‘Frozen Eye’ ? Post Blowout Fracture Surgical Correction ? A Case Report

The Rationale: “Frozen Eye” is a very uncommon sequel after treatment of orbital blowout fractures requiring implant placement. Patient Concerns: The implant may faultily impinge on the ocular and extra?ocular muscle(s), causing the abnormality in the movement of the eye. Diagnosis: We present a 56?year?old male whose ocular implant impinged on muscle, causing “frozen eye” and had an infected implant. Treatment Outcomes: The same was removed and surgically corrected. The manuscript describes the details and discusses the possible mechanism that led to the “Frozen Eye”

Intraoperative Computed Tomography Image Fusion for Orbital Blowout Fracture Reconstruction

ABSTRACT@#Intraoperative computed tomography (CT) has been previously described and acknowledged for its use in orbital blowout fracture reconstructions. We described a clinical case series managed by this technique combined with intraoperative image fusion for accuracy in orbital implant position. In total, eight patients who sustained a total number of 19 orbital wall fractures were described. From the total number of 19 blowout orbital fracture reconstructions comprised of medial and inferior (floor) orbital fractures, malposition was identified in a total of four orbital implants by using image fusion. All cases of implant malposition were immediately revised intraoperatively. Subsequent fusion was carried out to confirm whether the revision was satisfactorily achieved. We found that the intraoperative image fusion technique utilised to determine orbital implant position, especially at the posterior ledge, further augmented the role of intraoperative CT scanning. Image fusion conceptually provides an immediate, real-time, and objective solution for intraoperative image analysis and potentially eliminates problems with misaligned CT images. It also reduces the need for the surgeon to ‘eye-ball’ the CT images acquired or the need for additional intraoperative time, since the patient’s head orientation is always axially at random during the acquisition of the CT. Conventional methods for CT image assessment are subjected to one’s own interpretation and may introduce inconsistent or longer intraoperative decision-making. The technique facilitates intraoperative decision-making and reduces the risk of orbital implant malposition in orbital blowout fracture reconstructions. Hence, surgical complication in relation to orbital implant malposition in orbital blowout fracture management could be minimised. In addition, no further postoperative imaging is required.

Management of Orbital Blowout Fractures: ENT Surgeon's Perspective

A Meta-analysis of complications of orbital blowout fracture by surgical approaches / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the effect of conjunctival approach and skin approach on postoperative complications in orbital blowout fracture through Meta-analysis.<p>METHODS: Search literatures in PubMed, Web of Science, Cochrane library, OVID, Chinese biomedical literature database, Weipu, Wanfang and CNKI database from the establishment of the database to May 30, 2018. The main contents included randomized controlled trials and cohort studies about comparing the postoperative complications of orbital blowout fracture through the transconjunctival approach and subciliary approach. Meta-analysis of the incidence of complications was performed using Review Manager 5.3 statistical software.<p>RESULTS: A total of 7 cohort studies were included. The Newcastle Ottawa Scale(NOS)score showed that the quality of the included literature was above 6 points. Meta-analysis showed no significant difference in odds ratio(OR)between the transconjunctival approach group and subciliary approach group \〖<i>OR</i>=0.74, 95% <i>CI </i>(0.44-1.24),<i> P=</i>0.25\〗. Sensitivity analysis showed that the results of the Meta-analysis were stable and reliable. Funnel plot analysis showed that there might be publication bias in the included literature.<p>CONCLUSION: The effect of skin approach and conjunctival approach on the incidence of postoperative complications of orbital blowout fractures is not significant. The two approaches have their own advantages and disadvantages. It is necessary to combine the clinical practical considerations to select the most suitable surgical approach.

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

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

Orbital blowout fracture reconstruction using titanium mesh pre-bent with computer-aided rapid prototy-ping technology / 医学研究生学报

Objective This study was to evaluate the clinical outcomes of orbital blowout fracture repair using the individual titanium mesh bent by computer-aided rapid prototyping . Methods The CT imaging data of 11 cases of orbital blowout fracture were analyzed.The subciliary approach was used for the exposure of the fractures .An appropriate 3D-printed titanium mesh pre-bent by computer-aided rapid prototyping was selected and implanted according to the characteristics of a given defect .The surgical results were analyzed by evaluating diplopia , eyeball movement , enophthalmos , and the position of the titanium mesh and comparing the orbital vol-ume before and after surgery . Results All the operations were successfully accomplished .No remolding or trimming was needed for the pre-bent titanium mesh and implanted titanium mesh was tightly fixed to the orbital wall .The patients were followed up for 3 -12 months, which revealed no symptoms of diplopia in any of the patients . Volumetric analysis showed a significantly reduced orbital volume difference from (2.60 ±0.43) mL preoperatively to (-0.07 ±0.62) mL postoperatively (P<0.01).Enophthalmos was desirably correc-ted, with the enophthalmos difference decreased from (2.35 ±0.81)mm preoperatively to (-0.10 ±0.52) mm postoperatively (P<0.01).No extra-ocular muscle limitation was observed . Conclusion The individual titanium mesh bent with computer-aided rapid prototyping technology can be applied to orbital blowout fracture repair , which may achieve a high success rate of anatomic restoration of the orbital volume and effective prevention of enophthalmos .

Effect of Eye Movement Training Combined with Traction Test on Diplopia after Orbital Blowout Fracture / 中国康复理论与实践

@#Objective To compare the effects of simple eye movement training and eye movement training combined with traction test on the vision after orbital blowout fracture. Methods 143 cases with orbital blowout fracture after operation were divided into the experimental group (63 cases) and control group (80 cases). The experimental group was treated with eye movement training and passive traction test within 3 days after operation, while the control group was treated with eye movement training alone. The changes of diplopias of all patients were observed. Results The efficient rate in the experimental group was 93.6% (59/63), that of the control group was 72.5% (58/80). The effect of the experimental group was superior to that of the control group (P<0.01). Conclusion The eye movement training combined with traction test can improve the diplopia of the patients with orbital blowout fracture after operation.

A Case of Dislocation of the Globe into the Maxillary Sinus after Orbital Wall Fracture

PURPOSE: We report a case of a 38-year-old man who suffered a blowout fracture of the orbital wall with an intact eyeball entrapped within the maxillary sinus after trauma. CASE SUMMARY: The 38-year-old man was admitted to the emergency room after sustaining a work-related trauma. His chief complaints were loss of vision and bleeding from the left periorbital area. He had no light perception and no eyeball was found in the orbit. Facial CT revealed that the intact eyeball was entrapped within the maxillary sinus. The condition of the optic nerve was difficult to ascertain. Ten hours after post-trauma, reduction surgery was done with a graft from the iliac bone. Ruptured extraocular muscles were not primarily sutured. After four months, vitrectomy was performed on the left eye. The eyeball was repositioned in its place. He had no light perception. Extraocular motility improved at the last follow-up examination. CONCLUSIONS: We report the dislocation of the eyeball globe into the maxillary sinus after a blowout fracture. Visual acuity showed no light perception as a result of central retinal artery occlusion and optic nerve injury. We were able to obtain a good aesthetic and functional result after the operation.

Experimental study on prevention adhesion after orbital blowout fracture repaired by man-made plates of amniotic membrane / 眼科

Objective To explore the effect of preventing adhesion after the orbital blowout fracture on orbit tissue by amniotic membrane. Design Experimental study. Participants Twenty-six New Zealand rabbits. Methods Establishing rabbit orbital blowout fracture model, the right orbit of twenty rabbits was repaired by hydroxyapatite (HA) parceled of amniotic membrane, and left orbit was only repaired by HA, the orbits of the other six rabbits weren't repaired. Then we got the tissue around bone after one week and one month, and compared the difference of three groups. Main Outcome Measures Inflammatory response of tissue around bone was ana- lyzed by HE, picric acid Sirius Scarlet dying, TGF-?immunohistoehemical observation. Results One week after operation, HE and im- munohistochemistry showed that the difference was not significant in inflammatory response between experimental group and control group (P=0.351, P=0.413), and difference is significant between blank group and experimental group (P=0.012, P=0.041). One month after operation, HE and immunohistoehemistry showed that the difference was significant in inflammatory response between experimental group and control group(P=0.037, P=0.048), and there is no significant difference between experimental group and blank group(P=0.285, P=0.472). Conclusion It has an important role of anti-inflammatory and anti-adhesion in the chronic stage of inflammatory after orbital blowout fracture repaired by man-made plates of amniotie membrane.

Analysis of Persistent Diplopia and Enophthalmos after Surgical Repair of Blowout Fracture

PURPOSE: To evaluate the incidence of persistent diplopia and enophthalmos and possible risk factors leading to their occurrence in patients who had orbital blowout fracture repair. METHODS: We retrospectively evaluated clinical features in 76 eyes of 76 patients with orbital blowout fracture, who were repaired surgically after its diagnosis from March 1995 to November 2001. We analysed the relationship between persistent diplopia and enophthalmos after reconstruction and timing of surgery, patient age, fracture location, fracture size and alloplast material. RESULTS: Postoperatively, 11 patients (22.9%) expirienced diplopia and enophthalmos persisted in 11 (28.2%) patients. Timing of surgery, patient age, fracture location, fracture size was found to be significant for the development of postoperative diplopia but alloplast material was not significant for the development of postoperative diplopia (p>0.05). Timing of surgery and fracture size was found to be significant for the development of postoperative enophthalmos but patient age, fracture location and alloplast material was not significant for the development of postoperative enophthalmos (p>0.05). CONCLUSIONS: We believe that timing of surgery is important prognostic factor that decreases the incidence of persistent diplopia and enophthalmos after surgical repair of blowout fracture. In addition, this study will provide important prognostic informations that can be of benefit to both patients and surgeon in performing surgical repair of blowout fracture.

Three-dimensional diagnostics and surgical correction of late deformities of orbital blowout fractures / 中华医学美学美容杂志

Objective To investigate the mechanisms of enophthalmos and deformities of orbital walls in patients with orbital blowout fracture and to evaluate the reconstructive surgical methods. Methods The features of orbital deformities, the change of orbital volume and the mechanisms of enophthalmos were measured and analyzed by means of 3-D CT technique and 3-D diagnostic computer-assisted system. The reconstructive operations were employed on these 11 cases with orbital blowout fractures to correct deformities and restore orbital volume by applying autogenous bone grafts or hydroxyapatite bone substitutes. Results There were no serious complications such as infection of bone graft, exposure of hydroxypatite implant in all 11 cases, 10 cases got satisfactory appearance of eyelids and orbit, of which thediplopia and enophthalmos were corrected with protrution of eyeball restoring normally. 1 case remained diplopia after surgical correction. Conclusions The enophthalmos is mainly caused by orbital volume enlarging and orbital content herniating into paranasal sinuses. Implanting autogenous grafts and hydroxyapatite substitutes to restore orbital volume are proved to be effective.