according to the sex. RESULTS: The normal mean orbital volume of male adults was 24.51+/-2.89 mm(3) (range, 19.3~31.9 mm(3)), and that of women, 21.59+/-2.19 mm(3) (range 18.0~26.5 mm(3)), showing the difference of 2.92 mm(3) (p=0.049) between the sexes. When both orbital volume measurements were summed up, the volume of the left and right orbits was 24.41 cm(3) and 24.10 cm(3) in adult men, respectively. On the other hand, it was 21.54 cm(3) and 21.45 cm(3) in adult women, respectively. The differences in each group (0.31 cm(3), male; 0.09 cm(3), female) showed no statistical significance (p=0.064, male; 0.698, female). CONCLUSIONS: We could measure orbital volumes of normal adults with accurate data on orbital structures by orbital CT. We believe our data will be very helpful in diagnosis of orbital bone fractures, anophthalmic socket, tumors and abnormalities of the orbit. Furthermore, they will play an important role in treatment as well.
Subject(s)
Adult , Female , Humans , Male , Diagnosis , Fractures, Bone , Hand , Orbit , Orbital Diseases , Pathology , Sutures , Tomography, X-Ray ComputedABSTRACT
PURPOSE: This study is to know a normal orbital volume of adult Koreans. METHODS: We had taken 3-dimension orbital CT of 100 patients who had visited the department of ophthalmology and emergency room. Among them 30 patients who were reported to show abnormal orbital CT finding were excluded. Thereafter we measured orbital CT volume in eyes of 70 patients. We appointed inner sides of orbital wall in coronal plane image and reconstructed 3-dimension images by means of soft ware program(silhouette) in CT to measure the orbital volume. RESULTS: Average of orbital volume was 24.5 mm 3(left orbital vol. 24.25 mm 3, right 24.75 mm 3), in males and 23.5 mm3(left 23.25 mm 3 , right 23.75 mm 3)in females. Difference between right orbit and left orbit was 2% and average of male orbital volume was bigger than female by 4%. CONCLUSION: Adult Korean orbital volume measure was useful for differential diagnosis in orbital desease.
Subject(s)
Adult , Female , Humans , Male , Diagnosis, Differential , Emergency Service, Hospital , Ophthalmology , Orbit , Reference ValuesABSTRACT
Enophthalmos is a common result of blow out fracture of the orbit. Prior to CT volume analysis no reliable measurement of the degree of bony and soft tissue deformity was available to identify patients who would develop enophthalmos. Evaluation of orbital volume expansion and volume expansion percentage were performed in 23 patients with blow out fracture, after 1-4 days of injury. All studies were performed on a CT (Somatom Plus, Germany, Siemens), using transaxial scan technique(140 kVp, 206 mA, 3 mm contiguous sections). The radiological boundaries of the orbit were defined anteriorly by a line mrrecting the anterior surface of the zygomaticofrontal process to the nasomaxillary suture and posteriorly to the optic foramen. The Hounsfield Unit(HU) ranges were -100 to 0 and 0 to +100. It is difficult to distinguish blood from fat in the orbital volume measurement. We used three methods to obtain more accurate orbital volume. First, The concave margin or the air meniscus surface area is blood and the convex margin area is fat. Second, It can be distingushed blood from fat by Hounsfield Unit of specific area pixel. Third, The homogenous area is blood and inhomogenous area is fat or mixture of fat and blood. The patients(> or =13% orbital volume expansion) are managed surgically. 15 patients were classified in operative group and 8 patients were in conservative treatment group. The volume expansion percentage is 12.7% to 28.8% in operative group and 4.2% to 11.2% in conservative group. There was no enophthamos in each groups after 3 months of operation and injury. CT measurements of orbital volume expansion and volume expansion percentage can predict the final degree of the late enophthalmos and may facilitate the planning of surgical intervention. To obtain more accurate prediction of enophthalmos, we consider not olny volume expansion but also volume expansion percentage, because everyone doesn't have the same normal orbital volume.